Dialysis

As of 2017, more than 2.8 million patients with chronic kidney failure worldwide regularly undergo dialysis.

For 2018, the world has two manufacturers of drugs for peritoneal dialysis - an American corporation Baxter (87% of the world market) and (the German Fresenius 13%)^[1]

Renal failure

Main article: Renal failure

The kidneys are vital organs and perform excretory (excretory) and secretory (active excretion) functions. Persistently reduced kidney function is called chronic renal failure (CKD). With a decrease in kidney function, the formation of urine is disturbed and its components, for example, water and waste products, accumulate in the body, which leads to uremia.

Ways to replace kidney function

Hemodialysis and peritoneal dialysis are the main ways to replace kidney function.

Dialysis is a method of partial replacement of kidney function, during which blood is purified from waste products, excess salt and liquids are removed, and blood pressure and the balance of electrolytes such as potassium, sodium, chlorides, etc. are maintained.

For some patients, only a certain method of therapy is suitable. Not every dialysis center offers all kinds of treatments.

There are three main types of therapies:

• Hemodialysis (HD) is a treatment during which an arteriovenous fistula is formed with the help of a surgeon, through which blood moves to a dialysis machine, undergoes purification and safely returns back to the patient's body.
• Peritoneal dialysis (PD) is a process in which a catheter is permanently implanted into the abdominal cavity. Blood purification occurs using the peritoneum in the abdomen. A special solution is poured into the abdominal cavity through the installed catheter, into which toxic substances and excess fluid come from the blood, passing through its own filter - the peritoneal membrane. This process can be performed by the patient on his own.
• Kidney transplantation.

Hemodialysis and peritoneal dialysis have been performed since the mid-1940s. Dialysis as a regular treatment began in 1960, and it later became the standard treatment worldwide. PAPD (permanent outpatient peritoneal dialysis) began to be applied in 1976. Now dialysis is a safe procedure that has helped thousands of patients around the world.

To decide which therapy option is more appropriate for the patient, various medical, social and psychological aspects need to be considered. The doctor will advise which treatment is most appropriate.

Hemodialysis

In hemodialysis (HD), special equipment is used to purify blood. During the hemodialysis process, blood is purified outside the body using a special filter called a dialyzer, and then returned to the circulatory system of the purified patient.

Dialyzer

A dialyzer is a device in which a semipermeable membrane separates a patient's blood to be purified from a cleansing (dialyzing) solution.

The dialyzer has two main parts, one part for blood and the second part for dialyzate. Both of these parts are separated from each other by a dialyzer membrane. Blood and dialysate never mix and always remain isolated from each other. Red blood cells, proteins and other necessary components remain in the blood because they are too large to pass through the membrane. Smaller waste products such as urea, sodium and potassium, as well as excess fluid, pass through the membrane and are removed. Changes can be made to the dialysate fluid according to the specific needs of the patient. These changes are determined by the dialysis assignment.

In the dialyzer, blood passes through hundreds of small tubes. These tubes are made of special membranes with thousands of small holes that allow certain toxins and chemicals to pass through them and be removed from the blood. These chemicals and toxins are then removed by the dialysis machine. At the other end of the tubes is specially treated water called dialysate. This is very clean water that went through a special purification process at the dialysis center, that is, removing from it all chemicals that could harm your body during the procedure. After purification, this water is mixed according to a special formula with the dialysate concentrate in the dialysis apparatus and then passes through the dialyzer.

The dialysis solution is a mixture of super-purified water and electrolytes used in dialysis to replenish the needs of the body. There are different types of dialysis solution, including those with added glucose. The dialysis solution usually contains sodium, magnesium, potassium, calcium, chloride and bicarbonate. During dialysis, the waste products contained in the blood pass into the dialysis solution through a semipermeable dialyzer membrane.

