Haemodialysis

The solution for the chronic renal failure and hemodialysis problems was started at Republican Clinical Urology Hospital by forming "Kidney transplant and hemodialysis department" (Kidney Center) in 1970 (Sultan Aliyev was assigned as the first head of the department). The first hemodialysis was successfully carried out in September, 1970. A wide range of clinical, scientific and practical activities was implemented thanks to great efforts under the guidance of academic M. Javad-zade.

Orqanizmin həyat fəaliyyəti nəticəsində insanın orqan və sistemlərinin işinə və funksional vəziyyətinə mənfi təsir göstərə bilən xeyli miqdarda toksik maddələr yaranır və ya The solution for the chronic renal failure and hemodialysis problems was started at Republican Clinical Urology Hospital by forming "Kidney transplant and hemodialysis department" (Kidney Center) in 1970 (Sultan Aliyev was assigned as the first head of the department). The first hemodialysis was successfully carried out in September, 1970. A wide range of clinical, scientific and practical activities was implemented thanks to great efforts under the guidance of academic M. Javad-zade.

 Of course, human organism has disposal systems which neutralize toxins and self-defense mechanisms against the harmful factors. However, the bodies and mechanisms with the function of cleaning the organism from "toxins" cannot always cope with this work due to the urbanization, spoiled ecology and fast life rhythms. This leads to the accumulation of unnecessary agents and changes in the internal environment of the body, so serious metabolic disorders and pathological cases, which are dangerous for the organism, occur. Thus, a number of diseases based on the pathological changes in the immune system (allergic changes, autoimmune reactions, the weakening of the immune system and resistance) and disruption of metabolic processes, such as hypertension, ischemic heart disease, sclerotic changes in vessels of the brain, diabetes, gout, etc. develop.

The traditional treatment methods applied in most of these diseases only eliminate the symptoms of the disease, - prevent the development of allergic reaction or infection, dilate the bronchi during bronchial asthma or lower blood pressure, etc. At the same time, it does not affect to the main cause of the disease and is achieved at the expense of a number of side effects.

As a logical conclusion it may be assumed that the excretion of the toxic substances which are the products of organism’s activity can be a turning point in the course of disease. In this view, using the extracorporeal hemocorrection methods it is possible to obtain satisfactory results during the treatment process.

Extracorporeal hemocorrection is the quality and quantity change of the blood cell elements, re-development of the protein and water-electrolyte, enzyme and gas composition with a variety of technical methods outside the organism. Hemocorrection is conducted through the efferent (efference-excretion) therapy methods. Efferent therapy methods- direct removal of harmful substances got to the organism at the background of various diseases or from the external environment have been directed to the internal purification of the internal milieu. 

The most effective types of these methods which are used more in clinical practice are the following:


-    Hemodialysis;
-    Hemosorption;
-    Plasmapheresis;

In this case, toxins, nitrogen byproducts (creatinine, urea etc.), immune complexes, cholesterol and other pathological products causing a variety of diseases are removed from the blood. Selective effects such as detoxication (purification of the toxic substances from the organism), reocorrection (improve the rheological properties of the blood), immunocorrective (boost the immunity) stand on the basis of each method.

I. Hemodialysis (hemo-blood, dialysis-purification) is a method in which the blood is removed from the body and purified passing through the hemofilter (dialyser) and the purified blood returns to the organism. Hemodialysis is carried out through the “artificial kidney” device.

Hemodialysis room and osmosis-water treatment room of Republican MIA Hospital named after A.Heydarov.

The device works on the principle of blood treatment by transferring the semiconductor membrane-dialyzator (hemofiltration) made of special material and enabling to perform certain functions of the human kidney (removal of nitrogen residues, water-salt exchange, regulation of homeostasis and etc.) and the osmotically active dialysate of special compound and  adapted to the gas and electrolyte composition of the blood (the buffer solution in accordance with the blood composition-acetate and bicarbonate).

 

The device is combined with the blood circulation by puncturing the special vascular access created with the help of surgical operation using the fistula needle (fistula). The blood enters the dialyzer through the magistrial shunts for purification. At this time, a certain part of the blood (200-300 ml) remains outside the body, circulates uninterruptedly, is purified from hazardous substances and eventually returns to the blood circulation of the body. As a standard the dialysis program usually takes 3 -4 hours a week and this program is called hemodialysis or periodic hemodialysis and chronic hemodialysis. The majority of patients come to special departments - hemodialysis centers 3 times a week and receives this operation on an outpatient basis. If a patient is selected for hemodialysis under the proper instruction, he (she) can receive treatment for years or 10 years and lives an idyllic life by the help of dialysis.

If a patient follows the recommended regime and fulfils medical advice he (she) will maintain working ability for a long time and continue active living.

