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There are two types of dialysis – hemodialysis and peritoneal dialysis.

HD uses an out-of-body filter called a dialyzer. With the help of the hemodialysis machine, the blood from the body is filtered through an artificial membrane – “dialyzer”, or “artificial kidney” to clear toxins that the kidneys can no longer remove. Peritoneal dialysis is a way to remove waste products from the blood in a different way from the more common blood filtration procedure called hemodialysis.

A peritoneal catheter is required before initiating PD. PD uses the lining of the abdominal cavity, called the peritoneal membrane, which serves as a natural filter to remove fluids and harmful substances from the blood. This is achieved by periodically infusing a special solution into the abdominal cavity. The lining of the abdomen (peritoneum) acts as a filter to remove waste products from the blood. Your doctor can tell you which type of dialysis may be the best option for you.

Factors to consider are:

– Your kidney function – Overall health

– Your personal preferences

– Your way of life

Peritoneal dialysis may be a better option if:

– You want to minimize the interruption of your daily activities

– You want to work or travel easier

– You have some residual kidney function

Peritoneal dialysis may not work if you have:

– Adhesions and mechanical defects of the abdominal wall also complicate the procedure.

– Inflammatory bowel disease or frequent attacks of diverticulitis

– Impossibility to observe strict hygienic measures

Advantages of peritoneal dialysis

– No vascular access with fistula or catheter is required;

– Patient mobility

– The therapy is carried out at home

– Lower risk of transmitting dangerous viral infections.

Disadvantages of peritoneal dialysis:

– Risk of infections

– Risk of obesity

– Impaired fat metabolism

– Cleansing from nitrogenous bodies (urea and creatinine) is not so good

People with kidney disease often undergo a number of medical tests and procedures. They are an indicator of the diagnosis made or are performed to monitor progress during treatment.

To determine the state of renal function, tests for creatinine, blood urea and albumin are most often prescribed.

Creatinine – is a waste product of muscle activity. It is usually removed from the blood by the kidneys and passes into the urine. When kidney function is reduced, it remains in the blood. The main reason for the increased levels of creatinine in the blood is the reduced glomerular filtration in the kidneys, which is due to acute disease or chronic diseases.

When the patient is on dialysis, creatinine levels are always high.

The appointment of a creatinine test may be for prophylactic or diagnostic purposes or in case of suspicion of certain diseases.

Urea – Urea is a waste product that is formed in the liver. Blood urea testing provides important information about kidney and liver function, helping to diagnose various kidney diseases.

If the body retains urea, it means that the kidneys are not working properly. Increased urea levels may also occur during strenuous exercise, as well as when taking certain drugs, such as hormones. Generally speaking, urea levels in the blood inform the kidneys’ ability to remove harmful substances from the body.

Albumin – Human albumin is a small globular protein consisting of 585 amino acids. Albumin is synthesized in the liver, after which it is excreted into the bloodstream. It plays an important transport role – for hormones, vitamins, or medications.

An important indicator is the amount of albumin and the ratio of total sweat in various disease processes: chronic liver disease, chronic kidney failure, cancer or in the diagnosis of edema.

The renal nuclear scan is a diagnostic test and can be performed in several different ways using a radioactive indicator. It is used to diagnose suspected kidney problems and to assess their function. It is an extremely effective diagnostic tool because, in addition to showing their anatomy, it reveals how well they are functioning at the moment.

Radioisotope research is done by introducing a small amount of radioactive isotope into the body and monitoring its entry, accumulation and excretion by the kidneys. During the scan, the corresponding indicator is injected into a vein and monitored to and through the kidneys with special detectors. The process is monitored on a computer screen. The resulting images show the delivery of fluid to the kidneys through the bloodstream and the ability to excrete fluid from the kidneys through the ureters and bladder. The ability to analyze kidney function allows doctors to diagnose specific kidney diseases and problems much more accurately than with the possible standard imaging tests.

Reasons for conducting the test

– to assess renal function

– to see abnormalities in the size, shape and structure of the kidneys

– renal artery stenosis

– to monitor renal function after transplantation

– detect damage or obstruction in the ureters

– for diagnosis and evaluation of tumors, cysts or abscesses in the kidneys.

Scanning the kidneys is generally painless, but it is possible to experience mild discomfort. The patient can return to his daily activities immediately after the procedure. Redness and soreness at the injection site are possible side effects. Although radiation exposure is minimal, you should tell your doctor if you are pregnant or breast-feeding before undergoing the procedure.

pH is a scale that measures the alkaline and acidic properties of the aquatic environment and represents the ratio of positively charged hydrogen ions to negatively charged ones in a solution. This is one of the most important indicators of homeostasis in the body. Our body is made up mainly of water, and the environment we need to maintain is slightly alkaline – from 7.35 to 7.45.

