How many hemodialysis procedure lasts. Under what indicators creatinine, urea, glomerular filtration are usually prescribed by hemodialysis? What is hemodialysis

Healthy kidneys are a blood filter. All its volume passes through the renal filter per day more than 1000 times. 1 liter of blood purified in 1 minute. In the short segment of the kidney time - our natural filter, takes the molecule toxic substances from the blood for the body and the extra volume of water that fall the urinary tract and leave the body. Useful materialwhich circulated in the blood return to the bloodstream.

Unfortunately, for various reasons, the kidneys can be damaged and lose their functions, which leads to a delay in poisoning substances in the body. If you do not clear the blood from toxins, then a person will perish from self-defense. About 50 years ago, people with renal failure died at a young age. Hemodialysis is currently depends on the availability of due equipment, professionalism of medical staff, concomitant diseasesBut most of the person himself, the image of his life and adequate to their health.

Artificial renal filter

In the middle of the 18th century, applying the laws of physics, a scientist from Scotland has developed a blood purification system. He studied her on dogs devoid of kidneys. The device did not meet expectations due to the development of a plurality of complications.

For the first time, the procedure of hemodialysis was conducted by a German doctor in the early 19th century. It was completed 15 procedures to different people who, after that they lived for a long time. This is due to the development of thromboembolism. Used weight leeches - thinning protein blood, which was quickly neutralized immune system Patients and blood thickened with the formation of thrombov. Positive result The method was achieved in 1927 on the procedure using heparin, but the patient died still.

In the fall of 1945, the Dutch doctor improved the device used in those days and successfully removed the patient from the uremic state, finally proving the effectiveness of hemodialysis. In 1946, the Doctor issued a manual for the treatment of patients with Uremia with hemodialysis.

Magic filter mechanism

Hemodialysis is a blood purification system without attracting kidneys. To perform the procedure, access to Vienna and Artery is needed. These vessels introduce systems and forms shunts that attach to the hemodializer. From the arterial shunt, blood enters the apparatus where there are capillaries with semipermeable membranes. The capillary is surrounded by a cavity with a dialysis fluid, where there are harmful molecules in the law of osmosis. Of the dialysate in the capillary, the necessary substances come to the life and fall into the patient's bloodstream. In order to prevent thrombosis, an anticoagulant is introduced into the system. Recycled dialysate is removed, and purified blood returns to the patient. By time, the procedure lasts from 4 to 12 hours and is repeated 3 times a week, and in some cases every day.

How many people live on hemodialysis? Statistics shows - on average 15 years old, but there are data in history that there were patients who lived 40 years. In the Russian book of records described a woman who spent 30 years on dialysis.

The method of extracorporeal blood purification is accomplished in itself. Per year per person spent over a million rubles. Currently there is a state program, thanks to which the cost pays the state. Scientists' devices themselves try to improve, so that in the near future this procedure will be available to all suffering from renal failure. Consider what kind of hemodialysis devices exist.

By functionality

1. Classic - apparatus with a small membrane area. Only fine molecules pass through the filter. Blood flow speed up to 300 ml / min. The procedure lasts 4 hours.
2. Highly efficient. Square semipermeable membrane 1.5 - 2.2 sq.m. Overclocking the speed of blood flow to 500 ml / min., Which reduces the duration of the procedure up to 3 hours. In the opposite direction of blood, dialyzat moves, speed up to 800 ml / min.
3. High flow. Allows you to clean the blood from anything, even large molecules skip.

By type of dialyissors

Capillary. The closest is close to the physiology of a healthy kidney.

Disk (plate).

Portable devices

There are portable blood purification devices. They are distributed in Western countries. These devices use more than half of patients with CPNs. Equipment is expensive, estimated at 20 thousand dollars. Portable devices have their advantages:

No queue;

The ability to infect blood contact infections (hepatitis, HIV) is excluded;

With them can be moved to it during the implementation of the procedure.

The disadvantage of such a wellness that an unpredictable reaction may occur and emergency assistance will be required.

Peritoneal dialysis

In the abdominal cavity, liquid (dialyzate) is introduced through the puncture on the front abdominal wall. The volume is about 2 liters. One end of the tube is in the stomach, and the second is closed. The dialyzer is not required. Membrane B. this case It is a permah, through it there are toxic substances into a solution of dialyzat. The extract of the liquid is 4-5 hours, after which the fluid is excreted through the catheter, and a clean solution is again poured in the same volume. There is a risk of inflammation of the peritoneum, which can entail additional methods Treatment, up to an emergency operation. When performing any type of hemodialysis, it is necessary to follow the rules of sterility. This procedure is contraindicated with overweight persons (abdominal type of obesity) and people who have adhesive disease.

What are the causes of hemodialysis

This procedure has become the only salvation for thousands of patients whose kidneys could not perform their functions.

Hemodialysis is appointed to people who have the following health problems:

1. Acute and chronic and CPN). It is characterized by a small release of daily urine, a laboratory confirmed decrease in glomerular filtration rate (SC). How many kidney hemodialysis live, depends on the tolerability of the procedure and compliance with the doctor's recommendations to the patient. Dialysis is carried out with the aim of replacing the fully lost function of the kidneys and removing nitrogen slags at CPN. In acute renal insufficiency, the hemodialysis is carried out in order to remove toxic substances from the body that caused the OPN and the release of excess fluid.

2. Diabetic nephropathy. It is a late vascular complication of diabetes. Capillaries of renal filters are sclerized due to constantly increased level glucose. The renal threshold of the blood glucose level is 10 mmol / l. When the sugar level is higher than this indicator - glucose begins to filter in the urine. Molecules are large and damage the gentle walls of capillaries. How much can you live on hemodialysis with diabetesdepends on the degree of compensation for pathology, the level of glycated hemoglobin, the presence of other heavy species of complications. Diabetes older than 70 years of hemodialysis is contraindicated.

3. or ethyl). Metabolites of some alcohols cause the formation of crystals that damage the kidney tissue and an acute renal failure occurs. How many live on hemodialysis after poisoning, depends on the degree of damage to the renal tissue. There are chances of restoring the kidney function, and the hemodialysis procedure is no longer needed.

4. Toxic impact medicines and poisoning poisons. There is a direct damaging effect on the kidneys. Hemodialysis is carried out in order to remove poison and medicinal metabolites from the body. If the body is able to cope, then hemodialysis is carried out until the kidney function is restored. How many kidney hemodialysis live in this situation depends on the type and number of the damaging agent.

5. The state of hypershydration when the body contains a large amount of water ("water poisoning") and there is a risk of developing brain edema and lungs. The purpose of the procedure will be removing excess water, reduction arterial pressure and reducing swelling.

6. Violation of the ratio of electrolytes in the body. Occurs when the loss of liquid frequent vomiting, diarrhea, intestinal obstruction, long-lasting fever. Use special dialysates with the necessary electrolytes, with the aim of compensation or deletion. Conducted to restore the equilibrium of electrolytes.

7. Kidney transplantation. Until the transplanted kidney will be launched, it is supported. How many people live after rejection of the kidneys on hemodialysis? As much as they would live without transplantation. About 20 years.

Indications to Procedure

Certain indicators in which "artificial kidney" is shown:

1. Daily urine release of less than 500 ml. Normally - 1.5-2.0 liters.
2. Reduced below 15 ml / min. Normal value - 80-120 ml / min.
3. Creatinine value - above 1 mmol / l.
4. Urea level - 35 mmol / l.
5. Potassium above 6 mmol / l.
6. Bicarbonate indicator below 20 mmol / l is metabolic acidosis.
7. The growing edema of the brain, lungs, hearts, unnecessary standard therapy.

