Kidney failure is a major public health problem. Indeed, it can progress to major or end-stage chronic renal failure which will require replacement treatments: transplantation or dialysis. Depending on the patient’s choice, the latter can be done at home or in a health facility.
In France, approximately 7 to 10% of the population have kidney damage*. A scourge that continues to grow since more than 11,000 people learn each year that they suffer from end-stage chronic renal failure. The latter requires a “replacement treatment”, by dialysis or by transplant, which makes it possible to replace the functioning of the kidneys.
“Chronic diseases such as diabetes or hypertension can lead to progressive deterioration and insufficiency of renal function”, explains Professor Thierry Lobbedez, nephrologist at the CHU de Caen and president of the dialysis commission at the SFNDT (Francophone Society of Nephrology Dialysis and Transplantation). ” The kidney is an organ whose function is to purify the blood of toxins produced by metabolism.. When its purification capacity becomes less than 15 ml per minute, a replacement treatment must be considered. »
The transplant: the most effective treatment
In France, in 2020, of the 91,875 people suffering from end-stage chronic renal failure, 55% were on dialysis and 45% had a kidney transplant. “The transplantation of a kidney from a living or deceased donor is the best treatment for end-stage chronic renal failure, recognizes the nephrologist. However, because of their state of health or their personal choice, too many people cannot benefit from a kidney transplant. Dialysis treatment is then proposed. »
Dialysis: treatment at home or in the hospital
Dialysis eliminates toxins that are no longer eliminated by the kidneys. It is a restrictive treatment that has a significant impact on the quality of life of patients. It can be done at the patient’s home or in a health facility, in consultation with the care team. “But patients are often polypathological and have no choice of treatment,” replies Jan Marc Charrel, president of France Rein, which brings together more than 10,000 members. Our role is to make them aware of all the options in order to find the one that will allow them to live the disease as best as possible. »
Hemodialysis: 3 sessions per week
There are two types of dialysis. First of all, hemodialysis which is a method of extracorporeal purification. The patient’s blood is filtered outside the body in a machine equipped with an artificial filtration membrane. “A connection (fistula) between the vein and the artery of the arm must first be created surgically in order to increase the diameter and the blood flow in the vein”, explains the doctor. After four to six weeks, the vein becomes strong enough to tolerate repeated punctures.
The dialysis session generally lasts from 3 hours a day daily to 4 hours 3 times a week, in a medical environment. “The treatment can also be done at home following an apprenticeship, the main difficulty being to learn how to puncture the arteriovenous fistula. »
Peritoneal dialysis
Other technique used: peritoneal dialysis, which will use the filtration capacities of the peritoneum (membrane surrounding the organs of the abdominal cavity and the digestive tract). This method allows exchanges between the blood and a liquid called dialysate, inside the body. “We will inject 2 liters of this liquid into the abdomen, which will gradually become loaded with toxins and which will be renewed following 4 to 6 hours”, explains the nephrologist.
This manipulation is done through a flexible catheter that will have been placed by a surgeon regarding two weeks before the start of treatment. ” The injection can be done manually or automatically during sleep using a machine that fills and empties the abdomen. » Peritoneal dialysis can be managed at home by the patient himself or with the help of a nurse.
Fatigue, the main side effect of dialysis
Dialysis treatment is well tolerated. “He leads despite everything a feeling of fatigue which is a source of discomfort for the patient, recognizes the professor. Nevertheless, it is possible to continue working, playing sports and even carrying a pregnancy to term while being treated with dialysis,” says Professor Lobbedez.
However, the survey on the quality of life of dialysis patients reveals a reduction or even a total cessation of professional activity as soon as they go on dialysis. “Their quality of life is strongly impacted, and apart from medical care, there is no specific social support, especially for patients practicing the technique at home”, specifies Jan Marc Charrel.
The life expectancy of patients on dialysis depends on the therapeutic possibilities and the management of their pathologies. “Unfortunately, it is lower than that of the general population”, recognizes the doctor. Indeed, kidney disease at the dialysis stage increases the risk of cardiovascular disease.
Can dialysis be stopped?
It is not possible to interrupt a dialysis treatment. “But everything must be done to reduce its impact on the quality of life of patients, assures Professor Lobbedez. The simplification of dialysis devices, the reduction in the size of the machines and the increase in the performance of treatments make it possible to reduce the impact of chronic kidney disease on the health of individuals. »
In parallel, healthcare teams are working to improve access to kidney transplantation“the only way to significantly improve the future of patients”.
Educate patients
It is estimated that 6 million people have diseased kidneys and are unaware of it. When they realize this, it is often too late and they have to consider urgent treatment – transplant or dialysis. “Kidney diseases are silent because they do not cause noticeable symptoms,” continues Jan Marc Charrel. But by being screened, it is possible to delay or even avoid these very serious pathologies. »
It is with this in mind that the association France Rein organizes every year, at the beginning of March, ” National Kidney Week “. Its mission: to raise awareness of early detection by encouraging patients to have regular check-ups with their general practitioner or at the hospital. Many information and screening stands have been set up throughout France. As a form of popular health education…
*According to the latest figures from REIN (Epidemiological Network and Information in Nephrology).