The acid-base balance requires the cooperation of three main organs: the liver, kidneys and lungs.

The acidic environment is rich in protons, while the alkaline is rich in electrons. Electrons determine an oxygen-rich environment that provides the required amount of oxygen throughout the body and meets the needs of normal, aerobic cells.

Plasma buffer systems include plasma proteins, phosphate and bicarbonate, and carbon buffers. The kidneys help to control the acid-base balance by releasing hydrogen ions and generating bicarbonate, which helps keep blood plasma pH within normal limits.

With disturbed alkaline-acid balance with low pH values there are problems related to weight, allergies, arthritis, fungal infections, impaired metabolism, chronic fatigue and lack of energy, muscle pain, cramps.

The kidneys and lungs are the main factor in neutralizing the acid accumulation in our body. They help in the process of acid control and support the balance of the blood. Their main task is to neutralize sulfuric or uric acid through urination. As these or other acids increase, the kidneys increase their production of hydrogen ions to balance these processes.

Thanks to their work, our body has a filtering mechanism that removes acids from the bloodstream, eliminated through the urine. Proper kidney function is ensured by alkaline reserves or alkaline substances, which are desirable to be regularly provided to the body through an optimal diet.

Alkaline food intake helps to:

– Proper metabolism

– Digestion

– Energy depots are increasing

– Immunity

Potassium is a mineral and electrolyte that we need to maintain and regulate key processes in our body. It is one of the seven major macrominerals and plays an important role in kidney function. It is found in most of the foods we eat and is needed in our diet because it supports muscle movements, keeps the nervous system healthy and participates in the process of balancing the amount of water in the body. The amount of potassium in the blood is controlled by the kidneys. They remove excess potassium from the blood and excrete it in the urine, which process is reduced in patients with CKD.

Having too high or too low potassium levels can lead to complications that affect kidney function. In people with kidney disease, potassium levels can build up to higher levels. This is called hyperkalaemia and can be dangerous for the heart.

People with chronic kidney disease should limit the amount of potassium they consume, as their kidneys cannot process potassium properly and this leads to its accumulation in the blood. On the other hand, drugs used to treat CKD can also increase potassium levels.

It is recommended that healthy men and women over the age of 19 consume at least 3400 mg and 2600 mg of potassium per day, respectively. However, people with kidney disease who are on a potassium-restricted diet should usually keep their potassium intake below 2000 mg per day.

The optimal amount of potassium in the diet maintains and has a beneficial effect on the muscles that control heart rate and respiration.

Potassium restriction in the hemodialysis diet

Potassium-rich foods are limited for hemodialysis patients as potassium accumulates in the periods between dialysis treatments and can cause problems such as weakness, muscle cramps, fatigue, irregular heartbeat and heart problems.

Potassium is present mainly in fruits, vegetables and dairy products. Some fruits and vegetables are high in potassium and others are lower.

Foods that are low in potassium – meat, poultry, bread, pasta.

Potassium-free foods – butter, margarine and oils

When the kidneys are healthy and functioning properly, filtering fluids, minerals and waste products from the blood, they usually do not allow large amounts of serum protein to be isolated in the urine. But when the kidneys do not filter properly, proteinuria can occur, which means that an unusual amount of protein is present in the urine.

The two main groups of serum proteins in the blood are albumin and globulins. Albumin is abundant in the blood, making up more than 50% of all serum proteins. Its functions include maintaining the right amount of water in the bloodstream, as well as binding and transporting substances that are poorly soluble in water – fat-soluble vitamins, calcium and some medicaments.

Transient proteinuria is a temporary release of protein and can be the result of strenuous exercise, fever, exposure to cold, stress and other conditions. Pregnant women can also excrete more protein in their urine. Transient proteinuria does not involve underlying kidney disease and does not require treatment.

Proteinuria might be also due to kidney disease, such as glomerulonephritis, primary focal segmental glomerulosclerosis (FSGS), or kidney damage due to systemic disease. Microalbuminuria means that low levels of albumin are found in the urine. Microalbuminuria may indicate that people with diabetes or hypertension develop an early stage of kidney disease.

Symptoms of proteinuria

In most cases, proteinuria has no symptoms and is detected during routine screening in people with high blood pressure or diabetes. If the protein loss is severe, swelling or edema may occur. Swelling may be present in:

• The face and around the eyes
• Hands and feet
• Ankles and feet
• Abdomen

There are three types of kidney damage (insufficiency) – prerenal, renal and postrenal. The mechanisms of occurrence are radically different, as in some cases the cause lies in the kidneys, and in others they are secondarily affected.