Vascular access

All patients for dialysis require the formation of vascular access. With the help of vascular access, sufficient blood flow is provided that passes through the dialyzer (filter), namely at least 250 ml of blood per minute. No peripheral vein (from which blood is usually taken for tests or donated blood is received) is able to provide half of the necessary flow: so much blood simply does not flow through the vein. The flow through the vein is the 20th part of all blood pumped by the heart (the minute volume of the heart is 4-5 liters). For 2017, high-flow dialysis and hemodiafiltration require blood flow as early as 300-400 ml/min.

Vascular access is created surgically in the arm, leg, or near the collarbone. There are three main types of vascular access in HD:

• AV-fistula
• Vascular prosthesis
• Central venous catheter

Arteriovenous fistula (AV fistula)

Arterio-venous fistula is the most common type of vascular access. Creating a fistula is a small operation that results in a junction of the artery and vein, usually on the forearm.

Blood begins to flow into the vein under blood pressure, which ensures sufficient blood flow through the vein. In addition, due to the same blood pressure, the vein gradually expands, sometimes several times, its wall thickens, and it is fixed in the surrounding tissues. It is also often called native fistula.

Good vascular access is critical to the delivery of full dialysis therapy. Since AVF puncture is an intervention in the body and, in fact, a small operation, you should adhere to the usual preoperative hygiene measures. This is closely followed by doctors and nurses. Dialysis patients should also pay close attention to vascular access hygiene, as they are particularly vulnerable as a result of their disease and reduced body resistance. Before starting the dialysis procedure, the hand with AB fistula should be washed with soap and wiped dry with disposable wipes. Medical personnel use medical gloves while working with any vascular access, the procedure is carried out according to strict infection control rules.

Those who are shown vascular access in the form of an arteriovenous fistula undergo a small (usually under local anesthesia) operation. After such an operation, it takes, as a rule, 2-3 weeks for the tissue to heal and the AV fistula to begin to function in full.

Once the AV fistula is created, you may be asked to do some exercise to best develop and "mature" the fistula. The process of "maturation" of the fistula takes approximately 3 to 8 weeks. This process is facilitated by exercises with a hand expander. To do this, you need to take the expander in the hand on which the AVF is located, and perform contractions, having previously squeezed the hand above the AVF. You can squeeze your hand with another hand or tourniquet, or with an air-pumped cuff, which is used to measure blood pressure. What is the optimal way to develop an API for the patient, please check with the treating physician. In order to avoid damage to the vascular access, never do anything that can harm the fistula.

It is also necessary to learn how to observe the sensations resulting from the functioning of the AV fistula. Pulsation and noise sensation are signs that the blood circulation process occurs in the fistula. Some patients use a stethoscope to hear so-called vascular noise, others just need to put their hand on the skin above the fistula to feel its functioning. Wound care during the first 2 weeks after fistula formation and regular dressing changes are the most important in the AVF care process. The hand with AVF can usually be washed after 24-48 hours (check with the surgeon). To prevent possible complications (for example, AVF infections), it is very important to ensure that the skin above the fistula is not damaged.

In order to avoid infection of the AV fistula or prosthesis of the vessel, as well as to extend their service life, proper access care is extremely important. The following instructions must be followed:

• Avoid taking blood samples from the AB fistula arm (except for hemodialysis (HD) or with permission from the dialysis center).

• Avoid wearing tight clothing or wristwatches on your hand with vascular access.

• Report immediately to the dialysis center if you have concerns that the AV fistula may not be working.

• Check the working condition of the AV fistula every day, as you were shown at your dialysis centre.

• Always wash your hand with vascular access before each dialysis procedure in the way that dialysis center medical staff have taught you. Thus, you can significantly reduce the risk of developing infections.

• Avoid activities that could impair blood flow to the AV fistula, such as not sleeping on your arm with the AV fistula, carrying shopping bags in it, or measuring blood pressure on it.

Once the fistula has formed, it can last a very long time. In some patients, the fistula has been in working order for 30 years. However, if a fistula is formed in a person in old age or in a diabetic person, it may not exist in the necessary state for very long.

At the same time, the fistula or prosthesis remains the best way for hemodialysis access, because:

• the risk of infection is lower than with an installed catheter
• less likely to increase blood clotting
• provides more blood sweat in dialysis, thereby making it more effective
• the fistula usually has a longer "life" than the prosthesis, but both have more than the catheter.