Contraindications for hemodialysis

1. Infectious process. Microorganisms are circulated in the bloodstream. The hemodialysis procedure helps to strengthen blood flow throughout the body and there is a huge risk of pathogenic flora in the heart, which can cause its inflammation. Dangerous development of sepsis.
2. Acute violation brain circulation. The procedure may increase blood pressure and exacerbate the situation.
3. Mental disorders and epilepsy. Hemodialysis is stress for the body. Minor change blood pressure May cause headache and attack of mental disorder or convulsive syndrome. For qualitative conduct of therapy, it is necessary to calm the patient and the fulfillment of medical requirements of the working personnel of the Dialysis Center during the procedure.
4. Foci of tuberculosis in the body. This species Patients are a source of infection and cannot attend hemodialysis centers. Even if you create a specialized dialysis department, there is a risk of the organism of the organism by mycobacterium tuberculosis.
5. Malignant tumors. Dangerous distribution of metastases.
6. Chronic heart failure acute infarction Myocardium and the first day after it. Hemodialysis affects the electrolyte ratio and any change in its violation. heart Rhythm, right up to stopping cardiac activity. For chronic disease Hearts Blood flows along the vascular channel at a lower rate and there are areas of thicance, and the dialysis procedure can provoke the thrombus movement and blocking any artery.
7. Heavy degree of arterial hypertension. There is a risk of hypertensive crisis.
8. Age older than 80 years old. The reason is that the cardiovascular system of age patients undergoes involution. Vienna and artery become fragile, which makes it difficult for accession of hemodialysis. It is noted that people after 60 live on hemodialysis, how much the possibilities of their of cardio-vascular system.
9. Blood diseases. The introduction of heparin can aggravate the blood coagulation disorders, and the hemodialysis procedure is able to destroy part of the erythrocytes, which worsens the course of anemia.

Hemodialysis complications

• Inflammation and purulent complications at the venue of vascular access.
• Muscle pain and discomfort.
• Contact dermatitis.

System:

• Violation general status In the form of weakness, headaches, malaise, nausea, muscle pain.
• Generalized allergic reaction on the components of membranes.
• Violation of blood pressure level (reduction or increase).
• Aerial embolism.
• Sepsis. In case of non-compliance with the rules of asepta against the background of weakened immunity in this category of patients.
• Non-generation - infection viral hepatitis and HIV. It is necessary to use a high degree of sterilization. In the conditions of a large flow of patients and a small amount of equipment there is an insufficient level of system processing. It all depends on the work of medical personnel.

Who is performing

Hemodialysis procedure in the hospital should only be performed by health workers. In recent years, the practice of performing hemodialysis at home has spread. For the patient, it is much more convenient because it remains in the circle of relatives. At home, any person (not a health worker) has been trained. How many on average they live on hemodialysis, in this case it depends on how much the procedure person performs sterility. If he does not carefully wash his hands (this should be done first with soap, after a destery, for example, "betadine"), does not observe sterility when imposing a dressing at the place of introducing a patient into the body of a fistula, which fell into the body of a patient infection can kill it in a matter of months. If you do everything correctly, the patient will live as much as a person who does not have problems with the kidneys.

Diet with hemodialysis

How much can be burned on hemodialysis, to a large extent depends on how the patient is watching its health. He can not drink, smoke, drink smoked, salting, marinades, flour sweets, fried. The menu of such a person should consist of fresh high-quality products containing vitamins and proteins (chicken, rabbit, low-fat beef, boiled eggs). Limit itself in such products like milk, beans, nuts, cheese.

In chronic and acute renal failure, poisoning may require a blood cleaning procedure. For its execution, an artificial kidney apparatus is used. The hemodialysis procedure is called in specialized departments under the supervision of doctors.

What is hemodialysis

The artificial kidney apparatus performs blood filtering, cleans it from the exchange products, prevents intoxicating the body. Hemodialysis can be carried out both at all, and regularly in chronic pathologies. In this case, the frequency of procedures is determined by the doctor individually, taking into account the function of the kidneys.

Artificial kidney

The device consists of three components, each of which has its own functions:

1. Blood supply device. Collects portions biological fluid For further filtering.
2. Device for the implementation of a dialysis solution. In this segment, the composition is prepared, sent for further interaction with the systemic bloodstream in order to future purification of biological fluid.
3. Dializer. The center part with a permeable membrane, which filters water and all toxins in the blood composition.
4. For the receipt and movement of blood, doctors use the catheter inserted into the fistula (artificially created odds).

Dializers for hemodialysis

Blood during the procedure first passes with high-quality cleaning, and after the patient's intravenously returns to the body. Hemodialysis is able to maintain the viability of the body in the case of acute intoxication or kidney dysfunction. When own kidneys and liver do not cope with the load, their direct functions perform a special medical device.

Choosing dialyzators for hemodialysis, it is important not to forget that the main constructive feature The semi-permeable membrane is considered. It is better if it is made of cellulose-based natural substances. The synthetic bases are also found, but have a greater number of contraindications. It is required to control such a filter, since when interacting with toxins and poisonous substances, it has a clogging property.

Indications for hemodialysis

There are such indications for the upcoming procedure:

• hepatic and renal failure of acute or chronic stage;
• the strongest intoxication with medical drugs;
• disorders of the electrolyte composition of blood;
• poisoning of dialyzat, poisonous substances.

Diet with kidney dialysis

If the patient is prescribed the hemodialysis kidneys, it is necessary to correct daily menu, eliminate heavy food from it. If this is not done, the procedure is somewhat complicated. Diet with hemodialysis eliminates potassium salt, phosphates, lipids, simple carbohydrates. In addition, moderate portions of the fluid are shown to avoid elevated dummy of the dermis. The basis medical nutrition protein products become natural vitamins. Only in this case the rules of the diet are observed.

Hemodialysis at home

Hemodialysis can be implemented at home, for this, the patient has to lease artificial kidney. Such medical equipment cannot be bought in the online store or order in the catalog. It is better to entrust your health professionals.

If it is necessary to implement hemodialysis at home, the process is required to control. It is regularly cleaned by the unit, measure the indicators, maintain the balance of the chemical composition of the blood, comply with the duration and general recommendations Doctor.

Complications of hemodialysis

From side effects during intensive therapy Nobody is insured. The patient should know that there are complications of hemodialysis. More often they are temporary, after the disappearance of anxiety symptoms, the patient feels steady therapeutic effect. Possible anomalies may be such:

• the emergence of infectious diseases;
• blood pressure jumps;
• nausea, less often - vomit urge;
• muscle cramps;
• epilepsy attacks;
• clogging catheter;
• aerial embolism.

How many live on hemodialysis

Patients with chronic renal failure accounts for the whole remaining life to use artificial kidney to filter blood. Arteriovenous hemodialysis helps to maintain the viability of the body for 15-20 years. This is an inaccurate, since the abundance of blood purification depends on many factors and the overall state of the patient's health.

Hemodialysis - contraindications

Medical restrictions on the conduct of hemodialysis are as follows:

• tuberculosis;
• nervous disorders;
• the presence of malignant tumors;
• chronic alcoholism;
• aggravation of infectious ailment or inflammatory process;
• next to bleeding.

Price for hemodialysis

The cost of hemodialysis depends on the choice of clinic and diagnosis. On average, it is 2,000-3,000 rubles. It is necessary to contact the Dialysis Department of its city and find out the exact price for hemodialysis. For medical Indications It is better not to postpone with the beginning of intensive therapy, what would not be the price.

Video: Hemodialysis apparatus

Kidney hemodialysis is a process that replaces the natural function of the kidneys. That is, it leads extra liquid and toxic substances, urea and creatin from the body, maintains the content of potassium and phosphorus in the body at an acceptable level. Sometimes you can hear another name - "artificial kidney", it is also about hemodialysis. For today's day, this process quite successfully helps people with serious impairment of kidney function or at all with refusable authorities to behave more than a fullest life.

First of all, a new artificial body is necessary blood vessels. Therefore, a small preparatory surgery is performed on the forearm. During it, qualified specialists form a vessel with sufficiently thick walls and a suitable blood flow for the future organ. After the intervention, the vessel continues to be formed independently, this whole process takes about a month.

Hemodialysis itself is that the needle introduced into the prepared vessel to which the flexible tube is connected. On the tube, the blood enters into a special device for dialysis, where it is cleaned of excess electrolytes, excess liquid and toxins. Then the blood is again sent to the patient's vessels. In order to prevent coagulation before the procedure, heparin is introduced.

When there is no time to prepare a special vessel for hemodialysis limited to the input of the catheter in the area where circulatory system It will endure this process.

To keep relatively full-fledged hemodialysis, a person is needed with the support of the kidney function three times a week. The duration of each procedure will be at least 4 hours. All at this time the patient must be in a special chair connected to the hemodialysis apparatus. At this time, you can read the book, listen to music, sleep, or watch a movie.

Indications to Procedure

Hemodialysis needed to people who were seriously damaged by the kidney or patients with acute renal failure. When acute damage Hemodialysis procedures can be terminated with the end of the organ regeneration.

In cases where the kidneys are denied completely due to serious damage Or severe disease, the patient needs constant hemodialysis until the transplantation of a new organ or life.

