HEMODIALYSIS

ENGLISH LESSON

Assignment from the teacher

Mr. Christovel kahuweka S.Pd

Arranged by :
Jovelia Judistyra Kojongian
XII SCIENCE 2
CHRISTIAN SENIOR
HIGH SCHOOL 2 BINSUS TOMOHON

2019
 DEDICATION
Thank you to God who is omnipotent because on his favor I was able to

complete this paper. I dedicate this paper to all who have supported me in completing

this paper. for my mother and father, my family and my friends, thank you for helping

me. and especially for Mr. Christovel Kahuweka who has commissioned this so that I

know how to make it, thank you all for encouraging me.
 VALIDATION

This paper is titled “HEMODIALYSIS” compiled by :

Name : Jovelia Judistyra Kojongian

Class : XII science 2

Gender : female

Email : kojongianjovelia@gmail.com

In fulfillment the final assigment first semester class 12 in christian high school 2 binsus

tomohon.

Tomohon, 25 july 2019

Accepted and validated Discover

Teacher Headmaster

Mr. Chirtovel F. B kahuweka S.Pd Dra. Stephanny L. Wuwungan

NIP. 19640102199110332003
 PREFACE

Gratitude was offered to God who commanded because it was mixed up and I

could complete the task of this paper.

The writer also wish to express his deep and sincere gratitude for those who

have guided in compleing this paper. This English paper contains some knowledge

about the blood washing process and some diseases that are experienced so that it is

required to wash the blood.

Hopefully, this paper can help readers find out all about hemodialysis.
 TABLE OF CONTENT

TITLE PAGE……………………………………………………………………………

DEDICATION SHEET…………….……………………………………………………

VALIDATION SHEET…………………………..................................................

PREFACE..…………………………………………………………………………….

TABLE OF CONTENT.………………………………………………………………

CHAPTER I PRELIMINARY

1.1 BACKGROUND………...................................................................................
1.2 PROBLEM FORMULATION………………………………………………..
1.3 RESEARCH OBJECTIVES………………………………………………….
1.4 BENEFITS OF RESEARCH………………………………………………….
 CHAPTER 1
PRELIMINARY

1.1 Background

Dialysis or dialysis is an artificial way to get rid of waste products and Excess

fluidfrom the body. This needs to be done if kidney function is only only 5-10 percent

of itsnormal capacity so that its functions must be replaced by kidney dialysis or kidney

transplantation. Hemodialysis is the most common dialysis form. At present the most

frequent and popular method is to use a dialysis machine, where this method aims to

remove excess fluids, chemicals and waste products from the blood (Yosep,2012)

Worldwide, an estimated 2 million people get dialysis every year.In Indonesia in recent

years there has been an increase in numbers patients who get dialysis, even though the

facilities are limited. Maybe there is 100,000 people who need dialysis (Kumar, 2012).

Based on a survey conducted at the Regional General Hospital Rantauprapat in

Labuhanbatu Regency was noted during 2012 that patients were hospitalized the way of

hemodialysis is 741 people.

The main risk factors for kidney failure, are diabetes mellitus and hypertension.

The best prevention strategy to reduce the number of patients with kidney failure is do a

healthy lifestyle and early screening. At 45 years old, do it periodic laboratory checks.

Also measure blood pressure, cholesterol, blood sugar and kidney function. If the results

are normal, repeat the year next. Kidney disorders can reduce a person's productivity

even life threatening. Kidney function is very diverse not only removing toxins from the

body but regulates blood pressure (Suharjono, 2011).

 Chronic kidney disease is a public health problem major throughout the world.

Because of the progressive increase both in incidents and prevalence of patients with

end-stage kidney disease or End Stage Renal Assessment (ESRD), and high mortality

rates and increased maintenance costs.

Some psychosocial factors include stress, depression, treatment anxiety. Stress

can arise due to the process of adjusting the patient to his condition. Patient with ESRD

undergoing a complex treatment regimen that involves not only dialysis but also a

and psychological functions.

For example, proceslong-term treatment, patients must use strategies to manage

their disease. Thus, individuals with a high level of self-care and self-efficacy that is

better able to manage their ESRD.

Patients with ESRD must try to adapt to the disease chronic physical and need,

in many cases, to overcome dependence on the dialysis machine to stay alive.

Adjustment in cognitive, emotional, and psychological behaviors and adjustments

needed by the patient. Attitude patients with disease seem to be important enough for

their results. In a manner specifically, patients who do not understand themselves and

have no control in a situation, it can cause stress. (Abolfazl et al., 2008) Stress is a form

of the body's reaction to situations that look dangerous or difficult.

 This stressful situation will make the body produce adrenal hormones which

functions to defend itself. If this hormone is excessive it will causing sufferers to be

prone to physical illness, according to their individual conditions. (Yekti Ari, 2010).

Patients with kidney failure who undergo hemodialysis, need 12-15 hours for

dialysis every week, or at least 3-4 hours per therapy.This activity will continue

throughout his life (Bare & Smeltzer, 2002). Dependence on dialysis machines for the

rest of his life and adjustments to the conditions of the illness result in changes in the

life of the patient. Change in life, is one trigger for stress. This change can be a variable

identified as a stressor (Rasmun, 2004). Patients usually face financial problems,

difficulties in maintaining work, sexual drive which disappears and impotence, worries

about marriage and fear against death (Bare & Smeltzer, 2002).