"In hemodialysis, the main problem of patients on renal replacement therapy is the safety of the arterio-venous fistula or arterio-venous prosthesis. These accesses undergo degeneration over time, constrictions occur in the area of ​ ​ vascular anastomoses, and outflow pathways are difficult. Previously, such access was refused in favor of the formation of new ones. But it is important to note that the number of possible vascular access is limited by the presence of vessels that can be used, - said in March 2021 the head of the department of X-ray endovascular methods of diagnosis and treatment of GBUZ "City Clinical Hospital No. 52 of the Moscow Department of Health," Alexander Vanyukov. - In the presence of a narrowing or blockage of the central vein, this limb cannot be used to form vascular access for hemodialysis. Modern endovascular technologies allow the restoration of narrowed vessels and the reconstruction of blocked central veins. Endovascular reconstruction allows for quite a long time to avoid the traumatic formation of a new vascular access, while maintaining the functionality of the existing one. This not only significantly improves the quality of life of patients, but also makes it relatively comfortable to tolerate all procedures. "

Central venous catheter

The central venous catheter is a plastic tube that is inserted by a doctor into the central vein.

Sometimes it is not possible to wait until the AV fistula is ready for dialysis, in which case a central venous catheter is needed. Temporary catheters are held in place by surgical threads. Permanent catheters designed for long-term use are attached under the skin using a special cuff.

The central venous catheter is a flexible plastic tube, about as thick as a pencil, placed in a central vein on the neck or chest. About 15 cm of the tube is brought out. A bandage is applied to the catheter exit site. It needs to be kept clean and dry, so you need to pay additional attention to it when taking a shower or bath, as well as when washing your head. The catheter is not visible under the clothing.

When using a catheter, a number of problems may develop:

• catheter may become clogged (clogged),
• become infected or lead to narrowing of the veins in which it is installed, so careful care of the catheter is required.

The catheter is the only access for as long as your fistula or prosthesis heals and makes it possible to receive dialysis at a time when other forms of vascular access are not possible for you.

Since the use of catheters may be accompanied by infection, it is strongly recommended to carefully follow all recommendations of the medical staff for catheter care. Events such as redness, swelling, pain, rapid pulse or fever/fever or around the catheter should cause alertness and the dialysis center should be contacted immediately in such a situation.

It is strictly forbidden to use scissors or other sharp objects to remove a patch, bandage or other means that protect the catheter from the environment.

Vascular prosthesis

A prosthesis is an artificial vessel that connects an artery and a vein on the arm or hip. If the patient's veins are too small or weak to create an AV fistula, a synthetic prosthesis (made of synthetic material) may be used to create vascular access. It is located, like its own vessels, under the skin. Compared to AV fistula, the risks of complications developing in the process with the functioning of the prosthesis are significantly higher and are associated with the development of narrowing at the junction of the prosthesis with its own vessels, the formation of blood clots and infections. In this regard, the need to replace the prosthesis appears more often than the need to form a new fistula. However, if you carefully take care of the prosthesis, it can serve for years. Ask your doctor for the rules of care for the prosthesis. The implementation of these simple rules will help to keep vascular access in working order for a long time.

Hemodialysis procedure

During the hemodialysis procedure, the patient, as a rule, does not experience unpleasant sensations. As a rule, dialysis regimen is three hemodialysis procedures per week, each of which lasts approximately 4-5 hours. Sometimes an increase in the frequency or duration of dialysis is required. More rare or short dialysis procedures can adversely affect the patient's well-being and the general state of his body.

The time required for dialysis depends on:

• how well your kidneys work
• how much fluid do you gain between treatments
• how many vital products are in your body
• how much do you weigh
• what type of dialyzer (artificial kidney) is used.

You may experience some discomfort inserting needles into the fistula or shunt, but most patients do not experience any other problems. The dialysis procedure itself is painless. However, blood pressure may fall in some patients. In this case, you may feel nauseous, you may have vomiting, headache, or cramps. With frequent procedures, these problems usually go away. However, if you ever feel unwell on dialysis, be sure to tell your nurse. It may be possible to somehow change your procedure to ease the symptoms you are experiencing.

