Kidney dialysis, how is it going?

The famous “fatigue” which accompanies this purification of the blood is no longer systematic. Patrick, 60, is even surprised: “I don’t know if it’s due to the vitamins and EPO (hormone that stimulates the red blood cells) that we are injected but I feel rather in good shape after dialysis …” The centers are intended to be more welcoming, like the renovated unit at the CHU de Créteil. Each bed has its own screen. “Before, I used to bring crosswords, books, says Annette, 56 years old. Now we have TV. Through broadcasts and documentaries, we open up to the world while the disease tends to withdraw and refocus us on ourselves. ” In France, 3 million people suffer from kidney failure.

What exactly is dialysis?

When kidney function is poor, waste products build up in the blood. This blood must then be filtered regularly: dialysis, which becomes necessary when renal function reaches 18% of normal, while waiting for the transplant. There are two methods …
Hemodialysis involves taking blood from a vein, passing it through a machine that filters it and then injecting it back into the bloodstream.
Peritoneal dialysis consists of introducing a solution into the abdomen, allowing exchanges to take place between this solution and the small vessels of the peritoneum. The used liquid is then removed.

How do you plug in the patient?

For hemodialysis to be effective, large amounts of blood must be filtered. However, the flow in the superficial veins is low. “We therefore create a fistula (connection of a superficial vein to an artery). Initially, the vein has a diameter of 2 mm and a flow rate of 50 ml / min, explains Dr Boutheina Ben Taarit, nephrologist at CHU Henri-Mondor, in Créteil, so that a diameter of 6 mm and a flow rate of 600 ml / min is required. After 5 weeks, the fistula has developed and the flow is sufficient. “The ideal is to create the fistula 6 months before the start of dialysis, but 35% of patients arrive in emergency dialysis” , specifies Prof. Philippe Lang, head of the nephrology service at CHU Henri-Mondor.

Do you have to follow a special diet?

The diet must be adapted, in particular to avoid the accumulation of potassium in the blood. “Potassium paralyzes”, warns Dr Hamid Abbassi, head of the dialysis unit at the Hospitals of Saint-Maurice. The excess of potassium causes cramps, tingling, heart rhythm disturbances, even a heart attack. Salt is also to be avoided.
At the hospital, the dietician learns which foods to avoid (chocolate, bananas …), how to cook … But the day before dialysis, you can overdo it! And during, everything is allowed, even chocolate, since the blood is being filtered.

Do we have to go to a center?

Most patients are followed in dedicated centers, 3 or 4 times a week. But dialysis is possible at home. Less than 10% of patients benefit: 7% opt for peritoneal dialysis and a little more than 0.5% for hemodialysis.
Home sessions allow you to pursue a professional activity. It is like in the hospital, but with smaller machines (the size of a large printer, not always easy to store at home). The sessions are daily (six days a week) and last 2 hours. It can also be done at night (every other day).
The method requires prior training and the presence of another person at home (parent, spouse, etc.).

It is the Aura association (Association for the use of the artificial kidney), with its correspondents in the provinces, which takes care of the logistics.

Is peritoneal dialysis as effective?

All methods are effective. But peritoneal dialysis works on the mode of natural filtration, therefore slower. It is the peritoneum, the thin membrane rich in small vessels that lines the abdomen, which serves as a filter. A liquid with a high concentration of sugar, bicarbonate and other minerals is injected between the two layers of the peritoneum. In contact with this liquid, and by osmosis, exchanges take place until the liquid is saturated. It is then purged.

This dialysis can be done during the day (4 sessions at 8 am, noon, 4 pm and 8 pm) or at night. Like home hemodialysis, it allows certain dietary variations, because its mode of action is closer to that of the kidney.

Can we go on vacation?

The healthcare teams get in touch with a center in the region. There are even cruises that offer dialysis on board. Or tour operators who organize stays … where dialysis is part of the program. For those who practice dialysis at home (hemodialysis or peritoneal dialysis), any type of travel is possible as long as one can carry the dialysate bags! “One of my patients wanted to visit Thailand, we managed to get it delivered”, says Dr Abbassi. More incredible, the epic of Jean-Louis Clémendot, who was preparing a round-the-world sailing tour when he discovered his kidney failure. With delivery at each stage, he was able to achieve it!

Read also :
Infographic: get to know your kidneys
Kidney transplant: donating a kidney while alive is possible
Kidneys: identifying patients at risk of dialysis