The occurrence of stress due to stressors that are perceived and perceived by

individuals, is a threat that can cause anxiety. other than that dependency on dialysis

machines for the rest of his life and adjustments self against sick conditions resulting in

changes in life patient. Changes in life, is one of the triggers for this stressed out. This

change can be a variable identified as stressor (Rasmun, 2004). Patients usually face

financial problems, difficulties in maintaining work, sex drive that disappears and

impotence, worry about marriage and fear of death (Bare & Smeltzer, 2002).
 The influence of patients on stress varies on the level of lightness, stress will be

easily overcome by simple things, such as using music therapy,relaxation, counseling,

getting closer to God, and lying down. However If stress has reached a severe level,

treatment must be done Guided by a doctor who supports not being mistaken for
therapy

or a psychiatrist.(Yekti Ari, 2010).

Hemodialysis is a treatment for people who have decreased kidney function.

Hemodialysis takes over kidney function to cleanse the blood by flowing through

"artificial kidneys". The background of the contents of this paper is expected to prevent

hemodialysis treatment for patients with impaired kidney function by increasing fluid

intake for kidney function that has not been chronic.

Hemodialysis is the release of metabolic waste substances such as urea and other

toxic substances, by flowing blood through a dializer device that contains a selectively-

permeable membrane where fusion of unwanted substances occurs. Haemodialysa is

carried out in conditions of kidney failure and some forms of poisoning

Many people feel uncomfortable and hesitant when the first time is done

hemodialysis. When you do hemodialysis, you will not feel anything, some people will

feel tired after hemodialysis is done, especially if it has only been hemodialysis several

times. After several times of hemodialysis, the excess fluid and toxins from your body

will decrease, you will feel energized again.

1.2 Problem Formulation

1) What is hemodialysis used for?

2) When should dialysis be started?

3) Can dialysis be temporary?

4) What are the signs that you need dialysis?

5) Can dialysis be stopped?

6) how does hemodialysis work?

7) what complications might occur from hemodialysis

8) Are diet changes necessary?

9) What are the pros and cons of hemodialysis?

10) What Are the Side Effects of Dialysis?

1.3 Research Objectives

1. to find out all about hemodialysis

2. To find out when should dialysis be started

3. To find out that can dialysis be temporary

4. To know what are the signs that we need dialysis

5. To know that can the dialysis be stopped

6. to find out how hemodialysis works

7. to find out the side effects of hemodialysis

8. to find out the history of hemodialysis

1.5 Benefits of Research

1.5.1 Nursing Education

The results of this study are expected to be useful for increasing knowledge

students and literature in the library about knowledge, attitudes and stress

hemodialysis outpatients.

1.5.2 Nursing Services

The results of this study can be used as information to nurses who work

in hospitals and clinics that have space facilities

hemodialysis in providing services

1.5.3 Nursing Research

The results of this study can be used as a source of data for research

then about knowledge, attitudes and stress of hemodialysis outpatients.

 CHAPTER 2

 Getting to Know Dialysis (Hemodialysis)

When you hear the term dialysis, surely almost some readers feel afraid and afraid.

Dialysis or hemodialysis becomes a negative scourge in the general public, due to the

myth that dialysis is the same as dying, if it has been carried out dialysis it will be done

for life and will definitely die. This opinion is not entirely true, because hemodialysis is

a medical treatment which is a therapeutic tool for kidney disease patients with certain

conditions. Indeed there are patients who need a lifetime of dialysis but there are also

those who only need a few times and the patient will return to normal. The opportunity

for improvement through hemodialysis depends on the severity of the patient's illness

caused by the delay in treatment, due to the patient and family's reluctance to have

dialysis immediately. But it must be remembered that of the 1 million people with

kidney failure there are 400 people who need dialysis therapy / hemodialysis.

The history of dialysis starts from a Scottish chemist named Prof. Thomas Graham who

in 1854 discovered the principle of separation of substances / substances through a

semipermeable membrane. In 1912 the first hemodialysis was performed on animals

using an artificial kidney (Artificial Kidney) by John L Abel, LG Rowntre and BB

Turner from John Hopkins Medical School. The first hemodialysis in humans was

carried out by George Haas in 1914 in Germany. While in Indonesia hemodialysis was

first performed in 1972 at Cipto Mangunkusumo Hospital (RSCM) Jakarta.

Hemodialysis involves blood circulation through a filter or dialyzer on a dialysis

machine. Dialyzer has two fluid compartments and is configured with a hollow capillary

fiber tube bundle.

Blood in the first compartment is pumped along one side of the semipermeable

membrane, while dialysate (the liquid used to clean blood) is pumped along the other

side, in separate compartments, in the opposite direction.

Gradients in blood and dialysate concentrations cause desirable changes in blood

composition, such as reduction of waste products (urea nitrogen and creatinine);

correction of acid levels; and equilibrium at various mineral levels.

Excess water is also removed.

The blood then returns to the body.

Hemodialysis can be done at the dialysis center or at home. At the center of

hemodialysis it usually takes 3 to 5 hours and is done three times a week. The patient

will need to travel to the dialysis center for hemodialysis at the center.

Some health centers can offer nocturnal (nighttime) hemodialysis options where this

therapy is carried out while the patient is sleeping. The duration of nocturnal dialysis

offers patients better survival and an improvement in their quality of life.

Hemodialysis at home can be done in a number of situations. A care partner is needed to

help patients with dialysis treatment. A family member or close friend can be chosen,

although sometimes people can hire a professional to help dialysis. Hemodialysis at

home can be done as a traditional treatment three times a week, long nocturnal

hemodialysis (overnight), or short hemodialysis every day. Daily hemodialysis and long

night hemodialysis offer advantages in quality of life and better control of high blood

pressure, anemia, and bone disease.

 Peritoneal dialysis.

Peritoneal dialysis uses a membrane layer (peritoneum) from the stomach as a filter to

cleanse the blood and get rid of excess fluid. Peritoneal dialysis can be done manually

(ambulatory peritoneal dialysis continuously) or by using a machine to do dialysis at

night (automatic peritoneal dialysis).