The need for a procedure determines a qualified nephrologist. It is focused on the general condition of the patient, as well as on complaints, results of analyzes and the presence of certain symptoms.

Most often, the procedure is assigned if the patient has expressed the following testimony to hemodialysis:

• The level of glomerular filtration is reduced less than up to 10 ml per minute;
• Broken brain activity due to the effect of uremic toxins;
• Potassium level exceeds 6.5 mmol per liter;
• There are difficulties with blood pressure control;
• On serous shells of the body, toxic substances begin to be deposited, which for the patient can be expressed by a strong itching;
• The acid-alkaline balance is broken;
• Strong nausea, sometimes vomiting, general weakness;
• Swelling of various organs, are dangerous in that the swelling of the lungs or the swelling of the brain may occur;
• Sharp weight, which is becoming more and more noticeable with further progression of the disease.

All listed symptoms, often together with the relevant results of analyzes, are just the reason for the patient to the patient the hemodialysis procedure.

Types of hemodialysis

This process is classified depending on the instrument used for the procedure, as well as from the selected place of execution.

Depending on the place of procedure

There are several possible options for hemodialysis - at home, outpatient or in the hospital.

Home option

For the house procedure, special portable preparations are used. They can apply even a simple manual, the field of passing special training courses. True, the instrument will have to use every day and devote it from two to four hours. Such an option in Western countries often replaces kidney transplant operation to a large number of patients.

The use of portable devices is easy and safe. The patient is accustomed to visit medical institution And stand in the queues. In addition, there is no risk to infect hepatitis and other infectious diseases. And it becomes possible to lead a practically full life. However, portable preparations are quite expensive. In order to learn from them to contact them will need to pass special courses, but even despite this, in the first few procedures without the help of a medical worker, it will not be possible to do.

Suitable for patients with acute and chronic renal failure, if the renovation of the kidneys is not foreseen. The desired duration and frequency of the procedure - 4 hours three times a week.

The procedure will be submitted in sterile conditions under the supervision of doctors, sometimes possible delivery of a patient from home to the procedure and back. However, in this case there is some risk to infect hepatitis. In addition, there is a need to visit the medical center at least three times a week a week a day, and in the presence of queues - also for a longer time interval. With such a schedule, to lead a full life more difficult.

Stationary

Used for patients with acute renal failure or for those who have received serious poisoning. For the procedure, practically the same drugs are used as for outpatient hemodialysis, with the only difference, which in this case the patients lie in the hospital or in half season.

The procedure is carried out under the constant control of medical personnel. However, in order to get it, you must lie in the hospital. In addition, there is a small risk of hepatitis infection.

Depending on the device

According to the functionality of the equipment, the procedure is divided into ordinary, highly efficient and high-flow.

Normal

With a normal procedure, blood purification is performed using a device with low permeability filter. It skips only fine molecules. The area of \u200b\u200bthe filter membrane is 0.8 - 1.5 square meters. At the same time, blood current is obtained small, and the duration of the session is 4 - 5 hours.

High-performance

In this case, the surface of the membrane has already a large area, about one and a half to about two square meters. The blood current is obtained noticeably higher, so the time of the session is reduced to 3 - 4 hours.

High strength

With this type of procedure, drugs with a special membrane are used capable of passing large molecules. Thus, out of blood it turns out to withdraw a greater number of extra substances, which significantly increases the chances of the patient's survival. However, when using such equipment it is important to remember that not only harmful substances from the blood will be excluded, but also some molecules from the hemodialysis fluid will be able to get into the blood, so it is worth using only a sterile solution.

Features of hemodialysis

The procedure is performed as follows. Venous blood enters the hemodialysis apparatus, where it is cleaned using a special filter. The filter consists of a membrane, different sides which flows venous blood and a special solution that stretches from it harmful substances and excess liquid, which usually remove the kidneys. The solution must be selected individually for each patient, but modern devices can do it automatically.

This solution normalizes the level of electrolytes in the blood, displays the exchange products, maintains a normal acid-alkaline balance, contributes to the prophylaxis of blood clots and an air embolism, and also removes excess water.

The procedure is verified by the level of urea after it. In hemodialysis, twice a week, this level should decrease by 90%, if it is possible to carry out the procedure three times a week, then the percentage of cleansing should be at least 65.

Contraindications

Hemodialysis is not prescribed to patients with the following states:

• Violation of the blood formation system, especially the presence of anemia and degraded blood coagulation, since hemodialysis is able to significantly aggravate these states;
• The presence of infectious diseases in which the pathogens may fall into the blood and cause, for example, sepsis;
• Elderly age, over 80 years old, and in diabetes - over 70. In such people, weak veins and reduced immunity, therefore, the conduct of hemodialysis is very risky for them;
• Availability of stroke or various mental deviationssince the procedure can provoke deterioration;
• The presence of malignant tumors, since hemodialysis can provoke metastases;
• Tuberculosis of the lungs and other internal organs in the active stage. The infection can begin to spread faster. In addition, the risk of infecting other patients is increasing;
• A period of a few months after a heart attack, as well as chronic heart failure, as the risk of blood formation increases.

IN emergency casesWhen a person is close to death due to the failure of the kidney, hemodialysis is carried out urgently, neglected by the existing contraindications.

Side effects

Among the side effects of hemodialysis, the following are most often found:

• Blood pressure jumps like up and down;
• Headaches;
• Muscle cramps;

Headaches - Possible Hemodialysis Side Effects

Of the rarest phenomena, you can call nausea, malfunctions in the work of the heart, thrombosis.

In order to reduce the risk of side effects, patients are parallel with hemodialysis can be appointed different kinds medical therapy. For example, the reception of drugs normalizing blood pressure. Between the procedures it is recommended to follow special diet from limited consumption liquids. In the breaks between the courses, it is also important to control body weight. He should not rise too much.

In addition, it is necessary to ensure that the body sufficiently receive all the necessary vitamins and trace elements, in particular calcium, phosphorus, vitamin D3. It is important to remember that hemodialysis can indirectly affect the reception of drugs governing blood clotting, so drugs of this class can be used exclusively by appointing the attending physician.

Diet with dialysis therapy

Patients with renal impairment, receiving hemodialysis procedure, it is necessary to adhere to certain norms in the diet. Here are several simple rules: limit fluid consumption, as well as reduce the number of products containing potassium (potatoes, nuts) and phosphorus (fish, various types of cheeses).

In addition, it is important to monitor the daily rate of protein intake. The desired amount is 1.2 g of protein per 1 kg of weight. Half from the entire volume of protein consumed should have an animal origin.

If, when compliance with all the norm, the power is insufficient and weight loss is observed, then the following activities are performed to avoid exhaustion. Additional protein mixtures are added to the diet, if it does not help, the patient is powered through the probe, and the absence of the effect is introduced intravenously.

It is impossible to use salt and its substitutes with potassium, as well as salty dishes. In parallel with hemodialysis, the reception of vitamins C, D, as well as groups B. It is often necessary to take drugs containing iron or stimulating the function of the blood formation.

The effect of hemodialysis on life expectancy

The need to obtain the hemodialysis procedure imposes some restrictions, especially if we consider the fact that in Russia there are practically absent portable devices. That is, the patient needs to at least three times a week to visit the Special Center for the adventure of the procedure. It consesses that in Russia for such patients, three sessions are free of week. And if you wish to go on vacation to another city, you can contact the center in advance at the place of rest and go through the procedure there, again for free.

So in general, patients receiving such a procedure can live a full life, learn, work, play sports, relax. The average life expectancy on the "artificial kidney" according to statistics is currently 20 to 30 years, and this is a significant time. For people who have reached 75 years of age, the forecast is no longer as rainbow, but, as a rule, it is still the same years, especially in the absence of diseases that worsening the condition of the body.

In order to live 20-30 years, getting hemodialysis, you need to get used to interaction with medical workersAlso comply with the diet, monitor your own weight and diet. In addition, it is important to at least roughly understand the action of all appointed medical preparations and learn to determine when the condition of the body is critical and required urgent help. Take any medicines without consultation with the attending physician should not.

The kidneys perform a very important cleaning function in our body. Thanks to these pair authorities, various toxins and vital products are derived, which makes it possible to maintain human health. Unfortunately, there are situations where the urinary system gives a failure, the kidneys cannot fully purify the body. In this case, patients have to resort to hemodialysis - artificial blood purification.

