This is a post from my facebook dated 27th December 2016. I wanted to write something that was sort of in between medical students and lay person target audience. I wanted to summarize the essence of that few months in haemodialysis unit. So far I have not had the time to write part 2 yet.
The day starts early for chronic (or long term) haemodialysis patients. Some of them come as early as 6am, leaving home right after Subuh prayers.
When they arrive at the General Hospitals Haemodialysis center, they first register at the counter and get a number. Then the patient will weigh in and measure their blood pressure, entering the figures in their haemodialysis (HD) record book.
After that, they collect their dialyzer, or artificial kidney, in a tray with other tubes and packed fluids, and begin to ‘prime’ the dialyzer by setting up the equipment and letting two bags of fluids run through. The bag marked ‘X’ contains heparin, a blood thinning medication that prevents blood from clotting while it runs through the tubes.
Some patients are well enough to do all this on their own, while many other require some degree of assistance from family members and the dedicated staff.
During the time, there is a frenzy of activity while the patient’s get ‘hooked up’ to the 26 or so HD machines. Nurses go around, with their masks and gloves, sticking two rather large sized needle into the patients fistula. One line brings blood to the dialyzer while the other returns back blood that is ‘cleaned’.
The HD machine requires a large amount of blood pushed through the dialyzer, about 300ml/min, so normal veins are not big enough for this purpose. The patient will have a minor surgery done under local anaesthesia to connect an artery in the arm to a vein. This high pressure blood from the artery will with time, and exercise, allow the veins to grow big enough, usually about 2 months.
It hurts every time.
I would say all except one patient that I observed, winced, every time the needle goes in. And this happens three times a week, every week, for the rest of the patients life. The one patient who did not wince, was actually able to insert the needles himself. I was very impressed.
The patient then has to wait four hours for the process to finish. Some of them have breakfast, chat with their friends, watch television, while others sleep. All of them have containers with medication, scissors (to cut tape), and other bits and pieces. Many have to take calcium carbonate three times a day and chew it with food to absorb excess phosphate. It’s the unmistakable pink tablets.
One of the function of the kidneys is to control blood calcium and phosphate levels. The kidneys produce activated vitamin D. When the kidneys fail, calcium ion is not absorbed because vitamin D is needed for this process to take place. When calcium levels fall, phosphate levels increase. The parathyroid gland produces more parathyroid hormone (PTH), which then releases calcium from the bones. If allowed to continue, this can cause bone disease or ‘renal osteodystrophy’.
To prevent this complication of chronic kidney failure, we replace vitamin D and calcium, plus removing the excess phosphate, all by medication. Unfortunately, the HD machine cannot replace vitamin D.
In some patients, despite treatment, the PTH levels continue to rise. They may have to undergo surgery to remove the parathyroid glands.
To be continued…