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Abstract
Renal failure refers to temporary or permanent damage to the kidneys, that results in derangement or insufficiency of renal excretory and regulatory functions. (1) There are two different types of renal failure, acute and chronic. Acute renal failure has an abrupt onset and is potentially reversible. Chronic failure progresses slowly over at least three months and can lead to permanent renal failure or end stage renal disease (ESRD). When ESRD occurs, it leads rapidly to death unless renal replacement therapy (RRT) is started.(2) The most common underlying leading causes of ESRD are diabetes and hypertension.( 2-4)
The overall incidence of ESRD in the USA is 242 cases per million population (p.m.p) per year, with prevalence 1500 p.m.p.(5) In Europe, prevalence of ESRD is 585 p.m.p.(6) According to the Egyptian Renal Registry, the incidence of ESRD in Egypt is 80 p.m.p/year, with prevalence of 225 p.m.p.(7) In the end of 2004, there was an increase in the number of global population with ESRD by 7 % compared with the end of 2003. The number of ESRD patients undergoing treatment is expected to exceed 2 million patients by the year 2010.(5,8 )
Renal replacement therapy is life long, complex, and costy. ESRD is either treated by extra-corporeal blood purification (dialysis: hemodialysis, and peritoneal dialysis), or by kidney transplantion.(2,9)
The majority of patients are treated with hemodialysis (69 %), followed by kidney transplantation (23 %), and the minority by peritoneal dialysis (8%).( 5,10)
Hemodialysis (HD) cleans and filters blood using a machine to temporarily get rid of body harmful wastes, extra salt, and extra water. HD helps to control blood pressure and keeps the proper balance of important chemicals such as potassium, sodium, calcium, and bicarbonate. HD uses a special filter called a dialyzer that functions as an artificial kidney to clean blood. The dialyzer is a canister connected to the HD machine. During treatment, blood travels through tubes into the dialyzer, which filters out wastes, extra salt, and extra water. Then the cleaned blood flows through another set of tubes back into the body.(11)