What is hemodialysis kidneys

The kidney hemodialysis is the process of artificial blood purification from toxic substances, slags and other productivity products, as well as the restoration of water and electrolyte balance. For the first time this procedure was held back in 1960. It is prescribed to this day, as it allows you to replace the kidney function and maintain the normal functioning of the body over the years. Hemodialysis helps the previously incurable sick to survive and significantly increase the term of their life, which allows them to wait for their turn to the transplant of donor kidneys. This procedure is called chronic software hemodialysis, as it is required to carry out several per week throughout the entire period of the operation.

Unfortunately, this is a very expensive procedure. In Russia, there is a lack of necessary equipment, and some patients have to stand in line for a long time. According to the compulsory health insurance policy (OMS), each patient with a violation of the kidney work annually stands out about one and a half million rubles for hemodialysis procedures. Each time more than a hundred liters of dialysis fluid and consumable disposable materials are used.

Hemodialysis is prescribed to patients in order to purify blood from substances harmful to the body:

• urea - product decay of proteins;
• creatinine - substances generated in muscles and secreted into blood;
• poisons - arsenic, strontium, aniline, nitrobenzene and others;
• components of medication preparations;
• ethyl and methyl alcohol;
• electrolytes (sodium, potassium, calcium, chlorine);
• excess water.

The blood plasma contains a large amount of water, organic and inorganic substances, the level of which must be monitored

Principle of operation of the unit for blood purification

In some sources, the device for hemodialysis is called "artificial kidney", which completely corresponds to the essence of its functions. The device performs similar actions, consistently cleaning and returning blood back to the body. It consists of the following parts:

• dialyzer;
• blood supply instrument;
• devices for the preparation and supply of a dialysis solution.

The device for hemodialysis is otherwise called "artificial kidney"

During the procedure, blood purification occurs through a special semi-permeable membrane with very small pores. Using the roller pumping installation, the blood is pumped into a dialyzer at a speed of approximately 350 ml per minute. Hemodialysis solution flows in reverse side With a little more speed - 500 ml / min., It sucks out excess water and vital products from the blood. This is due to diffusion, during which substances from liquids with greater density are transferred to a liquid with less density. It is due to this process that blood is cleaned from toxins.

Due to the diffusion, the blood of the patient is cleared of unnecessary substances and retains the required amount of electrolytes

In order to remain in the blood, only the required amount of electrolytes remain, in the diffuse solution, they are added to the concentration corresponding to the indicators healthy man. If the patient had more potassium, sodium, chlorine or calcium, then their level is leveled to normal values. In case of lack of substances, they move from the diffuse solution into the blood and fill it.

Dialysis solution is selected individually for each patient. Most often, potassium level correction and sodium is corrected depending on the initial number of blood electrolytes.

Highly an important point is regulation acid-alkaline balance (pH) in human blood. To do this, during hemodialysis, a special substance is added to the buffer fluid - sodium bicarbonate. Finding into the plasma, it gradually penetrates the red blood cells, increasing the pH level.

Another problem of people with renal failure is an excess water that is very poorly excreted from the body. This can lead to edema not only limbs, but also internal organs. In the apparatus of "artificial kidney", a pressure difference between blood and a dialysis solution is created, which allows you to remove the excess fluid into dialysate.

Also during hemodialysis, the prevention of thrombosis is carried out with the help of gradual administration to the blood of heparin, interfering blood consumption. To prevent air from entering the air, a special "trap" is used, which eliminates bubbles and the resulting foam.

Video: Purification of blood with the help of the "Artificial Kidney" apparatus

Difference from peritoneal dialysis

Exists alternative way Purification of blood - peritoneal dialysis. It is distinguished by the fact that the patient himself is used as a membrane. The catheter is introduced directly into the abdomen, with its help, dialyzate with glucose, electrolytes and others is poured inside required substances. Inner surface The peritoneum performs filtering functions and passes only small particles. After about 20-50 minutes, the liquid is sucking back and poured a new portion of dialysis. The duration of the procedure itself can be even a few days.

Peritoneal dialysis is less effective compared to hemodialysis and worse restores the level of electrolytes and other substances in blood plasma. Among other things, the risk of infection is significantly increasing due to the entered catheter.

Peritoneal dialysis is one of the blood purification methods in chronic renal failure

Video: How peritoneal dialysis is held

Methods for the procedure of hemodialysis

The implementation of the hemodialysis procedure may differ depending on the place of its implementation. What kind of patient will come up, only the attending physician can solve. Matter and material capabilities of the patient. In some cases, you have to buy expensive equipment to make the procedure most comfortable.

Cleansing blood at home

This type of hemodialysis is suitable for those patients who can afford to buy a special expensive device and do not need constant medical control. To enjoy such a device at home, close patient or he himself must pass special training courses. The NXSTAGE Medical's Portable System One is particularly popular, which is used by most patients with renal failure in Europe.

Since the device is in the permanent order of the patient, he can control his schedule itself and select convenient time For procedure.

Typically, hemodialysis takes about two hours a day. Thanks to this, people can work, lead an active lifestyle and even travel. A big plus is the fact that only one person uses the device, the risk to get hepatitis is zero. Unfortunately, to buy such a home installation, an impressive amount will be required, about $ 20,000.

With the help of a home hemodialysis system, the patient can significantly simplify life and conduct a procedure at any convenient time.

Hemodialysis in outpatient conditions

There are special centers in which there are a large number of hemodialysis installations. In this case, patients are recorded and in turns come to blood purification sessions. Three procedures are usually assigned per week for a duration of about four hours. A qualified medical personnel works with each patient, which studies the results of the tests and modifies the composition of the dialysis solution in a timely manner. Of course, there is a risk of infection with hepatitis if the sterilization of the equipment was performed in defective.

There are special hemodialysis centers in which a large number of patients comes daily

Hepatialize hemodialysis

In most hospitals and medical centers there are devices for hemodialysis. They are used in emergency cases when patients with poisoning or with acute renal failure are coming. The difference between such procedures is that a person is constantly in a medical institution and does not go home after hemodialysis.

Among other things, the speed and quality of hemodialysis may vary depending on which machine is used to clean blood:

1. Regular dialysis takes about five hours, this is the slowest type of blood purification in renal failure. Special low-speed filters are used, which are missing only the smallest molecules. Blood movement rate - up to 300 ml / min.
2. Highly efficient dialysis is carried out with the help of more advanced membranes, which increase the speed of blood to 500 ml / min. Cleaning occurs faster, and the duration of the procedure itself decreases to 3-4 hours.
3. High-flow dialysis is carried out using special filters with high permeability, which allows you to increase the amount of substances from which the blood can be cleaned. This is one of the most effective types of hemodialysis, patients decreases the risk of developing anemia and various complications.

Video: What you need to know the patient about the procedure of hemodialysis

Advantages and disadvantages of hemodialysis

Hemodialysis is a very important procedure, saving the lives of thousands of patients around the world. She has many advantages:

• the possibility of a long time to maintain the life of patients with renal failure;
• painlessness;
• the possibility of emergency blood purification from deadly poisons;
• there can be a regular lifestyle between sessions.

Of course, like any procedure, hemodialysis has a number of shortcomings:

• with hemodialysis in stationary and outpatient conditions Sometimes you have long to wait for your turn;
• it is necessary to undergo a procedure several times a week, which prevents the usual way of life;
• the cost of one procedure in the absence of the OMS policy is very high, from 7 thousand rubles;
• there is a risk to infect hepatitis B and S.

Indications and Contraindications for the procedure

Hemodialysis is a very serious procedure that is appointed only at:

• chronic renal failure (CPN). If the kidneys work only by 10%, then at least three sessions per week are assigned, if 20% is at least two. In the case when blood tests show increased quantity Toxins, more frequent hemodialysis will be required. Usually, such patients are prescribed to the procedure for life or before the kidney transplant operation;
• acute renal failure (OPON). This condition may be caused various diseases, such as, glomerulonephritis, etc., such patients need to urgently clean the blood from toxins and remove the excess fluid from the body. Sometimes there is enough of only one procedure, and the kidneys begin to function normally after removal of poisonous substances. If the improvements did not happen, hemodialysis is carried out until the patient's condition is normalized and obtaining satisfactory test results;
• the poisoning of toxic substances, such as arsenic, polar refining poison, etc. In this case, emergency hemodialysis is prescribed to the patient. Depending on the indications, one procedure can be carried out for about twelve hours or three sessions for four hours within one day. It helps to avoid kidney failure and takes poison from the body;
• poisoning with various drugs. In case of timely carrying out this procedure, you can avoid renal and liver failure. Depending on the type of medication, the doctor will select a special dialysis fluid (oil emulsion, aqueous solutions). Many patients have enough only session, in more heavy cases The procedure is carried out three days in a row;
• mematylene alcohol poisoning and ethylene glycol. Emergency hemodialysis is carried out in the hospital if the amount of methanol exceeds 0.5 g / l. Typically, the patient is prescribed one procedure for twelve hours;
• poisoning by narcotic substances containing opium. Extra hemodialysis can save the patient from the failure of the liver and kidney. Usually in such cases there are several procedures within one day;
• excess water content in the body leading to the eternal organs. Hemodialysis allows you to bring extra liquid and reduce blood pressure. The number of sessions and their duration depends on the state of the patient;
• critical reduction in the level of electrolytes in the blood after burns, dehydration, peritonitis and other heavy conditions. The number of hemodialysis procedures and their duration are prescribed to the patient individually depending on its condition and recovery speed.

