HEMODIALYSIS

A dialysis is a form of renal replacement therapy. The kidney’s role of filtration of the blood is supplemented by artificial equipment for the removal of excess water, solutes, and toxins. Dialysis ensures maintenance of homeostasis (a stable internal environment) in people experiencing a rapid loss of kidney function, known as acute kidney injury (AKI), or a prolonged, gradual loss in renal function, called chronic kidney disease (CKD, previously end-stage renal disease, ESRD). It may serve to tide over an acute decline in renal function, to buy time until a kidney transplant is performed or lifelong for those who are not candidates for transplant. Approximately 2.5 million people worldwide received chronic renal replacement therapy (RRT) in 2010. It is the mainstay in end-stage renal disease management, a renal condition with a rising global burden attributed mainly to diabetes mellitus (45%) and hypertension (30%). There are three primary types of dialysis which are hemodialysis, peritoneal dialysis, and hemofiltration. This activity reviews the multiple aspects of the conduction and indications of hemodialysis and highlights the role of the interprofessional team in ensuring adequate physical, psychological, social, and emotional preparedness of patients on long-term hemodialysis as well as their caregivers.compare their current eating habits and physical activity levels with those 6 to 12 months back helps avoid the lack of awareness. The concept of a 'healthy start,' with dialysis commencing before the onset of severe uremia symptoms, is associated with prolonged survival. An early start will prepone the need for a change of modality or further procedures without any improvement in the quality of life while adding to healthcare costs. The Renal Physicians Association's (RPA) criteria for identifying dialysis patients with a poor prognosis beyond 75 years of age includes:

Provider's estimation of the likelihood of patient mortality in the next six months

Greatly impaired functional status

High comorbidity score

Severe chronic malnutrition (low serum albumin)

Quality of life also strongly predicts mortality. It provides a comprehensive toolkit to encourage shared decision-making.

Mortality rates among dialysis patients are markedly higher among younger age groups, primarily attributed to cardiovascular (40%) and infectious causes (10%). High cardiovascular mortality in dialysis patients could be related to shared risk factors such as chronic inflammation, significant changes in extracellular volume, dystrophic vascular calcification, and altered cardiovascular dynamics during dialysis. The study of heart and renal protection (SHARP) having dialysis and non-dialysis requiring CKD patients showed a 17% reduction in cardiovascular death and major cardiovascular events with simvastatin-ezetimibe treatment. Cardioprotective strategies such as beta-blockers, aspirin, and renin-angiotensin-aldosterone system inhibitors are recommended in dialysis patients based on their cardiovascular risk profile. Hypertension has a graded association with ESRD risk as it is both a cause and a consequence of CKD. The first three months after dialysis initiation, especially among older patients, has the highest mortality rates. This could be due to risks associated with the commencement of dialysis (central venous catheter placement) and more severe comorbidities causing deterioration of renal function. Effective interprofessional collaboration is needed to improve overall outcomes in patients with ESRD requiring dialysis.