Heart disease is the major problem in dialysis
A general plan for kidney disease care often includes:
- Screen high risk patients for potential kidney disease.
- Prevent or delay dialysis by early detection, diagnosis and management of chronic kidney disease.
- This involves staging and developing an action plan.
- Patients should receive education regarding measures to save their arm veins for future access.
- Try to contain blood sugar control in diabetics, blood pressure, cardiovascular risks, underlying disease processes.
- This includes lifestyle - diet and cigarette smoking.
- As disease progresses identify and manage anemia, acidosis, hypoalbuminemia and calcium disorders.
- In addition to fluid and mineral balance and ridding the body of wastes, the kidneys make a product that stimulates the formation of red blood cells and prevents anemia. It also is responsible for the activation of vitamin D.
- Due to abnormalties in calcium and vitamin D metabolism, patients develop elevated parathyroid hormone levels.
- Patients need to understand that their metabolism of medication changes when their kidney function decreases.
- Inflammation, vascular calcification and anemia are also risk factors for kidney disease.
- Assist the patient in deciding whether to choose hemodialysis or peritoneal dialysis.
- The patient will also need to make a decision regarding transplantation.
- Occasionally a patient can preempt dialysis altogether and receive a transplant early.
- An AV fistula should be placed early so that it will mature and be ready in time for dialysis.
- Serum potassium can rise late in the course of kidney disease and needs to be monitored.
- Optimally patients can start dialysis with their hemoglobin, serum albumin and blood pressrue in target.
- During dialysis dialysis adequacy and access function will need to be monitored on a regular basis.
- Fluid management, blood pressure, weight gains will be monitored closely while on dialysis.
- Anemia, serum albumin, metabolic acidosis, serum potassium, serum phosphorus, parathyroid levels are among the tests that will be measured regularly during dialysis.
- Dialysis patients receive a synthetic factor that promotes the formation of red blood cells, a vitamin D analog, vitamins. They may also require additional medications known as calcimimetics to control the parathyroid disease.
For further information see the NKF K/DOQI Clinical Practice Guidelines