Two types of machines are available, and they are set with alarms that sound loudly if faults develop. Ideally, efforts are made so as to make the lifestyle as near to normal as possible. Some dialysers may be used at night when the patient is asleep; three 10-hour spells weekly being adequate. Other types are more powerful, and require shorter sessions.
The artificial kidney, as it is often called, is far less efficient than the real one, and many patients exist in a mild state of chronic renal failure. For this reason eating habits may be restricted, the diet may be low in protein, sodium and potassium, and the patient may be allowed only 600 ml of fluid daily.
Initially the patient may be treated in hospital in a dialysis unit. However, many are taught to run their own units, and can manage well at home. This, of course, throws added burdens on the marital partner, for supervision is always necessary and the whole system can alter the usual lifestyle in a home.
Various medical problems are inevitable with a system interfering so markedly with the normal operation of the body.
Access must be gained to the blood circulation. This is often at the wrist or ankle. Various devices are used. A so called arteriovenous teflon silastic shunt is popular. This basically consists of a tube connecting the artery and vein at the wrist. It is made of silastic and consists of two halves connected when not in use.
When dialysis is about to be carried out, the halves are separated and hooked to the machine. In some types, normal heart action is sufficient to pump the blood through the dialyser, but in others a blood pump is necessary. Blood comes from the artery through the dialyser where the unwanted metabolites of the body are filtered off, and then returned to the vein to re-enter the body’s circulation.
Dialysis vs Transplant
There is a continual question as to which form of treatment is best. There is no doubt that having a functioning organ, if possible is far preferable to having to rely on regular treatment with a machine. However, surgery carries with it the usual risks that go with an operation – possibly of the patient’s own life. Most patients are happy to accept the risk.
The main problem at present is not the acceptance of the concept by the patient, but the availability of suitable kidneys for transplant. At any given time there are probably 2000 to 3000 persons on the waiting list, anxious to undergo surgery, and hoping that a suitable opportunity (a suitable matching kidney) will become available. With greater public awareness and education, it is to be hoped that more supplies will become available. Many Western countries have taken the initiative in public educational programs, and have altered legislation making the total enterprise simpler, and notification easier. In the next few years one would expect to see a major step forward in this rewarding and lifesaving field.