Dialysis

90% of hospital admissions in patients with heart failure are due to fluid overload that further destabilizes the heart, sometimes compromising other organs such as the lung and kidney, and increasing the risk of mortality.

The pharmacological treatment indicated in these cases may not be sufficient, especially when they do not respond well to diuretic treatment.

In these cases, we have what is known as ultrafiltration, a treatment which, through a venous access, allows the blood to be extracted and a volume of water to be removed from it through an external filter.

This technique offers a series of advantages with respect to pharmacological treatment: controlled and adjustable volume and speed of liquid extraction, it does not have an effective negative effect on the levels of electrolytes in the blood, it has been shown to improve that of heart failure and to achieve more or less prolonged hemodynamic stability in the majority of these patients.

Indications:

• Heart failure with demonstrated resistance to diuretics.
• Acute heart failure with oligoanuric renal dysfunction (reduced urine volume).
• Bridge treatment to heart transplantation.

Liver failure and/or cholestatic itch are two processes that in certain situations become severe or refractory to usual medical treatment.

Liver failure can be acute, due to viruses, drugs or toxins that cause acute damage to the liver, or as a result of acute chronic liver failure in a patient with known liver disease.

When the liver loses its functions, due to failure or major resection in case of tumors, a large amount of toxic substances such as bile acids, conjugated bilirubin, amino acids, etc., accumulate in the body, which can cause a severe generalized toxicity picture compromising life.

In these situations and while waiting for the definitive treatment such as liver transplantation or the regeneration of the residual tissue at resection, we have a liver dialysis system called MARS. Both studies on MARS and the results of our experience show how this system provides clinical stability, with usual hemodynamic and neurological improvement and, as a consequence, it can prolong the survival time while waiting for liver transplantation or tissue regeneration.

Regarding the indications of cholestatic refractory pruritus, they are usually minor, and the aim is to reduce it after several consecutive sessions for a more or less long time. It is postulated that substances responsible for the patient's pruritus are eliminated.

Indications:

• Acute decompensation of chronic liver failure.
• Acute hepatic dysfunction caused by viruses, toxins, drugs, etc.
• Initial hepatic dysfunction of liver transplantation from treatable cause such as hepatotoxicity, etc.
• Liver dysfunction after liver resection surgery.
• Pruritus (itching) that does not respond to treatment in chronic cholestatic syndromes such as primary biliary cirrhosis, sclerosing cholangitis, etc.

Although sufficient data have long been available to state that the use of MARS can stabilize the liver function of patients with acute liver failure or acute chronic liver disease, its final impact on the mortality of these patients is not yet clear.

Multiple myeloma is a tumorous disease of the bone marrow that consists of an atypical proliferation of plasma cells.

Plasma cells come from B lymphocytes and under normal conditions are responsible for the production of immunoglobulins, blood proteins with an important defense function against infection.

These atypical cells produce and secrete an abnormal immunoglobulin into the blood which produces an excess of light chains that the kidney is unable to eliminate effectively and which can cause irreversible damage to kidney function.

The simultaneous application of a chemotherapy treatment to reduce the plasma cells that produce these light chains and another treatment that allows the effective elimination of these very high chains in the blood and toxic to the kidney, increases the possibilities of a better recovery of the renal function.

Renal involvement in multiple myeloma is one of the most frequent complications (50% of cases). Renal failure is the main cause of morbidity and mortality in myeloma patients. Clinical research indicates that reducing the period of exposure of the kidney to light chains to toxic levels reduces the risk of developing permanent kidney failure.

Indication:

• Patients diagnosed with multiple myeloma with excess free light chains and associated renal failure, attributable to that cause, who have been scheduled for chemotherapy treatment for myeloma.

The Nephrology Service, in close collaboration with the Haematology Service, carries out this type of haemodialysis as a coadjuvant treatment in chemotherapy in those patients with multiple myeloma who meet the inclusion criteria.

Radioactive iodine is administered as a complementary treatment to surgery for differentiated thyroid carcinoma.

This iodine is mainly eliminated through the urine so, in those patients with renal failure, hemodialysis is strictly necessary to decrease the radiation to the rest of their body.

Otherwise, the treatment with radioactive iodine could not be carried out since the risk of diminishing blood cells (myelosuppression) and irradiation of other organs such as salivary glands, digestive system, etc., would be very high.

The hemodialysis procedure is carried out in a special isolation room that the patients occupy during the treatment with radioactive iodine. It is performed by means of a conventional hemodialysis monitor reserved for these treatments and with a standard and equivalent guideline to that performed in your usual center.

Before and after each session, radiopharmaceutical levels are taken to determine the duration and number of sessions required. Under all the radioactive protection measures, the nurse connects you to the dialysis and to the monitor for taking constants and then monitors the dialysis from outside the room through a video-camera system.

Every time you see abnormal indicators on the dialysis or constants monitor, you will enter with the protective measures and solve the problem.