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Kidney dialysis is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. Along with kidney transplantation, it is a type of renal replacement therapy.
Kidney failure, also known as renal failure or end-stage renal disease (ESRD), is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as either acute kidney failure, which develops rapidly and may resolve; and chronic kidney failure, which develops slowly and can often be irreversible. Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications of acute and chronic failure include uremia, hyperkalemia, and volume overload. Complications of chronic failure also include heart disease, high blood pressure, and anaemia.
Uremia is the condition of having high levels of urea in the blood. Urea is one of the primary components of urine. It can be defined as an excess in the blood of amino acid and protein metabolism end products, such as urea and creatinine, which would normally be excreted in the urine. Uremic syndrome can be defined as the terminal clinical manifestation of kidney failure. It is the signs, symptoms and results from laboratory tests which result from inadequate excretory, regulatory, and endocrine function of the kidneys. Both uremia and uremic syndrome have been used interchangeably to denote a very high plasma urea concentration that is the result of renal failure. The former denotation will be used for the rest of the article.
Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of filtering the blood of a person whose kidneys are not working normally. This type of dialysis achieves the extracorporeal removal of waste products such as creatinine and urea and free water from the blood when the kidneys are in a state of kidney failure. Hemodialysis is one of three renal replacement therapies. An alternative method for extracorporeal separation of blood components such as plasma or cells is apheresis.
Chronic kidney disease (CKD) is a type of long-term kidney disease, in which either there is a gradual loss of kidney function which occurs over a period of months to years, or an abnormal kidney structure. Initially generally no symptoms are seen, but later symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications can relate to hormonal dysfunction of the kidneys and include high blood pressure, bone disease, and anemia. Additionally CKD patients have markedly increased cardiovascular complications with increased risks of death and hospitalization. CKD can lead to kidney failure requiring kidney dialysis or kidney transplantation.
Peritoneal dialysis (PD) is a type of dialysis that uses the peritoneum in a person's abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood. It is used to remove excess fluid, correct electrolyte problems, and remove toxins in those with kidney failure. Peritoneal dialysis has better outcomes than hemodialysis during the first two years. Other benefits include greater flexibility and better tolerability in those with significant heart disease.
Home hemodialysis (HHD) is the provision of hemodialysis to purify the blood of a person whose kidneys are not working normally, in their own home. One advantage to doing dialysis at home is that it can be done more frequently and slowly, which reduces the "washed out" feeling and other symptoms caused by rapid ultrafiltration, and it can often be done at night, while the person is sleeping.
In medicine, Kt/V is a number used to quantify hemodialysis and peritoneal dialysis treatment adequacy.
Focal segmental glomerulosclerosis (FSGS) is a histopathologic finding of scarring (sclerosis) of glomeruli and damage to renal podocytes. This process damages the filtration function of the kidney, resulting in protein presence in the urine due to protein loss. FSGS is a leading cause of excess protein loss—nephrotic syndrome—in children and adults in the US. Signs and symptoms include proteinuria and edema. Kidney failure is a common long-term complication of the disease. FSGS can be classified as primary, secondary, or genetic, depending on whether a particular toxic or pathologic stressor or genetic predisposition can be identified as the cause. Diagnosis is established by renal biopsy, and treatment consists of glucocorticoids and other immune-modulatory drugs. Response to therapy is variable, with a significant portion of patients progressing to end-stage kidney failure. An American epidemiological study 20 years ago demonstrated that FSGS is estimated to occur in 7 persons per million, with cisgender male African-Americans at higher risk.
Renal replacement therapy (RRT) is therapy that replaces the normal blood-filtering function of the kidneys. It is used when the kidneys are not working well, which is called kidney failure and includes acute kidney injury and chronic kidney disease. Renal replacement therapy includes dialysis, hemofiltration, and hemodiafiltration, which are various ways of filtration of blood with or without machines. Renal replacement therapy also includes kidney transplantation, which is the ultimate form of replacement in that the old kidney is replaced by a donor kidney.
Interstitial nephritis, also known as tubulointerstitial nephritis, is inflammation of the area of the kidney known as the renal interstitium, which consists of a collection of cells, extracellular matrix, and fluid surrounding the renal tubules. It is also known as intestinal nephritis because the clinical picture may in some cases of acute pyelonephritis include mesenteric lymphadenitis. More specifically, in case of recurrent urinary tract infection, secondary infection can spread to adjacent intestine. In addition to providing a scaffolding support for the tubular architecture, the interstitium has been shown to participate in the fluid and electrolyte exchange as well as endocrine functions of the kidney.
Hypouricemia or hypouricaemia is a level of uric acid in blood serum that is below normal. In humans, the normal range of this blood component has a lower threshold set variously in the range of 2 mg/dL to 4 mg/dL, while the upper threshold is 530 μmol/L (6 mg/dL) for women and 619 μmol/L (7 mg/dL) for men. Hypouricemia usually is benign and sometimes is a sign of a medical condition.
