CHM 271

PRINCIPLES OF PHYSICAL CHEMISTRY

CASE STUDY
TITLE DIALYSIS : HOW AND WHY?

DATE OF SUBMISSION 5 JUNE 2020

GROUP MEMBER 1 : NURTYSHA BALQIS BINTI

MUHAMAD YAZID ( 2019233468 )

GROUP MEMBER 2 : DAYANA BATRISYA ( 2019408186 )

NAME OF LECTURER NOR HABIBAH MOHD ROSLI



INTRODUCTION

Dialysis, which started in the 1950s as an exploratory effort to preserve the lives of
selected patients, now offers life-saving care for millions of people with kidney
failure worldwide. With the advent of maintenance hemodialysis, the development of
other types of kidney failure treatment resulted in the implementation of a more
comprehensive concept of renal replacement therapy that included hemodialysis and
peritoneal dialysis, as well as kidney transplant.

Unfortunately, despite major advances in hemodialysis technology and in controlling

its complications, patient morbidity and mortality on dialysis remain high, at a time
when the incidence and prevalence of kidney failure is continuously growing.

Despite efforts to minimise the risks and complications, we face many technical
issues, some of which are difficult to overcome. Technical issues may be linked first
to patient characteristics and then, in short, to access problems, dialysis solutions,
drug administration, problems with equipment and operators and other issues that are
not yet well known.Other than that, dialysis costs a large amount of money. In certain
cases, the federal government pays 80 per cent of the expenses of dialysis. The
reduction of private health insurance or state Medicaid programs is also beneficial. A
potential loss of independence and changes in body image can be distressing to
patients who may find coping with disruptions of lifestyle a challenge.

Regarding solutions, the composition is constantly optimised to ensure minimal

disruption of the metabolic homeostasis, maximal removal of uremic toxins, and
ultrafiltration capabilities. Nevertheless, temperature of the dialysate, conductivity,
osmotic pressure, buffer capacity, and electrolyte and dextrose concentrations in both
HD and PD solutions are a few of the factors that can affect the success of the
dialysis treatment in the short or long term. The more we know about our patients'
problems, the more we understand that there are new challenges to surmount.
Research and creativity will continue to help pave the way for more secure care for
patients.
BACKGROUND

Dialysis is a treatment that does some of the things done by healthy kidneys. It is
needed when your own kidneys can no longer take care of your body’s needs. It is
also used in the treatment of cases of kidney failure, often known as end-stage renal
disease. This is where the kidney were seriously damaged and almost all of their
ability to work was lost. The kidneys are two bean-shaped organs, found behind the
liver and intestines at the back of the abdomen. The kidneys filter human blood every
day, eliminating waste products that are collected as part of your usual body
processes, as well as any extra fluid. The waste products and the extra fluid are urine,
which will be collected in the bladder before we go to the water. The kidneys have
millions of tiny filters that are known as nephrons. Nephrons flush out extra fluid
from the blood as blood flows through the kidneys, and waste products. They are then
released as urine from the body. But, if the nephrons get affected, the kidneys can
lose their filtering capacity and dangerous fluid and waste products can build up.
Without treatment, kidney failure will inevitably prove fatal. Both hemodialysis and
peritoneal dialysis cause side effects. This is because of the way dialysis is carried
out, and because dialysis can only compensate for the loss of kidney function to a
certain extent. One of the side effect is fatigue. Fatigue is a common side effect in
people who have had long-term use of both hemodialysis and peritoneal dialysis.
Fatigue is believed to be caused by a combination of the loss of normal kidney
function the impact that dialysis can have on the body, the dietary restrictions
associated with dialysis, the general stress and anxiety faced by many people with
kidney failure. Another side effects of hemodialysis is low blood pressure and muscle
cramps. While, the side effects of peritoneal dialysis is peritonitis.
RECOMMENDATIONS

Patients have to be proficient in certain basic skills for home therapies, both
peritoneal dialysis (PD) and hemodialysis (HD), and they must be reassured that
backup support is available around the clock at all times. Dialysis benefits patients
who have failed their kidneys but it is not as successful as a normal kidney. Patients
undergoing dialysis must be careful of what and how much they are drinking and
eating, and they must take medicine. The solution for the fatigue is to consult your
dietition as the patient’s diet will need to be changed to increase your energy levels.
For the low blood pressure, the easiest way to alleviate low blood pressure symptoms
is to ensure that you stick to your guidelines for routine fluid intake. Low blood
pressure can be caused by the drop in fluid levels that occurs during dialysis. Low
blood pressure can cause nausea and dizziness. If low blood pressure symptoms
continue, contact the dialysis care team, because it might be appropriate to change the
amount of fluid used during dialysis. Many people experience muscle cramps during
a hemodialysis session, usually in the lower legs. This is assumed this is because the
muscles are responding to the loss of fluid that happens during hemodialysis. Lastly,
peritonitis is treated with antibiotic injections (intravenous antibiotics). Antibiotics
are usually injected directly into the peritoneum tissue. The most effective way to
prevent peritonitis is to keep the dialysis equipment clean. Patients are going to
receive training on how to do this.