 About 2 to 3 liters of dialysis fluid is introduced into the abdominal cavity via catheter

access. This liquid contains substances that attract waste and excess water from the

tissue.

 The liquid is allowed to stay for 2 to several hours before being drained to take

unwanted waste.

 Liquids usually need to be exchanged four to five times a day.

 Peritoneal dialysis offers more freedom compared to hemodialysis because patients do

not need to come to the dialysis center for treatment. Patients can do many of their usual

activities while undergoing this treatment. This might be a better therapy for children.

Most patients are candidates for peritoneal hemodialysis and dialysis. There is a slight

difference in the results between the two procedures. The doctor may recommend one

type of dialysis based on medical history and the patient's surgical history. The best way

is to choose the dialysis modality after understanding both procedures and matching

them to one's lifestyle, daily activities, schedule, distance from the dialysis unit, support

system, and personal preferences.

 Before discussing further, let us understand a few understandings of dialysis.

Hemodialysis is an act of cleansing toxins in the body, because the kidneys are no

longer able to get rid of the remnants in the body. Hemodialysis is performed in patients

with chronic kidney disease and acute kidney disease in certain conditions.

1) What is hemodialysis used for?

Hemodialysis cleanses and filters your blood using a machine to temporarily cleanse

your body of harmful waste, extra salt, and extra water. Hemodialysis helps control

blood pressure and helps you control the balance of important substances such as

potassium, sodium, calcium, and bicarbonate.

Dialysis can restore kidney function. Diet, medication, and fluid limits are often needed

as well. Your diet, fluid, and the amount of medication you need will depend on the

treatment you choose.

2) When should dialysis be started

"Dialysis must begin when the benefits of reduced uremic signs / symptoms outweigh

the risks and other side effects on the quality of life of patients,"

The decision to start dialysis can be seen from uremia-related signs and symptoms,

estimated glomerular filtration rate (eGFR), eGFR reduction rate, patient quality of life

and patient choice. The decision to initiate dialysis is often complex. A general

approach can be made with conditions:

 Patients with eGFR> 15 ml / min / 1.73 m2. In this patient, dialysis initiation was not

performed even though there were symptoms that might be related to end-stage renal
 failure (ESRD) because it was usually still responsive to medical treatment so dialysis

was very rarely performed.

 Asymptomatic patients with eGFR 5-15 ml / minute / 1.73 m2. In this patient's

condition a rigorous evaluation is carried out. Dialysis is not done without signs /

symptoms related to ESRD.

 Patients with eGFR 5-15 ml / min / 1.73 m2 with signs / symptoms that may be due to

ESRD. Conservative management is carried out. If signs / symptoms are related to

refractory ESRD to therapy, dialysis is initiated. Unless there is an absolute indication

of dialysis it should not be postponed.

 Patients with eGFR <5. Patients with this condition initiate dialysis even without signs /

symptoms related to ESRD.

When to start dialysis in elderly patients

Internal Medicine Specialist from Awal Bros East Bekasi Hospital, Dr. Indah Fitriani,

SpPD explained that dialysis is a life-long therapy that often causes discomfort and

other risks for patients so it requires careful consideration of risk-benefits, especially in

elderly patients. Usually every dialysis will be done in general approach first but the

decision is complex because the signs / symptoms of uremic often are not apparent and

are almost always non-specific.

In elderly patients, when dialysis is done the effect is not the same as young age.

Generally in patients who continue dialysis can cause quality of life that can decline

after initiation of dialysis. Increased incidence of hospitalization and side effects of

dialysis (fatigue malaise) are more pronounced in elderly patients. "For this reason,

education for patients and families is needed for intradialytic complications

(complications that occur during hemodialysis / dialysis procedures)," he explained.

 3) Can dialysis be temporary?

It should be noted that dialysis is a kidney replacement therapy, this can be

temporary or permanent depending on the type of illness suffered by a patient.

So, can it be a while? Of course! Why it can be like that. In normal people, the kidneys

work 24 hours without stopping as long as humans are still alive. Various kidney

functions, the most important is the function of excretion that is releasing fluids along

with it is also removed toxins and metabolic substances that are not needed by the body

(read: kidney poison) which if not removed will cause bodily functions.

In performance, the kidneys must always be protected from conditions that can cause

kidney damage, namely high blood pressure (hypertension), diabetes (diabetes mellitus),

kidney stones / urinary tract, severe fluid deficiency, drugs that damage the kidneys, and

so forth. If kidney damage begins to occur, there will be an increase in kidney damage

marker, namely creatinine. There is also another kidney marker, the ureum which is the

end result of protein metabolism. Ureum and creatinine are indicators of the degree of

health in the kidneys.

In patients with severe fluid deficiency (for example due to acute diarrhea and massive

vomiting, not drinking for days, acute bleeding) there will be a decrease in blood flow

to the kidneys, this causes the kidneys to become less optimal in filtering and removing

kidney toxins so that eventually they occur increased ureum and creatinine. Although

adequate fluid therapy has been given, it is very likely that the ureum and creatinine

markers are still high so that it has finally been decided to dialysis. Is this the end of

everything? Not.

Precisely when a person is decided to dialysis because it is caused by a severe

lack of fluids, this is an act of relief so that kidney poisoning does not attack the brain

and can eventually cause death. In this case the kidneys are actually still good, but can

not work normally because of decreased blood flow to the kidneys. If after dialysis,
kidney toxins go down, the fluid is fulfilled and the subsequent evaluation of urea and

creatinine does not increase again, meaning that dialysis is only temporary. When

patients refuse dialysis and complications due to kidney toxins that are not removed,

that is precisely the end of everything.

