Implementation
The point at which a patient has inadequate kidney function and is therefore subject to dialysis is determined on the basis of the patient’s clinical picture together with certain laboratory values. One value that is well related to kidney function is creatinine. Nevertheless, an increase in this value is not sufficient to definitely justify the start of dialysis.
The glomerular filtration rate (GFR) is used as a more important and meaningful kidney value. It is a measure of how well the kidneys can filter and thus clean the blood. The standard GFR value for young adults is 100-120 ml/min.
This value naturally decreases steadily with age. However, from approx. 10-15 ml/min, chronic kidney weakness is so severe that permanent dialysis cannot be avoided.
In addition, just as acute events in an emergency as acute kidney failure or poisoning are indications for dialysis. In the practical implementation of permanent dialysis, i.e. for classic dialysis patients, there are two options: outpatient dialysis or home dialysis. Outpatients receive a dialysis plan at the beginning of the therapy, which sets out the dialysis appointments per week.
A popular and useful scheme would be, for example, the dialysis schedule Monday-Wednesday-Friday. At least three times a week, the patient must visit a suitable site for this. Hospitals can perform dialysis on an outpatient basis, but in many places there are also dialysis centers that specialize in treating this group of patients.The latest development here is night-time dialysis, where the patient can sleep.
The aim is to have as little impact as possible on the daily lives of those affected. A dialysis session lasts on average about 5-6 hours. Before each dialysis session, general parameters such as blood pressure, body weight and laboratory values are collected.
Then the shunt is punctured with two cannulas and the blood is cleaned. The patients then return home. A dialysis patient often notices significant fluctuations in sensitivities between cycles.
For example, most people feel much better immediately after dialysis than shortly before, as undesirable substances have accumulated again after 1-2 days. The only way to get rid of the permanent dialysis obligation is a kidney transplant. Without this, dialysis is a therapy set for life. In acute or emergency dialysis, one or a few sessions are usually sufficient, as the kidney itself is still intact and only one poison or cause had to be eliminated.