Dialysis: Key Principles and Concerns for Patients

Dialysis

The principle of dialysis is to remove waste products and excess fluids from the blood when the kidneys are no longer able to perform these functions effectively.
It is typically indicated for patients with end-stage renal disease or severe kidney dysfunction.
If you are concerned that your father may not need dialysis, it is important to consult with a healthcare professional who can evaluate his kidney function through tests such as serum creatinine levels, glomerular filtration rate (GFR), and other relevant assessments.

w1025, 20~29 year old female. Ask Date: 2002/02/26

Dr. Wang Yiming reply Internal Medicine

The purpose of dialysis is to remove excess toxic waste from the body that cannot be excreted.
This is achieved through hemodialysis or peritoneal dialysis.
The criteria for initiating dialysis typically include: 1.
Serum creatinine greater than 8 mg/dL, 2.
Blood urea nitrogen greater than 100 mg/dL, 3.
Pulmonary edema with excessive fluid accumulation, 4.
Severe nausea, vomiting, and loss of appetite, 5.
Muscle cramps or seizures, 6.
Severe electrolyte imbalances, 7.
Any patient meeting the above criteria, along with impaired kidney function, should undergo dialysis.

Reply Date: 2002/02/26

More Info

Dialysis is a medical treatment that performs the functions of the kidneys when they are no longer able to do so effectively. It is crucial for patients with kidney failure, whether acute or chronic, to understand the principles and concerns surrounding dialysis to make informed decisions about their health care.

Key Principles of Dialysis
1. Purpose of Dialysis: The primary goal of dialysis is to remove waste products, excess fluid, and toxins from the blood when the kidneys can no longer perform these functions. This is essential to maintain a proper balance of electrolytes and to prevent the buildup of harmful substances in the body.

2. Types of Dialysis: There are two main types of dialysis: Hemodialysis and Peritoneal Dialysis.

- Hemodialysis involves using a machine to filter blood outside the body. Blood is drawn from the body, filtered through a dialyzer (artificial kidney), and then returned to the body.

- Peritoneal Dialysis uses the lining of the abdomen (peritoneum) as a natural filter. A special solution is introduced into the abdominal cavity, where it absorbs waste products and excess fluids, which are then drained away.

3. Indications for Dialysis: Dialysis is indicated when a patient’s kidneys have lost about 85-90% of their function. This can be due to conditions such as chronic kidney disease (CKD), acute kidney injury (AKI), or end-stage renal disease (ESRD). Symptoms that may indicate the need for dialysis include severe fatigue, swelling, shortness of breath, and electrolyte imbalances.

4. Assessment for Dialysis: Before starting dialysis, healthcare providers assess the patient's overall health, kidney function (often measured by glomerular filtration rate or GFR), and the presence of symptoms related to kidney failure. This assessment helps determine the necessity and urgency of starting dialysis.

5. Patient Autonomy and Decision-Making: It is essential for patients and their families to be involved in the decision-making process regarding dialysis. Open communication with healthcare providers can help clarify the need for dialysis and address any concerns about unnecessary treatment.

Concerns for Patients
1. Fear of Unnecessary Dialysis: It is understandable to be concerned about undergoing dialysis when it may not be needed. Patients should discuss their fears with their healthcare team, who can provide clarity on the necessity of the treatment based on medical evaluations.

2. Quality of Life: Dialysis can significantly impact a patient’s quality of life. Patients should consider how the treatment fits into their lifestyle, including time commitments, dietary restrictions, and potential side effects.

3. Potential Complications: While dialysis is a lifesaving treatment, it is not without risks. Complications can include infections, blood clots, and cardiovascular issues. Understanding these risks can help patients make informed choices.

4. Emotional and Psychological Impact: The diagnosis of kidney failure and the need for dialysis can lead to emotional distress. Patients may experience feelings of anxiety, depression, or isolation. Support from family, friends, and mental health professionals can be beneficial.

5. Long-Term Management: Dialysis is often a long-term treatment, and patients should be prepared for the ongoing management of their condition. This includes regular check-ups, monitoring of lab results, and adherence to dietary and fluid restrictions.

Conclusion
In conclusion, dialysis is a critical treatment for patients with significant kidney dysfunction. Understanding the principles behind it, the indications for its use, and the concerns that may arise can empower patients and their families to make informed decisions about their healthcare. If there are doubts about the necessity of dialysis, it is essential to have a candid discussion with the healthcare provider to ensure that the treatment plan aligns with the patient's health needs and personal preferences.

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