In other cases, there are patients with urinary tract stones. Because there is a stone, the

urine produced by the blocked kidney cannot be removed, causing the kidney to swell

and eventually the kidney poison becomes increased. The right course of action in this

case is to make the stone, but before removing the stone, kidney poison must be lowered

first by dialysis. If this is done and the kidney poison has dropped, the stone removal

action will be carried out smoothly, urine can return out smoothly, the kidneys are

saved, kidney poison drops, the patient no longer needs dialysis.

Sometimes patients because they are afraid, refuse the dialysis action which results in

not being able to do the disposal of stones. Over time the kidney becomes damaged and

becomes chronic, if this continues, it will threaten the patient's life. This is precisely

what causes everything to end.

Excited by dialysis

Kidney is an organ if damaged can not be repaired anymore. Patients with Chronic

Kidney Disease (CKD) caused due to chronic high blood pressure, diabetes

complications, kidney polycystic disease, lupus / autoimmune complications, kidney

stones with impaired kidney function, and kidney infections should be treated with

kidney replacement therapy. One of the most common kidney replacement therapies is

dialysis. When the patient is decided to dialysis, then that is not the end. Rejection or

delay will cause more serious complications that can even be life threatening.

Keep in mind that patients with routine dialysis with good discipline, regularly take

medication and always check their condition, the survival rate is high. Many patients

who routinely with dialysis survive above 10 years. Complications that occur due to
lack of discipline in treatment. The majority of CKD patients have high blood pressure

and should be given regular high blood therapy. Complications of high blood pressure

are stroke and cardiovascular events (heart and blood vessels).

To increase discipline, feelings of joy must be developed by dialysis. There are many

ways to grow that feeling of joy. When dialysis, patients will gather in one room,

making it a place to share and stay in touch. Exchange ideas and experiences. In

addition, forming a community of patients with dialysis is commonly done. This

community functions as a place to motivate each other, especially in patients who have

just had dialysis, a place to remind one another and share tips and tricks in living a life

with dialysis. Hospitality will go well, depressed mood due to dialysis will be replaced

by feelings of joy always meet fellow dialysis friends.

Actually there are some kidney replacement therapies besides dialysis, namely dialysis

peritoneum (dialysis in the stomach) and kidney transplantation. However, because the

majority are still dialysis using a machine, then we should discuss this matter.
Remember, dialysis is not the end. But dialysis helps to help the quality of life to

continue his life reaching for ideals and love.

4) What are the signs that you need dialysis?

an example of kidney failure

In general, symptoms of the cause of kidney failure are difficult to detect. Because this

disease can be started from mild and vague symptoms of kidney failure. However,

slowly but surely this disease will get worse over time.

Usually, most patients who suffer from kidney failure have lived with kidney disease

for some time, before the characteristics of kidney failure appear. Here are some

symptoms of kidney failure that you should be aware of.

1. Fatigue

Severe decline in kidney function can cause a buildup of toxins and impurities in the

blood. This can cause people to feel tired, weak and can make it difficult to concentrate.

Another complication of kidney disease is anemia, which can cause weakness and

fatigue.

2. Dry and itchy skin

Dry and itchy skin can be a sign of mineral and bone disease that often accompanies

advanced kidney failure. The appearance of symptoms of dry and itchy skin indicates

that the kidneys are no longer able to maintain the balance of minerals and nutrients in

your blood.
3. Bloody urine

Healthy kidneys usually maintain blood cells in the body while filtering waste from the

blood to produce urine. But if the kidney filter has been damaged, these blood cells will

"leak" into the urine. Besides indicating kidney failure, blood in the urine can also be an

indication of other diseases such as kidney stones or infection.

4. Urinating foam

Excessive bubbles in the urine - especially those that require you to water several times

- indicate protein in the urine. This foam might look like the foam you see when you

beat eggs, because the ordinary protein found in urine, albumin, is the same protein

found in eggs.

5. Swelling

Decreased kidney function can cause sodium retention which causes swelling in some

parts of the body. That is why one of the features or symptoms of kidney failure that we

can see is swelling in the legs, arms, hands, or face due to excessive accumulation of

fluid in the body.

6. Low back pain

Generally, many patients complain of pain in the right or left waist. This location

coincides with the presence of the kidney, and when there is pain in this area, symptoms

of kidney failure should be suspected.

the only way to determine whether you have kidney disease is to do a laboratory test.

Moreover, for those of you who do have a history of diabetes and hypertension. It is

better to check regularly.

 Until now there is no drug that can cure kidney failure. Treatment of this disease

is only focused on reducing the symptoms of early kidney failure caused and controlling

the progression of the disease so that it can prevent more serious complications.

That is why, the most important thing to prevent kidney failure is to start implementing

a healthy lifestyle by consuming healthy food and drinks and exercising diligently,

especially for those of you who have a family history of kidney disease.
 5) Can dialysis be stopped?

The decision to stop the dialysis process is a decision that must be made by doctors and

patients. If the patient undergoes dialysis due to acute kidney failure, recovery can occur

and dialysis can be stopped. But if patients undergo dialysis due to chronic kidney

disease, then stopping dialysis can increase the severity of the disease which can lead to

death.

People with kidney failure who do dialysis or kidney transplants allow them to

live longer and enjoy life. However, everyone still has their own choices. They have the

right to choose what and how the treatment they receive.