Analgesic nephropathy is injury to the kidneys caused by analgesic medications such as aspirin, bucetin, phenacetin, and paracetamol. The term usually refers to damage induced by excessive use of combinations of these medications, especially combinations that include phenacetin. It may also be used to describe kidney injury from any single analgesic medication.
Dialysis disequilibrium syndrome (DDS) is the collection of neurological signs and symptoms, attributed to cerebral edema, during or following shortly after intermittent hemodialysis or CRRT.
Robert Provenzano is an American nephrologist. He is also an Associate Clinical Professor of Medicine at Wayne State University School of Medicine.
Nathan W. Levin is an American physician and founder of the Renal Research Institute, LLC., a research institute dedicated to improving the outcomes of patients with kidney disease, particularly those requiring dialysis. Levin is one of the most prominent and renowned figures in clinical nephrology as well as nephrology research. He has authored multiple book chapters and over 350 peer-reviewed publications, including articles in leading journals such as Nature, the New England Journal of Medicine, and The Lancet.
The International Society of Renal Nutrition and Metabolism (ISRNM) is a learned society on nephrology that has the objective of advancing knowledge, education and awareness pertaining to nutrition and metabolism in kidney disease by fostering communication of the advancements of knowledge in renal nutrition. The ISRNM website states that it promotes expert patient care, advances medical research, and educates the kidney community on the role of nutrition in chronic kidney disease and acute kidney injury including the role of nutritional status, uremic malnutrition, protein-energy wasting, and dietary derangement. The site also mentions a role in informing policymakers about issues of relevant to kidney and nutrition communities and the patients.
Kamyar Kalantar-Zadeh is a US American physician doing research in nephrology, kidney dialysis, nutrition, and epidemiology. He is best known as a specialist in kidney disease nutrition and chronic kidney disease and for his hypothesis about the longevity of individuals with chronic disease states, also known as reverse epidemiology including obesity paradox. According to this hypothesis, obesity or hypercholesterolemia may counterintuitively be protective and associated with greater survival in certain groups of people, such as elderly individuals, dialysis patients, or those with chronic disease states and wasting syndrome (cachexia), whereas normal to low body mass index or normal values of serum cholesterol may be detrimental and associated with worse mortality. Kalantar-Zadeh is also known for his expertise in kidney dialysis therapy, including incremental dialysis, as well as renal nutrition. He is the brother of Kourosh Kalantar-zadeh, who is an Australian scientist involved in research in the fields of materials sciences, nanotechnology, and transducers.
A renal diet is a diet aimed at keeping levels of fluids, electrolytes, and minerals balanced in the body in individuals with chronic kidney disease or who are on dialysis. Dietary changes may include the restriction of fluid intake, protein, and electrolytes including sodium, phosphorus, and potassium. Calories may also be supplemented if the individual is losing weight undesirably.
Peter Stenvinkel is a Swedish nephrologist and academic. He is a senior lecturer at Karolinska University Hospital and a professor of nephrology at Karolinska Institutet.
References
- 1 2 3 "VU: Ikizler Lab". Archived from the original on 2021-07-12. Retrieved 2008-09-17.
- ↑ Ikizler, TA, Pupim, LB, Brouillette, JR, Levenhagen, DK, Farmer, K, Hakim, RM, Flakoll, PJ. Hemodialysis stimulates muscle and whole body protein loss and alters substrate oxidation. Am J Physiol Endocrinol Metab, 282(1), E107-16, 2002
- ↑ Caglar, K, Peng, Y, Pupim, LB, Flakoll, PJ, Levenhagen, D, Hakim, RM, Ikizler, TA. Inflammatory signals associated with hemodialysis. Kidney Int, 62(4), 1408-16, 2002
- ↑ Pupim, LB, Flakoll, PJ, Brouillette, JR, Levenhagen, DK, Hakim, RM, Ikizler, TA. Intradialytic parenteral nutrition improves protein and energy homeostasis in chronic hemodialysis patients. J Clin Invest, 110(4), 483-92, 2002
- ↑ Pupim, Lara B, Flakoll, Paul J, Levenhagen, Deanna K, Ikizler, T Alp. Exercise augments the acute anabolic effects of intradialytic parenteral nutrition in chronic hemodialysis patients. Am J Physiol Endocrinol Metab, 286(4), E589-97, 2004
- ↑ Chertow, GM, Soroko, SH, Paganini, EP, Cho, KC, Himmelfarb, J, Ikizler, TA, Mehta, RL. Mortality after acute renal failure: models for prognostic stratification and risk adjustment. Kidney Int, 70(6), 1120-6, 2006
- ↑ Pupim, LB, Flakoll, PJ, Ikizler, TA. Exercise improves albumin fractional synthetic rate in chronic hemodialysis patients. Eur J Clin Nutr, 61(5), 686-9, 2007
- ↑ Majchrzak, KM, Pupim, LB, Flakoll, PJ, Ikizler, TA. Resistance Exercise Augments the Acute Anabolic Effects of Intradialytic Oral Nutritional Supplementation. Nephrol Dial Transplant, 2007
