Dialysis – a procedure that saves lives every day. What is it about? Is kidney transplant a better treatment option?

About 4,2 million adult Poles suffer from chronic kidney disease. As the disease initially develops with little or no symptoms, as many as 90% of patients do not know that there is something wrong with their kidneys. Dialysis may be necessary when this organ is damaged and cannot function properly. What is? What are the indications for its implementation? What steps should be taken when dialysis is not enough?

What is dialysis?

Dialysis is a method that aims to replace the physiological functions of the kidney. This organ removes harmful metabolic products from the body (including metabolites of taken drugs), which ensures metabolic balance, normalizes blood pH, maintains normal blood pressure and helps to get rid of toxins from the body. The procedure uses the properties of a semi-permeable membrane, which allows for effective purification of electrolytes from colloidal solutions. This membrane retains some of the compounds and allows the rest to flow freely. This is possible thanks to a phenomenon called diffusion. Thus, the more blood reaches the membrane, the more effective dialysis will be.

What are the indications for dialysis? In most cases, patients with renal insufficiency and after poisoning, e.g. with ethylene glycol, are eligible for the procedure.

In Poland, 16 thousand people undergo dialysis each year. up to 20 thousand sick. Statistics show that only 5% of them can count on kidney transplantation. These data do not inspire optimism, because compared to other European countries (about 30% of dialysis patients have a chance of being transplanted), Poland does not look very favorably.

It is worth noting that dialysis therapy completely disorganizes the patient’s life. Regardless of whether the procedures take place in a dialysis center or at the patient’s home, the patient must take into account the need to spend about 15 hours a week (3-5 hours on average every other day). Dialysis is a heavy burden on the circulatory system, so the patient has the right to feel tired after the procedure and requires rest. If the catheter connection procedure is not performed under sterile conditions, there is a risk of developing an infection.

Dialysis undoubtedly saves lives, but is burdensome for the patient and ties him to the place of residence and the dialysis center.

Types of dialysis and their course

There are two types of dialysis:

1. Hemodialysis – performed extracorporeal. It is used in advanced kidney diseases and is carried out using the so-called artificial kidney. Two needles are most often used during the procedure. One carries blood to the dialyzer and the other brings purified blood into the body. The purpose of hemodialysis is to remove all harmful substances from the blood that could not be removed with the urine due to impaired kidney function. This type of dialysis is performed in a dialysis station, and approximately 50 liters of blood pass through an artificial kidney during one session.
2. Peritoneal dialysis – the patient’s peritoneum is used as a semipermeable membrane. The dialysis fluid is introduced into the abdominal cavity of the patient, the composition of which has been selected in such a way as to be able to effectively retain harmful metabolic products. Thus, the blood pH and blood pressure are balanced and the body gets rid of undesirable substances. Before the procedure, it is necessary to implant a catheter into the peritoneal cavity (about 2 months before the planned dialysis). The procedure is usually performed at the patient’s home, which requires a short training course for both the patient and the person who is caring for him.

Dialysis saves lives, but transplantation is definitely the better treatment option

Kidney transplantation is an effective renal replacement therapy. It should be performed in patients for whom transplantation is not contraindicated. In Poland, the number of transplants is still too low. On average, about 900-1100 of these operations are performed, of which only 40-60 kidneys come from living donors. This result is ten times lower than in other European Union countries, mainly the Netherlands and the Scandinavian countries. It is believed that this may be related to low transplant awareness among both patients and medical staff.

It is most beneficial for the patient to obtain a kidney from a living donor. After transplantation, such an organ functions on average for about 15 years and successfully performs all physiological functions. The best situation is when the donor is a closely related family member – a sibling or parent. Often, organ donation is also decided by people who are in an emotional relationship with the needy, e.g. spouses or friends. An organ for transplantation can also be obtained from a dead donor, however, it is associated with a slightly worse treatment effect. Such a kidney functions on average for 9-12 years.

Before donating an organ, the donor must undergo a number of necessary diagnostic and laboratory tests. It is necessary not only to assess his general health, but also to perform a histocompatibility test. This reduces the risk of possible transplant rejection.

Contraindications to live kidney transplantation are:

1. advanced age of the patient,
2. active neoplastic diseases,
3. severe damage to internal organs (mainly the heart),
4. conditions that cannot be treated,
5. addictions, including smoking or alcohol addiction,
6. some chronic diseases, e.g. generalized atherosclerosis.

It is worth remembering that kidney transplantation doubles the life of patients compared to dialysis and significantly improves their quality of life. He does not have to give up his current lifestyle and most importantly, he is not dependent on dialysis. The average waiting time for an organ in Poland is approx. 11 months.