Dialysis is a medical treatment for individuals with failing kidneys. It acts as an artificial kidney, filtering waste products and excess fluids from the blood. When kidneys fail, harmful substances like urea, creatinine, and acids build up, becoming life-threatening. Dialysis removes these toxins, restoring balance. It is a treatment for advanced kidney disease, also known as end-stage kidney disease (ESKD) or kidney failure, enabling patients to sustain life.
Recognizing Symptoms of Kidney Decline
As kidney function diminishes, the body shows various signs due to waste and fluid accumulation. Common symptoms include profound fatigue and weakness, often due to anemia from toxins suppressing red blood cell production. Swelling, particularly in the legs, ankles, and feet (edema), is another sign, resulting from excess fluid retention. This fluid can also accumulate in the lungs, causing shortness of breath.
Changes in appetite, such as nausea, vomiting, or loss of desire to eat, are common as waste products irritate the digestive system. Individuals may also notice changes in urination patterns, like urinating less frequently or producing reduced urine volume. Muscle cramps or twitching can occur due to electrolyte imbalances, especially with potassium and calcium, which failing kidneys struggle to regulate.
Persistent itchy skin is linked to the buildup of phosphorus and other toxins. Difficulty sleeping, including restless legs syndrome, can arise from kidney failure’s systemic effects and electrolyte disturbances. Some individuals also experience cognitive changes, such as brain fog or difficulty concentrating, as uremic toxins affect brain function.
Key Medical Indicators
The decision to initiate dialysis is guided by specific medical indicators, focusing on the kidneys’ filtration capacity and waste product levels. Glomerular Filtration Rate (GFR) is a primary measure of kidney function, reflecting how well the kidneys filter blood. A GFR below 15 mL/min/1.73m² signifies Stage 5 Chronic Kidney Disease (CKD), where dialysis or a kidney transplant becomes necessary.
Blood tests for creatinine and Blood Urea Nitrogen (BUN) provide further insight. Creatinine is a waste product from muscle metabolism; elevated levels indicate impaired kidney clearance. About 50% of kidney function must be lost before a rise in serum creatinine is detected. Elevated BUN levels suggest kidneys are not effectively removing nitrogenous waste.
Severe electrolyte imbalances, such as high potassium (hyperkalemia), elevated phosphorus, or low calcium, are strong indicators for dialysis. These can lead to serious complications, including life-threatening heart rhythm abnormalities. Fluid overload unmanageable with diuretics also indicates the need for dialysis, as excess fluid can accumulate in the lungs, causing pulmonary edema and shortness of breath. Other complications, like severe anemia unresponsive to treatment or metabolic acidosis (blood becoming too acidic), can also necessitate dialysis.
The Collaborative Decision-Making Process
The choice to begin dialysis is a shared decision, involving the patient, their family, and a multidisciplinary healthcare team, including nephrologists, nurses, and social workers. This process goes beyond laboratory values, considering how kidney disease symptoms impact the patient’s overall health and quality of life. Debilitating symptoms like severe nausea, fatigue, or cognitive impairment often influence the decision, even if GFR values are slightly above the threshold for dialysis.
The medical team also assesses for acute, life-threatening complications requiring immediate intervention. Examples include severe fluid overload leading to pulmonary edema, high potassium levels, or inflammation of the heart sac from uremic toxins. These acute issues may necessitate urgent dialysis regardless of long-term kidney disease progression. Discussions also cover different types of dialysis, such as hemodialysis and peritoneal dialysis, and the possibility of kidney transplantation, with dialysis often serving as a temporary measure or long-term therapy.
Patient preferences and values are central to this collaborative approach. Understanding the patient’s treatment goals, lifestyle, and concerns about dialysis demands is important. The timing of dialysis initiation, while guided by medical parameters, also considers the patient’s readiness and preparation for the significant lifestyle adjustments treatment requires. This shared decision-making ensures the treatment plan aligns with the individual’s well-being and personal circumstances.