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Water - Such a simple thing but but plays a major role in our lives.

Water if not clean can make you very very sick.

However, for Kidney Failure patients who are on Hemodialysis water plays another major important role.

On one hand Kidney Failure patients have to restrict water intake based on their residual kidney function and capacity to remove extra fluid from body.

On other hand a lot of Water is used in the Hemodialysis procedure.

In today's podcast we will talk about the importance of quality of water used in Hemodialysis.

So to draw comparison and to explain the kind of exposure Dialysis patients have with Water lets understand the volume of water we get exposed

A normal healthy human - 5-6 liters per day i.e. 24 hours | (Acceptable TDS limits - Upto 100-200)

A hemodialysis patient - 120 - 192 liters in a 4 hour hemodialysis session (Acceptable TDS limits - less then 10, but strict compliance to AAMI/EU/ISN guidelines)

There are Water purification or treatment plants specifically designed for filtering water to a level where it can be used for Hemodialysis.

There are very stringent international guidelines which are now being adopted in India as well where specific parameters are provided on which filtered water has to qualify. Association for the Advancement of Medical Instrumentation (AAMI) and the European Best Practice Guidelines (EBPG) are two such guidelines. ISO standards, Indian Society of Nephrology - Guidelines

These guidelines define the acceptable limits for various contaminants, including bacteria, endotoxins, chemical impurities, and water conductivity.

In my experience Very few Dialysis centers regularly test their water sources, dialysis machines, and dialysate to ensure compliance with these standards.

As a patient, you shall be aware of these facts and you may also ask your dialysis clinic or dialysis provider to show the water testing report which can provide you details of the quality of water which is being used in your dialysis.

Any compromise in the water quality may lead to health issues and in extreme conditions be fatal for patient's life.

Woh kehte hain na ... JAL HI JEEVAN HAI. To jagrook rahiyee aur apne dialysis program me sacchee partner aur bhagidaar baniyee.

https://www.kidneysupportnetwork.com/

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Dialyzers, which are also known as Artificial Kidneys are the most important component of Hemodialysis. In simple words Dialyzers are filters which are used to filter blood and remove waste products, excess fluid and toxins from the body during dialysis.

Key Points

1. Dialyzer Surface Area -
   1. Dialyzer surface area is measured in Square Meters or generally you will se dialyzers size written as 1.3, 1.5 or 1.8. This 1.3 or 1.8 means that the dialyzer's surface area is 1.3 sqmt or 1.8 sqmt. The more the better. However decision on surface area shall be made in consultation with your treating Nephrologist.
2. Dialyzer Flux
   1. As we had told you that dialyzer has membranes which have microscopic holes. The size of these holes decide which all molecules can come out of blood.
   2. Its a two way process - Higher the dialyzer flux - it can remove larger molecules from body (eg. Beta2M). However, with high flux dialysers there is always a risk of water/dialysate entering into the blood stream. Thus its very important to ensure water quality is as per required standards.
3. Single use Vs. Re-use of Dialyzer
   1. Single Use or Re-Use - Understanding this is very simple. Dialyzers are either used only once and then discarded or its re-used.
   2. Obviously single use dialysis is going to be costly as a new dialyzer is tobe used in every dialysis procedure. In India due to cost considerations most of the patients are dialyzed by reusing dialyzers.
   3. When it comes to re-usage of dialyzers its important to understand that after every dialysis few of these hollow fibers get clogged or closed. Thus overall efficiency of Dialyzer gets reduced. And its essential to ensure dialyzers are not re-used once they fall below a certain efficiency. This is measured with term Fibre bundle volume in technical term.
   4. Considering that there is no manual way of checking fibre bundle volume there are Dialyzer re-processing machines which are used to not only clean and disinfect the dialyzers but also check if the efficiency of dialyzer and cases of damage.
   5. Patients shall be alarmed if they want to take dialysis in clinics where dialyzers are reused and the clinic does not have Automatic Dialyzer Reprocessing machine. And try not to take dialysis in clinics which do reuse of dialyzers and do not have a automatic dialyzer reprocessor machine. In case you can't avoid taking dialysis in such clinics then try and keep the no. of times a dialyzer is re-used to minimum.
   6. Number of reuse - This is one of the very interesting discussions I have had with patients and doctors both. How many times do we re-use dialyzers ? So we all need to understand - if a dialyzer is declared fit to be reused by the automatic reprocessing machine it shall be treated as good to be reused and else not. It can be 3rd time or 10th time. Considering the process is automated without any human intervention it eliminates chances of error or miscalculation.
4. Company / Brand of Dialyzers :- Government of India has fairly stringent norms for dialyse registration & thus for patients dialyzer brand shall not be a major concern. So, if you are asked to pay more for a particular brand of dialyzer then its better to save the money and use it in getting 1 extra dialysis a month or proper medication etc. Again a very personal choice and there is no wrong decision here.

