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Dialysis: When kidney failure is no longer an option 

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Omar P. Haqqani, MD
Midland Daily News
February 5, 2017

When weighing the different types of organ failure that a person can experience, kidney failure is among the most detrimental, as its effects are some of the most damaging. However, through the use of dialysis — a process that helps to take on the organs’ functions — kidney failure doesn’t have to end in tragedy.

A multitude of risk factors and conditions can lead to kidney failure. Prerenal conditions, such as dehydration and hypovolemia, for instance, decrease the amount of blood supply to the kidneys, which refuses to allow the organs to function properly.

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Certain medications can also cause damage to the kidneys over time, including nonsteroidal anti-inflammatory drugs, like naproxen and ibuprofen, lithium, medications that include iodine, and certain sects of antibiotics.

Additionally, in particular cases, some poorly controlled conditions can lead to kidney failure, including diabetes, hypertension, and glomerulonephritis (acute kidney inflammation).

As kidney failure progresses, the organs are no longer able to perform properly, as they are unable to filter the blood’s waste products.

Not only this, but because of the kidney’s vital role in blood pressure regulation, producing red blood cells, and balancing electrolytes, it can also mean that other systems of the body can be impacted by the organs’ failure.

This is where dialysis can come in as a method of performing the kidneys’ functions when either acute or chronic kidney disease, as well as end-stage renal disease, has taken over.

Though, often times, kidney failure is an irreversible condition, dialysis is often the preferred method of performing these functions when kidney transplant is unable to be performed.

The process of dialysis typically occurs three days a week for three to four hours per day. It is a commitment that is necessary in order to process waste that has accumulated within the circulatory system.

In order to be fitted for the process of dialysis, as well as the machine used to perform these functions, a patient must have a blood access site that is able to withstand frequent needle puncture for the length of treatment.

There are several common “conduits” that can be used in order to connect a dialysis machine to a patient: A temporary dialysis catheter, or a surgical procedure to connect an artery and vein together called arteriovenous fistula (AV fistula).

With a temporary catheter, a thin, flexible tube is placed into a large vein located in the neck, used for a maximum of three months. Those who are expected to utilize dialysis for long periods of time will require another solution over time, and a high risk of infection comes with this surgery, as the catheter is placed directly into the blood stream.

During an AV fistula, an artery and vein are sewn together through a small incision, allowing for the vein to become thicker and tougher, increasing in size over six to 10 week’s time.

In order to tell if a graft is functioning correctly, a patient should be aware of two signs. The first sign is to be able to detect if a “thrill” occurs — a gentle vibration that is felt by gracing your fingertips over the site of the incision.

The other sign is referred to as a “bruit” — a loud, swishing noise that can be heard through a stethoscope.

If neither of these conditions can be detected, the graft may not be in solid working order, and could narrow due to the collection of blood clots.

However, there are signs in order to detect if a graft is not working, such as if bruising or discoloration around the site of placement occurs. In this case, a vascular surgeon may utilize the inflation of a balloon to widen the graft’s opening, improving blood flow as a result.

Reportable signs or symptoms that occur in or around a dialysis access site include, but are not limited to: Signs of infection, sizable bruising spreading away from the graft site, pulsating hard knots under the skin, or coldness, paleness, aching or tingling.

Once a successful connection is made, and the dialysis access site is created, any number of potential dialysis procedures can be performed, though the main two types of dialysis are hemodialysis and peritoneal dialysis, which, through their own ways, help to remove waste materials from the blood.

Hemodialysis is undergone through the use of a dialysis machine and dialyzer, which acts as an artificial kidney, usually occurring when a patient has 10-15 percent of their kidney function left.

Peritoneal dialysis is done through a different process. Through this type of procedure, a catheter is placed in the stomach through a minimally invasive procedure. Through the catheter, a cleansing fluid is put in the stomach, and then leaves through the catheter again once treatment has finished.

Though losing the kidneys to organ failure can be both physically and emotionally taxing on a person’s health, it shouldn’t discourage someone from losing all hope when it comes to their condition.

Thanks to the advancements in dialysis treatment, all hope isn’t lost for those suffering from kidney failure.

Dr. Omar P. Haqqani is the chief of Vascular and Endovascular Surgery at Vascular Health Clinics in Midland.

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