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Bucher Porträts
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An out-patient dialysis practice for the treatment of renal and hypertensive diseases
Comprehensive care for kidney patients
Healthy people have two kidneys. When one stops working or is damaged, people can continue to lead their normal life without any restrictions. However, if both kidneys fail, the person will die within a few days if they do not receive treatment. There are about 60,000 people in Germany who require so-called kidney replacement therapy.
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The internist and nephrologist Götz Krupp (photo below) knows all about these figures. He has worked with Dr. Henrik Jakobs in the only out-patient dialysis practice in Berlin-Buch and the surrounding area which opened in 1993. About 60 patients regard this modern practice in the Allwall-Haus in Viereckweg, Buch, as a second home, and they spend 12 to 15 hours a week there.
Healthy kidneys ensure that the body excretes salts, toxins and water in the urine. If they cease working then the only thing that can help is kidney replacement therapy. This involves a number of methods including washing the blood (hemodialysis), peritoneal dialysis and kidney transplantation. Patients attend the practice three times a week for hemodialysis. This involves connecting them up to a dialysis machine for about four to five hours. During the procedure, the blood is circulated outside the body and passes through a semi-permeable membrane. Harmful metabolic products pass through the membrane into the dialysis fluid, and water is also removed from the blood. The purified blood is then returned to the patient. Patients undergoing dialysis no longer produce any urine.
The advance of kidney diseases
According to Götz Krupp, most of the patients in the practice are over the age of sixty. This is because, in the majority of cases, kidney diseases are a consequence of diabetes and high blood pressure and these conditions increase in old age. Accordingly, the number of patients requiring kidney replacement therapy increases annually by about three to five percent.
A small fraction of the patients use peritoneal dialysis, which can be carried out at home. Their peritoneum acts as a dialysis membrane. The patients themselves use an implanted catheter to administer the dialysis solution to the abdominal cavity. Toxins are removed from the body by regularly changing the fluid four times a day. The effect is similar to that of hemodialysis. In addition, the practice also looks after patients who are awaiting kidney transplantation or who have already undergone this operation. It is particularly important that any impairment in kidney function is detected early and treated properly.
A total of 17 staff ensure that dialysis is carried out without any problems involving 32 dialysis beds. A special recent service provided by the practice is night-time dialysis. The patients can sleep for eight hours while connected to the dialysis machine. This is very gentle since the slower the removal of water by the dialysis machine the better it is tolerated by the patients. This is the method of choice especially for overweight patients, for they need a longer period of dialysis because, on account of the greater body weight, more water needs to be removed. However, night-time dialysis also improves the quality of life of patients who need to make use of the daylight hours because of their job.
 If patients have damaged kidneys and require dialysis, their lifestyle plays a great role in determining their future fate, so says Götz Krupp. „People who are disciplined and have no other serious conditions can live until old age if they are on dialysis.“ In the case of dialysis patients, there are a number of factors that are important : their diet should be low in salt and protein and they should not drink to much. Also, marked swings in weight should be avoided.
Prevention is possible
Prevention is very important in order that the kidneys do not cease to function properly. This is because kidney damage can occur virtually unnoticed. This is why Götz Krupp ensures that all patients with abnormal renal values or protein and red cells in their urine immediately consult an expert in kidney diseases. If they wait until they suffer problems like weakness and reduced functional ability then, in most cases, it is already too late.
If treatment is started promptly, kidney failure can be successfully prevented. Those at greatest risk of irreparable kidney damage are poorly controlled diabetics and patients with high blood pressure. In addition, restricted kidney function can also lead to other conditions like high blood pressure, anemia and bone alterations, which need to be diagnosed and treated promptly.
Accordingly, the practice regularly holds an Open Doors Day, like the one at the end of September, 2005. More than 150 citizens and patients learned about kidney diseases, dialysis and transplantation and found out how to prevent kidney diseases.
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