EP.5 Can I still go abroad after dialysis?

foreword

Kidney dialysis is one of the most important businesses in the nephrology department. Traditional dialysis includes hemodialysis and peritoneal dialysis. People often ask: What kind of dialysis is traditionally referred to as "kidney dialysis"? Do both dialysis methods require going to the hospital 3 times a week for 4 hours each time?

In fact, hemodialysis and peritoneal dialysis have many similarities, but also many differences. If the kidney function is poor, you must go on dialysis. How should you choose?

This article will first introduce you to hemodialysis, which is traditionally called "washing blood", hoping to give you a deeper understanding of hemodialysis!

Dialysis equals loss of freedom?

Do you have any impressions of Yoshiro Mori, the former Prime Minister of Japan?

When Lee Teng-hui passed away, Yoshiro Mori led a delegation to Taiwan to offer condolences when the new crown pneumonia epidemic was severe, and the visiting delegation went back and forth on the same day. And everyone knows that Yoshiro Mori is a hemodialysis patient and must go to the hospital for dialysis regularly in order to maintain the functioning of his kidneys.

At this time, people were curious: "Can I go abroad for dialysis? Can I also do what I usually want to do?" I often encounter some elderly people in clinical practice. , willing to die without dialysis.

In fact, everyone should correct this concept. Although kidney dialysis will have some restrictions on life, it is possible to go abroad for kidney dialysis, and it can also maintain your usual interests. How to balance health and quality of life? Let's move on.

Principles of hemodialysis

Hemodialysis is traditionally called "washing blood", and the proper name is "Hemodialysis, HD". As the name suggests, when the kidneys fail to function, they cannot excrete toxins and water produced by metabolism in the body. Artificial kidneys are needed to excrete wastes from the body to maintain the body. Normal function, relieve discomfort.

Before pumping out the dirty blood, there must be a strong pipeline. Cardiovascular surgeons will first establish an arteriovenous tube. Since the pipeline must withstand the blood pressure of 160~200 CC per minute, generally small The venous indwelling needle and blood vessels cannot bear it, so the dialysis treatment can be started only after the blood vessels are nourished for 1 to 3 months.

The treatment process consists of inserting two needles into the tube, one end of which draws the dirty blood out of the body, and after the dialysis machine (ie artificial kidney) removes the toxins in the blood, the other needle removes the clean blood. flow back into the body.

Kidney function is not good, when do you need kidney dialysis?

The normal value of creatinine (commonly known as toxin) in kidney function is below 1.3 mg/dl. "Muscle" represents muscle. The greater the muscle mass, the more creatinine. According to the regulations of the National Health Insurance Administration, dialysis can be started when creatinine is greater than 6 mg/dl, but dialysis is not based on numbers, but depends on the condition. If the creatinine value is low, but the patient's symptoms are severe, dialysis is necessary; Conversely, if the creatinine level is high, but the patient is in good spirits and is still active, dialysis is not necessary.

For example, some little girls or old women weighing 30 or 40 kilograms have low muscle mass and low creatinine value, but when the kidney function is not enough to support the quality of life, kidney dialysis is necessary.

Most importantly, assuming

 The creatinine value is already greater than 6 mg/dl, and the body is beginning to feel uncomfortable, so you can no longer delay, and you must start kidney dialysis.

Common hemodialysis lines

1. Double Lumen Catheter: It is a short-term catheter suitable for patients who need short-term hemodialysis. It is usually placed in the femoral vein (groin), and the catheter is placed on a relatively large blood vessel, so that when the dirty blood is drawn out , blood vessels are less likely to constrict.
2. Hickmann catheter: It is a short-term catheter. The catheter is implanted from the internal jugular vein and subclavian vein by percutaneous puncture, and the end of the catheter is fixed to the superior vena cava. A chest X-ray will be taken on the day after implantation. , to determine whether the Hick-type catheter is placed in the correct position, when the patient does not need dialysis, or when there is a fixed tube, this venous catheter can be removed. Both double-lumen catheters and Hick-type catheters should not be left in the body for too long because the relative chance of infection is high
3. Dialysis tube: commonly known as "hand tendon", it is used for long-term hemodialysis and needs to enter the operating room to receive the surgery of implanting a dialysis tube. The dialysis tube can be divided into the following two types:

• Arteriovenous catheter (AV fistula, AVF): Connect the artery to the vein at the wrist or arm of the non-dominant hand. After about 2 to 3 weeks, the blood vessel can be pierced and used. In the process of nourishing the blood vessels, the kidney friend will be taught to hold a ball similar to a tennis ball and exercise to increase blood flow by holding the ball. Some young patients, or Abers who used to exercise habits, usually have thick blood vessels, and sometimes the blood vessels can be used after about 1 to 2 weeks. It is currently recognized that it has been used for the longest time and has the fewest complications.
• AV graft (AVG): For patients with poor vascular conditions (such as the elderly, diabetes, etc.), the artificial blood vessel of synthetic material is regarded as a bridge at the wrist or arm of the non-dominant hand, connecting arteries and veins. About 2 to 4 weeks after the wound has stabilized and swelling, it can be used. Generally, the operation time of artificial blood vessels is longer, the postoperative swelling is more serious, and the probability of complications such as blockage and infection in the future is higher, and the average service life is about 2 to 3 years.