If patients agree, they will be sent to the kidney transplantation after 3-6 months of dialysis treatment. In this period patients’ condition gets better, they are examined thoroughly and in the absence of contra-indication renal transplantation operation is carried out. Kidney transplantations without dialysis may be carried out only in the case of well establishment of organizational work. Vascular access is established to connect the “artificial kidney” device to the patient’s bloodstream: during the acute renal failure (ARF)-temporary (insert a catheter to subclavian, jugular, femoral vein), during the Chronic renal failure (CRF)-permanent (arteriovenous shunt, arteriovenous (AV) fistula.

There are two types of hemodialysis:

-    Acute hemodialysis
-    Chronic (program) hemodialysis

Acute hemodialysis is applied during the acute renal failure caused by a variety of etiologic factors. After a few hemodialysis session a patient returns to normal life and if serious irreversible pathology occurs at the level of the kidneys, the permanent chronic hemodialysis will be continued in accordance with the living index or a patient will be sent to the renal transplantation.

Tips for Chronic (software) hemodialysis (during Chronic Renal Failure):

1.    Renal clearance of creatinine 10-15 ml/min/less than 1,73 m2;
2.    Renal clearance of urea 7 ml/min/less than1,73 m2;
3.    Creatinine level in the blood - higher than 600-700 mk mol/l;
4.    Potassium level in the blood-higher than 6,5 mmol/l;

The presence of one of the following clinical signs:

- symptoms of  uremia;
- hyperhydradation, uncontrolled AH, congestive heart failure, starting pulmonary edema;
-progressing  uremic neuropathy;
- metabolic acidosis, in the case  of decompensation;
-uremic pericarditis, uremic precoma;
- protein–energy malnutrition, hypercatabolism.

Relative contra-indications against the program (chronic) hemodialysis:

1.  Malignant tumor;
2.  Ischemic heart disease, myocardial infarction, heart failure;
3.  Decompensation phase of chronic hepatitis, cirrhosis of the liver;
4.  Obstructive lung diseases, active TB;
5.  Damage of cerebral vessels;
6.  Mental diseases (schizophrenia, epilepsy, psychosis etc.)
7.  Blood diseases (aplastic anemia, leukemis etc.)
8.  Low intelligence level, the lack of interest in social rehabilitation (alcoholic, drug addict, homeless hobo);
9.  Severe diseases of the nervous system;
10. Patients with a high risk of massive bleeding in the case of anticoagulant injections. (uterus fibroid, Mallory–Weiss syndrome, stomach and Duodenal ulcer). Aneurysm of the heart and magistral arteries.

 It should be noted that it is impossible to guarantee for the help of hemodialysis treatment for patients when the clinical course of the disease gets worse as a result of not referring the patients with chronic renal insufficiency and potentially in need of the program hemodialysis to a nephrologist on time.

For that reason, timely sending of a patient    to   nephrologist  for advice is very necessary as measures taken with these specialists allows to remove the  CRF complications in pre-dialysis period. On the other hand  the improper specification of  instructions for hemodialysis treatment leads  to  further deterioration of the patient's condition and acceleration  of  fatal ending.

In general, hemodialysis is not only the treatment but also a way of life!

II. Hemadsorption. It means the operation in which blood is carried through the charcoal made with a special method. At this time, blood is purified getting through the special heaters with activated charcoal in order to remove various toxic substances in the blood. When the patient's blood goes through the surface-active structures located in the sorption apparatus, toxic ingredients are fixed and the cleaned blood is returned to the patient.

Especially, the “average molecular” ingredients are cleaned from the blood during the hemadsorption. Therefore, hemadsorption is combined with hemodialysis in the treatment of chronic renal failure. In addition, hemadsorption is widely used for acute kidney and liver failure, endogenous and exogenous intoxication, allergic and other diseases.

III. Plasmapheresis- It is a type of extracorporeal methods and process of separating the pathological components of the plasma part of the blood and replacing with blood and blood substitutes. The operation is carried out with the help of a special device and plasma filters. A number of pathological ingredients do not possess electrical load and are neutral because of their enclosed structure. (e.g., immune complexes, some types of allergens, cholesterol, etc.); they cannot be fixed in sorbent. The lasmapheresis method based on the disposal of the plasma and toxins dissolved in plasma from the body is more effective in such cases.
Thus, plasmapheresis is applied for acute and chronic renal failure, acute and chronic glomerulonephritis, blood and nervous system diseases, chronic alcoholism, rhesus-conflict of the blood, pregnancy toxicosis of different origins and pathological cases due to its strong immunocorrector and reocorrector characteristics (normalization of the rheological characteristics of the blood).

So, the substances creating toxic effect on the body are excreted during the efferent procedures and as a result it leads to a significant decrease in the concentration of the pathogen substances, long-term remission (no symptoms of the disease) and even recovery.