After an aesthetic treatment with malpractice, Silvina Luna suffers from a serious illness that forces her to do dialysis three times a week. He suffered methacrylate poisoning, a substance that entered his bloodstream and caused a chronic picture of hypercalcemia (high calcium level) and kidney failure. The diagnosis put her on the waiting list for a kidney transplant. But, at the same time, they are treating her for a bacterium that she has in her blood and this makes surgery impossible. What is it about this disease that affects your health?
"Chronic kidney failure is mainly caused by a harmful lifestyle. It is the progressive deterioration of kidney function for more than 3 months. This organ is responsible for filtering the blood to produce urine, but when it is damaged, its functional unit (glomerulus) is destroyed internally. The kidney can fail chronically or acutely. Type 2 diabetes and high blood pressure are the two most frequent causes," says Gabriel Lapman, nephrologist and author of the book "Reset. Lifestyle medicine", in dialogue with Clarín.
Currently, 5,511 Argentines are waiting for a kidney transplant, according to INCUCAI data. According to the Terminal Chronic Renal Failure Registry, about 30,<> patients are on dialysis. Kidney disease has the possibility of replacement treatment by dialysis and transplantation.
Fernando Cichero is medical director of the Manuel Rocca rehabilitation hospital. He performed transplants for 12 years and spent 30 years doing vascular accesses for dialysis in adults and pediatrics. He explains to Clarín that the causes of kidney failure can be pre-renal (problem with the irrigation of the kidney), renal (problems within the kidney) or postrenal (the ureters become obstructed and thus the kidney cannot filter the blood).
Silvina Luna during a TV interview, where she talked about her state of health. Capture TV.
"Silvina Luna had a kidney problem because methacrylate, which is a plastic, clogged all the filter (nephron) that the kidney naturally has. So it no longer works and can no longer filter the blood to produce urine," Cichero describes.
What is hypercalcemia? "The fact that the kidneys do not work properly and end up on dialysis produces chronic hypercalcemia because there is a hormone that is missing in the diseased kidney and that cannot control renal metabolism," says Cichero.
What is it like to live with dialysis?
In the face of chronic renal failure, the only way for patients to stay alive is through hemodialysis. What does it consist of? In going to a dialysis center three times a week to connect to a machine that, through special filters, removes from the blood the toxins that the body itself produces.
The specialists consulted agree that the treatment of blood dialysis or hemodialysis offers excellent quality of life, controlling the diet, taking remedies to generate red blood cells and doing sports.
Because of her kidney condition, Silvia Luna must undergo dialysis three times a week.
"Kidney failure has 5 degrees. In stages ranging from 1 to 4, a change in the patient's lifestyle is required. In stage 5, however, you need hemodialysis to live. This treatment can be temporary or permanent," Lapman describes.
He notes: "There are two modalities of dialysis. One is hemodialysis, which involves going to a health center three times a week to connect for four hours to a device with vascular access. It is a treatment to filter toxins and water from the blood, as the kidneys did when they were healthy. It helps control blood pressure and balance important minerals in the blood such as potassium, sodium and calcium. The other is peritoneal dialysis that is performed at the patient's home and is done through the exchange of a substance."
How can it be done? There are two ways: by venous artery fistula (it is the surgical connection of an artery to a vein) or by a catheter when kidney failure is acute. Between 3 and 4 hours, the patient lies on the table. During that time, you can sleep, watch TV, or chat. The concurrency cycle is usually Tuesday, Thursday and Saturday and the other Monday, Wednesday and Friday.
"If the patient is not dialyzed, they are at risk of toxicity because the body begins to fail and retain potassium. Too much potassium in the blood intoxicates the brain and can cause cardiac arrest," says Cichero.
"In the face of chronic kidney failure, you need dialysis to regulate potassium and to expel urea and creatinine from the body," insists the expert.
And he warns: "The problem with dialysis is that the place where you are connected to draw and put your blood back has to be extremely clean and, sometimes, bacteria penetrate through that place and infections arise. In addition, at the time you are dialyzed they must anticoagulate you, and that anticoagulation can generate hemorrhages or thrombosis."
Is transplantation the only option?
In principle, kidney disease has the possibility of performing replacement treatment by dialysis or a transplant.
For Cichero, transplantation is the only option because there is no self-supporting dialysis machine that you can incorporate into your body that permanently replaces kidney function. Therefore, he considers that the ideal is to change dialysis for a kidney transplant.
"That's why, today, many people have the option of getting a transplant. But despite being on the waiting list, they are not transplanted. Why? Because they were on the waiting list for a long time and since they are already very old they are not candidates for transplantation due to the risks associated with surgery and the immunosuppressive drugs needed after the procedure," says Cichero.
And he theorizes: "Also, you never get to do more than 1,000 per year. There is a permanent deficit between the waiting list and those who can actually undergo a kidney transplant. In this sense, there is the paradox that there are more and more people who enter dialysis and obtain a good quality of life, but the number of donors to be able to reduce the list does not increase in the same proportion. "
When a transplant can be done
The question that arises, then, is why a transplant cannot be done if the patient has an infection. "Because it can generate sepsis (generalized infection). In other words, the infected patient cannot be admitted to any surgery unless the surgical intervention resolves the infection, for example, in the case of peritonitis," says Lapman.
And he emphasizes that the patient who is transplanted does not always do well. Why? "Because kidney transplantation can have complications such as rejection, infections or surgery problems," he explains.
How does the waiting list work?
In 2022, 4,079 patients on the waiting list received an organ and cornea transplant, which means a 26% increase in the number of transplants compared to 2021. Of this number, 2,006 received an organ transplant. In total, 1,383 kidney transplants were performed.
There is a single waiting list throughout the country for each type of body, controlled and supervised by INCUCAI. The distribution and allocation of organs and tissues is carried out through a computer system based on pre-established medical criteria that mainly take into account the severity of the patient, the compatibility between donor and recipient, the time on the waiting list. This system ensures fairness and transparency in distribution.
Patients enrolled on the waiting list do not have a priori a numerical positioning. That is, there is no pre-established list where one is first, another second and so on. The numerical ordering of the waiting lists is given in each donation process when knowing the characteristics of compatibility between donor and recipient according to the current distribution criteria.
"In the case of kidney transplantation, the method for distribution and allocation is established by a sum of points, that is, SINTRA gives each patient a score based on different variables that contemplate their situation. They consider, for example, seniority on dialysis, age, blood group, "they explain to Clarín from INCUCAI.
And they emphasize that these medical criteria seek the greatest compatibility between the donor and the recipient. "The sum of points establishes a list that positions in the first places the receivers who have the highest score. In case of equality of points, the day and time of admission to dialysis is taken into account", conclude from the National Institute.
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