Frequency of hemodialysis

This is the most frequently asked question by kidney friends: "Why do I have to wash 3 times a week for 4 hours each time, but the person next door only needs to wash it twice a week?"

Usually, the frequency of dialysis is every Monday, Wednesday, Friday, or Tuesday, Thursday, and Saturday, but this part is judged by the doctor based on the residual renal function of the kidney friend. But if the toxin is high, it needs to be washed more times and the time is longer.

In fact, kidney dialysis is not the worst result. Even if the kidney function is not good, the quality of life can still be maintained through artificial means. The official name of dialysis is "renal replacement therapy", which means to make up for the deficiency of kidney function through artificial means. For example, Kidney A is younger and more active. His renal function should be maintained at least 30 points, but his residual renal function is only 5 points. At this time, human intervention is needed to help him make up to 25 points.

On the other hand, patient B is an elderly person who does not need a lot of labor, and his activity is already insufficient before dialysis. He only needs 10 points of renal function in life, and his residual renal function is 5 points. At this time, he only needs to add 5 points artificially. .

so,

The frequency of dialysis depends on the residual renal function of each individual

The so-called residual renal function refers to the patient's urination status after dialysis. No matter how poor the renal function is, the residual renal function is still precious. Whether it is drainage or detoxification, it is better than an artificial kidney. Therefore, if there is a lot of residual renal function, the frequency of dialysis is not necessary. This part will be judged by the doctor based on the patient's symptoms and decide how much renal function to replenish the patient in order to maintain his quality of life.

Symptoms that may occur during hemodialysis

Kidney dialysis is to slowly remove water and toxins from the body. Usually, the amount of dialysis does not exceed the body weight. For example, a patient of 40 kg, 7 kg of each wash will definitely shock; if a patient of 100 kg, Although washing 7 kg may also cause shock, the probability is relatively low.

So how to calculate the weight and the amount washed out?

Assuming that the patient weighs 1 kg per day, if dialysis is performed every Monday, Wednesday, and Friday, when dialysis is performed on Wednesday, as long as the 2 kg accumulated in the previous two days is washed out, the process will be less uncomfortable; During kidney dialysis, the toxins and water accumulated for five, six, and three days should be excreted. The patient will feel slightly uncomfortable during the dialysis process. If coupled with poor heart function, when the amount of dialysis is a little more, the heart will suffer. Can't stand it.

Other possible uncomfortable symptoms include cramps, stomach discomfort, headache, nausea, blood pressure drop, etc. Therefore, we recommend that patients undergoing hemodialysis do not produce toxins and water every day, and try to maintain weight gain between two dialysis sessions. % before complications of dialysis treatment can be prevented.

COVID-19 is raging, can I do home hemodialysis?

Home hemodialysis (HHD) is not a new technology, but due to Covid-19, many patients and family members are worried that visiting the hospital for dialysis will increase the risk of infection, so the inquiries of home hemodialysis are relatively hot.

In fact, Dr. Lin Jieliang, a senior in the nephrology department, used hemodialysis at home for more than 20 years of dialysis, which not only effectively improved the survival rate, but also allowed kidney patients to have a stable daily life.

Our kidneys work 24 hours a day. Usually hemodialysis washes out the toxins and water from the past 48 hours or 72 hours within 4 hours, while home hemodialysis uses 8 hours of hemodialysis when we sleep at night , which is longer than in The hospital has double the number and the speed is slower, which can strengthen the removal of toxins and water in the patient's body, reduce the burden on the heart, and reduce cardiovascular complications.

The conditions for home hemodialysis are that the patient is older than 20 years old, has a co-resident, is willing, and has no mental illness. He needs to go through 8 to 12 weeks of home hemodialysis training, and rent a water treatment machine installed in the bathroom at home. After the home visit is approved, it can start. Hemodialysis at home will consume a lot of water and electricity. The average monthly cost of water, electricity and rental machines is about NT$8,000 to 10,000. Therefore, if you have kidney patients with multiple chronic diseases, it is still recommended to have kidney dialysis in the hospital.

Focus on finishing

Hemodialysis patients can also travel

You can go back and forth on the same day or for a day or two. If you are away for a week, you can make an appointment at the local dialysis center. As long as there is a bed, you can do dialysis locally.

Age is definitely not a determining factor for dialysis

Suppose a young patient has a serious car accident, must be bedridden for a long time, and has low expectations for himself or his family. If this type of patient needs kidney dialysis, it is recommended to give him a chance not to lose his original mental state because of poor kidney function.

patient's expectations

Everyone has different expectations for themselves. Some people expect a good quality of life when they are alive, and some people can’t let go of their family members at the end of their lives. They can choose dialysis; but some patients think that they have seen the world Prosperity, you can choose not to dialysis.

Attitudes of family members of kidney friends

It is suggested that family members and kidney friends should not be too strong when discussing the condition, for example: "You are told to wash but you do not wash", "You are told not to steal food, but you still eat", "Drinking too much water will cause pulmonary edema. ”, you should try to avoid some critical or accusatory words , otherwise it will be regarded as a burden by kidney friends.