Talk:Dialysis

From Wikipedia, the free encyclopedia

This article is part of a WikiProject to improve Wikipedia's articles related to nephrology. See WikiProject Nephrology and Wikipedia:Contributing FAQ.

Needs major rewriting so it sounds more professional. Alex.tan 06:12, 2 Apr 2004 (UTC)

I have done some rewriting and editing, but IANARF (I am not a Renal Physician, and therefore unqualified :). In my view, this copyvio-like stepwise list of a dialysis session still needs to be rewritten, but I utterly lack the drive to wade through this waffle. JFW | T@lk 18:09, 15 Jul 2004 (UTC)

I like the current version much better than what I wrote. I will take the blame for the original (unprofessional) stepwise list - but then, I'm not a professional!  :-) I did think the article needed a little more than a dry dictionary definition "Dialysis is the process of filtering blood..." and a little more about practically how dialysis happens. No doubt it can be improved further. I was suprised to see even small remanants of my original text left! I'd like to add a list of vascular access methods, as well as a list of nominal dialysis prescriptions by nation - it varies widely, as I understand.  :KBrown 16:51, 20 Jul 2004 (UTC)

Contents 1 Dialysis Catheters 2 Effectiveness of Dialysis 3 Splitting the article 4 Haemodialysis - Ultrafltration 5 Steps of dialysis 6 No Baxter? Over 50 dead are crying from the grave over another sign of US censorsip at wikipedia. 7 Grafts? 8 split 9 Clean-up 10 Proposed merge 11 Slash and Burn 12 Kolff 13 More hack and slash

[edit] Dialysis Catheters

It would be nice to have a section on dialysis catheters.

Please research it and write it! Hugely appreciated. JFW | T@lk 22:02, 16 Oct 2004 (UTC)

I am currently under going this but there is a large amount of text to go thro please bare with me and i will have a draft done and dusted at some point (I am not a Renal Physician, and therefore unqualified, i am a trainee renal doctor and a renal patient for 25 years hopefully it will give you a alternative look at things.)

( this is just a rough draft of what happens )

There are a vast amount of different ways practiced with dialysis catheters and different trement all around the globe i have been witness to 20 or so persuaders all with in the UK as far as am aware most are carried out in the same way. Please edit if they are incorrect.

Usually the patient is checked over prior to the operation standard tests blood work blood pressure temaputure, once the results are in the operation can begin most of theses operation are carried out with the patient under local anstic with some mild pain killers there are varied size's and makes of dialysis catheters they can be placed in ether side of the neck Chest, or groin and in extreme cases in the back adjacent to the kidneys. the side that it gos in depends on the doctor being right or left handed or if theres a medical problem with the patient.

A small incision is made above the main artery then the catheter is entered with in the artery in the direction of the blood flow about 5 to 6 inches is place in the artery, under controlled operations very little blood is lost, and the patient should not feel any of this once in the doctor then closes the skin around the bottom of the catheter once in then it is then attached to the patients body usually with 2 or 4 stitches once the doctor is happy that it is in place and is allowing blood to flow freely the patient is then released back to the real ward for obviation for half an hour if no sine’s of pain or discomfort or apparent the patient is usually free to go. Nice to be nice 09:46, 8 Apr 2005 (UTC)

[edit] Effectiveness of Dialysis

If anyone is familiar with the subject, I would be interested as to the effectiveness of dialysis as opposed to normal kidney function, and the effectiveness in the long-term. I have no knowledge to provide, but just a suggestion if anyone is up for it! --postglock 05:43, 13 Jun 2005 (UTC)

As a former dialysis patient, I can say it's a far cry from normal kidney function. Doctors say you can live on dialysis in theory forever, but I know people who have died while on dialysis, due to loosing fistula access, and places for fistulas. I was on peritoneal dialysis, and it's better than hemo dialysis, but again, not as effective as a normal kidney. -- Spinboy 16:52, 13 Jun 2005 (UTC)

A good conventional dose of haemodialysis could be very roughly approximated to a glomerular filtration rate of 15 ml/min. Peritoneal dialysis is worse in terms of small molecule clearance (equivalent to a GFR of around 8-10ml/min), but has the advantage of being a continuous modality. It's normally recommended that dialysis is commenced when the glomerular filtration rate of the native kidneys is <15ml/min, so its not surprising people don't feel better on dialysis, you're not greatly improving the kidney function, just mantaining a level compatible with survival. Of course if you could have daily overnight dialysis you'd achieve a respectible clearance perhaps equivalent to a GFR of around 35ml/min. Roughly "Normal" GFR >90ml/min/1.73m2 decreasing by 0.9ml/min per year after 40. John Prowle (talk • contribs).

[edit] Splitting the article

I think it makes sense to split the dialysis article into 'hemodialysis' and 'peritoneal dialysis.' I think they are very different. Any thoughts? Nephron 02:43, 14 July 2005 (UTC)

[edit] Haemodialysis - Ultrafltration

There's a major error in the haemodialysis explaination, the text implies that water is removed by passage down an osmotic gradient, this is untrue for all except the earliest (post 1950s) haemodialysers.