Without ongoing dialysis or kidney transplantation, people who have end-stage kidney

disease can develop uremia syndrome, in which toxins form in the blood. The patient

will receive any medication needed to treat the symptoms of uremia and other medical

conditions. However, if the toxins have already accumulated this can cause death.
 Patients who stop dialysis will receive palliative care. Palliative care is a treatment that

can be obtained by patients suffering from chronic disease with an advanced stage,

which aims to improve the quality of life of patients. Improvement of life is done by

approaching the psychological, psychosocial, mental and spiritual aspects of the patient,

thus making the patient more calm, happy, and comfortable when undergoing treatment

In patients with kidney failure that stop the process of dialysis, toxins in the body will

accumulate. Toxins that develop in a person will result in certain physical and emotional

changes. In addition, the body has a natural way to prepare itself to stop functioning.

Family and the closest people are good at understanding the changes that occur. It also

functions to prepare the patient and family's mentality. the patient's body can help the

friend and family member of the patient to prepare the family and the person mentally.

A series of physical changes that might occur include:.

 Loss of appetite and excess fluid

 Sleep most of the day

 Restless

 Disorientation, often looks confused and confused to recognize a familiar face

 Changes in breathing patterns can be irregular, too fast or even too slow. It can also

sound like gasping. Changing breathing patterns indicate decreased circulation in

internal organs and buildup of toxins.

 Changes in skin color and temperature

Medications can be given to treat pain or anxiety. However, other drugs are often

stopped when someone decides to stop taking dialysis treatments because treating

chronic conditions is no longer a priority.

A study reports that patients who stop dialysis usually experience a calm and pain-free

death.

6) how does hemodialysis work?

In hemodialysis, blood is removed from the patient's body and circulated in a

machine outside the body, so this method requires a way in and out of blood flow. For

this reason, an artificial pathway is made between the arteries and veins or is called a

arteriovenous fistula through surgery. Then with a tube of blood from the fistula, blood

is flowed and pumped into the dialysis machine. To prevent blood clots during the

washing process, the antifreeze drug Heparin is given.

 Actually the process of washing blood is done by a tube outside the machine

called dialiser. Inside the dialiser, the washing process takes place, similar to what takes

place in the kidney. On the dialiser there are 2 compartments and a membrane in the

middle. The machine is used as a recorder and controller of blood flow, temperature,

and pressure.

Blood flow into one of the dialiser compartments. In the other compartment, dialysate

flows, which is a liquid that has a chemical composition that resembles normal body

fluids. The two compartments are separated by a semipermeable membrane which

prevents the dialysate from flowing in the opposite direction. Garbage substances, toxic

substances, and water in the blood can move through the semipermeable membrane to

the dialysate. That's because, during blood screening, diffusion and ultrafiltration occur.

The molecular size of cells and blood proteins is greater than junk and toxins, so they do

not enter the semipermeable membrane. The filtered blood becomes clean and returned

to the patient's body. The dialysate becomes dirty because it contains toxic substances

and garbage, then it is drained out to the dialysate reservoir.

Diffusion is the event of the transfer of a substance in a mixture, from a

concentrated part to a thinner part. Diffusion can occur when there are differences in

levels of solutes in the blood and in the dialysate. Dialysate contains components such

as saline and glucose solutions that the body needs. If the body lacks these substances

during the hemodialysis process, the diffusion of these substances will occur from the

dialysate into the blood.

Ultrafiltration is the process of moving water and solutes due to differences in

hydrostatic pressure in the blood and dialysate. Higher blood pressure from dialysate
forces water to pass through the semipermeable membrane. Water has very small

molecules so that the movement of water through the membrane is also followed by

waste substances with small molecules.

Both events occur simultaneously. After the filtering process in the dialiser is complete,

clean blood will be obtained. The blood will then flow back into the body.

On average each person takes 9 to 12 hours a week to filter all the blood in the body.

But usually it will be divided into three meetings during the week, so 3-5 hours per

filtering. But this also depends on the level of kidney damage.

 7. what complications might occur from hemodialysis

The problem of vascular access is the most common reason for hospitalization

among people who do hemodialysis. Common problems include infection, blockages

from clots, and poor blood flow. These problems can be your treatment problems. You

need to fix the operation repeatedly to get access to that work.

Other problems can be caused by rapid changes in air and your body's chemical balance

during treatment. Muscle cramps and hypotension (sudden decrease in blood pressure)

are two common side effects. Hypotension can make you feel weak, dizzy, or have an

upset stomach.

You may need several months to adjust to hemodialysis. Side effects can often be done

quickly and easily, so you should always report them to the staff doctor and your

dialysis team. You can avoid many side effects if you follow the right diet, get your

fluid intake, and take medicine as directed.

an example of complications from one of the diseases resulting from the

hemodialysis process is kidney failure;

Patients who have entered chronic kidney failure must be careful of complications

that can worsen health conditions, you know. Reporting from various scientific sources,

here are 5 complications that may occur in patients with chronic kidney failure!

1. Excess potassium (hyperkalemia)

Chronic kidneys are excess potassium levels in the blood or in medical terms called

hyperkalemia. Someone who has chronic kidney failure will experience filtration

problems (initial filtering) in the kidneys. This results in the tubules in the kidney being

unable to exchange K + / H + ions with Na +, causing excess potassium levels in the

blood.

Potassium itself is indeed important for the body to smoothen the functioning of

muscles, nerves and heart. However, in excessive amounts can cause disruption of heart

function and can cause the heart to stop beating, even to death.

2. Swelling of the Lungs (Edema)

The condition of a person suffering from chronic kidney failure makes the kidney

experience a decrease in function. Kidney damage can trigger a decrease in albumin

levels in the body (hypoalbuminemia) and will cause increased capillary permeability.

This causes a rapid buildup of fluid, resulting in swelling of the lungs. This swelling

occurs in the interstitial and alveolar parts of the lung.

In normal conditions when the lungs expand it will be filled with oxygen, but due to a

buildup of fluid, fluid will be filled into the lungs. This causes sufferers to have

difficulty in breathing and can even feel pain when breathing.

