In preparing the following information presented to you by the Association for the Advancement and Preservation of the Public Kidney Patients in Israel are many partners: Professional Counseling – Dr. Farhuqui Victor – Key Director of Nephrology and Hypertension, Carmel Medical Center. Tal Kaminsky Rosenberg – Clinical Dietitian. Nepromor – Nephrology Institute Network, Atid Nephrology Forum Management Team – Dietitians Association in Israel. Writing & Editing – Katz-Vodi Selait marketing communications

What is dialysis treatment?

The dialysis device is used as an artificial kidney to remove excess fluid from the body and to remove toxins, processes that the kidneys perform in healthy people. During treatment, the undesirable substances pass through (diffusion) to the dialysis fluid and are eliminated from the body. The treatment is supportive, for life extension, it does not cure the kidneys. Dialysis is intended for patients whose kidneys have stopped abruptly (acute kidney failure) or for patients whose two kidneys are not functioning regularly (chronic kidney failure). Dialysis treatment can be performed in two methods: peritoneal dialysis or hemodialysis.

The Hemo dialysis

Hemodialysis is performed at the hospital or at external dialysis centers in arrangements with the health funds. The frequency of treatment is 3-4 times a week, about 4 hours at a time. This method of treatment requires creating access to the patient’s blood vessels by creating a shunt / fistula. In a surgical procedure, a vein connects to the artery to allow blood to be pumped from the bloodstream to a filter installed on the dialysis device. The blood passes through the filter and the toxins and excess fluid are evacuated from the blood to dialysate and thus removed from the body. The purified blood is returned to the patient’s body through the shunt to the vein. This method of treatment has a limit on the amount of drinking allowed by the patient as well as dietary restrictions.

Nutrition Limitations in Hemodialysis

• The key difference between the two thousand diet and the pre-dialysis heart and the dialysis mediator is the amount of protein recommended. Considering the body’s need for dialysis, the protein is rising, and the diet is high in protein (1.2-1.3 g / kg body weight / day)

• The definition of fluids and minerals may be more liberal in the daily performance of the bond.

• Sodium, Potassium and Phosphorus recommendations are similar to pre-dialysis, customizing each patient’s condition.

Peritoneal dialysis – peritoneal

Peritoneal dialysis is performed in the patient’s home by the patient himself, a family member or therapist. The treatment schedule is relatively flexible and tailored to the patient’s daily routine and health condition. Peritoneum), a membrane that surrounds the internal organs in the abdomen and has microscopic holes. In order to perform the treatment, a surgical operation is inserted into the silicone catheter (a small soft tube) through which a dialysis solution is injected into the peritoneum. The blood that comes into contact with the peritoneal membrane filters through it the toxins and excess fluid that pass into the dialysis fluid and drain out slowly and moderately through the catheter. This process is called elimination, it must be repeated several times a day. The treating physician determines for each patient the number of replacements needed per day, the number of days of treatment, the type of dialysis fluid and the recommended amount to use.

Nutrition Limitations in Peritoneal Dialysis

  • Peritoneal dialysis also has an increased need for protein, sometimes even more than hemodialysis (1.2-1.4 g / kg body weight / day).
  • Liquid and mineral restriction may be more liberal due to daily treatment.
  • Most of the solutions used to perform peritoneal dialysis contain sugar, which is partially absorbed into the blood. This should be taken into account when calculating total daily calories, and this can make it difficult to balance blood fat and balance diabetes.

What is the link between kidney failure and bone disease?

Kidney failure can cause various types of bone disease due to increased phosphorus levels and decreased calcium levels. A common condition is related to increased thyroid (parathyroid) activity, which causes an increase in blood phosphorus, decreased blood calcium, decreased vitamin D activity, and an excess secretion of hormone which absorbs calcium from the bones. As a result, calcium deficiency in the bones is manifested as bone pain and fractures.

 Sometimes the excess amounts of calcium-phosphorus in the blood sink into tissues outside the bones, such as lung, heart, subcutaneous tissue, etc. To lower the phosphorus level, it is important to adhere to a low-phosphorus diet and, if necessary, to use a phosphorus-binding drug that does not allow phosphorus-derived foods to be absorbed in the gut.

What is the link between chronic kidney disease and anemia?

Decreased renal function can lead to the development of anemia manifesting in general fatigue and weakness, dizziness, headache, rapid heart rate, difficulty concentrating, skin thinning and cornea and physical fitness. The anemia can also impair the cardiac function because the state of cardiac hypertension needs to exert more effort.

There is a direct correlation between renal function and blood hemoglobin levels. The decrease in hemoglobin usually begins when creatinine clearance is less than 60 ml / min. When a patient’s hemoglobin level of chronic kidney failure is equal to or less than 11 g / dec, it is recommended to consider anemia treatment.

Anemia development in patients with chronic kidney failure may be due to a variety of reasons, but the most common cause is the lack of the erythropoietin hormone that regulates the formation of red cells in the bone marrow. At the doctor’s discretion, erythropoietin can be treated with intravenous or subcutaneous injection.

About half of the patients with kidney failure also suffer from iron deficiency, so there is room to check the iron and if necessary give iron supplement directly to the vein. It is important to start treating anemia early because untreated anemia increases a patient’s risk of heart disease, which impairs his or her quality of life.

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