Advantages:

• free time on days between dialysis procedures, no need to worry about performing the procedure on your own;
• thanks to modern technology, blood purification is easy and effective;
• the procedure is usually performed in a dialysis center.

Peritoneal dialysis

Peritoneal dialysis is a way of cleaning the blood inside the body that can be performed independently by the patient at home.

A special solution is poured into the abdominal cavity through the installed catheter, into which toxic substances and excess fluid come from the blood, passing through its own filter - the peritoneal membrane. Of course, the peritoneal membrane lining the abdominal cavity is not created by nature for this: it is needed so that the intestinal loops slide freely in the abdominal cavity, moving the contents inside themselves. Many blood vessels pass through the peritoneum, absorbing nutrients from the intestine into the blood. Like the peritoneal membrane, this blood flow is not used for its intended purpose: blood that is separated by the membrane from the cleaning solution poured into the abdominal cavity gives uremic toxins to this solution. So, by giving additional functions to the lining of the peritoneum and the vessels of the peritoneum, a "new kidney" is obtained inside the body. The inflow of fluid into the abdominal cavity and its removal is provided by a peritoneal catheter, which is installed during a simple surgical operation (under local anesthesia).

Peritoneal dialysis procedure is easy to learn. It is carried out at home 2-5 times a day by the patient himself without the participation of medical personnel. Only one basic requirement must be met: the whole simple exchange procedure must be carried out very carefully and in clean conditions. Indeed, normally, the abdominal cavity is separated from the external environment and is not ready to meet with microbes, and during peritoneal dialysis, the patient opens the catheter several times a day, and there is a risk of infection getting inside.

Advantages:

• Fewer mode restrictions. In daily life, the peritoneal patient has more opportunities to continue working, do homework and habitual activity;
• There are fewer restrictions on diet and water-drinking regimen, since residual kidney function remains;
• Much less often it is required to attend a dialysis center: examinations are carried out 1-2 times a month.

Medical treatment

If dialysis is needed - hemodialysis or peritoneal dialysis - the attending physician will prescribe individually selected drugs. Below are the drugs that are prescribed most frequently for 2017.

Antihypertensive agents

Most patients suffer from increased blood pressure (hypertension). Blood pressure needs to be regulated through salt and fluid intake restrictions. If hypertension persists, the patient is prescribed antihypertensive therapy. However, it must be remembered that no drugs can affect the excessive supply of sodium (salt) and fluid into the body, which means that they do not remove the reason for the increase in blood pressure.

Vitamin D

Vitamin D enters the body with food and sunlight and must undergo activation stages in the liver and kidneys. Vitamin D makes it easier for the body to absorb calcium that comes with food. Calcium is essential for maintaining healthy bones and transmitting nerve impulses. People with kidney disease take vitamin D in a pre-activated form so that it can be used by the body.

Hardware

Iron is a vital structural component of hemoglobin, a key component found in normal red blood cells (red blood cells) and carries oxygen. Without iron, it is difficult for the body to create enough full red blood cells. The management of patients with iron deficiency includes recommendations for taking special drugs, however, most often iron preparations are administered intravenously directly during the dialysis procedure or after its end.

Phosphate-binding drugs

Our kidneys normally release phosphates obtained from food. In chronic renal failure, this process is disrupted. Therefore, the level of phosphate in the blood and in the cells increases, which leads to extraosseous calcification of soft tissues, for example, skin or vessels of the eyes, this can lead to irritation of the skin and eyes. Other possible negative effects are vascular calcification, which leads to the development of diseases of the cardiovascular system. Dialysis can only help reduce excess phosphate, but does not affect its intake into the body. Thus, it is required to regulate its level in the body through a low phosphate diet and properly selected phosphate-binding drugs. Such drugs "bind" phosphate and reduce its absorption into the blood from the intestines.

