By Dr. Nanah Sheriff Fofanah-Sesay, Guest Writer, USA
In order to appreciate the significance of dialysis treatment, the epidemiology of chronic kidney disease (CKD) and it accompanied sequelae must be highlighted.
According to Medscape Medical News (2017), I in 10 people worldwide have CKD. The report also found a wide range of prevalence globally. By region, the estimated prevalence ranges from 7 percent in South Asia, 8 percent in Africa, 11 percent in North America, 12 percent in Europe, the Middle East, East Asia, and Latin America. In addition, Saudi Arabia and Belgium have the highest prevalence rate at 24 percent each, followed by Poland at 18 percent, Germany at 17 percent, Singapore at 16 percent, and United Kingdom at 16 percent. On the contrary, Norway and Netherlands have the lowest prevalence rate of CKD at 5 percent each (Medscape Medical News, 2017).
CKD can affect almost every part of the body and it is associated with complications that includes but not limited to fluid retention, sudden rise in electrolytes levels, heart and blood vessels diseases, brittle bones, anemia, erectile dysfunction, reduced fertility, damaged central nervous system, Seizures, decreased immune response, pericarditis, and complications of pregnancies.
To put things in perspective, let me reiterate that one of the most important function of the kidneys is to clean the blood, as blood moves through the body, its picks up extra fluids, chemicals, and waste. The kidneys separates these materials from the blood. These materials are then carried out of the body in urine. If the kidneys are unable to perform this function and the condition is untreated, serious health problems results with eventual loss of lives.
For individuals suffering from end-stage-renal disease, the only option to sustain lives is the initiation and maintenance of dialysis treatment.
Dialysis treatment is the purification of blood by removing waste, chemicals, and excess fluids through an artificial dialyzer (National Kidney Foundation, 2017).There are two types of dialysis treatments: hemodialysis and peritoneal dialysis. In hemodialysis, the blood is pumped out of the body through tubing to an artificial kidney called a dialyzer where excess fluids, chemicals, and wastes are removed. In peritoneal dialysis, the inside lining of the individual’s belly or peritoneum acts as a natural filter.
For the sake of this article and for simplicity, the focus of this discussion is limited to hemodialysis treatment and what its entails. Since individuals suffering from kidney failure requiring dialysis treatments are the core of this discussion, let me start by emphasizing that the affected person needs to set aside 3.5 to 4 hours for treatment plus a travel time to and from the centers 3 times a week. It is also important to note that one year of hemodialysis treatment can cost up to 72,000 dollars (U.S. Renal Data System, 2014).
In order for hemodialysis to take place, the affected individual must first and foremost have a functioning dialysis access. These accesses can be temporary such as Quinton catheters, femoral catheters, and abdominal catheters. In addition, permanent catheters such as intrajugular and subclavian catheters are frequently utilized. Moreover, vascular accesses such as arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) are other forms of preferred permanent accesses. The AVF is a connection made by a vascular surgeon where an artery is connected to a vein whereas the AVG is a connection made by a vascular surgeon where a looped, plastic tube is used to connect an artery to a vein. The permanent and temporary catheters are usually inserted by general surgery.
Next in line is the availability of a reverse osmosis (RO) water system which uses a pump to push water through a semipermeable membrane or filter which removes almost all of the contaminants including bacteria and viruses to ensure product water. The product water is the ultra-pure water which enters the hemodialysis machines and is used to mix the dialysate in order for the treatment to take place.
Components of the water system includes pre-treatment water, blending valve, multimedia filter, carbon tanks, water softeners, R.O. pre-filters, R.O. machine, product recovery, alarm panel, D.I. tank, and endotoxin filter.
Next in line is the dialysis machine-which is used to filter the affected individual’s blood to remove excess fluids, chemicals, and waste products when the kidneys are damaged, dysfunctional, or missing. In addition to the dialysis machines, supplies such as dialysis solutions, dialyzers, needles, tubing, topical anesthetics, alcohol wipes,normal saline, gauzes, sterile drapes, gowns, and gloves are utilized.
Next in line is the availability of trained staff to carry out the hemodialysis treatment. These staff must be knowledgeable on dialysis procedures as well as the adverse effects of treatment and intervention that must be taken to stabilize the individuals during treatment.
The nephrologist is the medical doctor who specializes in kidney diseases and treatments. He or she evaluates individuals needing treatment and prescribes dialysis treatment based on the individual’s blood work, fluid retention, weight, and other factors.
Since the water system and dialysis machines are prone to breakages and malfunctions, there must be available trained personnel to repair these machines whenever necessary.
Lastly, the treatment environment must be spacious, clean, temperature controlled, have a drainage system, and storage area for supplies.
The motive behind this article is to shed some light on the treatment of dialysis and what its entails. It is my hope to provide information to readers especially those in part of the world where this treatment is barely or not available. In addition, providers who are interested in setting up dialysis treatment center or clinics in developing countries lacking this life saving treatment will be aware of what its entails in order for them to make an informed decision.
For more information on dialysis treatment, please contact National Kidney Foundation in the United States at www.kidney.org/atoz/content/dialysisinfo
International DaVita-outside United States at www.davita.com/about/international
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