At the end once you are equipped with information around 'Dialyzers' please do talk to your Nephrologist before changing anything or any protocol.

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In this episode we talk about Vascular Access. The Access used in Hemodialysis and how patients can maintain health of their vascular access to keep it healther and working for longterm.

As you may know Hemodialysis is required when someone's kidney's stop working completely or are still working but can not sufficiently or completely remove waste materials from our blood stream.

The Hemodiaysis procedure is done by taking out blood from the body and waste material and extra fluid/water is removed from it by passing it thru a Filter which is called Dialyzer or an artificial Kidney also. The entire process is controlled by highly sophisticated machines.

The location or body parts from where patient's blood is taken out or re-injected in the body is called access site. And the access created at the site is named accordingly.

There are 3 types of access used in Hemodialysis:-

1. Arteriovenous Fistula (AV Fistula) - “AV” is short for arteriovenous, referring to the connection created between an artery and a vein. Your arteries carry oxygen-rich blood from your heart and lungs to the rest of your body. Your veins then carry oxygen-depleted blood back to the heart and lungs.

AV fistulas are usually created in the forearm but may sometimes be placed in the upper arm also by a surgeon or a Nephrologist. In this surgical procedure Artery coming into forearm is connected to the Vein. If possible it’s best to have the fistula placed in your non-dominant arm.

The Fistula surgery is a minor surgery and is generally performed in a day care setting which means patient is not required to get admitted in the hospital in most of the circumstances.

Once AV Fistula procedure is done generally it takes 30-45 days for the access to mature for effective usage for Dialysis.

To maintain an AV fistula, you should: keep the area clean, avoid wearing tight clothing or jewelry on the fistula arm, do not sleep on the fistula arm, avoid carrying heavy objects with that arm, regularly check for a "thrill" (vibration) over the fistula, and immediately report any signs of infection like redness, swelling, or pain;always consult your healthcare provider for specific instructions regarding your fistula care.

Key points to remember:

• Avoid compression: Don't wear tight clothes, bracelets, or watches on the arm with the fistula as they can restrict blood flow.
• Sleeping position: Never sleep on the arm with the fistula.
• Lifting heavy objects: Avoid carrying heavy bags or objects with your fistula arm.
• Check for "thrill": Regularly feel for a vibration (thrill) over the fistula to ensure proper blood flow.
• Monitor for infection: Watch for signs of infection like redness, swelling, pain, or warmth around the fistula area.
• Hand exercises: Perform gentle hand exercises to promote blood flow in the fistula.
• Blood pressure checks: Always use your non-fistula arm for blood pressure measurements.

2. Central Venous Catheters (CVC) - Third option is using a Central Venous Catheter. This access method is what more than 80% of dialysis patients use to start dialysis as CVC catheterisation can be done in a day care procedure and unlike AV Fistula, it can be used for dialysis immediately after placement. They Can be placed in Jugular Vein or Femoral Vein depending on the requriement and conditio

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