Dialysis

of these articles describes the blood cleaning method, for the separation and cleaning method in the chemical laboratory and in the technology sees dialysis (chemistry).

general

dialysis (from Greek dialysis = dissolution) is a blood cleaning method (“artificial kidney”). It is used, if it to an acute or chronic kidney failure, and/or. Liver failure comes. Those world-wide first “blood laundry” (like it was called at that time) withHumans 1924 were accomplished by George Haas.

tasks of the healthy kidney

the kidney…

1. the blood cleans of waste materials, which result from metabolic procedures (e.g. Urine acid, urea).
2. adjusts the acid Basen household of the body. The pH value of the blood may confine only in very muchBorders vary, otherwise it becomes “sourly” or “alkalinely”, both one and the other one leads in the long run to death.
3. adjusts the content of body salts (sodium, potassium, Calzium).
4. adjusts the blood pressure.
5. Erythropoetin is involved in the blood new formation by the formation of the hormone.
6. produces in such a wayrenalen hormones mentioned Cholecalciferol, Erythropoetin, Kinine and Prostaglandine.
7. is at the Vitamin D - metabolism takes part.
8. adjusts the water regime of the body.

kidney failure

it gives two temporal process forms of the kidney failure, the chronic and the acute kidney failure. In both cases those functionKidneys qualitatively no more or only to very small extent (urine production can remain quantitatively invariably or be even increased). The difference in the process forms lies in the time interval and the prognosis. The acute kidney failure steps either in the context of an acute degradation of onebefore-existing kidney illness of many years (kidney insufficiency) like a chronic Glomerulonephritis, a diabetischen or hypertensiven kidney damage or by an acute incident (acute Glomerulonephritis, autoimmune illness, accident, infections, OI, Sepsis, etc.) up. It is in most cases reversible in principle and does not have itself not inevitable in interminal kidney failure develop. The chronic kidney failure can mean the final task of function of the kidneys (whereby nevertheless certain subfunctions to be further active to be able) when progressing into the terminal stage in the long run. The most frequent causes are chronic, often undiscovered inflammations of the Nierenkörperchen (chronic Glomerulonephritis) or damages by diabetes and/or blood high pressure.Both the acute and the chronic kidney failure cannot one always causally treat, one can then only symptoms treat and try to prevent complications. There are e.g. causal therapeutic starting points. with the treatment of kidney failure by autoimmune illnesses, here immunsuppressiv one treats. Also the frequentmedicamentous caused acute kidney failure are often rapidly declining by omitting the releasing medicine. In many cases of the acute and in all cases of the terminal kidney failure dialysis comes into question as only possible therapy option. A further possibility is the Nierentransplantation.

dialysis procedures

hemodialysis

in accordance with the principle of the concentration reconciliation of smallmolecular substances of two liquids will proceed here, which are separate by a semipermeable diaphragm (osmose). Separately from the filter diaphragm side is the blood with Nephrotoxinen, electrolytes , like potassium, phosphate and urine-requiring onSubstances. On the other side of the diaphragm is a germ-free, reversal-osmotically prepared solution, which naturally contains no waste products and one of the respective needs of the patient exhibits oriented portion of electrolytes. The semipermeable filter diaphragm between blood and the dialysis solution possesses pores, the small molecules like water, electrolytes and urine-requiring substances (e.g. Urea, urine acid) let through, but large molecules such as proteins and blood cells hold back. Basic condition for the execution of a hemodialysis is a sufficient cycle stability and a sufficient blood offer with the patient. The latter becomes by the operational plant of a arteriovenösen Fistel (in former times Scribner- Shunt (= short-circuit), today usually Ciminofistel at the lower arm or arteriovenöse Fistel at the upper arm with or without use of artificial containers (GoreTex), usually with a bad self-container situation (late damage diabetes mellitus), or by bringing a catheter into an accordingly large Körpervene (rarely border, usuallyNeck). The blood components, which fit by the pores, flow into the dialysis solution, which is on the other filter side. The filter is constantly flowed through by fresh solution (mind.500ml/min). In such a way cleaned blood is in-led again into the body. The hemodialysis treatment must usually at least approx.4-5 hours (night dialysis until 8 hours) per meeting and three times in the week to be accomplished (dependent on body weight, kidney remainder function, heart achievement). The extension of the dialysis time brings evidently in principle a better quality of life and a life extension with itself.

