As I write this, I'm sitting next to my son who has been on hemo- dialysis since August of 2001. He's actually having a treatment this very minute. He gets three four hour treatments a week. I think to most people who aren't familiar with the treatment process it is a mystery and an experience they hope they will never have to go through. It is a different world to be sure.
I guess one of the most notable dialysis patients right now is Natalie Cole. She is still touring and enjoying life. She experienced renal failure because of contracting Hepatitis C. She has made a claim that a medication to treat the Hepatitis is the reason for her kidneys failing. That is an argument for another day. The reality is that our filtering system which greatly depends on our kidney performance is a complex and precious bodily function. Kidneys do so much more than remove toxins and excess fluid. They regulate vitamin D, potassium levels and phosphorous levels. If these chemistries get out of balance patients experience brittle bones and heart conditions. Diet and fluid restriction play a great role in maintaining a healthy balance. Dialysis patients are restricted from foods high in potassium like beans, potatoes, bananas, nuts and many vegetables and fruits including dark leafy vegetables and fruits like cantelope, pumpkin, squash and tomato. As many of you know, too much potassium will stop your heart. My sons dietician said that one patients last meal, unwittingly, was banana nut ice cream. The phosphorus issue, which is contained in all foods, but more heavily concentrated in certain foods like colas, beans, nuts etc. is regulated differently than by people with normal kidney function. Dialyisis patients have to take what are called binders with their meals. These are usually calcium or magnesium based supplements that cause the excess phosphorous to be passed through the intestines in the stool.
Many dialysis patients experience total kidney shut down and they don't produce any urine at all. In these cases fluid restriction is a matter of life or death. There is no where for the fluid to go so if overloaded, drinking more than you should, fluid will fill the pulmonary system. Continually taking in more fluid than the recommended by the physician can result in weakening the heart muscles. The constant expanding with fluid then contracting with fluid removal weakens the hearts' ability to bounce back with the same initial vigor. If the patient really goes overboard they can literally drown as their lungs fill up with the excess fluid.
Many people don't have a clue how in the world the blood even makes it in to the machine. This is also a delicate and complex part of the treatment. A dialysis patient's life line is called an access. Some people use large catheters that are inserted by a vascular surgeon in to major arteries, usually located in the neck and chest area. One artery is the arterial, it pushes out the dirty blood and the other is called the venus, it accepts the clean blood as it has made its way through the machine. There are other accesses called grafts. These are artificial ports placed in to the arteries but remaining under the skin. Problems can arise with these two forms of accesses because the catheters remain outside the body they are often a source of infection. The grafts can get clogged and damage the arteries. The best form of access is called a fistula. This is when a vascular surgeon singles out two major arteries and stitches them close to the skin for access. Usually sonograms are done to search for the best arteries in the forearm or upper arm. In each case there has to be an artery to push out the dirty blood and one to accept the clean blood. The fistulas are the best form of access because there is nothing artificial and it is completely under the skin so the chance for infection is greatly diminished. I must note that there are risks and complications with each and every form of access. What is the most frightening of all is that arteries can get damaged and used and sometimes there is just nowhere to place an access.
What is difficult for most patients is the insertion, called canulation, of the huge needles that are attached to the lines that transport the blood to and from the patients. The machines are remarkable inventions that detect air bubbles, fluid balances, and the performance of the filter, the dialyzer, that the blood is filtered with. It goes through all kinds of tests and is cleaned out with bleach and vinegar. It gets programmed specifically to each patient and holds all the information of fluid removed, time of the treatment duration, and every single blood pressure taken in the four hour span. The tubes from the patients are primed with saline solution. They start out clear and then when the machine begins the treatment they turn crimson red. The entire clinic is filled with the lulling noise of the churning of the blood as it makes its way through the machine into the dializing filter and back in to the patient. There are also all kinds of beeps and alarms. If a problem arises with the patient's access or in the machine an alarm goes off to alert the staff. When the large needles are removed at the end of the treatment the sites must be held to stop the bleeding with gauze. The precise pressure must be applied or a patient might get bandaged up too early only to find themselves gushing blood on the way out. It's really hard to get used to this.
While on the machine there is a fine choreography of calculations done by the technicians and nurses to make sure the patient is getting all the excess fluid off and doesn't leave heavy. This is done by getting weighed each time before and after each treatment. Knowing the target weight of the patient is called the dry weight. Careful notes are taken to keep track of the patients weight, the recommended fluid allowance and the blood pressure. My son is allotted 1.5 litres each day to drink. This is easier understood when you break it down in to ccs. There are 30 ccs in an ounce. Eight ounces contains 240 ccs. He's allowed 1500 ccs a day, so he gets the equivalent of about 3-4 12 oz sodas. This is extremely hard for most patients because they constantly feel thirsty. The greatest challenge is over the weekend. Most patients are on a Monday, Wednesday, Friday schedule, so the two day span between treatments is always nerve wracking for me. I'm constantly checking with my son to make sure he can breathe Sunday nights.
While he's on the machine his blood pressure is taken at least once every half an hour. Usually the heavier the patient, the higher the blood pressure. Sometimes if we are trying to take off more fluid than we should his blood pressure will drop. At this time, we can control the fluid removal. The machine has a button that when pushed will stop removing fluid and continue to clean the blood. It can really wear the patients out. Their hematocrit is much lower than people who don't need dialysis. Red blood cell production is affected so many patients take medications that help red blood cell production, much like cancer patients do. A lot of dialysis patients experience a great deal of fatigue.
Some people opt for dialysis treatments at home. I feel better bringing my son to a facility because of the great professionals who are on hand. When a patient comes in very fluid overloaded, many times they need oxygen and maybe a chest X-ray. When a patient's blood pressure drops it can be very scary. Sometimes fluid has to be given to get the pressure back up. This is usually done like the way an IV fluid is administered only it goes through the machine.
Well, maybe this has been TMI for many people. My hope is that you have a better understanding of what these brave souls go through. Whether its feeling like they can't take another step or they experience a thirst that would make most of us feel like we've just run a marathon, they bravely show up each scheduled day for their treatment. A lot of patients are diabetic and the high blood sugar and poor circulation was just too much for their kidneys to handle. Some folks had extremely high blood pressure for many years that went untreated and the constant pressure on their kidneys wore them out. My son was born with a major birth defect. His kidneys gave out when he was eleven. I gave him one of my kidneys and it lasted for six years. He's been on dialysis for eight years now. He's on the list... that's a post for another time. But what is really hard is when someone doesn't show up because they're in the hospital or if they suddenly pass on. I've seen too many precious souls sitting in their assigned chair one day then unexpectedly never get to see them again.
I implore you to take care of yourselves. Get check ups and value the health you have.