Chemistry: Hemodialysis Vs. Peritoneal Dialysis

July 2015 my father was diagnosed with stage five kidney failure and heart failure; I remember thinking these illnesses were rare. I’ve come to find out that they aren't rare at all, the sad truth is that many people all around the world suffer from kidney disease and more severely kidney failure. There are three common treatments to combat these diagnoses; kidney transplant, hemodialysis and peritoneal dialysis. I wanted to learn more about the two treatments that my dad has personally attempted; hemodialysis (HD) and peritoneal dialysis (PD). Although my father is still on the waiting list for a kidney transplant we are still left crossing our fingers. My dad is an incredibly strong person and most would even say hard-headed; he reminds me that even if you have a terminal illness you can still be the funniest person in the room.

Kidney disease and kidney failure differ by severity and total amount of kidney function. Most recently my father has had 14% kidney function between both kidneys and that would place him in stage five kidney failure. This means that the kidney function is so low that they are no longer able to filter blood and make urine, causing toxins in the blood and inside the body to build up (Davita Kidney Care 2018). Treatment methods are being used to regulate waste materials as the normal human kidney does day and night. Kidneys have a very important job in the human body, they remove waste products from blood such as extra salts and water. Blood is pumped all over the body, distributing oxygen and nutrients to cells; it also carries “waste materials” from those cells to control our bloods composition carefully; some of the many things blood contains include dissolved ions, cells, proteins, organic waste and even proteins such as hemoglobin which our bodies still need (Casiday and Frey 2018).

Hemodialysis is a common recommendation for patients with kidney failure such as my father. I was shocked to learn that “ In 2015, the united states had more than 703,000 individuals being treated for end stage renal disease, with over 440,000 receiving hemodialysis” (Zins,Savannah,et.al.13). Before Hemodialysis can even begin; one of two pathways need to be created via surgery. One is called a graft which binds a vein to an artery via synthetic tubing and the other is called a fistula which also connects veins to an artery but using your own blood vessels instead of synthetic tubing to increase blood flow and make the vein grow larger to use in several needle injections during hemodialysis (National Kidney Center 2017-2018). My dad received the surgery for a fistula; making his forearm two times bigger overnight, now more like 3 times the size from regular dialysis use. The fistula will continue to grow in size as the years go on;it purrs like a kitten; and when I link arms with my dad I can feel his blood being pushed either which way. “Hemodialysis is a therapy that filters waste, removes extra fluid and balances electrolytes (sodium,potassium,bicarbonate,chloride,calcium,magnesium and phosphate)”(Davita Kidney Care 2004-2018). During hemodialysis two needles are inserted into the fistula; they are connected to a machine used to remove waste materials for the blood, creating a kind of closed circuit filtering system. The synthetic dialysis tubing used is somewhat porous, theses pores cannot be seen by the naked they are microscopic and small enough for waste to come through and leave the healthy nutrients in the blood cells. “Dialysis involves diffusion of solutes across a semipermeable membrane” (Wikipedia contributors 2018). Diffusion is something we covered in class from what I remember diffusion is a form of filtering; molecules move from a higher concentration area to a lower concentration area to achieve a more balanced solution or dynamic equilibrium. This process of dialysis worked well for my father; other than sitting 4 hours a day 3 days a week hooked up to a machine. My dad decided to look into other options to maintain more independence.

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“The largest responsibility for maintaining the chemistry of the blood falls to the kidneys, a pair of organs located just behind the lining of the abdominal cavity. It is the job of the kidneys to remove the harmful particles from the blood to regulate the bloods ionic concentrations, while keeping the essential particles in the blood” (Cassiday and Frey 2018)

