The decision to begin dialysis treatment is one that must be reserved for the patient and their physician. There are many factors that must be taken into consideration when evaluating the need for renal replacement and the initiation of treatment is not always based on standard textbook indications for dialysis. Similar to other areas of healthcare, positive patient care outcomes are usually dependent on an accurate medical diagnosis in conjunction with the patient’s approval of a treatment plan.
In general, individuals begin to develop the need for dialysis when their kidney function drops below 10 to 15 percent of normal. At this point, patients commonly start to experience adverse physical reactions that result from the buildup of excess water and waste. Some common symptoms include nausea, vomiting, swelling of the feet, and fatigue. While these symptoms are indicative of the need for treatment, many dialysis patients require therapy long before they develop any of these uncomfortable reactions. Individuals who are at risk of acute or chronic kidney disease need to engage in regular communication with their physician so that adverse health effects can be minimized.
General Indications for Dialysis
There are many potential indications for dialysis that may lead the physician to recommend that an individual begin the renal replacement process. One of the techniques that medical students use to remember the different factors that can lead to treatment is to memorize the pneumonic “AEIOU.” These letters stand for Acidemia, Electrolytes, Intoxication, Overload, and Uremia. Each of these conditions encompasses a number of different indications for dialysis that are related to acute kidney injury and that may lead to the initiation of treatment.
Acidemia refers to an unusually high degree of acid in the bloodstream that may require dialysis if it cannot be corrected with bicarbonate. Electrolyte abnormalities are especially concerning because they can cause a number of problems including sudden cardiac death. Intoxication refers to a number of different scenarios in which the patient may have ingested chemical compounds that are capable of severely damaging the kidneys and other organ systems. The pneumonic “SLIME” is often used to remember the different types of poisonous substances that are dialyzable. These letters stand for Salicylic acid, Lithium, Isopropanol, Magnesium-containing laxatives, and Ethylene glycol. Overload refers to the retention of fluid that cannot be eliminated using diuretics. Uremia is a condition that results when the body is no longer able to use the kidneys to remove wastes. Many different illnesses resulting from uremia may serve as indications for dialysis.
In addition to acute causes of kidney failure, there are chronic causes that may also lead a physician to recommend dialysis as a treatment option. Individuals who suffer from diabetes, high blood pressure, and a number of different developmental diseases may be at increased risk of developing dialysis dependent kidney failure. The medical team will collect blood samples and perform a number of tests to determine if a patient’s glomerular filtration rate warrants renal replacement. Some important indications for dialysis related to chronic kidney disease include pericarditis, pleuritis, progressive uremic encephalopathy, neuropathy, bleeding diathesis, persistent metabolic disturbances, fluid overload, hypertension, persistent nausea or vomiting, and malnutrition.
The 5 Stages of Kidney Disease
Glomerular filtration rate (GFR) is of particular importance for determining the severity of kidney damage. Individuals who have a GFR greater than 90 are classified as having Stage 1 disease and may experience few symptoms. Patients who have a GFR between 60 and 89 are classified as having Stage 2 disease and may experience mild symptoms such as changes in blood pressure, anemia, and abnormalities in phosphorous or calcium levels. Those who have a GFR between 30 and 59 are classified as having Stage 3 disease and may experience fatigue, anemia, swelling, and high blood pressure. Individuals who have a GFR between 15 and 29 are classified as having Stage 4 disease and are nearing the point where they will require dialysis. Patients who have a GFR of less than 15 are classified as having Stage 5 disease and are suffering from severe kidney failure requiring dialysis, a transplant, or both.
The diagnosis and treatment of kidney disease is a complex process that requires the expertise of a trained physician. Kidney disease is far too complex to develop a single set of standards for all cases. Patients must work with a doctor to design a treatment plan that reflects the patient’s unique health care status, quality of life expectations, and preferences. Patients are free to choose how to handle their disease and they should voice their concerns prior to following through with a course of treatment.
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