Kidney transplantation, hemodialysis, and peritoneal dialysis are three common renal replacement therapies for people with end-stage renal failure.
End-stage renal failure (stage 5) is when the disease is most severe. The kidneys are severely damaged, losing most or all of their function. The glomerular filtration rate (the amount of blood filtered through the kidneys in a unit of time, usually measured in minutes) is at its lowest (less than 15mL/min/1.73 m2).
Weak kidney filtration causes excess substances and toxins to accumulate and harm the body, especially the cardiovascular, digestive, nervous, respiratory, skin and blood systems. Patients are at risk of death if they do not receive a kidney transplant in time.
Dr. Vo Thi Kim Thanh, Deputy Head of the Department of Nephrology, Center for Urology - Nephrology - Andrology, Tam Anh General Hospital, Ho Chi Minh City, said that to prolong life, patients need hemodialysis, peritoneal dialysis or kidney transplant. Depending on health status and economic conditions, doctors will provide appropriate options for patients and their relatives to choose from.
Hemodialysis (artificial blood filtration) is a method of filtering blood outside the body using a specialized machine. This method is also indicated for people with acute kidney failure, often due to poisoning.
The dialysis machine pumps the patient's blood through a filter, then returns the blood to the body. The machine's filter retains blood cells, proteins, and other important substances, and removes waste products such as urea, creatinine, potassium, and excess fluid from the blood.
The advantage of this method is that it helps patients control blood pressure and maintain fluid and mineral balance in the body. However, patients must go to the hospital three times a week for dialysis. The process can cause complications such as blood vessel blockage, low blood pressure, and blood loss.
Patients undergoing hemodialysis at Tam Anh Hospital in Ho Chi Minh City. Photo: Dinh Tien
Peritoneal dialysis (peritoneal dialysis) is a method that uses the patient's own peritoneum as a filter membrane.
The peritoneum has an area almost equal to the body area, about 1-2 m2. Dialysate is introduced into the abdomen to carry out the metabolic process between blood and the dialysate through three mechanisms: diffusion, ultrafiltration and absorption. Metabolites and excess water will pass through the peritoneum and be excreted when the fluid is changed. Patients need peritoneal dialysis every day, which can be done manually or by machine.
This method is quite simple and can be done at home or in places where there is no dialysis machine. Patients have monthly check-ups and receive dialysate and medication. Peritoneal dialysis is suitable for many people, especially those who go to school or work. Patients do not need to abstain too much from their diet.
However, after peritoneal dialysis, patients may face risks such as hypotension due to ultrafiltration withdrawing a lot of fluid, hyperglycemia, peritonitis, and catheter outlet infection due to non-compliance with the instructed procedure when performing at home.
According to Dr. Thanh, the two methods above are the most popular today and can be combined during treatment.
Nurse instructs and performs peritoneal dialysis for patients. Photo : Anh Thu
Kidney transplantation is the best treatment option, increasing the chance of a longer and healthier life for people with end-stage renal failure. According to Dr. Kim Thanh, the success rate of this method is high. A healthy kidney replaces a kidney that has lost its function. The source of the transplanted kidney can be from a living donor (relative or non-relative) or a person who is brain dead.
Before the transplant, the patient may or may not have had kidney replacement therapy with peritoneal dialysis or hemodialysis. If the transplant is successful, the patient can return to a normal life, with a better quality of life than with other methods.
However, according to Dr. Kim Thanh, patients need to take anti-rejection drugs for life, and the risk of rejection of the donated organ can occur at any time. Surgery costs are high, and the source of donated organs is quite scarce.
Hoang Lien Son
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