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 Blood Purification


Blood Purification Medical Team

The division of blood purification is composed of two units, i.e., hemodialysis and peritoneal centers. The former provides hemodialysis, plasmapheresis, and hemoperfusion, while the latter offers continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your bones strong and your blood healthy. When your kidneys fail, harmful wastes build up in your body, your blood pressure may rise, and your body may retain excess fluid and not make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys. Hemodialysis is the most common method used to treat advanced and permanent kidney failure. Hemodialysis means "cleaning the blood" -and that is exactly what this treatment does. Blood is circulated through a machine which contains a dialyzer (also called an artificial kidney). The dialyzer has two spaces separated by a thin membrane. Blood passes on one side of the membrane and dialysis fluid passes on the other. The wastes and excess water pass from the blood through the membrane into the dialysis fluid which is then discarded. The cleaned blood is returned to your bloodstream. Most patients go to a clinic--a dialysis center--three times a week for 3 to 5 hours each visit.

One important step before starting hemodialysis is preparing a vascular access, a site on your body from which your blood is removed and returned. There are three basic kinds of vascular accesses for hemodialysis: an arteriovenous (AV) fistula, an AV graft, and a venous catheter. The AV fistula is considered the best long-term vascular access for hemodialysis because it provides adequate blood flow for dialysis, lasts a long time, and has a complication rate lower than the other access types. A surgeon creates an AV fistula by connecting an artery directly to a vein, usually in the forearm. Connecting the artery to the vein causes more blood to flow into the vein. After the 4 to 6 weeks the fistula needs to heal, needles can be placed so that arterial blood can be pulled off for dialysis. Turbulent blood flow over the AV fistula is commonly felt and termed a thrill.

The advantages of hemodialysis:
Hemodialysis cleans and filters your blood temporarily rid your body of harmful wastes in a shorter and more efficient way. Besides, it is usually done in a dialysis center by nurses and trained technicians. Most patients need to visit a dialysis center three times a week. You can have a better interaction about the medical team.

Possible Complications:
Vascular access problems are the most common reason for hospitalization among people on hemodialysis. Common problems include infection, blockage from clotting, and poor blood flow. These problems can keep your treatments from working. Other problems can be caused by rapid changes in your body's water and chemical balance during treatment. Muscle cramps and hypotension, or a sudden drop in blood pressure, are two common side effects. Low blood pressure or hypotension can make you feel weak, dizzy, or sick to your stomach. You'll probably need a few months to adjust to hemodialysis. Side effects can often be treated quickly and easily, so you should always report them to your doctor and dialysis staff. You can avoid many side effects if you follow a proper diet, limit your liquid intake, and take your medicines as directed.

Plasmapheresis is an extracorporeal therapy used to remove, clean, and return of blood plasma from blood circulation. During “double-filtration” plasmapheresis, blood is initially taken out of the body through a needle or previously implanted catheter. Plasma is then removed from the blood by a cell separator, and the blood cells are returned to the person undergoing treatment. The plasma, which contains the antibodies, will then flow through a second hemofilter to remove harmful antibodies or substances before returning to the patient. In a similar therapy called plasma exchange, the removed plasma is discarded and the patient receives replacement donor plasma or saline with added proteins. Diseases that can be treated with plasmapheresis include rejection of graft kidney, systemic lupus erythematosus, pulmonary hemorrhage, fulminant hepatitis, primary biliary cirrhosis, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy: hemolytic uremia syndrome, multiple myeloma, thrombotic thrombocytopenic purpura, hyperviscosity syndrome: and familial hypercholesterolemia. 


    Hemoperfusion is an extracorporeal therapy used to remove toxic substances from a patient’s blood. The technique involves passing large volumes of blood over a hemofilter containing adsorbent substance such as resins and activated charcoal. Its major uses include removing drugs or poisons from the blood in emergency situations, removing waste products from the blood in patients with kidney failure, and as a supportive treatment for patients before and after liver transplantation.

Peritoneal Dialysis
Peritoneal dialysis uses peritoneal membrane in our body as the natural semi-permeable membrane. The kidneys are replaced by peritoneal membrane to eliminate metabolic waste product and water. First, we should implanted Tenckhoff catheter via surgical procedure into the peritoneal cavity. After about 1 to 2 weeks of implantation with good wound healing, regular peritoneal dialysis could be performed. Among peritoneal dialysis, there are several methods. The most common is continuous ambulatory peritoneal dialysis (CAPD). Patients should exchange the dialysate 4-5 times per day and during each exchange, the old metabolic waste product in the peritoneal cavity should be drained out first. Then the fresh dialysate was instilled. The whole procedure usually spends about 20-30 minutes. The fresh dialysate retains in the peritoneal cavity for about 4-6 hours to remove metabolic waste product and patient could perform his own daily activity such as working or studying.

The advantages of peritoneal dialysis:

1. Continue dialysis. When we produce metabolic waste products, peritonea dialysis continues to remove them simultaneously. This kind of dialysis is performed slowly and persistently. Besides, the hemodynamic is fluctuated more slowly. Therefore, peritoneal dialysis could decrease the discomfort during dialysis.

2. Patients could perform peritoneal dialysis by themselves. There is no obvious restriction to the place for exchanging dialysate. Besides, it spends only short times to exchange. Patients could work and go to school as them need.

3. The diet restriction is less intensively then hemodialysis.

4. There is no necessity for puncture.

5. The severity of anemia is lesser.

6. The effect on cardiovascular system is lesser.

The disadvantages of peritoneal dialysis:

1. Infection, which is including peritonitis and exit site infection, …etc. The hands washing is very important.

2. Protein loss. During peritoneal dialysis, little protein was lost via peritoneal membrane. Therefore adequate protein intake is necessary. 

3. The body weight and serum triglyceride may be increased.


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(Last revised: 2017/05/08 by Joyce)