Erythropoietin (EPO or EPO)

Erythropoietin, often referred to as EPO, is a hormone produced in the bulk of the kidney. EPO stimulates the red bone marrow to produce red blood cells. Because erythropoietin synthesis in patients with chronic kidney disease is reduced, red blood cell levels are reduced, leading to anemia. Synthetic erythropoietin may be administered intravenously or under the skin as a substitute for erythropoietin produced by the body itself in order to maintain the levels of red blood cells necessary for normal functioning and well-being.

EPO (EPO) is the most common abbreviated name for erythropoietin. Erythropoietin, genetically engineered^[2], is used to treat anemia in dialysis patients].

The effectiveness of antihypertensive drugs may vary depending on the progression of the decrease in residual function of the own kidneys, dialysis regimen, fluid and salt intake, emotional state. Do not forget to inform your doctor about any changes in health and wellness.

Complications

A number of common complications are associated with renal failure and dialysis. This includes anemia, cramps, dry and irritated skin, weight loss. Distant complications can be depression, weakened sexual function, abnormal bone regeneration and bone pain. Despite the fact that these are quite common complications, this does not mean that they all occur. Many patients talked about how dialysis and a drug called EPO (which helps prevent anemia) alleviated many of the symptoms they experienced before dialysis: itching, fatigue, mood changes and bouts of insomnia.

Life on dialysis

For most patients, the biggest difference from previous life is the amount of time they must spend each week conducting dialysis sessions. To this are added visits to the doctor and control measures. Thanks to modern medicine and modern dialysis methods, it is now much easier to maintain personal freedom in terms of organizing daily life.

Including everything in your daily routine just requires a little more skill in managing time and flexibility. In the initial period, it is best to create a weekly schedule in which you include new activities that are medically necessary, as well as everything that matters to your profession, your hobbies and your private life. So you do everything that's important to you. After a while, the new routine of life will become second nature for you - as if it always was.

Exercise

Exercise will be good for your overall health. Many people with chronic kidney disease say exercise was a key point that helped them feel "normal" again after they started undergoing dialysis procedures. Before starting any exercise program, be sure to consult your health care provider so they can determine the "right" type of exercise for you and get it approved. The exercise program should meet your individual needs and interests. Learn how exercise can help you feel better physically and more in control of your emotions.

Driving a car

Kidney failure alone does not affect your ability to drive. If you have a heart condition, vision problems, or feel unwell after the procedure, seek advice from your doctor.

Smoking

Along with what we all know about the harm that smoking causes to the lungs and heart, studies have shown that it also exacerbates kidney disease. Smoking is a load for blood vessels and the heart. While on dialysis, you should quit smoking. Depending on whether you are in the early stages of kidney disease or on dialysis, your doctor will discuss with you different ways to promote smoking cessation.

Work

Many patients with chronic kidney disease (CKD) are employed at full or part-time work. With the permission of the doctor and subject to open discussion with your employer of all related issues, you will be able to continue to work. Your doctor will try to plan procedures in a way that is convenient for you; be sure to discuss the details with the medical staff.

Sex

Sexuality means not only sexual intercourse, but also includes feelings, communication and a degree of willingness to build relationships. Disease-induced physical and emotional changes can affect your sexuality. Kidney disease can cause physical and emotional changes that can reduce sexual attraction and/or potency. People with end-stage renal disease may feel tired after a hemodialysis procedure. The constant feeling of fatigue should be discussed with a doctor and dietitian specializing in renal disease. Men with kidney failure may experience changes in hormone levels that affect sex drive. Be sure to discuss this issue with your health care provider so he can find the appropriate remedies for you.

Travel

Every person needs a change of scenery from time to time, and renal patients are no exception. However, travelling for dialysis patients actually requires more thoughtful planning, so last-minute ticket orders are not a realistic option. Be sure to ask the medical staff to help you with the planning process and providing a pleasant vacation. Your health care provider will help organize dialysis procedures in different countries during vacation. Patients on peritoneal dialysis are much easier to travel. Tell your health care provider where you want to go; it will arrange for dialysis supplies to be delivered to the vacation location you specify.

