Dialysis

Dialysis is a treatment that does some of the things done by healthy kidneys. It is needed when your own kidneys can no longer take care of your body’s needs.

When is dialysis needed?

You need dialysis when you develop end stage kidney failure –usually by the time you lose about 85 to 90 percent of your kidney function and have a GFR of <15.

Dialysis Facilities at KYAMCH:

  • KYAMCH is providing efficient dialysis with 32 dialysis machines.
  • Providing both Acetate and Bicarbonate dialysis.
  • Separate room with separate machine for Hepatitis C patients.
  • The cost of dialysis is the cheapest and most affordable as compared to other private dialysis centers.
  • Providing 3 shifts of dialysis with emergency facility.

Hemodialysis

While healthy kidneys have several functions in the body, the most well-known job is to produce urine. When kidney function goes below 10% to 15% kidneys are no longer able to filter the blood and make urine. This causes toxins to build up in the body along with excess fluid. Fortunately, we live in a time when there are treatments and medicines that can replace the functions of the kidneys and keep the body alive. One type of renal replacement therapy — meaning a treatment that replaces kidney function — is hemodialysis. Hemodialysis is a therapy that filters waste, removes extra fluid and balances electrolytes (sodium, potassium, bicarbonate, chloride, calcium, magnesium and phosphate).

Why Hemodialysis at KYAMCH:

Bangladesh has nearly 20 million people suffering from various kidney and urological problems. Every year 15-20,000 patients develop Acute Renal Failure, 70% of those can be treated by dialysis therapy and further 18-20,000 patients are developing End Stage Renal Diseases. In the Chittagong area alone around 3 million people estimated to be suffering from suffering from Chronic Kidney Diseases.

How does hemodialysis work?

In hemodialysis, a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean your blood. To get your blood into the dialyzer, the doctor needs to make an access, or entrance, into your blood vessels. This is done with minor surgery, usually to your arm.

How long will each hemodialysis treatment last?

Hemodialysis treatments usually last about four hours, and they are done three times a week.
Your doctor will give you a prescription that tells you how much treatment you need. Studies have shown that getting the right amount of dialysis improves your overall health, keeps you out of the hospital and enables you to live longer. Your dialysis care team will monitor your treatment with monthly lab tests to ensure you are getting the right amount of dialysis. One of the measures your dialysis care team may use is called urea reduction ratio (URR). Another measure is called Kt/V (pronounced kay tee over vee). Ask your dialysis care team what measure they use and what your number is. To ensure that you are getting enough dialysis:

  • *your Kt/V should be at least 1.2 or
  • *your URR should be at least 65 percent.

Will I be uncomfortable on hemodialysis?

When you begin hemodialysis, the needles put in your fistula or graft may be uncomfortable. Most patients get used to this in time. Your dialysis care team will make sure you are as comfortable as possible during your treatment. Symptoms like cramps, headaches, nausea or dizziness are not common, but if you do have any of them, ask your dialysis care team if any of the following steps could help you:

  • *Slow down your fluid removal, which could increase your dialysis time.
  • *Increase the amount of sodium in your dialysate.
  • *Check your high blood pressure medications.
  • *Adjust your dry weight, or target weight.
  • *Cool the dialysate a little.
  • *Use a special medication to help prevent low blood pressure during dialysis.

You can help yourself by following your diet and fluid allowances. The need to remove too much fluid during dialysis is one of the things that may make you feel uncomfortable during your treatment.

Continuous Renal Replacement Therapy (CRRT)

If your patient is critically ill with acute kidney injury (AKI), CRRT is one of the primary therapies. The goal of any continuous renal replacement therapy (CRRT) is to replace, as best as possible, the lost function of kidneys. CRRT provides slow and balanced fluid removal that even unstable patients – those with shock or severe fluid overload – can more easily tolerate. Both average and smaller size patients can undergo CRRT therapy and it can be adapted quickly to meet changing needs.

Advantages & Disadvantages of CRRT

Advantages of using CRRT
  • Suitable for use in hemodynamically unstable patients.
  • Precise volume control, which is immediately adaptable to changing circumstances.
  • Very effective control of uremia, hypophosphatemia and hyperkalemia.
  • Rapid control of metabolic acidosis
  • Improved nutritional support (full protein diet).
  • Available 24 hours a day with minimal training.
  • Safer for patients with brain injuries and cardiovascular disorders (particularly diuretic resistant CCF).
  • May have an effect as an adjuvant therapy in sepsis.
  • Probable advantage in terms of renal recovery.

Disadvantages of using CRRT

  • Expense – probably the same as IHD.
  • Anticoagulation – to prevent extracorporeal circuit from clotting.
  • Complications of line insertion and sepsis.
  • Risk of line disconnection.
  • Hypothermia.
  • Severe depletion of electrolytes – particularly K+ and PO4, where care is not taken.
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