Reasons for Kidney Dialysis

Kidney dialysis, also referred to as renal replacement therapy, dialysis, or membrane filtration, is a medical intervention tailored to compensate for diminished kidney function. This treatment becomes necessary when the kidneys can no longer meet the body’s needs or perform their essential duties effectively. Specifically, dialysis is indicated when kidney function has declined to approximately 85-90%, with a glomerular filtration rate (GFR) of less than 15 milliliters per minute.

Deciding to initiate dialysis involves considering several factors, including the patient’s age, overall health, laboratory test results, the patient’s willingness to commence treatment, and the severity of symptoms associated with kidney failure. Additionally, if there are complications such as nutritional issues or difficulties in fluid balance and blood pressure control, dialysis may be warranted. It is important to note that in some instances, dialysis may be started before complications arise. Ultimately, the timing for initiating dialysis is heavily influenced by the healthcare provider’s clinical judgment and the patient’s condition. Once a decision for dialysis is made, the patient must adhere to all scheduled sessions to prevent complications arising from unmanaged kidney failure. Below are specific conditions that may necessitate kidney dialysis.

Chronic Kidney Failure

Chronic kidney failure, or chronic renal failure (CRF), is characterized by gradual damage to the kidneys, impairing their functionality over an extended period. Early diagnosis is essential for effective management and to minimize complications. Treatment focused on the underlying cause aims to slow disease progression. It is important to recognize that chronic kidney failure cannot be resolved except through dialysis or kidney transplantation. Notably, chronic kidney failure may not present obvious symptoms due to the kidneys’ remarkable ability to function, which can result in diagnosis based solely on blood and urine tests without any subjective symptoms. In contrast, advanced stages may lead to fluid retention, known as edema, usually manifesting in the feet, ankles, or legs, with fewer instances in the hands or face. Other symptoms accompanying chronic kidney failure may include chest pain, fatigue, headaches, muscle pain, nausea, and shortness of breath.

Chronic kidney failure is often attributable to long-standing medical conditions that rarely cause immediate renal failure. Some of these conditions include:

Hypertension: Long-term elevated blood pressure can damage the nephrons, the components responsible for filtering waste.
Prolonged urinary obstruction problems, such as kidney stones, benign prostatic hyperplasia, and certain cancers.
Diabetes (Type 1 and Type 2): Uncontrolled diabetes in later stages has a significant association with kidney failure, although it rarely occurs within the first ten years of diabetes onset.
Vesicoureteral reflux: This occurs when urine backflows to the kidneys instead of being expelled from the body.
Interstitial nephritis: A condition characterized by inflammation between kidney tubules, potentially affecting kidney function.
Polycystic kidney disease: A hereditary disorder in which cysts develop on the kidneys, leading to potential functional impairment.
Glomerulonephritis: Inflammation of the glomeruli, critical for waste filtration, which can occur acutely or gradually.
Pyelonephritis: A urinary tract infection affecting one or both kidneys; in some cases, it can cause kidney failure, particularly if recurrent.
Others: Additional causes of chronic kidney failure can include systemic lupus erythematosus, prolonged medication use, and substance abuse, such as heroin or malaria.

Acute Kidney Injury

Acute kidney injury (AKI) is a sudden health condition impacting kidney function within a brief timeframe, typically two days or less. The severity of AKI can range from mild functional impairment to total kidney failure. Importantly, AKI is often reversible if diagnosed and treated promptly. Treatment approaches depend on identifying the underlying cause and the kidney’s recovery rate. Most cases necessitate hospitalization for management, with treatment options including:

Treating the underlying cause: Addressing the condition responsible for AKI is essential to resolve the issue.
Managing complications: Healthcare providers must address complications according to their nature, which may include:
- Maintaining fluid balance by using diuretics to eliminate excess fluids while administering IV fluids for dehydration.
- Regulating electrolyte levels with appropriate medications.
- Kidney dialysis, often hemodialysis, to remove excess fluids and toxins from the body.

The causes of acute kidney injury may include reduced blood flow to the kidneys, urinary obstruction, or direct injury to the kidneys. Elderly individuals over 65, as well as those with chronic health issues like chronic kidney failure, diabetes, liver disease, and heart failure, are at higher risk for AKI. Symptoms vary based on the cause, and many cases may present silently, only identified through laboratory testing. Possible symptoms of AKI include:

Swelling in the legs, ankles, and around the eyes.
Reduced urine output.
Shortness of breath.
Fatigue and exhaustion.
Confusion.
Nausea.
Chest pain.
Severe cases may lead to coma or seizures.

Other Causes

Several additional factors may necessitate renal dialysis, including:

Hyperkalemia: This critical condition requires medical oversight and may necessitate dialysis when other treatments prove ineffective or if there is total renal failure.
Kidney injury: Kidney injuries are classified into blunt trauma or penetrating injuries. Blunt trauma may only be detected through tests or present initial external signs like bruising. Penetrating injuries, such as stab wounds or other sharp objects, can harm the kidneys even if the wound does not occur nearby. In severe cases of kidney injury, dialysis may be an appropriate treatment option.

The Importance of Adhering to Dialysis Sessions

Individuals undergoing dialysis must prioritize attendance at all treatment sessions. Missing even one session consistently can seriously jeopardize the patient’s health, as it may result in insufficient treatment and allow toxin levels to rise in the body. If a single session is missed while adhering to the rest of the schedule, predicting the body’s response can be challenging; some patients may cope short-term, while others might not. Therefore, it is crucial to attend all dialysis sessions and to consult a healthcare provider if unforeseen circumstances arise that prevent attendance.

Medical Care for Dialysis Patients

Effective kidney dialysis requires collaborative efforts from the patient, their family, and healthcare providers. The roles of each healthcare professional involved in the dialysis process are as follows:

Physician: A nephrologist initiates patient care by prescribing dialysis and closely monitors the patient’s health before and after treatment, addressing any arising complications.
Nurse: Nurses ensure that patients receive their medications and treatments appropriately, oversee the dialysis process, and educate patients and their families on home dialysis procedures.
Social Worker: Social workers provide counseling to assist patients and their families in coping with kidney disease and the resulting lifestyle changes, aiming to enhance the patient’s quality of life.
Nutritionist: Nutritionists recommend dietary plans that align with the patient’s health status, as nutrition plays a critical role before and after dialysis.

References:

(*) Glomerular filtration rate: A test conducted to assess kidney health, measuring the volume of blood that passes through the kidney’s glomeruli each minute, where glomeruli are the small filtering units responsible for waste elimination from the blood.

(*) Systemic lupus erythematosus: A common form of lupus characterized by the immune system mistakenly attacking various body parts, including joints, skin, brain, kidneys, and blood vessels.

(*) Ureters: These are narrow tubes that transport urine from the kidneys to the bladder, forming a part of the urinary system.