Defining advanced chronic kidney disease in the permanent loss of more than 90% of the filtering function of the kidneys, Prof. Dr. Ercan Ok said that in this case, kidney transplantation or dialysis is the rule for the patient to continue his life. Stating that one out of every 1000 individuals in Turkey has advanced chronic kidney disease, Prof. Dr. Ercan Ok said, “75% of more than 80 thousand patients with advanced kidney disease are treated with hemodialysis. Looking at the last 5 years
, we can say that this number has increased by 1.5-2% every year.” said.
We are the second in Europe and the fifth in the world in residential hemodialysis
Pointing out that many patients in our country have started to do hemodialysis at home in the last 10 years, Prof. Dr. Ercan Ok said, “With the prestige of the end of March 2020, the number of patients doing residential hemodialysis was 835. With this number, Turkey is in the middle of the countries that provide residential hemodialysis services to the largest number of patients, second in Europe after England, and fifth in the world after the USA, England, Canada and Australia. Currently, the number of dialysis centers providing residential hemodialysis services in our country is around 10%, but the number of these centers, both in public and private, is increasing. The number of patients is also increasing in parallel with this.” he said.
Underlining that with a proper and successful hemodialysis treatment, the kidney performs its function to a significant extent, although it is not as wonderful as itself. Dr. Ercan Ok explained hemodialysis as follows: “Hemodialysis is the process of cleaning the patient’s blood from harmful chemicals
by contacting with purified water called dialysate and a liquid containing some chemical aspects necessary for the body, through a semi-permeable membrane.”
Prof. Dr. Ercan Ok listed the advantages of residential hemodialysis over conventional dialysis as follows: “Having to go to a dialysis center three times a week is a problem, especially if distances are a matter of speech. The residence is more comfortable than the center; If the treatment is done while sleeping in your own bed at night, this creates an extra comfort. Dialysis at home is more reliable. Compared to crowded wards and going to crowded centers and receiving dialysis treatment there, dialysis at home is much more reliable in terms of all kinds of infections. In central dialysis, the dialysis day and time of the patient is fixed, and the patient has to comply with this. In residential dialysis, the patient can easily change the day and time of the dialysis treatment when he needs it, on the basis of performing dialysis three times a week. This gives the patient the opportunity to plan his life. Doing the treatment at home
increases the time he spends with his family. The biggest advantage of residential dialysis is that it allows long dialysis sessions that take up to eight hours instead of four. Tension drop and cramping in eight hour sessions are very prominent. High blood pressure becomes commonplace in more than one patient without the use of medication. Fluid excess, heart failure is not seen much. Phosphorus, which cannot be reduced with diet and phosphorus
-lowering drugs in four hours of dialysis, is easily cleaned in eight hours. Moreover, in the vast majority of them, phosphorus drugs are also discontinued, and the diet is liberated to a valuable extent. There is no need for strict diets, the appetite of the patients increases.”
Residential hemodialysis patients are safer during the coronavirus process!
Referring to the advantages of residential hemodialysis for patients during the coronavirus period, Prof. Dr. Ercan Ok continued as follows: “Seasonal viral respiratory tract infections are seen 4-
5 times more frequently in hemodialysis patients compared to the general population and can have a more significant course due to both being in a crowded and closed environment and the weakness of the immune system. Coronavirus infection is also experienced more severely in dialysis patients. In a study involving 1,530 patients in England, the frequency of coronavirus infection was reported as 5.6% in peritoneal dialysis and residential hemodialysis patients, while it was 21.5% in central hemodialysis patients. The risk of coronavirus infection in residential dialysis patients is 75% lower than in central dialysis. Because residential dialysis patients do not go to crowded centers, they do their treatment in their homes and they do not come into contact with anyone from outside.”
Explaining the importance of having a longer dialysis time for patients while performing hemodialysis at home, Prof. Dr. Ercan said: “The cleaning of the blood from waste matters (urea, creatinine, phosphorus, potassium) increases. Increasing the timeout from four hours to eight hours makes it possible for the fluid to be withdrawn from the body in that session to be withdrawn at a slower rate, which prevents blood pressure
from falling and cramping during the session. Likewise, in eight hours of dialysis, the level of the elements in the blood and the changes in the body environment are slower, in other words, a more stable environment is provided. Because the problems that occur during and after the session, such as the shortness of time, rapid fluid withdrawal and rapid changes in the blood-body are the most valuable reasons underlying the post-session fatigue.”
It is a well-known fact that in addition to the clinical results of hemodialysis application in the residence, it has additional benefits such as increased quality of life, flexible dialysis planning, better business and social life, looser diet, and increased self-confidence. by Prof. Dr. Ercan Ok, “In a study conducted in Finland, the labor force participation of patients doing residential hemodialysis was seen twice as high as compared to patients who had a kidney transplant
, in a similar form compared to central hemodialysis. In an evaluation made among the patients who started residential hemodialysis treatment in Turkey, the rate of actively working patients was found to be 48.4%.” said.
There are patients who participated in the Istanbul Marathon by performing residential hemodialysis
Since dialysis three times a week for four hours is insufficient, 60-90% of conventional hemodialysis patients in the world have excess fluid in the body and high blood pressure. Expressing that the heart functions of these individuals are impaired because of this, Prof. Dr. Ercan Ok continued as follows: “Physical performance decreases significantly in conventional dialysis patients, mainly due to excess fluid, blood pressure problems, cardiac dysfunctions, anemia, malnutrition, muscle-
border problems.
With eight hours of dialysis, most of these problems are eliminated, and patients experience valuable increases in their performance. Since fatigue does not disappear quickly after the dialysis session, these patients who do dialysis at night wake up in the morning with vigor and energy, and start the day. The physical activities of residential dialysis patients increase significantly in daily life, and those who want to start doing sports systematically.
As we have patients who work in heavy jobs, we also have patients who do sports that require a lot of strength. One of our residential dialysis patients participated in the Bosphorus Intercontinental Swimming Races when she was 56 years old. We have another patient who participated in bicycle races on trails up to forty kilometers, another of them participated in the Istanbul Marathon. There are many more that I do not know.” said.
