Kidney Failure

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Dialysis and Hemodialysis

Dialysis cleanses the body of waste products in the body by use of filter systems. There are two types of dialysis; 1) hemodialysis, and 2) peritoneal dialysis.

Hemodialysis uses a machine filter called a dialyzer or artificial kidney to remove excess water and salt, to balance the other electrolytes in the body, and to remove waste products of metabolism. Blood is removed from the body and flows through tubing into the machine, where it passes next to a filter membrane. A specialized chemical solution (dialysate) flows on the other side of the membrane. The dialysate is formulated to draw impurities from the blood through the filter membrane. Blood and dialysate never touch in the artificial kidney machine.

For this type of dialysis, access to the blood vessels needs to be surgically created so that large amounts of blood can flow into the machine and back to the body. Surgeons can build a fistula, a connection between a large artery and vein in the body, usually in the arm, that allows a large amount of blood flow into the vein. This makes the vein swell or dilate, and its walls become thicker so that it can tolerate repeated needle sticks to attach tubing from the body to the machine. Since it takes many weeks or months for a fistula to mature enough to be used, significant planning is required if hemodialysis is to be considered as an option.

If the kidney failure happens acutely and there is no time to build a fistula, special catheters may be inserted into the larger blood vessels of the arm, leg, or chest. These catheters may be left in place for weeks. In some diseases, the need for dialysis will be temporary, but if the expectation is that dialysis will continue for a prolonged period of time, these catheters act as a bridge until a fistula can be planned, placed, and matured.

Dialysis treatments normally occur three times a week and last a few hours at a time. Most commonly, patients travel to an outpatient center to have dialysis, but home dialysis therapy is becoming an option for some.

Outpatient dialysis is available on some cruise ships. They are equipped with dialysis machines with trained health care professionals ready to care for those with kidney failure while traveling. Continue Reading

Reviewed on 1/23/2015
References
REFERENCE:

Longo DL, et al. Harrison’s Principles of Internal Medicine. 18th edition. McGraw Hill Professional. 2011.

Medscape. Renal Failure, Acute.

NIH. Amyloidosis and Kidney Disease. IMAGES:

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10. Veer

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13. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH)

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