However, even these diseases and heavy states Do not always indicate the need for hemodialysis. This procedure is prescribed only if certain indicators are available:

• the amount of urine released less than 500 ml per day (oliganuria);
• the safety of the kidney function is 10-15%, when they purify purify less than 200 ml of blood per minute;
• the level of urea in the blood plasma is more than 35 mmol / l;
• creatinine concentration in blood plasma more than 1 mmol / l;
• potassium content in blood plasma more than 6 mmol / l;
• the level of standard blood bicarbonate is below 20 mmol / l;
• signs of the growing brain edema, hearts, lungs, which cannot be removed by medicines.

As with any other procedures, hemodialysis has contraindications. However B. emergency situationsWhen the patient's life is under threat, doctors conduct blood purification even if there are any restrictions. The procedure should be postponed or canceled if the following diseases exist:

• various infectious lesions that can provoke an extensive sepsis due to the acceleration of blood current;
• recently transferred stroke;
• mental illness, as a small brain edema during the procedure can provoke their exacerbation;
• active tuberculosis, as it can spread with blood flow, patients with this disease are forbidden to visit hemodialysis centers;
• oncological tumors - can be more metastasted due to the movement of atypical cells on the bloodstream;
• chronic heart failure, recently transferred;
• malignant arterial hypertension;
• diabetes in patients older than 80 years - due to violations of the cardiovascular system;
• blood diseases, such as anemia, leukemia, etc.

Features of the procedure for pregnant women, children and elderly patients

During pregnancy, hemodialysis is trying not to carry out without emergency testimony. This procedure increases the risk of miscarriage or premature birth. Also, the fetus often reduces weight. If a woman has renal failure, doctors will recommend the conception of a child only after a kidney transplant.

Woman with renal failure doctors recommend planning a pregnancy only after a successful kidney transplantation, while hemodialysis is trying not to conduct a child without emergency testimony.

In the elderly patients, hemodialysis can be difficult, as they often detect various age-related changesaffecting the cardiovascular system. Vein walls weakened, thinned and no longer able to cope with increased load During hemodialysis.

In newborns and children preschool age Sometimes it is difficult to install the catheter of the desired size, as they still have insufficiently broad vessels. Sometimes you have to use pearl VeenAlthough it is not desirable if the kidney transplant is planned soon. When conducting hemodialysis in children sometimes reduce the speed of blood flow through the equipment. There is a high risk of a sharp drop in blood pressure, which is why emergency resuscitation activities are required.

Video: What is developing renal failure

Method of execution

Before each hemodialysis procedure, the patient is examined by a specialist. The doctor measures pressure, temperature, pulse, weight. Also about a week before the procedure is made of hepatitis. A special fistula is installed in the selected vessel a few days before the session. Hemodialysis is carried out as follows:

1. The patient is placed in a special chair or on a couch in a half-hour state.
2. The tubules from the device are connected to the vessels.
3. The pump action makes the blood flow into the dialyzer, where it is in contact with the solution through a special membrane.
4. The blood purified and enriched with special substances enters the body through another vein.

The number of sessions and the time of their conduct depends on the state of the patient and its diagnosis. Some sufficient one session, the other is prescribed by hemodialysis every day, but in most cases it is required to hold it 3-4 times a week. The duration of the procedure is also individual, from 1 to 14 hours.

If there is an opportunity to purchase a device for conducting hemodialysis at home, then the patient can carry out procedures not only at home, but also at work, on business trips, in any other conditions.

During hemodialysis, blood from one vein enters the device, and then returns back to the body already purified and enriched with the necessary substances.

Restoration after hemodialysis

After the procedure, the patient is measured by blood pressure. If it is normal, then a person can return to its usual activities. The fistula installed in Vienna should always be clean to avoid infection. During the day after hemodialysis, it is necessary to observe the state of its health, measure the temperature if necessary. With a worsening of well-being, it is necessary to urgently consult a doctor. In some cases, the patient is prescribed the following drugs:

• biology active additives with calcium and vitamins;
• diuretics to eliminate extra liquid;
• iron preparations to improve blood indicators;
• laxatives, if the patient is tormented by constipation;
• phosphorizing drugs to reduce the amount of phosphorus;
• preparations to reduce or increase blood pressure.

Video: How to reduce the amount of water in the body between hemodialysis procedures

Possible consequences and complications

The apparatus "artificial kidney" allows patients to increase the duration of their life for 10-25 years, depending on the basis of the body. This procedure has become a real salvation for huge number of people. But despite all the advantages, there is a big risk of the appearance of various complications:

• reduce or increase blood pressure;
• cramp;
• loss of consciousness;
• headaches;
• epilepsy attacks;
• acute bleeding from the access place;
• allergic reactions;
• nausea;
• itching;
• arrhythmias;
• brain edema;
• gastric bleeding;
• syndrome disturbed osmomolarity;
• stroke;
• heart attack;
• infection with hepatitis C and B;
• infectious infection.

Deadly cases during hemodialysis are extremely rare, their main cause is to increase blood pressure, which provokes infarction and strokes. Also, lethal outcomes often occur due to the enemy of the brain and lungs.

Diet with kidney hemodialysis

The patient's condition, which often conduct hemodialysis procedures, is very dependent on its diet. Metabolism is broken due to frequent blood purification, useful trace elements are derived, the lack of protein is developing. Therefore, patients are prescribed a special individual diet. Doctors recommend to keep a diary of food to take into account all the uses. It is also important to calculate the amount of water drilled and other liquids.

The list of permitted and forbidden products may vary during the course of treatment.

The hemodialysis diet is based on therapeutic table number 7. It is aimed at reducing the accumulation of products of life and to replenish the missing substances:

• The rate of protein use increases to 1-1.2 g / kg body weight per day, it comes out about 50-80 g per day. During hemodialysis, the protein is lost and its absorption is worse, the rate of decay increases. Because of this, patients are shown to use more dietary meat (turkey, rabbit) and products containing protein (eggs, cottage cheese).
• During the day, the necessary energy value of the diet should reach 35-40 kcal / kg of patient weight. On average, about 2800 kcal per day. For lying patients, these indicators can slightly decrease.
• The diet of the patient should not contain a large amount of fat. It will be optimal 100 g per day. It is worth cutting the consumption of cholesterol, saturated fatty acids.
• Need to add to food vegetable oils and fish, rich omega 3 and 6 fatty acids.
• In the case of low glucose levels, you can use honey, candy, jam. Contraindication is diabetes.
• It is very important to control the number crash saltIt should not exceed 4 g per day. Typically, food is not solid and exclude any chips, smoke, dried fish, pickles, semi-finished products, etc.
• It is necessary to reduce the use of products containing potassium (dried fruits, bananas, nuts, beans, mushrooms, greenery, rice, vegetables, chocolate, soluble coffee). On a day, it is possible to use only 3 g of potassium, that is, per day is allowed to consume no more than one raw vegetable vegetable and fruit containing a large amount of this element.
• Phosphorus with great difficulty is removed from the blood with hemodialysis, so it is necessary to reduce the use of products with its content (nuts, croup, bran, bean, wholegrain croup).

Forbidden products when hemodialysis passes:

• legumes;
• meat broths;
• mushrooms;
• fat meat;
• canned;
• melted cheese products;
• pickles;
• margarine;
• peaches;
• apricots;
• dried fruits;
• pepper;
• cinnamon.