Hämo (dia.) filtration

with dialysis one differentiates between thatProcedure, with which the blood is cleaned against a rinsing liquid from the Hämofiltration, with the blood waters over a diaphragm is squeezed off and afterwards electrolytic solution led back. The Hämofiltration made possible fast volume changes in the patient body. As spontaneous filtration (for the first time of professor Dr.med. Assigned in Goettingen) one designates Peter Kramera procedure, with which by self-pressure of the patient cycle plasma is squeezed off, in order to support the heart function with heart failure acutely.

The Hämodiafiltration designates a extrakorporales procedure for the blood cleaning, with which hemodialysis and the Hämofiltration are used in combination. This procedure comes in particular with chronic kidney insufficiencyfor application and both the distance of down and of centralmolecular substances makes possible with controlled substitution of the Ultrafiltrats by physiological electrolytic solution.

Peritonealdialyse

peritoneum dialysis is well-known also under the term Peritonealdialyse (PD). There are different PD-procedures, e.g. CAPD (continuous ambulatory peritonealdialysis, continuous ambulatory Peritonealdialyse), IPD (intermittent PD), NIPD (nocturnal intermittent PD) etc. The choice of the procedure hangs among other things of the transportation characteristics of the Peritoneums (see below) off.

The peritoneum (Peritoneum) is a serous skin, which lines the abdominal cavity and large parts of the intestine coated.It is a well supplied with blood fabric, which plays for example also an important function in the immune defense of the body. Due to the special structure the Peritoneum can be likewise used as “filter diaphragm”: For this the patient a hose (catheter) is implantiert into the abdominal cavity. Overthis catheter a dialysis solution is filled into the abdominal cavity and there over several hours (e.g. with CAPD) or for 20-30 minutes (e.g. IPD) leave. The smallmolecular substances can cross now from the blood over the capillary containers of the peritoneum into the dialysis solution, since a concentration gradient prevails.Since the dialysis solution exhibits usually a higher content of soluble substances, as the blood, in this way also liquid (water) can be extracted from the body. The dialysis solution must after a certain time (usually about four to six hours with CAPD) discharged and througha freshness to be replaced. Contrary to the artificial diaphragm with blood dialysis the Peritoneum is quite permeable also for proteins, whereby it can come to a relevant protein loss. For this reason a PD-patient must nourish itself usually more protein-yieldingly than a hemodialysis patient.

An advantagethis procedure is the indulgence of the cycle, so that also old and heart-ill patients can be treated. A further possible advantage is large independence of the patients from a dialysis center (also hemodialysis one at home can accomplish, the expenditure is however clearly higher, an auxiliary person(e.g. Marriage partner) is necessary and the dialysis center is necessary for the telemeteric monitoring of the treatment). With suitability one can accomplish dialysis at home, also vacation trips is naturally possible. A disadvantage is the danger that the abdominal cavity with a possible contact with the environment with pathogenen Germs one infects , the patients must therefore at changing the solutions very sterile work. If the procedure is limited by the body weight and the kidney remainder function - the weight is too large and the kidney remainder function too small, the PD is suitable less.

alternative: Nierentransplantation

All of this replaced not normal kidney function but it acts itself also here around kidney spare therapy, so that the Nierentransplantation, as far as individually possible and desired, although always the worthwhile goal is not, there the waiting periods for a donor organ at least in Germany between sixand is appropriate for eight years. A Nierentransplantation contributes not only to the re-establishment of the physical efficiency, quality of life and social integration of the concerning, but is economically regarded also the most favorable solution. A successful Nierentransplantation costs inclusive. the aftercare in the 1. Year about as much as 2 years dialysis.Whereby this criterion for the concerning with security the most unimportant will be. Further the chances of success of a Nierentransplantation rose clearly in the last years. The action periods of the transplantierten kidneys lie increasingly within the range 10-20 years, tendency rising. Also the survival periods of the transplantierten patients are today clearly more largely than those of the dialysis patients.

From patients treated in Austria 2003 the 6564 with kidney spare therapy 49% were nierentransplantiert, 4% were peritonealdialysiert and 47% were under hemodialysis treatment (Kramar R., mute-fully manufacturing costs, ÖDTR, annual report 2003 of the Austrian society for Nephrologie).

Web on the left of

• Federal association kidney registered association. Self-help roof federation
• dialysis-on-line Community
• federation German kidney centers of the DDNÄ registered association.
• KfH Kuratorium for dialysis and Nierentransplantation registered association.
• SHG family Zystennieren e.V
• homepage of a dialysis patient
• PHV The dialysis partners
• global Dialysis
• information for young kidney patient
• association of friends of child dialysis Vienna

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