Discuss the Management of Kidney Failure by Dialysis and Transplant
Most humans are born with two bean-shaped kidneys (approximately 11cm long and 6cm wide) located in front of the twelfth ribs at the back of the abdominal cavity. Oxygenated blood and nutrients are supplied to the kidneys by the renal artery and the renal vein carries away filtered blood to the heart.
Kidneys play a crucial role in homeostasis, working as vital filtration and purification organs. They filter poisonous urea and other waste products from the bloodstream so that they can be eliminated by excretion from the body in urine. The production of urine containing variable amounts of water and solute ...view middle of the document...
A net movement of urea, water, glucose and salts such as sodium and potassium out of the blood is ensured by the composition of the dialysate. The cleaned blood returns. Haemodialysis is usually carried out in hospital or a special clinic, the process taking four hours, three times a week. Patients will be lying on a couch or sat in a chair and can pass the time reading or watching television. Home treatment is possible but only after extensive technical training has been received by the patient. For home treatment, this form of dialysis, unlike peritoneal dialysis, realistically requires a separate room and therefore has a greater degree of interference with the home.
Peritoneal dialysis utilizes the peritoneum as a dialysing membrane. A stoma is made in the abdomen wall and the dialysing fluid is introduced through a tube. It must be performed four times every day but as a dialysing treatment is still considered to be the least time consuming as haeomodialysis can involve lengthy journeys to and from hospital. Perhaps its greatest advantage is that during peritoneal dialysis treatment, the patient is free to walk around. It can be done at any hour and can provide a greater sense of independence. The dialysate must be exchanged every six hours but this is a simple procedure which the patient can carry out themselves after some basic training. It can be executed at home, in the workplace or on holiday, with comparative ease. Bags of solution are easy to take on holiday. In the case of Haemodialysis, holidays are only possible where dialysis can be organised in another unit. If the unit is non-NHS, the patient is responsible for costs that exceed the NHS equivalent.
Diet is essential in kidney failure because waste products from our food can not be eliminated and so should be reduced. Salty foods should be avoided. Potassium and phosphate should be controlled. The diet for a haemodialysis patient is stricter than that of a peritoneal dialysis patient.
Dialysis is an invasive technique and it presents risks and side effects. Damage to the access point or bleeding can occur. Catheters present risk. Risks of infection, particularly peritonitis (in peritoneal dialysis) with its flu-like symptoms or septicaemia (particularly haemodialysis) are possible. Cleanliness and good hygiene facilitate prevention. Anaemia due to reduced levels of erythropoietin (especially haemodialysis), hypertension, MRSA, risk of hepatitis B and C due to exposure to blood during treatment and the theoretical risk of HIV are all concerns.
Overall, it is considered that of the dialysis options, peritoneal dialysis entails less financial burden. Dialysis filters are expensive pieces of precision engineering that can be used for only a few sessions and must then be discarded. Due to the costs of this equipment, maintenance and personnel, dialysis treatment is substantially more expensive than kidney transplant.
Kidney transplantation involves a kidney from a donor being...