Small molecules (Urea, etc) pass down a concentration gradient for that molecule into the dialysate. Water, however, passes down a pressure gradient form blood side to dialysate side (lower pressure) the rate of water loss is determined by alterng this trans-membrane pressure gradient. Sodium Chloride then equilbrates with the water lost. This process is termed ultrafiltration. Unlike Peritoneal Dialysis there is no osmotic gradient in conventional Haemodialysis.

• fixedHswapnil 16:00, 3 October 2005 (UTC)

[edit] Steps of dialysis

the whole section about what happens when a patient comes for dialysis sounds out of place...should we make it a separate subheading? (rather than scrapping it altogether, i guess a patient going for the first time may find it useful)Hswapnil 19:03, 28 October 2005 (UTC)

Please edit this according to your experience. I've found it a bit dense to edit. JFW | T@lk 01:14, 30 October 2005 (UTC)

I made a start on it (sub-divided it) after splitting-out the hemodialysis section. I think it is useful... just needs a good re-work. Nephron 17:27, 17 December 2005 (UTC)

[edit] No Baxter? Over 50 dead are crying from the grave over another sign of US censorsip at wikipedia.

How come there isn't a single word about the "Baxter Althane" scandal on the entire Wikipedia, the failed CIA operation which probably tried to eliminate known kidney patient Osama bin Laden with poisoned dialysis equipment, but ended up killing about 50 people in Europe due to the two shipments being mixed up at the port?

What on earth are you talking about? Who censored what? Anyway, it sounds very fascinating but cannot be included unless you have neutral, previously published and verifiable material. If you could provide that, I see no immediate reason why the Baxter Althane issue cannot be covered. JFW | T@lk 15:18, 4 November 2005 (UTC)

Baxter Althane disaster... actually there is something on Wikipedia, nameless friend. Karmafist 04:30, 19 February 2006 (UTC)

[edit] Grafts?

Should something about grafts be mentioned under the types of access in hemodialysis? Along with fistulas and catheters, grafts are a very common method of access for hemodialysis (that's about all I know, however). -- Natalya 04:48, 21 November 2005 (UTC)

[edit] split

as Nephron suggested above, I am going to create two sub-divisions of HD and PD over the next few daysHswapnil 18:40, 12 December 2005 (UTC)

Go for it... it is something I haven't gotten around to doing. Nephron 02:57, 16 December 2005 (UTC)

[edit] Clean-up

Does anyone mind if I do a major clean-up on this article when I've finished on the PD and HD split pages? When that's done, it will make much of this page redundant, and the layout is appalling anyway. I think the focus on this page should really be about renal replacement therapy and the principles of dialysis-most of the rest of it could just be chucked. Whaddya think?Felix-felix 16:50, 30 January 2006 (UTC)

Go for it --KBrown 19:34, 31 January 2006 (UTC)

I'd turn this into a disambiguation page with links to hemodialysis, peritoneal dialysis, continuous veno-venous hemofiltration, "liver dialysis" and other possible meanings. JFW | T@lk 17:15, 1 February 2006 (UTC)

[edit] Proposed merge

I think there was sufficient agreement here for the split-- if you read the various comments here. I don’t see any compelling reason to re-open that discussion. Also, I don’t think a merge would be a good thing-- as it isn’t only hemodialysis that got split-out... there is also peritoneal dialysis. If you disagree feel free to voice your opinion here... or re-post the merge box with a link to this page (as opposed to the hemodialysis talk page). Nephron 04:35, 24 March 2006 (UTC)

Agreed, there's plenty on the HD and PD pages, this page needs stripping down, not remerging the daughter pages.Felix-felix 15:21, 26 March 2006 (UTC)

[edit] Slash and Burn

Finally done it, ditched most of the old article and added some basic explanatory stuff. I don't really think that there should be much more on this page except, perhaps links to other RRTs and extracorporeal therapies...I drank alot of coffee this morning, so let me know if I've gone over the top. CheersFelix-felix 11:41, 30 March 2006 (UTC)

Good stuff. I think the only thing-- is that it could have "main article" links, so that it is clear there are articles devoted to each HD and PD. Nephron  T|C 04:22, 31 March 2006 (UTC)

Good planFelix-felix 12:28, 31 March 2006 (UTC)

[edit] Kolff

We should really mention Willem Johan Kolff somewhere. JFW | T@lk 10:20, 17 July 2006 (UTC)

Not here.Hemodialysis, or preferably a history of dialysis article-it's a fairly big topic, Stewart Cameron has written a book about it I think.Felix-felix 13:31, 18 August 2006 (UTC)

[edit] More hack and slash

Heavy trimming on the external links, most of which were fairly good, but were not directly related to dialysis (renal diet recipes for example) most of these, if really needed should go on the chronic renal failure page. Also fixed some links in the indications section. I think this article is pretty good now...Or am I being a self deluded fool?Felix-felix 13:27, 18 August 2006 (UTC)

I think the article has improved considerably. That said, I think a few of the references got lost and I think some of the discussion about the initiation of dialysis was better in this earlier version of the article. Being a strong proponent of references, I think a few things need to be referenced. Nephron  T|C 03:24, 20 November 2006 (UTC)

No disagreement from me-all these articles need loads more refs, and 'm terrible at putting them in!Felix-felix 08:06, 20 November 2006 (UTC)