Overview of Kidney Function & Dialysis Treatment

In a healthy body, the kidneys act as filters and clean around half a cup of blood every minute. They take out waste and extra water, creating urine. This urine then travels from the kidneys to the bladder through slim, muscular tubes known as ureters – one on each side of the bladder. The bladder holds onto this urine until it’s time to release it. All these parts – the kidneys, ureters, and bladder – come together to form your urinary tract.

(https://visualsonline.cancer.gov/details.cfm?imageid=9050)

Having conditions such as high blood pressure and diabetes increases your chances of developing kidney failure. Kidney failure can also come from injurious sources such as physical injuries, diseases, and other conditions. When your kidneys aren’t working properly, waste can build up in your body. Dialysis takes over the job of cleaning your blood, keeping your body balanced by getting rid of extra fluids and waste. Plus, it helps control your blood pressure, which is important for your health.

Revolutionizing medical care, dialysis has evolved into a pivotal treatment for kidney malfunction. It emerged as a standard approach in addressing kidney failure. This intervention has since transformed the lives of countless individuals worldwide.

Types of Dialysis & Dialysis Procedures in Singapore

When it comes to dialysis, there are two main techniques: haemodialysis and peritoneal dialysis. It’s strongly recommended that you consult with your doctor to explore these alternatives and determine which aligns best with your lifestyle and condition.

(https://www.kdf.org.sg/haemodialysis)

Haemodialysis is more efficient at removing toxins and restoring a proper balance of salts. It is typically scheduled for 2-3 sessions per week. In the haemodialysis process, a machine extracts blood from your body, channels it through a device known as a dialyzer, and reintroduces the purified blood back into your system. This dialyzer serves as an artificial kidney, containing a filter that effectively segregates waste from your blood. Each haemodialysis session generally takes about 3 to 5 hours to complete. To facilitate this, a specialised entry point is established into your bloodstream. This entry point is also known as the dialysis access. Various forms of access can be employed, including arteriovenous fistulas, grafts, or central venous catheters.

(https://www.kidney.org/content/what-peritoneal-dialysis)

On the other hand, peritoneal dialysis follows a distinct methodology. In this approach, a catheter is used to infused a specialized fluid into your abdominal cavity, more precisely referred to as the peritoneal cavity. This unique fluid has the ability to absorb waste and excessive fluids from your blood. After a span of hours, the fluid, along with the accumulated toxins, is drained out from your body. Peritoneal dialysis has the advantage of being home-based; however, due to its relatively lower efficiency, it needs to be performed daily. To initiate peritoneal dialysis, patients typically undergo a minor surgical procedure to insert the catheter into the peritoneal cavity.

Types of Dialysis Access in Singapore

Vascular access for haemodialysis pertains to the technique of creating a superficial high flow conduit on a patient’s arm (or leg) to facilitate easy access to the blood circulation system. This procedure empowers individuals with kidney failure to undergo haemodialysis. Irrespective of the underlying cause of kidney failure, all patients undergoing dialysis must have vascular access established. This access permits blood to flow through these tubes into the dialysis machine, where it undergoes purification before being returned to the bloodstream.

There are three forms of vascular access:

1. An arteriovenous fistula (AV fistula) is a surgical link created by a vascular surgeon. Using microsurgery, the patient’s vein is connected to their artery, usually in the arm. This makes the vein bigger as blood flows from the artery. After about 6-8 weeks, when the vein is big enough and its walls are thicker, it can be used for haemodialysis.

(https://www.astraveinvascular.com/av-fistula-creation/)

2. An arteriovenous graft (AV graft) involves linking a vein and an artery using a synthetic tube called a graft. This graft is positioned just under the skin’s surface. It becomes usable within a couple of weeks after surgery, once the surgical wounds have properly healed.

(https://www.azuravascularcare.com/medical-services/dialysis-access-management/av-graft-placement/)

3. Central Venous Catheter (CVC), also known as Permanent Catheter, entails inserting a Y-shaped catheter into a central vein, often the jugular or femoral vein. This arrangement facilitates blood withdrawal from one lumen for passage through the dialysis circuit and subsequent return through the other lumen. The insertion of these catheters can be carried out in an outpatient setting with minimal invasion.

(https://www.azuravascularcare.com/infodialysisaccess/difference-between-cvc-and-picc/)

CVCs can be categorized as non-tunnelled and tunnelled:

1. Non-tunnelled catheter access is suitable for short-term needs (around 14 days), and the catheter emerges directly from the skin at the point of entry into the vein.
2. Tunnelled catheter access (also referred to as Permanent Catheters) is generally intended for the longer term. It involves a lengthier catheter that is tunnelled beneath the skin from the insertion point in the vein to an exit site at a certain distance away. The internal jugular vein in the neck is often chosen for placement, while the exit site is typically on the chest wall. The tunnel itself acts as a safeguard against invading bacteria. Despite being termed “Permanent Catheters,” tunnelled catheters are designed for access in the short- to medium-term, primarily due to the ongoing risk of infection. It is not advisable to keep a tunnelled catheter for more than six months.