Patients undergoing dialysis treatment are at high risk of decreased physical function
and mobility, which are high predictors of failure, hospitalisation, falling and death
and are often associated with poor outcomes. Complications frequently found in this
patient population include peripheral neuropathy, congestive heart failure, heart
attack, stroke and amputation. Physical therapy can be suitable for patients on
dialysis care as it can be an important factor for improving quality of life through
physical function and mobility while addressing most of the same dialysis problems
and impairments typically found in patients. Maintaining good blood pressure can
help slow the deterioration of your kidneys.To avoid dehydration, drink fluids. Talk to
the doctor before take any anti-inflammatory drugs, including ibuprofen (Advil) and
diclofenac ( Solaraze. Voltaren ).For some people, kidney transplantation is another
option. It's a long-term commitment, too. Talk to the doctor about whether a
transplant is right for you.

PROPOSED SOLUTION
Kidney Transplantation
In 1954, Dr. Joseph E. Murray performed the first successful kidney transplant at
Peter Bent Brigham Hospital in Boston. The Patient, Richard Herrick, received a
donated kidney from his identical twin, Ronald. Previous kidney transplant attempt
on other patients had failed due to organ rejection. The Herrick case owed its success
to earlier research done on the body reaction to skin grafts.
Organ rejection was a major problem in transplants. During World War II, scientist
Peter Medawar was asked by Britain’s Medical Research Council to investigate why
skin taken from one person would not form a permanent graft to the son of another
person. Medawar discovered that a graft from a donor that was related to the patient
had a lower risk of rejection. He also learned a graft donated by a twin had a
dramatically reduced rate of rejection. More research revealed that the body’s
immune system was responsible for organ rejection. Foreign tissue was treated as an
invader and attacked by the body. Tissue from a genetically- related donor was more
likely to be accepted by the body and safe from immune system’s assault.
Once scientist realised the immune system was responsible for organ rejection, work
began to find a way to stop the immune response. Radiation was first used, but
discontinued because the side effects were too severe. Scientist discovered that a drug
called azathrioprine helped suppress the immune response when it was used with a
corticosteroid. This drug therapy led to higher success rates for organ transplants. In
the 1980s, a more effective immunosuppressant called cyclosporine was discovered.
This immunosuppressant, along with advanced techniques to match patient with
donors, helped boost transplant success to over 85 percent.
 According to the United Network for Organ Sharing ( UNOS ), more than 19000
people received kidney transplants in 2016. The average success rate one year after
transplant surgery was 90 percent. To date, there are over 97000 patients waiting for a
kidney.

ALTERNATIVES
Herbal Supplements
Some thoughts about using herbal supplements to help with any health concerns you
may have, but as a patient with kidney disease, should use caution with herbal
supplements. Use of herbal supplements is often unsafe if you have a kidney disease
since some herbal products can cause harm to your kidneys and even make your
kidney disease worse. Also, the kidneys cannot clear waste products that can build up
in patient’s body. The herbal supplement market is a multi-million dollar business.
Patient might hear from a friend or family member about and herbal supplement that
they think has improved their health or well-being and they suggest it to the patient.
While this advice may be fine for them, it can be dangerous for a person with kidney
disease.
HemoDialysis
Research has shown that patients with chronic kidney disease who are treated with
dialysis have impaired physical functioning that is associated with poor outcomes.
Research has also shown that patients with chronic kidney disease have decreased
gait speed which is known to increase their risk for reduced survival and adverse
health events.

Anemia Management
Healthy kidneys produce a hormone called EPO. EPO prompts the bone marrow to
make red blood cells, which they carry oxygen throughout the body. When the
kidneys are diseased or damaged, they do not make enough EPO. As a result, the
bone marrow makes fewer red blood cells, causing anemia.

Stem cell therapy

Stem cell research may also enable us to utilise the body’s own repair mechanism to
find treatments for kidney disease. In acute kidney disease, the body can often repair
kidney damage itself, but it is unable to do this well enough to tackle the progressive
damage that occurs in chronic kidney disease.
REFRENCES
- DaVita Inc (2004-2020) https://www.davita.com/treatment-services/transplant/the-
alternative-to-dialysis
- Kidney International Supplements(2012) https://www.niddk.nih.gov/health-
information/kidney-disease/anemia
- Alana Biggers (2014), Healthline media, What is Dialysis? And how can it help.
Retrieved https://www.medicalnewstoday.com/articles/152902#what_is_dialysis
on July 18, 2018.
- 3.Carissa Stephens (2005), Dialysis. Retrieved https://www.healthline.com/health/
dialysis#alternatives-to-dialysis on March 30.
- National Kidney Foundation (2015), https://www.kidney.org/atoz/content/
dialysisinfo.
- Melissa Chamney (2018), British Journal Of Nursing, Dialysis access and the
impact on body image. Retrieved from https://www.researchgate.net/publication/
5438976_Dialysis_access_and_the_impact_on_body_image_Role_of_the_nephrol
ogy_nurse on March 2018.