Photo Gallery: Products that should be removed from the diet when hemodialysis passages

Beans contain potassium and phosphorus, which are removed from the body during hemodialysis Fat meat broth - cholesterol source Pickles detain liquid in the body Dried fruits - source of potassium, the number of which doctors recommend to reduce when hemodialysis passes

On day, patients are usually enough to drink 800-1000 ml of water. If you move to the use of fluid, edema may appear, the body weight will increase, the pressure will increase.

The approximate menu of the patient may consist of the following dishes:

• boiled low-fat fish (cod, pollock, pike);
• boiled chicken, turkey, rabbit;
• boiled potatoes;
• baking bread;
• omelet;
• infusion of riding;
• vegetable broths;
• vinegret without salt.

Video: Nutrition for chronic renal failure

RCRZ (Republican Center for Health Development MD RK)
Version: Clinical Protocols MOR RK - 2013

Uncomfortable renal failure (N19)

Nephrology

general information

Short description

Chronic renal failure (CPN) - nonspecific syndrome, developing due to the gradual loss of major renal functionscaused by the development of sclerosis of the renal tissue against the background of various progressive kidney diseases.

Most primary and secondary kidney diseases can lead to the development of diffuse nephroangiosclerosis, which manifests the syndrome of chronic renal failure (CPN), the terminal stage of which inevitably leads to death if the methods of replacement renal therapy (SPT) - hemodialysis, peritoneal dialysis and kidney transplantation.

Methods replacement therapy (MZPT) are divided into extracorporeal - hemodialysis (GD), hemofiltration (GF), hemodailtration (GDF), peritoneal dialysis (PD) and kidney transplantation. GDF online - is a type of extracorporeal detoxification, used to remove medium molecules (B-2-microglobulin). All methods have their advantages and disadvantages, so the choice of MZPT use is determined in each particular case, depending on the age of the patient, the disease, the severity of the state, the experience of personnel.

I. The Output part

Protocol name: Hemodialysis

Protocol code:

Codes MKB-10:

N18 chronic renal failure

N18.8 Other manifestations of chronic renal failure

N18.9 chronic renal failure uncomfortable

N19 renal failure uncomfortable

N 17 Acute renal failure

N17.0 acute renal failure with tubular necrosis

N17.1 Acute renal failure with cortical necrosis

N17.2 Acute renal failure with medullary necrosis

N17.8 Other acute renal failure

N17.9 acute renal failure uncomfortable

Reduction, notation used in the protocol:

Hell - blood pressure

BB - Beta-adrenergic receptor blockers

BKK - blockers calcium canals

Branch - Angiotensin receptor blockers

BEN - protein-energy failure

Varms - congenital anomalies for the development of the urinary system

GD - hemodialysis

GDF - hemodailtration

GF - Gemofiltration

SPT - renal renal therapy

IAPF - angiotensin surge inhibitors

SIP -Chigual kidney

Im - myocardial infarction

MZPT - methods of substitution renal therapy

RFSS - total serum binding

ONMK - acute violation Brain circulation

OPN - acute renal failure

OCC - the volume of circulating blood "!

PTH - Paratyroid Hormone

SCF - glomerular filtration rate (J ^

TPN - Terminal Renal Insufficiency

EPO - Erythropoietin

HBP - chronic illness kidney

CPN - chronic renal failure

CAPD - Permanent CPN - Chronic Renal Assumption Ambulator Peritoneal Dialysis

NV - hemoglobin

SA-P - Phosphorian Calcium Exchange

KT / V - Dialysis adequacy parameters

URR - Dialysis adequacy parameters

Protocol development date: July 2013

Patient category: Patients with primary and / or secondary kidney diseases (glomerular, tubula interstal kidney lesions when systemic diseases), as well as with VARMS, complicated chronic renal failure (HBP 4-5 stage), patients with acute renal failure.

Users Protocol: Nephrologists, resuscitative.

Classification

International Classification Chronic kidney diseases (HBP) (by K / DOQI, 2002)

stage	description	SCF (ml / min / 1.73m2)
1	Kidney damage with normal or | SP.	>90
2	Damage to the kidneys with a slight decline SCF	6 0 -8 9
3	Moderate decrease in SCF	3 0 -5 9
4	Heavy Reduced SCF	15 -2 9
5	Terminal stage of renal insufficiency	<15 (диализ)

Chronic kidney disease is exhibited in the presence of damage to the kidneys and / or reduction of the SCF< 60 мл/мин/1,73м2 в течение 3 месяцев и более. Повреждение почек - это структурные и функциональные аномалии почек, выявленные в анализах крови, мочи или при визуальных обследованиях. Расчет СКФ у пациентов на стадии 4-5 ХБП проводится по формуле MDRD и CKD-EPI или определяется по суточному клиренсу эндогенного креатинина.

Diagnostics

II. Methods, approaches and diagnostic and treatment procedures

List of basic and additional diagnostic events

Main:
1. Common blood test (6 parameters)
2. Definition of creatinine, urea in the blood before and after dialysis
3. Blood electrolytes (potassium, sodium, calcium, phosphorus)
4. Serum iron

5. Ferritin
6. Paranthrhon
7. Common protein
8. ALT.
9. ACT
10. Coagulogram

11. IFA blood for hepatitis B and with
12. HIV
13. Vasserman reaction

Additional:
1. blood glucose
2. C - jet protein
3. Ozsass

4. USDG AVF
5. ECG

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Treatment

Procedure Requirements

1. Standard dose of dialysis - 3 times a week to 4 hours, even if the standard adequate dose expressed KT / V is achieved.

2. The duration and multiplicity of hemodialysis procedures can be increased in patients with hemodynamic instability and cardiovascular problems.

3. Regardless of the programs used, the overall KT / V must match or be greater than the week standard value, i.e. KT / V \u003d \u200b\u200bL, 2 for 4 hour 3 multiple per week of dialysis, or KT / V ^ O, 4-0.3 For daily dialysis.

Preparation of the "IP" apparatus for hemodialysis session

For a session of software hemodialysis, it is required to connect a patient with the terminal stage of CPN to the artificial kidney apparatus. Previously in the patient is preparing one of the types of vascular access - the outer catheter is installed or subcutaneous arteriovenous fistula is formed. The hemodialysis session is carried out when the patient is found in the bed or in a semi-dying chair with armrests for fixing the limb with the arterio-venous fistula. The apparatus "Artificial kidney" is located directly from the patient next to the bed or armchair. The dialysis space is provided by supplying electricity, highways with chemically clear water from the water treatment system and the sewer system for draining the spent dialysis solution.

Directly before the session is preparing a concentrate of a dialiance solution and in the corresponding interrupted cannors is delivered to the "Artificial Kidney" apparatus. Before starting hemodialysis, the device must undergo mandatory automatic testing according to a specified program that provides the suitability of all blocks of instruments.

After each procedure, it is necessary to carry out hygienic treatment of the surface of the artificial kidney apparatus, disinfection (decalcification) hydraulics.

Steps of connecting and disconnecting the patient from the apparatus '' Artificial kidney "

Connecting the patient's vessels to the highways of the artificial kidney apparatus produced in aseptic conditions.

1. For this purpose, a sterile diaper is placed under the antiseptic treated with antiseptics, a sterile diaper is placed, which, after puncture, the needles and connecting them with the highways of the artificial kidney apparatus, a section of vascular access is closed.

2. In the absence of special indications in the instructions for a dialyissant and plugs on the constacts of the dialysis circuit, connecting the mains of the dialysis solution of the artificial kidney apparatus, until the preparation of the bloodolining circuit.

3. The dialyzer is located in the holder vertically so that the label inscriptions are available to read and dialyzing the solution after connecting the highways of the artificial kidney apparatus, moving upwards.

4. After moving out air from the dialing solution contour, the dialyzer turns over 180 ° and the blood-conducting highways are connected so that the blood and the dialysis solution move into countercurrent.

5. Preliminary preparation of the circuit circuit consists in filling and washing the dialyzer and highways with a 0.9% sodium chloride solution in strict accordance with the instructions for applying a dialyzer. To do this, the arterial line is connected to the vial or bag with a sterile 0.9% sodium chloride solution, which is added to the anticoagulant in a dose equal to a bolus (Table 6) selected for this patient. A perfusion pump is turned on and with a speed of 150-180 ml / min. The solution begins to flow through the arterial line into the blood-tie contour of the dialyzer, displacing air out of it. To facilitate the fusion of air, briefly relieves the arterial highway. To remove possible residues of sterilizing substances and plasticizers, the first 300-500 ml must be drained. This ensures the prevention of possible anaphylactoid reactions.

