EMS providers are often called to care for patients with renal failure for a variety of reasons.  Renal failure occurs when there is a decrease or actual cessation of kidney function.  Patients lose the ability to remove toxins from the blood, maintain fluid and electrolyte balance, control blood pressure, and produce red blood cells.  As a result many can develop congestive heart failure, electrolyte disorders, bleeding disorders, anemia, and symptoms related to toxin accumulation.  There are 2 types, acute, a sudden onset and in most cases, reversible.  Chronic failure is a longstanding, smoldering illness that is not reversible.  The progressive failure of the kidneys in these people will result in death if left untreated.  The definitive treatment for chronic is kidney transplants.  Dialysis is used while awaiting a transplant or if they are not a candidate for the surgery.  So, as you see many medical problems can await EMS in the treatment of these people.

 

The kidneys are located behind the abdominal cavity just inside the lower ribs.  The kidneys maintain the volume and composition of blood and other bodily fluids.  Blood enters the kidneys and is filtered, once filtered it enters other filters and the toxins are modified to become urine.  This last filtering lets important fluids and electrolytes return to the blood stream.  They filter the volume of fluid in your body 4 times a day for a total of 50 gallons of blood that flow through the kidneys each day.

 

Dialysis provides artificial kidney function to patients without functioning kidneys.  There are 2 types of dialysis. The most common is hemodialysis, which is usually done in a specialized medical setting.  The blood is removed from the body through a shunt, directed to a machine where dialysis takes place.  The dialyzed blood is then pumped back into the body through the same shunt.  The other type, peritoneal, involves placing dialysate directly into the abdominal cavity.  This can usually be accomplished at home without any direct supervision by medical personnel.

 

Some complications of renal failure include, uremia.  Uremia occurs with inadequately treated kidney failure.  It presents with nausea, vomiting, diarrhea, weakness, short of breath, itchy skin, headache, and bruising.  Dialysis is the treatment.  Another complication is fluid overload caused by a reduction in the body’s ability to excrete fluid through the urine.  Signs are high blood pressure, swelling of legs, and fluid on the lungs, again dialysis is the treatment.  Anemia, a deficiency of oxygen carrying red blood cells, often occur with end-stage renal disease.  The kidneys play a large part in blood pressure maintenance, almost all have hypertension, or high blood pressure, many are on several medications to correct.  High potassium levels are common place. 

 

Dialysis also has a set of problems, hypotension, low blood pressure, is the most common.  Blood volume is reduced and fluid is removed faster than the body can compensate, thus causing blood pressure to drop.  Hemorrhage due to a low clotting factor and heprin (prevents blood from clotting) given during dialysis.  Equipment malfunction can introduce air or foreign bodies into a patient’s blood and are transported to the heart.  Often regular medications are removed from the body during dialysis. 

 

Understand your health problems, discuss them with your doctor, become familiar with your body and illness.  After all, you only have one.