Kidney Dialysis Health Article

Infectious diseases

Because there is a great deal of blood exposure involved in dialysis treatment, a slight risk of contracting hepatitis B and hepatitis C exists. The hepatitis B vaccination is recommended for most hemodialysis patients. As of 2001, there has only been one documented case of HIV being transmitted in a United States dialysis unit to a staff member, and no documented cases of HIV ever being transmitted between dialysis patients in the United States. The strict standards of infection control practiced in modern hemodialysis units minimizes the chance of contracting one of these diseases.

Normal results

Because dialysis is an ongoing treatment process for many patients, a baseline for normalcy can be difficult to gauge. Puffiness in the patient related to edema, or fluid retention, may be relieved after dialysis treatment. The patient's overall sense of physical well being may also be improved.

Monthly blood tests to check the levels of urea, a waste product, help to determine the adequacy of the dialysis prescription. Another test, called Kt/V (dialyzer clearance multiplied by time of treatment and divided by the total volume of water in the patient's body), is also performed to assess patient progress. A urea reduction ratio (URR) of 65% or higher, and a Kt/V of at least 1.2 are considered the benchmarks of dialysis adequacy by the Kidney Disease Outcomes Quality Initiative (K/DOQI) of the National Kidney Foundation.

Morbidity and mortality rates

The USRDS reports that mortality rates for individuals on dialysis are also significantly higher than both kidney transplant patients and the general population, and expected remaining lifetimes of chronic dialysis patients are only one-fourth to one-fifth that of the general population. The hospitalization rates for people with ESRD are four times greater than that of the general population.

Alternatives

The only alternative to dialysis for ESRD patients is a successful kidney transplant. However, demand for donor kidneys has traditionally far exceeded supply. As of March 1, 2003, there were 53,619 patients on the United Network for Organ Sharing (UNOS) waiting list for a kidney transplant, with an additional 2,405 waiting for a combination kidney and pancreas transplant. In the entire year of 2001, only 14,095 donors gave kidneys, according to UNOS.

For patients with diabetes, the number one cause of chronic kidney failure in adults, the best way to avoid ESRD and subsequent dialysis is to maintain tight control of blood glucose levels through diet, exercise, and medication. Controlling high blood pressure is also important.

BOOKS

Cameron, J. S. Kidney Failure: The Facts. New York: Oxford University Press, 1999.

National Kidney Foundation. Dialysis Outcomes Quality Initiatives (NOQI). Vol. 1-5. New York: National Kidney Foundation, 1997.

U.S. Renal Data System. USRDS 2002 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2002.

PERIODICALS

Eknoyan G., G. J. Beck, et al. "Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis." New England Journal of Medicine 347 (December 19, 2002): 2010–2019.

ORGANIZATIONS

American Association of Kidney Patients. 3505 E. Frontage Rd., Suite 315, Tampa, FL 33607. (800) 749-2257. <http://www.aakp.org>.

American Kidney Fund (AKF). Suite 1010, 6110 Executive Boulevard, Rockville, MD 20852. (800) 638-8299. <http://www.akfinc.org>.

National Kidney Foundation. 30 East 33rd St., Suite 1100, New York, NY 10016. (800) 622-9010. <http://www.kidney.org>.

United States Renal Data System (USRDS), Coordinating Center. The University of Minnesota, 914 South 8th Street, Suite D-206, Minneapolis, MN 55404. 1-888-99USRDS. <http://www.usrds.org>.

Paula Anne Ford-Martin

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

The dialysis treatment prescription and regimen is usually overseen by a nephrologist (a doctor that specializes in the kidney). The hemodialysis treatment itself is typically administered by a nurse or patient care technician in outpatient clinics known as dialysis centers, or in hospital-based dialysis units. In-home hemodialysis treatment is also an option for some patients, although access to this type of treatment may be limited by financial and lifestyle factors. An investment in equipment is required and another person in the household should be available for support and assistance with treatments. Peritoneal dialysis is also performed at home by the patient, perhaps with the aide of a home health-care worker.

QUESTIONS TO ASK THE DOCTOR

• When and where will my dialysis treatments be scheduled?
• How should my diet change now that I'm on dialysis?
• What kind of vascular access will I get?
• Does my new dialysis center have a dialyzer reuse program? If so, what safety checks are in place to ensure I receive a properly treated dialyzer?
• What can I do to make dialysis more effective?
• Can you refer me to any ESRD patient support groups?
• Should I change my medication routine?