The second treatment that was recommended to my father for his kidney failure or end-stage renal failure was peritoneal dialysis; a form of dialysis that is machine free and can be done from the comfort of your own home after a few training sessions. Before starting peritoneal dialysis there is a necessary surgery ment to create a pathway for to remove the toxins from the body artificially. This pathway is created via surgery and a catheter is inserted about six inches to the right of the belly button(in my dad’s case). Before surgery my father made me watch many videos of this surgery in preparation for the real thing, still unsettling to think about the catheter being inserted into a hole in his belly. The only way to make that pathway was to use what looked like a hook to poke through the belly button and out the side of the belly like something out of an alien movie. Instead of using synthetic tubing and the person's forearm; peritoneal dialysis uses the patents own belly, a catheter and a cleansing solution called dialysate.(National Kidney Foundation 2018). There are different concentrations of dialysate solution available for patients depending on severity. This at home treatment is rather simple but because the catheter is a direct line into the body, sterilization is a key factor. The peritoneal dialysis process is an exchange of fluid, clean fluid flowing through the catheter into the patient's abdominal cavity and once it has diffused it can be emptied out and flushed away with all the waste materials, proteins, phosphate and many other molecules our body doesn’t need in the bloodstream at that time. This process is done using gravity mostly, once the bag of cleansing fluid is connected to the catheter the bag is placed somewhere above abdomen and a valve is opened for the fluid to flow into the abdominal cavity; once the solution is completely within the patient; the valve can be closed and normal activities can commence. Three to four hours later a tubing can be connected from the catheter to your household toilet and the valve can one again open and flush out the cleansing solution now filled with waste molecules. (Kidney.org 2017). This process of dialysis works for a lot of kidney disease patients, sadly for my father this form of dialysis did not remove enough waste from his system to perform optimally. He was recommended this form of dialysis twice, twice he got a pathway surgery, twice he got the catheter removed it just wasn't enough to make up for 14% kidney function.

Although both of these processes are used to cleanse and regulate patients blood along with kidney function; it seems like they are quite different in procedure.Some would say they also differ in quality of life for patients using different forms of dialysis. Hemodialysis for example; patients reported “fatigue, intradialytic hypotension, cramps, and dizziness as common side effects of the treatment”.(Zins.et.al 21) Peritoneal dialysis patients have higher risks of infection because the catheter is connected to the person 24/7 a simple fall or poke could allow bacteria directly into the abdominal cavity if not properly taken care of. All in all the best quality of life is found in kidney transplant patients, and little to no difference in quality of life among hemodialysis and peritoneal dialysis patients.(Rad.et.al.391)

Works Cited

1. Casiday, Rachel, and Regina Frey. 'Maintaining the Body's Chemistry: Dialysis in the Kidneys.' chemistry.wustl.edu, Washington University Department of Chemistry , www.chemistry.wustl.edu/~edudev/LabTutorials/Dialysis/Kidneys.html. Accessed 1 Dec. 2008.
2. 'Hemodialysis.' National Kidney Center, Johns Hopkins and other Kidney Resources, 2018, www.nationalkidneycenter.org/treatment-options/kidney-dialysis/hemodialysis/. Accessed 29 Nov. 2018.
3. Pawel, Miriam. 'California Ballot Initiatives are Powerful. The Powerful have noticed.' The New York Times, 5 Nov. 2018, www.nytimes.com/2018/11/05/opinion/california-ballot-initiatives-direct-democracy.html. Accessed 28 Nov. 2018.
4. 'Peritoneal Dialysis: What you need to know.' kidney.org, National Kidney Foundation , 2017, www.kidney.org/atoz/content/peritoneal. Accessed 1 Dec. 2018.
5. Rad, Enayatollah H., et al. 'Health related quality of life in patients on hemodialysis and peritoneal dialysis.' Iranian journal of kidney diseases, vol. 9, no. 5, Sept. 2015, pp. 386-92. EBSCOHOST, web.a.ebscohost.com.ezproxy.occlib.nocccd.edu/ehost/pdfviewer/pdfviewer?vid=5&sid=0a085046-656d-46b3-8c97-8997e0508b71%40sdc-v-sessmgr04. Accessed 1 Dec. 2018.
6. 'What is Hemodialysis?.' Davita Kidney Care, Davita Medical Group , 2004-2018, www.davita.com/treatment-services/dialysis/in-center-hemodialysis/what-is-hemodialysis. Accessed 1 Dec. 2018.
7. Wikipedia Contributors. (2018, October). Hemodialysis in Wikipedia, The Free Encyclopedia. Retrieved November 29 2018, from https://en.wikipedia.org/wiki/Hemodialysis
8. Zins, Savannah, et al. 'Complementary Therapies for Pain Among Individuals Receiving Hemodialysis: A Systematic Review.' Nephrology Nursing Journal, vol. 45, no. 1, Jan. 2018, pp. 13-24..EBSCOHOST, ezproxy.occlib.nocccd.edu/login?url=search.ebscohost.com/login.aspx?direct=true&db=asn&AN=128108110&site=ehost-live. Accessed 28 Nov. 2018.