Diet

Control of liquid and salt consumption

The fluid rate for each patient is calculated based on the volume of urine excreted plus 500 ml per day. Approximately 500 ml is due to the loss of fluid through the skin and lungs. Weight gain between dialysis sessions should not exceed 1-1.5 kg in one day and 1.5-2.5 kg in 2-3 days. The smaller your size, the less weight you have to gain. If you have to remove large amounts of water during dialysis, you may feel bad. Your blood pressure may drop, you may feel dizzy and dizzy. This is called hypotension (low blood pressure). Therefore, it is important to always adhere to your fluid intake rate.

Blood pressure - pressure that exerts blood on the walls of blood vessels, especially on the walls of arteries. Too high blood pressure increases the risk of myocardial infarction and angina attack, an acute cerebrovascular accident. Hypertension must be under control. A lot in the control of hypertension depends on the patient receiving dialysis treatment: it is necessary to learn how to control the volume of fluid consumed (inter-dialysis gain can be 3% of the "dry" weight and should never exceed 5% of the "dry" weight), limit the intake of salt and salt-containing seasonings, as well as canned foods. If necessary, the doctor will prescribe drugs to reduce blood pressure (antihypertensive drugs). However, it must be remembered that no drugs can help if excess fluid and salt accumulate in the body.

To cope with thirst, stretch your fluid intake for the whole day using small cups. You can also rinse your mouth with ice water, suck ice cubes (containing no more than 10-15ml of liquid in each cube) or chew an elastic band. Avoid salt and salty foods such as chips, bacon and soup as they increase thirst. Do not forget about caution with hidden liquids, for example, with water for taking tablets, gravy, custard creams and milk in oatmeal.

For many patients, limiting fluid intake is one of the most difficult aspects of dialysis to deal with. However, there are a number of tips to follow throughout the day:

• be sure to know your fluid consumption rate
• avoid salted food because it causes thirst
• drink from a small cup or cup.
• use caramels when thirsty (be careful if you are diabetic)
• be aware of the liquid content in products such as watermelon, soup, gravy and frozen dishes like ice cream. They are all liquids.

If the water content in your body reaches high levels, the accumulated fluid will cause swelling of the body, primarily due to gravity, usually on the ankles, and then they will spread higher throughout the body. In the absence of treatment, excess fluid is localized in the lungs, which will cause such a life-threatening condition, which is called pulmonary edema. One of the main symptoms of this condition is difficulty breathing. Several such cases will harm the heart. You can try to remove excess fluid during the dialysis process, but if you continue to consume too much fluid, the damage will become irreversible over time and you will have chronic breathing and heart problems.

Development of dialysis technologies

Main article: Development of dialysis technologies

Chronicle

2024

The first Russian hemodialysis machine presented

On July 11, 2024, specialists from the Advanced Engineering School (PISH) "Intelligent Theranostics Systems" of the Sechenov University of the Ministry of Health of Russia presented the first Russian hemodialysis apparatus. The development was carried out in cooperation with the industrial partner of Rusat RDS JSC. Read more here

Indian Polymed localizes the production of hemodialysis products in Russia for 3 billion rubles

The Russian Direct Investment Fund (RDIF) and Poly Medicure Limited (Polymed), an Indian company in the production of medical devices, have agreed on a partnership to localize the production of hemodialysis products in Russia. The volume of investments in the project by RDIF and partners will amount to 3 billion rubles. The corresponding announcement was made on the eve of the official visit of Prime Minister of the Republic of India Narendra Modi to the Russian Federation. This was announced on July 8, 2024 to the medical portal Zdrav.Expert by representatives of the RDIF. Read more here.

A plant for the production of catheters for hemodialysis for 665 million rubles will be built in the Pskov region

A plant for the production of catheters for hemodialysis for 665 million rubles will be built in the Pskov region. The corresponding project of the BetaMed company was approved by the supervisory board of the Moglino special economic zone, the press service of the regional government said on January 16, 2024. Read more here.

