Dialysis (blood washing) – treatment, effect and risks

Application and function

Dialysis is usually used when there is acute or chronic kidney failure and the organ can no longer perform its function. Accordingly, dialysis can either be temporary or permanent.Acute dialysis is used in acute kidney failure. Acute kidney failure becomes noticeable, for example, through rising potassium levels, symptoms of poisoning due to substances that are excreted in the urine, or signs of overhydration. In addition, acute dialysis for poisoning is a method of treatment. Thus, the procedure can save the lives of patients suffering from poisoning with dialyzable substances.

If acute renal failure becomes chronic, long-term use of dialysis is necessary. In such a case, the affected patient must appear regularly for dialysis. Often the blood is cleaned every other day. Dialysis is an older measure. It was carried out for the first time in 1924. Currently around 70,000 people in Germany use dialysis.

methods and procedures

There are three different methods of blood purification. A distinction is made between hemodialysis, peritoneal dialysis and hemofiltration. With peritoneal dialysis, the blood is cleaned outside the body. The patient is given vascular access. The blood is then cleaned using a dialyzer. After cleaning, the device directs the blood back into the organism.

A filter is used in hemodialysis. The procedure is the most commonly used. A specific flushing fluid flows through the filter and is separated from the blood by a membrane. Pollutants leave the body through the membrane. With hemodiafiltration, the blood is also cleaned outside the body. The blood flows through a membrane with pores. Blood pressure pushes plasma through the membrane, cleaning the blood.

What does the patient have to consider?

Dialysis always means a serious intervention in everyday life. After all, patients have to go on dialysis many hours a week. Work, family and hobbies may initially suffer from the new situation. It is therefore important that the patient has the support of his friends and relatives.

Those affected can regulate the urinary substances in their body through their diet. Accordingly, patients should not lose sight of their diet. If necessary, a dietitian can help. First, the diet should be low in phosphate. The damaged kidney is responsible for increased levels of phosphate in the blood.

Over the long term, high levels of phosphate lead to bone changes , vascular damage, and changes in parathyroid function . It is therefore advisable for dialysis patients to consume as little phosphate as possible. Foods containing phosphate include, for example, sausage, milk , egg yolk, offal, processed cheese and canned milk. In addition, phosphate-binding drugs can help.

The diet should also be low in potassium. High potassium levels can trigger cardiac arrhythmias. Too much salt in food raises blood pressure and should be avoided. Very salty foods such as pretzel sticks and salted meat do not belong on the menu. Instead of salt, herbs also add flavor to the food. In addition, the daily drinking amount is determined individually.

process and implementation

Because a lot of blood is taken during dialysis in order to then return it to the body, a specific vascular access is necessary. A dialysis shunt is placed first. This is an artificial connection between an artery and a vein. Because the vascular access is permanent, infections from frequent needle sticks can be avoided.

Large cannulas are used for acute dialysis. These are usually placed in the neck, groin or collarbone area . Because the blood comes into contact with plastic during dialysis, blood clotting is inhibited with medication during the process. The plastic causes blood to clot.

Dialysis can be performed both at home and on an outpatient basis. In Germany, the procedure is usually carried out under medical supervision. The blood is cleaned using various procedures and returned to the body. Because the process takes several hours, professional and social consequences cannot be ruled out.

Self-service or health insurance – who will bear the costs?

Dialysis is covered by health insurance. Those affected do not have to pay for the procedure themselves. When traveling within Germany, dialysis is also covered by health insurance. Even when traveling abroad, there are usually no complications from paying for the therapy. However, you should always ask your health insurance company before booking your holiday.

Depending on the mobility of the patient, the health insurance company will even cover transport to the dialysis center. However, a certificate of necessity must be issued for this.

Risks, dangers and complications

Like many other medical measures, dialysis does not only have advantages. So it can trigger specific complications. This includes, for example, the drop in blood pressure. Certain measures can prevent the symptoms. During dialysis, the patient is also deprived of minerals, which increases muscle cramps . A massage of the affected area usually helps.Many patients suffer from headaches . The intake of painkillers should be clarified, but is usually possible without any problems. If the dialysis takes a long time, nausea and vomiting may occur. Symptoms often go away with treatment for the drop in blood pressure. Infections sometimes occur in the area of ​​vascular access.