6. After filling the mains and the first portion of the first portion, the perfusion pump is stopped and the end of the venous highway to the bottle or bag with a 0.9% sodium chloride solution is performed.

7. The pump turnover increases to 300 m / min. And the system recycling is ensured in a system for 10-15 minutes with multiple short-term shifting of the arterial highway.

8. The subsequent filling of the mains and dialyzer blood of the patient is carried out only after careful washing and displacing air from the blood-conducting contour with sterile saline.

9. Anticoagulation (heparinization) is made taking into account the condition of the patient's coagulation system, body weight, the presence of hidden heels of bleeding. Preference is given to dosage heparinization at which a part of the dose (5000 units) is bolted, the rest is injected dosed during the entire dialysis using the heparin pump.

(Table 6).

Standard Dosage Heparin, Table 6

Duration of hemodialysis	Hemoglobin< 100 г/л		Hemoglobin\u003e 100 g / l
	bolusno	dosage	bolusno	dosage
4 hours	5000 Ed.	5000 Ed.	6000 Ed.	6000 Ed.
5 o'clock	6000 Ed.	6000 Ed.	7000 Ed.	7000 Ed.

In case of individual intolerance of heparin, low molecular weight bands are used - obverse, dalutparin, anoxaparine (Table 7).

Dosage of drugs of low molecular weight heparins, Table 7

Duration of hemodialysis	Nadroparin		Deltaperin		Eanoxaparin
	bolusno	dosage	bolusno	dosage	bolusno	dosage
4 hours	0.3 ml	0.6 ml	2500	5000 Ed.	0.2 ml	0.4 ml
5 o'clock	0.6 ml	0.6 ml	5000 Ed.	5000 Ed.	0.4 ml	0.4 ml

10) When the patient is connected to the device "IP", the doctor conducting hemodialysis controls either the parameters of the blood flow rate (150-350 ml / min), a stream of a dialysis solution (500 ml / min), conduction and temperature of a dialysis solution (36-38 ° ), time and volume of ultrafiltration. The volume of ultrafiltration is established on the basis of the difference between the current and dry weight, which is determined by weighing the patient before and after the procedure.

11. After the apparatus "Artificial kidney" is fully ready for operation (the initial test passed, the blood wireting circuit is filled and washed with a 0.9% sodium chloride solution, air from the blood circuit and the dialing solution circuit) is connected to the patient under aseptic conditions, which should occur in accordance with the requirements regulating the work order

12. Puncture of arterio-venous fistula. The puncture is carried out by a fisty needle cut down at an angle of approximately 300 to the surface of the skin. When puncture a cut up at an angle of 450 after entering the lumen of Fistula, the needle must be turned over an axis to 1800 to prevent damage back wall vessel. Repeated punctures should be avoided in the same point, which leads to the formation of aneurysm, as well as a direct puncture of the skin and vessel (after puncture, the needle must pass through subcutaneous tissue, then get into the vessel). The arterial needle (blood pressure) should be located as far as the blood current, venous (blood return) - on the contrary, for blood flow. The distance between the needles should be at least 5 cm, which prevents recycling and deteriorating the quality of blood purification. When using a two-dimensional dialysis catheter, the fence and return of blood should be carried out in accordance with the labeling of connector on the catheter: red - arterial, blue - venous.

13. The bolus administration of the anticoagulant is made in a venous needle immediately after puncture (either in the venous rope of the catheter), the dosage introduction begins parallel to the filling of the mains of blood.

14. After connecting the arterial line with an arterial needle, a blood pump is included and a 0.9% solution of sodium chloride from the mains system and dialyzer blood with blood is not more than 150-180 ml / min begins. The sodium chloride solution is supplanted until it appears in the blood of the distal venous highway (modern devices have a special detector below the venous air trap), after which the blood pump stops, the venous highway is shifted and connected to the venous needle.
15. The reliability and correctness of all connections is checked, after which the blood pump is included and the required blood flow rate is set depending on the possibilities of vascular access and the condition of the cardiovascular system. Typical is the speed of blood flow in the range of 200-300 ml / min.

16. The return of blood after the completion of the procedure is carried out by displacing it with a sterile 0.9% sodium chloride solution, the amount of which should be taken into account when programming ultrafiltration. At the same time, after stopping the perfusion pump, the arterial needle is removed, and the end of the arterial line is connected to a container with a solution. The perfusion pump turns on again and inhibits a sterile sterile sodium chloride solution that displaces blood. After entering the washing solution, sodium chloride into the dialyzer should be repeatedly briefly temporarily overlook the arterial highway until the dialyzer is completely purified from the blood. Completely returns to the patient blood, then the perfusion pump stops and the venous highway is finalized.

17. After removing the needles of punctures are pressed with rolled sterile napkins (in the absence of special plasters) until it stops bleeding, after which the dry bandage is superimposed.

18. Control biochemical indicators Uremia "" is performed depending on the state of the patient and the stability of the parameters of the procedure (effective blood flow in the dialyzer, effective time dialysis), but at least once a month. It is estimated mainly prediatic indicators that make correction in blood purification regimes.

Treatment of hemodialysis complications

1. Arterial hypotension during hemodialysis session is often a consequence of the decline in the UNCC rapid removal Fluids from the patient's blood, which leads to a decrease heart Emission and fall hell. In this regard, it is required to reduce ultrafiltration or conduct it in small limits.

If the patient's hemodialysis falls during the patient's hemodialysis, it is necessary to put in the position of Trendelenburg (if there is no respiratory failure) and assign inhalation of the moistened 30% oxygen. Then, 100-150 ml of 0.9% solution of sodium chloride solution is injected into the vein (venous highway), and ultrafiltration is removed to a minimum. In addition to isotonic 0.9% sodium chloride solution, a hypertensive 10% sodium chloride solution, 40% dextrose solution, colloidal solutions can be introduced.

2. Arterial hypertension. Treatment of high blood pressure in dialysis patients should begin with achieving "dry weight". To relieve a hypertensive crisis, drugs of several groups are used: calcium channels (nifedipine) blockers, ACE inhibitors (captopril), drugs of central action (uproidyl), nitrates (flames).

3. Muscular cramps. It is recommended to introduce a 0.9% sodium chloride solution in a volume of up to 500 ml, but it is preferable to enter hypertensive solution (10-20%) sodium chloride or dextrose (40%) of 20-40 ml, which quickly removes convulsive syndrome.

4. Nausea and vomiting are found in 10% planned dialysis. For the treatment of this complication, it is necessary to eliminate the causes of the hypotension, part of the patients requires a decrease in blood flow rate in the dialycator in the first hour of dialysis by 20-30%.

5. Headache - A frequent symptom on dialysis and is connected, most often, with a rise or drop of blood pressure. It can be the first symptom of the starting edema of the brain in the syndrome of the disturbed osmotic equilibrium, less often - brain tumors. The treatment is to normalize blood pressure, reduce the speed of blood flow (while the time of dialysis should be increased), the introduction of analgesics inside or parenterally.

6. Pain of the sternum and violation of the rhythm of the heart. The treatment is to normalize the blood pressure, reduce the speed of blood flow and ultrafiltration, inhalation of moisturized oxygen, the 2 -2 dose of sublingual, is assigned after the adhesive rise. In the event of Tahiaritimia - amiodaron.

7. Skin itching. To reduce the skin, it is recommended that the use of sedative drugs during a session, in combination with antihistamine agents, is recommended. With diffuse hyperplasia parachitovoid glands, peripheral calcification, pathological fractures of bones, combined with skin itemThe subtotal parathyroidectomy or sclerosis is shown. For the correction of phosphate exchange in the interdialysis period, it is not necessary for the purpose of phosphatebinder (Severmer Carbonate), calcium drugs (calcium carbonate), active vitamin D metabolites (alpha cellsidol).