3. High Acid Levels in the Body (Acidosis)

The kidneys are responsible for filtering the blood and reabsorbing (reabsorbing) the

ions that are still needed by the body. H + ions should be bound to HCO3 - because H +

ions need to be removed from the body to maintain a pH balance in the body so they are

not too acidic. Kidney damage causes disruption in the tubules so that HCO3- cannot be

reabsorbed. This causes the buildup of H + in systemic blood vessels so that acid levels

increase (acidosis).
 Acidosis causes disorders in the body such as muscle weakness, decreased reflexes

can even cause paralysis. It also can trigger the deposition of calcium in the blood and

have an impact on the formation of kidney stones.

4. Brain Disorders (encephalopathy)

Generally in the body metabolism occurs protein that comes from food and

occurs in the digestive tract (duodenum). Protein will be broken down into

amino acids and the remaining substance in the form of ammonia. Ammonia is a

toxic compound that will be detoxified (converted to non-toxic compound) in

the liver and then excreted through the kidneys in the form of urine.

In patients with chronic kidney failure will experience interference in the

process of excretion (release of compounds that are no longer used by the body),

causing ammonia can not be removed and eventually accumulate in the body.

This causes ammonia to enter the systemic bloodstream and get carried to the

brain. Ammonia will cause damage to the brain and interfere with brain

performance. The body will experience changes in consciousness, disruption of

activity to the most severe can cause seizures.

5. Anemia

Anemia occurs in patients with chronic kidney failure triggered by kidney

damage. Kidney as an organ that produces erythropoietin which functions to

form red blood cells. Disruption of the process of formation of red blood cells

causes a decrease in red blood cell production which causes anemia. In addition

to the disruption of red blood cell production, other factors that cause anemia are

lack of iron, vitamins, and the life span of erythrocytes that experience

hemolysis due to bleeding.

According to research, anemia is a complication that needs special attention.

This is because most patients with chronic kidney failure are unaware if they are

exposed to complications from anemia. Patients need to be alert if they

experience signs or symptoms of anemia such as dizziness, pale face, body

weakness, headache or heart palpitations.

Thus information about complications that can haunt patients with a history of

chronic kidney failure. Need a balanced effort between health workers and also

from patients to jointly prevent kidney damage that is getting worse, so that

complications do not occur above, yes. Chronic kidney disease is hard to cure,

but you can prevent it from getting worse!

 7) Are diet changes necessary?

Hemodialysis and proper diet reduce waste that accumulates in your blood. A dietitian

is available at all dialysis centers to help you plan meals according to your doctor's

orders. When choosing food, remember to:

 Eat a balanced amount of high-protein foods such as meat, chicken and fish.

 Control the amount of potassium you eat. Potassium is a mineral found in salt

substitutes; some fruits, like bananas and oranges, vegetables, chocolate, and

nuts. Too much potassium can harm your heart.

 Limit how much you drink. When the kidneys don't work, water builds up

quickly in your body. Too much fluid can swell your tissue and can cause high

blood pressure, heart problems, and cramps and low blood pressure during

dialysis.

 Avoid salt. Salty foods make you thirsty and increase water intake in your body.

 Limit foods such as milk, cheese, nuts, and dried beans. This food contains a lot

of phosphorus. Too much phosphorus in your blood causes calcium to be

withdrawn from your bones, which makes them weak and brittle and can cause

arthritis. To prevent bone problems, your doctor may give you special

medicines, which you must use with food every day as directed.

Foods that need to be restricted when undergoing hemodialysis

Eating the right foods and drinks can help you improve your health during the

hemodialysis process. The doctor may ask the patient to approve certain foods while

still undergoing the hemodialysis procedure.

The following is a list of some substances that need to be added to food:

  Fluid

After you have done the hemodialysis method, your doctor or nutritionist will determine

how much fluid you can consume each day. Limitation of fluid intake is so that the

body does not experience excess fluid, due to decreased kidney function to filter fluids.

 Phosphor

During the hemodialysis procedure, you are advised to limit consumption of foods

containing phosphorus. This is to prevent muscle cramps and low blood pressure. In

addition, consuming too much phosphorus can also weaken bones and make the skin

itchy. Therefore, avoid consuming foods that are high in phosphorus, such as milk,

cheese, dried beans, peas, soda, and peanut butter.

 Potassium (potassium)

Eating too much potassium when your kidneys are sick can harm your heart and even

cause death. Consuming too much potassium can affect your heart rate. Therefore, you

are encouraged to limit foods that have a high potassium content, such as oranges,

bananas, tomatoes, dates, and potatoes.

 Salt

Other substances that you need to limit while undergoing hemodialysis are salt

(sodium). Limiting salt consumption can help you control blood pressure and reduce the

risk of excess weight gain due to fluid buildup. Avoid foods that are high in sodium or

sodium, such as instant noodles, canned foods, and crackers.

Instead, you are encouraged to eat foods that contain protein, such as fish meat, chicken

meat, and eggs. The point is to replace the wasted protein intake during the dialysis

process. In addition, protein foods produce less waste when hemodialysis.

Hemodialysis can improve the quality and life expectancy of kidney failure patients,

although this procedure cannot cure chronic kidney disease or advanced kidney failure.

If you feel a complaint after hemodialysis, you should immediately consult a doctor.

Everyone can have different reactions to these medical procedures.

 8) What are the pros and cons of hemodialysis?

Everyone responds differently to the same situation. What might be a negative factor for

one person might be positive for another. Look at the list of advantages and

disadvantages of hemodialysis at the clinic and at home in the list below.

