Hemodialysis: A Life Saver fo... Video Transcript

Participants

Lisa Clark , Jai Radhakrish MD, MRCP (, Leonard Stern MD

Summary

One of the most important lifesaving advances for kidney failure, dialysis, was invented during World War II, but not widely available until the 1960s. Today, thousands of kidney patients owe their survival to this process. Join our panelists as they focus on the benefits of hemodialysis.

Webcast Transcript

LISA CLARK: I'm Lisa Clark. Welcome, and thank you for joining us for this webcast. Make no mistake, the diagnosis of kidney disease is a serious medical issue, but the last 50 years have seen the kinds of medical advances which make kidney disease something you can live with. One of the most important lifesaving advances, dialysis, was invented during World War II, but not widely available until the 1960s. Today, thousands of kidney patients owe their survival to this process. In the next few minutes, we'll take a look at dialysis, how it works, and who can benefit from it.

Joining us this evening, Dr. Leonard Stern and Dr. Jai Radhakrishnan. Both men are Assistant Professors of Clinical Medicine at the College of Physicians and Surgeons of Columbia University.

I'll start with you, Jai. To understand the role of dialysis in treating kidney disease, you have to be aware of the main function of the human kidney, to filter toxins and waste from the bloodstream. What criteria did doctors use to determine how much kidney function is required or is lost before they consider dialysis as a treatment option?

JAI RADHAKRISHNAN, MD: By trial and error, we came to know that we need about only 10% to 15% of kidney function. Certainly below 10%, most patients do feel the effects of not having adequate kidney function, and approximately thereabouts, we start the dialysis procedure.

LISA CLARK: Now, there are several types of dialysis -- peritoneal dialysis, and there's hemodialysis. For the purposes of this segment, we're going to focus on hemodialysis, which is a specialty of yours, so I'll ask you to begin with a brief explanation of the process. What happens when someone goes in for dialysis?

JAI RADHAKRISHNAN, MD: Hemodialysis essentially means cleaning the blood, and hemodialysis is a process whereby a machine which takes over part of the kidney function takes a large volume of blood from the patient, processes it the way the kidneys would normally process it, get rid of the waste and return the blood washed, in a manner of speaking, back to the patient. So when a patient who is supposed to be dialyzed comes to our unit, for example, you would sit in a chair, the nurse would put a needle into a special vein, which is surgically created, called a fistula. The two needles are connected to a machine, which then runs through the treatment time, which is about four hours. At the end of the treatment, the patient basically disconnects from the machine and is able to go home.

LISA CLARK: Len, is the fistula a permanent access site for hemodialysis?

LEONARD STERN, MD: Hopefully. The fistula is created by the surgeon in preparation for starting dialysis. These fistulas take a long time to mature, so the optimum management of a patient would be to create the fistula perhaps six months to a year before the patient requires treatment so that the vein would grow in size and would become large enough. The requirement of the fistula is that two needles are placed into the fistula repeatedly. The patients refer to it as a lifeline. After the needles are placed in and then removed, the fistula is reusable. An ordinary vein, when you place a needle into an ordinary vein, it collapses. It's no longer usable.

The fistulas have problems, though. In older patients, which are the majority of people that start dialysis, their veins are not good enough to create a fistula. Then they have to resort to artificial graft material, which is called Gore-Tex graft material, and the surgeons place these in position between arteries and veins, and these tend to have a limited lifespan. There are technical problems with them. They clot off frequently. But they also represent one form of access.