Central Vein Stenosis: The Risks and Complications of Dialysis Treatment

Central Vein Stenosis (CVS) is a significant issue that can arise from the extended usage of Permanent Catheters (Perm Caths). When a catheter is inserted into a vein, it can trigger inflammation in the vein wall due to its foreign nature. This inflammation leads to the formation of scars and subsequent narrowing of the vein, causing a hindrance in the normal blood flow. As a result, CVS can block the proper circulation of blood.

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This condition is not uncommon and can have noticeable effects. People with CVS may experience swelling in areas like the face, neck, chest, or upper limbs. These symptoms are a result of the compromised blood flow due to the narrowed vein caused by the inflammatory response and scarring caused by the catheter.

Identifying The Optimal Treatment for Patients Experiencing Kidney Failure

When it comes to determining the optimal treatment for kidney failure, several crucial considerations come into play. These encompass factors such as your lifestyle, age, existing health conditions, and the presence of a support system. Making this decision should be more than just a reflection of your medical history or your doctor’s recommendations; it should also take into account your family’s input and your personal preferences. Gaining a comprehensive understanding of the available treatment options will empower you to make a well-informed decision that resonates with your unique situation.

Quality of Life After Dialysis

Positive quality of life after dialysis is attainable as modern techniques allow for flexible scheduling and comfort during treatments. Advancements in technology enhance the dialysis experience, while emotional support and educational resources aid patients and families in coping. Maintaining a healthy lifestyle through diet, exercise, and condition management is key. Dialysis doesn’t preclude social interactions or hobbies; many patients continue work, travel, and engage in activities they enjoy with some adjustments. Overall, with a combination of modern treatment approaches and personal resilience, dialysis patients can lead fulfilling lives.

Support Groups for People with Kidney Disease

KidneySG, known as Renal Friends, stands out as a robust support group provided by KDF to ensure comprehensive patient care. Dr. Lina Choong, KDF’s Medical Director, established this group in 1997 with a focus on catering to the emotional and psychological needs of dialysis patients and their families. The group’s activities encompass offering companionship to those in distress, arranging engaging social events, and conducting informative talks and seminars. These endeavors not only promote mutual support and interaction among patients and families but also boost understanding and awareness about kidney disease. Renal Friends has successfully extended its impact by organizing trips to various places of interest, enhancing the support network and contributing to the enrichment of patients’ lives.

(https://www.giving.sg/kidney-dialysis-foundation/aap19)

The National Kidney Foundation Singapore (NKF) stands as a notable organization in Singapore, dedicated to providing comprehensive support for kidney patients. Their mission goes beyond delivering dialysis services, encompassing vital aspects such as advancing renal research, conducting public education campaigns about kidney diseases, and instituting patient welfare programs. These welfare initiatives aim to assist patients in managing their illnesses, facilitating their reintegration into society, and extending support to their families. With an extensive presence, NKF manages 29 dialysis centers across Singapore, underscoring their unwavering commitment to ensuring accessible and holistic care for individuals grappling with kidney-related challenges.

Final Words

In summary, understanding kidney function and dialysis treatment reveals the critical role of the kidneys in maintaining bodily balance and eliminating waste. Kidney failure can arise from various causes, prompting the need for dialysis, which revolutionizes medical care. Haemodialysis and peritoneal dialysis are two main techniques that cater to different needs, with vascular access being crucial for effective treatment. The risks of complications like Central Vein Stenosis highlight the importance of proper care. Ultimately, a positive quality of life is achievable after dialysis, as modern techniques, emotional support, and a healthy lifestyle contribute to patients’ well-being.

FAQs:

References:

[1] https://my.clevelandclinic.org/health/treatments/14618-dialysis

[2] https://medlineplus.gov/ency/patientinstructions/000591.htm

[3] https://www.kidney.org/atoz/content/hemoaccess

[4] https://www.nephrocare.com/patients-home/living-with-dialysis/access-care

[5] https://www.nephrocare.com/patients-home/living-with-dialysis/access-care

[6] https://siouxlandvascular.com/dialysis-access-patients-10-common-terms-you-should-know/

Dr Chen Min Qi profile

Dr. Chen Min Qi is a fellowship-trained Vascular and Endovascular Surgeon who graduated from the National University of Singapore in 2005. He subsequently completed his basic and advanced training in General and Vascular Surgery while obtaining the Member of Royal College of Surgeons of Edinburgh (MRCSed) qualification in 2010, and the Master of Medicine (General Surgery) qualification in 2015. Dr Chen was subsequently successful at the fellowship exams obtaining the Fellow of Royal College of Surgeons of Edinburgh (FRCSed) qualification in 2016.

Upon completion of his advanced surgical training, Dr Chen Min Qi joined the newly opened Ng Teng Fong General Hospital (NTFGH) as a specialist in the Vascular Surgery division. In 2018, Dr Chen was awarded the Health Manpower Development Plan (HMDP) grant from MOH to undergo further subspeciality Vascular training at the internationally renowned St Mary’s Hospital in London, United Kingdom. There Dr Chen gained further experience in surgeries on complex abdominal and thoracoabdominal aortic aneurysms, redo open repair of abdominal aortic aneurysms following failed EVAR surgeries as well as carotid endarterectomy surgery and lower limb revascularization surgeries.

Upon his return in 2020, Dr Chen Min Qi joined the newly formed Woodlands Health as head of their Vascular service, before joining his current practice at the Vascular and Interventional Centre in January 2023.