Hemodialysis in a health clinic

Pro:

 Facilities widely available.

 Professional officers are trained with you at all times.

 You can get to know other patients.

 You don't have to have a partner or you have to maintain the equipment in your

home.

Counter:

 Treatment is scheduled by the clinic and is relatively fixed.

 You have to travel to the clinic for treatment.

 This treatment has a strict diet and many fluid restrictions.

 You will need to use and pay more for medicines.

 You may feel the tides more often in how you feel from day to day.

 It might take several hours to feel better after treatment.

Hemodialysis of the house

Pro:

 You can do it at the time you choose - but you still have to do it as often as your

doctor ordered.
 You don't have to travel to the clinic.

 You gain a sense of independence and control over your care.

 The machine will need less space.

 You will experience less ups and downs in how you feel from day to day.

 Hemodialysis at home works more friendly than treatment at the center.

 Your diet and fluids will be more normal

 You can carry a new portable engine in the car, while camping, or on a plane.

 You can spend more time with your loved ones.

Counter:

 You must have someone else at home who takes care of you.

 Helping with your treatment might be stressful for your family.

 You and the person caring for you will need training.

 You need space to store machinery and equipment at home.

 You may need to take time off from work to complete training.

 You will need to learn to insert a dialysis needle.

 Daily hemodialysis and nocturnal home hemodialysis are not yet available in all

locations.
 9) What Are the Side Effects of Dialysis?

Side Effects of Washing Blood by Method

Dialysis or dialysis is divided into two namely hemodialysis and peritoneal dialysis.

Releasing, the side effect of dialysis is a prolonged feeling of weakness. However, each

washing blood has different side effects of washing blood.

In the hemodialysis dialysis method, dialysis can only be done in a hospital and can be

done up to three times in the discussion. Side effects of this blood washing:

 Blood pressure is too low or high

The most common side effect of hemodialysis is a decrease in blood pressure, especially

for those of you who also have diabetes. Other symptoms that may occur are shortness

of breath, stomach cramps, muscle cramps, nausea or vomiting. Conversely, blood

pressure can also surge too high, especially if you are a sufferer of kidney disease

accompanied by a history of hypertension who still consume excessive salt or water.

 Anemia

Anemia or a condition often referred to as lack of blood, is one of the side effects that is

quite common, related to the effects of kidney disease and dialysis.

 Itchy Skin

The presence of phosphorus buildup due to hemodialysis can cause itchy skin. This

condition is common but to prevent or alleviate the symptoms of itchy skin, you may

need to undergo a special diet and consume phosphate binders regularly as directed by

your doctor.
  Muscle cramp

Although the cause is unclear, muscle cramps during hemodialysis can usually occur.

Warming or giving a warm compress in the area, can be done to help expedite blood

circulation and reduce muscle cramps that are felt. While the dialysis method peritoneal

dialysis, can be done at home with supervision and direction from a doctor. It's just that

this dialysis method must be done every day on a regular basis. Like hemodialysis,

dialysis peritoneal dialysis also has side effects, although different.

 Peritonitis

Peritonitis is a common complication caused by peritoneal dialysis. This infection can

occur when the dialysis device used is not sterile so that the possibility of germs or

bacteria spread to the peritoneum or stomach lining can occur. So before using dialysis

equipment, make sure that the equipment is sterile.

 Weight gain

In peritoneal dialysis, dialysis fluid used generally contains sugar so that the

possibility of sugar absorbed by the body. This can increase calorie intake in the body.

For those of you who undergo medical treatment, consult your doctor about diet and

exercise that is recommended so that weight can be controlled properly.

 Hernia

People who undergo peritoneal dialysis have a higher risk of developing hernias. This

is due to the presence of fluid that lasts for hours in the peritoneal cavity which causes

tension in the abdominal muscles. This can trigger hernias.

  Ineffective

If you have been doing peritoneal dialysis for years, your doctor may suggest

switching to hemodialysis. Because, in the long run, peritoneal dialysis no longer works

effectively.

The side effects of dialysis vary in each person. However, this action is considered

important to undergo in patients with kidney disease, to help replace kidney function so

that it can run the metabolism properly. Consult your doctor regularly to maintain a

healthy body while undergoing dialysis and get the proper and effective handling of the

side effects of dialysis.

Alright, we answered the question in Problem Formulation

Definition of Hemodialysis According to Some Most Complete Experts

Below you will try to explain the definition of hemodialysis so that it can be used as

information for readers about dialysis methods to be shared with friends, family or

relatives affected by diseases that require dialysis. Some definitions of hemodialysis

from several experts are:

1. According to DR. Nursalam M Nurs

Hemodialysis is the process of cleaning up the blood by accumulating waste matter.

Hemodialysis is performed in patients with end-stage renal failure or acute illness

patients who require dialysis with a short time.

2. According to Christian Brooker

Hemodialysis is the process of removing metabolic waste products from the body such

as ureum and other toxic substances, by flowing blood through a dializer that contains a

permeable-selective membrane through which the fusion of unwanted substances

occurs. Hemodialysis is done in conditions of kidney failure and some forms of

poisoning.

3. According to price and Wilson

The definition of hemodialysis according to price and Wilson is a process in which the

solute and water experience the event of the transfer of substances in the solvent. This

transfer starts from the high concentration portion to the low concentration portion

through the porous membrane.

4. According to thiser and wilcox

Definition of Hemodialysis According to thiser and Wilcox is defined as the movement

of solution and water from the patient's blood through a semipermeable membrane

(dailzer) into the dialysate. Dializer also functions to move a large volume of liquid.