2023

Pharmasintez started production of dialysis solutions

In November 2023, Pharmasintez began production of dialysis solutions. The Diasolution product line is delivered in volumes of 2000, 2500 and 5000 ml with a glucose concentration of 1.5%, 2.3% and 4.25%. They are manufactured at East Farm, which is part of the Pharmasintez group. Read more here.

Awak Technologies Raises $20M Investment to Test Portable Dialysis System

Awak Technologies has developed a dialysis machine that is so small that it can fit into a shoulder bag for on-the-go treatments. This was EverCare.ru announced by Zdrav.Expert on October 9, 2023.

Recently, this the Singapore company raised $20 million as part of another round of funding from the group. venture capital investors In total, Awak Technologies has already received more than 80 million from venture capital funds. dollars USA More. here

Medtronic recalls its defective hemodialysis catheters that can cause thrombosis

On August 11, 2023, the U.S. Food and Drug Administration (FDA) announced the recall of defective hemodialysis catheters manufactured by Medtronic. The use of defective products can provoke thrombosis. Read more here.

A criminal case was opened in the Kirov region after a complaint from 170 patients about the refusal of dialysis

In January 2023, a criminal case was opened in the Kirov region after a complaint from 170 patients about the refusal of dialysis. This was reported by the press service of the Investigative Committee of Russia (TFR).

170 citizens from the Kirov region turned to the head of the Investigative Committee of Russia Alexander Ivanovich Bastrykin on a social network, the ICR said in a statement.

According to the appeal, one of the patients is a resident of the region who has been a hemodialysis patient since 2011. In 2013, a specialized organization began working in the region, which at its own expense provided procedures in need.

As indicated in the TFR, after 5 years, a decision was made to terminate the activities of this organization, and patients were forced to refuse its services. Currently, patients are actually deprived of the opportunity to receive the required medical care, since the volume of allocated procedures is much lower than the necessary ones.

The government of the Kirov region said that the Kirov Regional Clinical Hospital is ready to accept all those in need of hemodialysis. They can be helped both in Kirov and in the districts - Sovetsk, Omutninsk, Slobodsky and Vyatsky Polyany. In addition, in 2023, patients will be delivered for hemodialysis by special vehicles through district hospitals.

In March 2023, Kirov patients with kidney diseases sent complaints to the Prosecutor General's Office and Russian President Vladimir Putin about reducing access to high-tech medical care (VMP) in the region. The reason was the decision of the Territorial Commission for the distribution of medical care to redirect part of the volume of VMP from the regional clinical hospital (OKB) operating in the region of the private medical center "Nefrosovet."

Two months later, the Federal Compulsory Medical Insurance Fund demanded clarification from the authorities of the Kirov region regarding the reduced volumes of the state assignment for hemodialysis services in the Nefrosovet center. But this did not solve the problem of patients.^[3]

2022

Medtronic recalls 1m defective dialysis catheters

On July 11, 2022, it became known that Medtronic was recalling more than 1 million dialysis catheters due to a malfunction that could potentially lead to the leakage of devices during use. Read more here.

A new operator began working on the Russian dialysis market

At the end of June 2022, a new player appeared on the Russian dialysis market. We are talking about the company "Nephrohels," which is going to build hemodialysis centers within walking distance from houses in the regions of Russia and work in the compulsory health insurance system (compulsory medical insurance). Read more here

2021: The opening of the dialysis department in the clinical hospital of Russian Railways

March 11, 2021 on the basis of the Clinical Hospital "Russian Railways-Medicine" named after N.A. Semashko in Moscow opened a dialysis department. This was reported by the press service of the network of clinics "Russian Railways." Read more here.

2020: US sorely lacks dialysis equipment

In April 2020, the United States began to lack dialysis equipment due to the COVID-19 pandemic. The sharply increased demand for dialysis equipment and supplies took doctors by surprise because they considered the virus a respiratory disease. However, some patients against the background of coronavirus infection develop not only damage to the respiratory system, but also renal failure, so they need round-the-clock dialysis. Read more here.

Dialysis in Ukraine

Main article: Dialysis in Ukraine

Notes