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Nephrology - Dialysis department
Réseau Hospitalier de Médecine Sociale
Belgium
This Website was developped and designed by Dr Debelle. Its content only reflects authors' own view.
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End-stage renal disease
When the patient reachs the end-stage, he/she develops symptoms such as nausea, vomiting, weight loss, tiredness, sleepiness or breathlessness. A blood testing is sufficient to confirm the terminal uremia. This situation is lifethreatening and urgent actions are required to "purify" the blood by dialysis technique.
            Thanks to hemodialysis, the metabolic waste and the water excess are removed.  The hemodialysis session which lasts 3 to 4 hours (three times a week) consists in taking blood via an arteriovenous fistula or a catheter, to filter it through a dialyzer ("the artificial kidney") and to render it to the patient. The hemodialysis session takes place at the hospital, at the low-care unit or even at home.
The peritoneal dialysis is a smooth and well-tolerated technique which uses the inner abdominal membrane called the "peritoneum" as a natural filter.  A fluid (the "dialysate") is infused though a catheter in the peritoneal cavity, allowing this fluid to dwell for a certain period (generally varying from 2 to 4 hours) and then draining it out (called an exchange or cycle). In this way, the solutes, the metabolic waste and the the surplus of water are eliminated. The cycle is repeated as needed, most often during the night by using a machine (the "cycler"). The treatment takes place 7 days a week. The peritoneal dialysis has the major advantage to be done at home and to allow the patient to attend to her/his business during the day.
Renal transplantation is considered to be the best treatment option for those patients in end-stage renal disease. A careful screening of potential recipient patient is mandatory since not all patients can be listed for transplantation due to unacceptable risks of complications (surgery or immunsuppressive drugs, e.g.). Kidneys can be obtained from living or cadaveric donors. To avoid rejection of the graft, the patient is obliged to take immunusuppression drugs during all his/her life. But thanks to this therapy, the patient is free of dialysis constraint.