When a patient is diagnosed with the last stage of Kidney Failure (Disease) (Stage5), he or she has 3 options for survival:

• dialysis
• transplant from a living or deceased
• a miraculous cure

Dialysis is a procedure in which a machine performs most of the functions of a normal kidney. Listed below are the main functions of the kidneys:

• maintaining overall fluid balance, quantity of water in the body;
• regulating and filtering minerals from blood;
• filtering waste materials, medications, and toxic substances;
• creating hormones that help produce red blood cells, promote bone health, and regulate blood pressure.

There are two main types of dialysis: hemodialysis and peritoneal dialysis.

• Hemodialysis uses a machine and a filter to remove waste products and water from the blood.
• Peritoneal dialysis uses a fluid (dialysate) that is placed into the patient’s abdominal cavity to remove waste products and fluid from the body.

Hemodialysis                                                Peritoneal dialysis

One must remember that the kidneys work 24 hours per day and 7 days per week. Therefore the longer and more frequent a patient undergoes dialysis the better. However due to the very high cost of this procedure it has to be limited to 2 to 3 times per week and it is usually completed in 3 to 4 hours. Peritoneal dialysis is cheaper and can be completed every day for 10 to 12 hours.

The table below is used to illustrate the results of dialysis from blood tests completed before and after dialysis. Most dialysis institutions will take blood from the patients on a monthly basis and sent the blood to the lab for testing. The results of these tests are used to ensure that the patient is maintaining results within acceptable ranges in order to help his/her health care providers make modifications as warranted to medication of the patients. I would encourage the dialysis institutions to either email or WhatsApp the monthly results to all patients. Patients who know and understand their blood results are more likely to take their medications, maintain proper diet and liquid restrictions. The ability to understand the blood results by the patients  will also encourage more effective dialogue between the patient and health care professionals.

In the table above, please note the following from the before and after dialysis blood tests.

The sodium level has increased. This would have been due to the patient requiring sodium during the dialysis since the blood pressure would have dropped during this process. However it should be noted that, in both cases, it is has not exceed the upper limit of the normal range..

The potassium has moved from high (5.1) to normal (3.5). High potassium can lead to heart attacks.

The chloride has remained almost constant within range.

CO₂ levels have increased to normal

The Anion Gap has decreased a little but is still very high

The Bun has decreased but not to normal levels.

.The Creatinine has decreased significantly but not to normal levels.

The machine has miraculously removed 3.5kgs of water from the patient’s system. Patients are advised to limit their liquid intake to 1litre or 1kg of liquids per day. The more kgs a patient added from the last dialysis the more complications they will have during dialysis. In my most recent dialysis I had added 3.4kgs from my previous dialysis. I had complications for 2.5 hours of my dialysis and the nurse had to give me more than one bag of saline. Complications included a significant drop in blood pressure, awful feelings and significant pains from cramps.

Here, for your information is an explanation of the tests:

Sodium helps with the function of nerves and muscles. It also helps to keep the right balance of fluids in your body. Your kidneys control how much sodium is in your body. If you have too much and your kidneys can’t get rid it, sodium builds up in your blood and can lead to high blood pressure (hypertension).

Potassium is a mineral and an electrolyte. It helps your muscles work, including the muscles that control your heartbeat and breathing. Potassium comes from the food you eat. Your body uses the potassium it needs. The extra potassium that your body does not need is removed from your blood by your kidneys.

Chloride is an electrolyte. It is a negatively charged ion that works with other electrolytes, such as potassium, sodium, and bicarbonate, to help regulate the amount of fluid in the body and maintain the acid-base balance.

CO₂ is the molecular formula for carbon dioxide which is a colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. Carbon dioxide is produced during respiration by all animals, fungi and microorganisms that depend on living and decaying plants for food, either directly or indirectly. It is, therefore, a major component of the carbon cycle.

Anion Gap is the difference between certain measured cations (positively charged ions) and the measured anions (negatively charged ions) in urine.

Blood urea nitrogen (BUN) is a medical test that measures the amount of urea nitrogen found in blood. The liver produces urea in the urea cycle as a waste product of the digestion of protein.

Creatinine is a substance that is found naturally in muscle cells. It helps your muscles produce energy during heavy lifting or high-intensity exercise.

Patients must never miss their dialysis session. The average patient will begin to feel discomfort between days 4-7. The build-up of water and toxins in the body will result in shortness of breath, itching in the body, nausea and vomiting, and fluid retention. Infection sets in as the immune system weakens. These symptoms would increase after day 7 and would result in the patient having to be admitted to the Accident and Emergency department of the hospital to save their life. One would most likely die from congestive heart failure, due to the gathering fluids.

Dialysis is a very expensive procedure. The Queen Elizabeth Hospital, according to a 2018 article written by the then CEO, spends US $ 9.5 million on dialysis per annum for almost 350 patients. This equates to US Twenty-seven thousand ($27 000) per patient. This is a substantial amount of money to spend on persons, most of whom are not in the work force. All patients must also be very grateful to the doctors, nurses and support staff who look after them in some cases for over 25 years. Special mention must be made of the nurses and nursing assistants who work many days without lunch and, to compound this, are required to work back-to-back shifts. These working conditions must be very difficult on them and their families. I hope that  patients and their families can find some way to say THANK YOU to these health care professionals for their contribution to our lives.                                    

I hope that this short article has demonstrated the importance of dialysis not only to the quality of life of the patient but to life itself.

Compiled by Allan Haynes, a dialysis patient, founder of Kidney Caribbean and a member of the Barbados Kidney Association

www.kidneycaribbean.com