8. Nephrogogenic anemia. The indication to the appointment of erythropoietins is a resistant reduction in hemoglobin level of less than 100 g / l, and hematocrit - below 30%. With more pronounced anemia in dialysis patients (HB less than 70 g / l, HT - below 25%) emergency treatment - Hemotransfusion of erythrocyte mass or washed red blood cells, parenteral administration of erythropoietins begins in parallel. The target level of hemoglobin in patients on chronic dialysis is 110 g / l. In this regard, such a dose of a particular drug preparation of this group is individually selected, which would achieve the target level within 1-1.5 months after the start of treatment and constantly maintain it throughout the remaining life. The initial dose of any erythropoietin is 50-60 units. On the kg of body weight 2 times a week subcutaneously or 3 times intravenously. In the absence of effect and eliminating the causes of the slow motion action of erythropoietin, its dose doubles and the treatment continues. When the target level of hemoglobin and stabilization is reached within a month, the total weekly dose is reduced by 30-50% (the transition into two injections instead of three or reduced dose each time). The main cause of an inadequate response to erythropoietin therapy is the deficiency of iron due to low reserves in the body or rapid recycling for the formation of heme. In this bonds in patients with CPN receiving program hemodialysis, it is necessary to eliminate bloodstures related to the work of the equipment, as well as to prescribe iron preparations, and, given the poor iron absorption at CPR in the intestine, it is required to assign iron-containing drugs parenterally (better intravenously). Eminent treatment with iron preparations is advisable at a level of serum ferritin less than 100 ng / ml.

Procedure Efficiency Indicators:

1. KT / V

Hemodilize: The average of 6 monthly measurements of KT / V should be not lower than 1.2 (\u003e 1.2) for patients on the DG, with the number of patients with KT / V level below 1.2 (<1.2) не должно превышать 30%. В этот критерий не входят пациенты, вновь начавшие лечение с ГД (менее 3 месяцев). Kt/V рассчитывается по формуле Daugirdas-2. Данный фракционный клиренс рассчитывается как произведение клиренса диализатора (К мл/мин) на время (t - длительность диализа), к объему распределения мочевины (V).

2. Hemoglobin

The average rate of 6-month measurements of hemoglobin should be within 110-120 g / l, while the number of patients with hemoglobin levels below 100 g / l should not exceed 25% and hemoglobin levels below 110 g / l - 40%. This criterion does not include patients who have newly started dialysis treatment (less than 3 months).

3. Phosphorus

The average rate of 6-month measurements of phosphorus should be within 1.13 - 1.78 mmol / l, with the number of patients with phosphorus level above 1.78 mmol / l should not exceed 40% and phosphorus level above 2.1 mmol / l - 20%. This criterion does not include patients who have newly started dialysis treatment (less than 3 months).

Hospitalization

Indications and Contraindications to the procedure

Indications for the hemodialysis procedure:

Violations of nitrogen balance - urea of \u200b\u200bblood serum over 30 mmol / l, decreased flushing filtration rate using endogenous creatinine below 10 ml / min (in patients with diabetes mellitus below 15 ml / min);

The development of decompensated metabolic acidosis - pH of capillary blood is less than 7.35 standard bicarbonate (hereinafter - SB) - below 20 mmol / l, the deficit of buffer bases (hereinafter - BE) - less - 10 mmol / l;

Hypercalemia over 6.5 mmol / l;

Anuria more than 24 hours;

Threatening clinical manifestations in the form of edema of the brain and lungs, a uremic comatose or precompetitive state.

The indication to the beginning of the depository therapy is to reduce the SCF below 10.5 ml / min / 1.7st. "When the symptoms of uremia and its complications appear in the patient (pericarditis, nausea, vomiting, swelling, resistant to therapy, severe acidosis, violation of blood coagulation, violation nutrition, neuropathy), the development of Ben Dialysis can be started at the SCF<15-20 ml/min/1.73т. В любом случае диализ необходимо начинать до того, как СКФ снизится до уровня 6 мл/мин/1,73м, даже при оптимальном преддиализном ведении пациента и отсутствии клинических проявлений болезни. У пациентов высокого риска, например при сахарном диабете, предпочтительно более раннее начало диализа.

3. Stable general condition of the patient: the absence of symptoms of decompensation and complications of the disease and dialysis access.

Contraindications for program hemodialysis in outpatient conditions:

1. The sharp stages of them and onmk.

2. The presence of a patient with chronic diseases under exacerbation and decompensation.

3. The absence of a patient functioning permanent dialysis, access.

4. Pronounced hemodynamic disorders.

Information

Sources and literature

1. Protocols of meetings of the Expert Commission on Health Development Mort RK, 2013
   1. 1. Zemchenkov A.Yu., Tomilina N.A. "K / DOQI refers to the origins of chronic renal failure." Nephrology and Dialysis, 2004, №3, C.204 - 220 2. KDOQI Clinical Practice Guidelines for Chronic * Kidney Disease: Evaluation, Classification, and Stratification. Am j Kidney DIS, 2002, T.2 SuppLl.p.l -246 3. Jander A, Nowicki M, Tkaczyk M et al. Does A LATE REFERRAL TO A NEPHROLOGIST CONSTITUTE A PROBLEM IN CHILDREN STARTING RENAL REPLACEMENT THERAPY IN POLAND? - A NATIONWIDE STUDY. NEPHROL DIAL TRANSPLANT. 2006 APR; 21 (4): 957-961. 4. Wuhl E, Schaefer F. Therapeutic Strategies to Slow Chronic Kidney Disease Progression. Pediatr NEPHROL 2008; 23: 705-716 5. Mattoo TK. Epidemiology, Risk Factors, and etiology of Hypertension in Children and Adolescents. IN UPTODATE ONLINE 16.1. UPTODATEL, INC. Niaudet P (EDS.) 2008 6. Association iPh: Blood Pressure Limits Chart. In, 2008 http: //www.pediatrichypertension.orr/bplimitschart.pdf 7. Strict Blood-Pressure Control and Progression of Renal Failure in Children. Escape Trial Group, Wuhl E, Trivelli A, Picca S et al. N engl j med. 2009 oct22; 361 (17): 1639-50 8. Rene G. Vandevoorde, Bradley A. Warady. Management of Chronic Kidney Disease, From Pediatric Nephrology; 1676-1677; Springer 2009 9. Clinical Practice Recommendations for anemia in Chronic Kidney Disese in Children. Am j Kidney DIS 2006; 47: 86-108. 10. RENE G. VANDEVOORDE, BRADLEY A. WARADY. Management of Chronic Kidney Disease, From Pediatric Nephrology; 1666-1670; Springer 2009 11. Boehm M, RiesenHuber A, Winkelmayer WC, Arbeiter K, Mueller T, Aufricht C. Early Erythropoietin Therapy Is Associated with Improved Growth in Children with Chronic Kidney Disease. Pediatr Nephrol. 2007 AUG; 22 (8): 1189-93 12. Jabs K. The Effect of Recombinant Human Erythropoietin on Growth and Nutritional Status. PEDIATR NEPHROL 1996; 10: 324-327 13. Gerson A, Hwang W, Fiorenza J et al. Anemia and Health-Related Quality of Life in Adolescents with Chronic Kidney Disease. Am j Kidney Dis. 2004; 44: 1017-1023 14. Wingen AM, Fabian-Bach C, Schaefer F et al. Randomised Multi-Center Study of a Low-Protein Diet On The Progression of Chronic Renal Failure in Children. European Study Group of Nut Teritional Treatment of Chronic Renal Failure in Childhood. Lancet 1997; 349: 1117-1123 15. Pereira am, Hamani N, Nogueira PC, Carvalhaes JT. Oral Vitamin Intake in Children Receiving Long-Term Dialysis. J Ren Nutr. 2000 Jan; 10 (1): 24-9 16. Lesley Ress, Vanessa Shaw. Nutrition in Children With CRF and On Dialysis. Pediatr Nephrol. 2007; 22; 1689 - 1702.

Information

III. Organizational aspects of the implementation of the Protocol

List of protocol developers:
Altynova V.Kh. - NNCMD JSC, Astana, Head. Dialysis Department, Chief Freelance Children's Nephrologist M3 of the Republic of Kazakhstan, Children's nephrologist of the highest category
Tuganbekova S.K. - Director for Science JSC "NNMTS" D.N., Professor, Chloating Nephrologist M3 RK
Gaipov A.E. - Head of OEKHGK JSC NNMTS, Nephrologist, Ph.D.
Smilelov Zh.T. - Chief Freelance Specialist in Hemodialysis UZK Astana, doctor of the highest category
Narmanova O.Zh. - D.N., independent accredited expert, nephrologist of the highest category
Mursalova Zh.Sh. - The main freelance nephrologist of the Uz Karaganda region
Aubakirov M.E. - JSC "RNCNMP", Astana, Chief Specialist of the Hemodialysis Department
Aushakhikov K. S. - GKB№1, Astana, head. Hemodialysis department
Avakian E.S. - GKB№1, Astana, Resuscitation Code
: no later than 3 years from the date of this statement or when new proven data appears

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