Prerenal acute impairment occurs when a sudden decrease in blood flow to the kidneys (renal hypoperfusion) causes loss of renal function. In these cases, the kidney structures are preserved and healthy but low blood pressure leads to a collapse of their function, stops the filtration of blood and urine production.

In renal damage, the renal glomeruli and especially the tubules (tubules) are affected by a real disease process. Treatment includes identifying and correcting the cause of the kidney damage. This often involves nephrotoxic drugs, glomerulonephritis, lupus, rhabdomyolysis and other specific kidney diseases. As a result of impaired blood supply through the renal arteries, secondary organic damage can occur, which can lead not only to a sudden loss of renal function, but also to remain even after the restoration of blood flow.

Postrenal renal failure is due to obstruction (blockage) of the urinary tract at various levels and causes the accumulation of waste in the kidneys. Obstruction of the urinary tract can lead to accumulation of urine in one or both kidneys. Over time, this accumulation of fluid can interfere with the normal flow of urine from the kidneys. This is usually a reversible process if the obstacle is removed. However, there are cases in which prolonged urinary tract infections can lead to permanent and severe damage to the renal parenchyma.

Chronic kidney disease (CKD) is a global health problem and is often associated with an increased risk of cardiovascular disease.

Cardiovascular disease is the leading cause of morbidity and premature mortality in people with chronic kidney disease. Also, patients with renal insufficiency have been found to be at higher risk of complications. The presence of cardiovascular disease can be a risk factor for CKD. The connection between them also contributes to their pathogenesis and progression in patients with any of the specific health problems. This risk often increases with the progression of CKD and is evidenced by a deterioration in urinary function, usually manifesting as a decrease in glomerular filtration rate and an increase in proteinuria.

Hypertension, one of the leading causes of renal failure, is a major culprit in this process, causing left ventricular hypertrophy, dilatation of the heart chamber and increased stress, ischemia, heart failure and arrhythmias. In addition to impaired coronary microcirculation, hypertension may contribute to the development of atherosclerotic coronary artery disease, especially in the presence of many lipid abnormalities observed in end-stage renal disease.

Some of the causes of cardiovascular disease are:

• High blood pressure – high blood pressure (hypertension) is one of the most important risk factors for CVD.
• Smoking.
• High cholesterol.
• Diabetes.
• Overweight or obese.
• Family history of CVD.

Patients with end-stage renal disease (CRF) treated with hemodialysis (HD) are increasing annually worldwide. Their quality of life to a large extent depends on the quality of their hemodialysis treatment. One of the main factors for this is the type of the used vessel access.

In practice, three main types of vascular access are used – arterio-venous fistula, arterio-venous prosthesis and central venous catheter – which in turn is divided into temporary and tunneled.

Temporary hemodialysis catheters were introduced in the mid-1970s, while tunneled catheters entered relatively later. Temporary vascular access is a consequence of emergencies through catheterization of large venous vessels. It is applicable in acute renal failure and is undesirable for chroniodialysis. Temporary catheters should be replaced by Permanent Tunneled Catheters.

The implantation of permanent tunneled catheters is performed by highly specialized physicians under constant ultrasound, X-ray or angiographic control during or after the procedure. They are most often implanted in the right atrium and are a complex medical procedure.

Permanent tunneled catheters are recommended in adult patients, such as those with cardiovascular disease, diabetics, cancer patients or in cases where prolonged stay of hemodialysis treatment is not expected.

The diagnosis of CKD is associated with the need for dialysis, for which, accordingly, there must be vascular access. An option for such access is the AV fistula, which is considered as the best choice, as it usually lasts longer and creates fewer problems.

AV fistula is a surgical connection made between an artery and a vein created by a vascular specialist. It is usually located in the arm, but if this is not possible, it can be placed in the groin or in the legs. With an AV fistula, blood circulates from the artery directly into the vein, delivering the right amount of blood flow needed to provide adequate hemodialysis treatment. AV fistulas are the preferred vascular access for long-term dialysis because they have fewer complications than other access methods and are less prone to infections and thrombosis. The fistula will take several weeks to mature, with an average period of 4-6 weeks.

Some of the benefits of AV fistula is that it provides the necessary blood flow needed for effective dialysis, which can help reduce treatment time, lower the risk of infection, and reduce the likelihood of clotting.

How is an AV fistula created?

The first step in creating an AV fistula is to assess the condition of the blood vessels (veins and arteries). These manipulations and examinations are performed by a vascular specialist. If necessary, minimally invasive tests such as ultrasound and possibly an angiogram can be used to determine the size and depth of the arteries and veins. These tests will determine if the blood vessels are able to support the AV fistula. The procedure is performed on an outpatient basis using local anesthesia. Once the AV fistula is established, it will take several weeks, in some cases a month or more, for the fistula to mature to the point where it can be used for hemodialysis treatment.