By enlarging vascular access, anticoagulation and the production of reliable and more

efficient dializers make hemodialysis the dominant method of action against acute and

chronic kidney failure in the United States.

from some of the expert definitions above, we can conclude that hemodialysis is a

method with high technology which is a very effective option for rescue measures for

patients affected by diseases that require dialysis.

Of course in undergoing the process of hemodialysis there are advantages and

disadvantages to dialysis which will be felt by patients suffering from diseases that

require dialysis. The advantages that can be felt for patients some of which are the

electrolytes in the patient's body become more balanced and reduce complications that

are at risk of causing death.

While the shortcomings felt by patients in the form of physical conditions that quickly

feel tired and weak because the process of dialysis takes quite a long time and the level

of sugar in the body increases because dialysate fluid contains sugar that can be

absorbed by the body.

As a result of not dialysis will be very detrimental to the patient and very dangerous so

that it can cause death. For this reason, it is very important to know how hemodialysis

works and the stages of the hemodialysis procedure so that the hemodialysis process can

run safely and smoothly.

Another thing that is no less important to be conveyed to the readers is to begin to

maintain personal health from now on. Because like a wise sentence we often hear

"prevention is better than cure". Many ways you can do in an effort to maintain personal

health including starting diligently in exercising and applying to consume highly

nutritious foods, to rest adequately and regularly.

Some simple things will be very useful if it is done with all my heart. And for those of

you who have been exposed to diseases that require dialysis, the most important thing to

deal with the disease is to always stay motivated and motivate yourself so that the desire

to recover does not decrease. Try to avoid stress, because stress will greatly affect one's

health condition.

For sufferers who require dialysis around Jakarta, now there is no need to worry

anymore to find a place to do the dialysis process. There are several dialysis places in

Jakarta with good facilities and services. The issue of dialysis costs at the hospital also

does not need to be a burden on the mind, because at the dialysis you will visit to

receive payments for dialysis fees using BPJS.

That's a little explanation of the definition of hemodialysis that can be conveyed.

Hopefully this information can provide benefits and knowledge for readers.
Dialysis for Overcoming Kidney Failure

in fact our bodies are naturally designed to be able to do dialysis automatically. But if

needed, the process of dialysis with the help of medical devices can be done. Dialysis or

hemodialysis will be needed when the kidneys are no longer functioning properly.

Nowadays dialysis is identical to the medical process to remove excess impurities and

water in the blood. In a natural process, the kidneys are the organs responsible for doing

this.
Dialysis Method

In the process of dialysis, there are two methods that can be chosen by the patient,

namely hemodialysis or peritoneal dialysis.

 Hemodialysis

This type of dialysis is the most widely known. Hemodialysis uses a special machine to

filter blood to replace damaged kidneys. In this dialysis process, medical personnel will

usually insert a needle in a vein to connect the blood flow from the body to the dialysis

machine. After that, dirty blood will be filtered in a blood washing machine, and after

filtering, clean blood will be flowed back into the body.

Hemodialysis dialysis usually takes about four hours per session. Within a week there

are 3 sessions that must be undertaken and can only be done in dialysis clinics or

hospitals. Side effects that usually arise due to hemodialysis are itchy skin and cramps

in the muscles.

 Peritoneal dialysis

This dialysis method uses the peritoneum (membrane in the abdominal cavity) as a

filter. Peritoneum has thousands of small blood vessels that can function like a kidney.

A small incision is made near the navel for the entrance of a special tube or catheter.

This catheter will be left in the abdominal cavity permanently. Its function is to enter

dialysate fluid, which is a liquid containing high sugar to attract waste substances and

excess fluid from surrounding blood vessels, into the abdominal cavity. After finishing,

the dialysate liquid containing the remaining substances is channeled into a special bag

which is finally disposed of. Then it is replaced with sterile fresh liquid.The advantage

of dialysis process with this method is that it can be done at home, anytime, and is
usually done while the patient is sleeping. However, this method must be done four

times each day and takes about 30 minutes. Side effects can be peritonitis (infection of

the peritoneum that surrounds the abdominal cavity), the stomach feels full when

dialysis takes place, weight gain due to dialysate fluid containing high sugar levels, or

the appearance of hernias due to the weight of fluid in the abdominal cavity.

Will the process of dialysis interfere with the patient's activities?

Although dialysis does not cause patients who do so to feel pain or discomfort, some of

them may experience headaches, nausea, vomiting, cramps, drop in blood pressure,

fatigue, and dry or itchy skin.

Although the things above may be felt, in fact dialysis does not interfere with patient

activity. Many patients who do dialysis, but still have a good quality of life. They can

still work or continue school. Dialysis is also not an obstacle to do various activities,

such as swimming, exercising, driving, or even on vacation, if there are no complaints

after the dialysis process.

The process of dialysis is a form of help against kidney organ damage. In patients with

kidney failure, dialysis can also help control blood pressure, and regulate mineral and

electrolyte levels in the body.

Because the importance of kidney function for life, then you need to maintain it by

living a healthy lifestyle and routinely carry out kidney function checks to monitor

kidney conditions. If there are complaints related to kidney problems, immediately

consult a doctor.
 CHAPTER 3

 CONCLUSION

Hemodialysis is a treatment for people who have decreased kidney function.

Hemodialysis takes over the function of the kidneys to cleanse the blood by flowing

through "artificial kidneys".

Patients who require hemodialysis are CHFD and ARF if there are indications of

hyperkalemia, acidosis, high urea / creatinine levels in the blood, fluid overload, severe

pericarditis and confusion, hypercalcemia and hypertension.

 SUGGESTION

Increasing times and technology are increasing as well as the risk of disease in humans,

especially in this case the loss of kidney function or kidney failure, then hemodialysis is

an important tool in overcoming this so that it can restore healthy kidney function.
here are some pictures related to hemodialysis
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