Dialysis is a life-sustaining treatment for individuals whose kidneys are no longer able to adequately perform their essential functions. This medical procedure removes waste products and excess fluid from the body. Understanding the various factors that influence the decision to begin dialysis is important for patients and their families.
Understanding Kidney Function and Chronic Kidney Disease
The kidneys are a pair of bean-shaped organs located on either side of the spine, just below the rib cage. Their primary role involves filtering blood daily, removing waste products and extra water to produce urine. Kidneys also play a significant role in maintaining the body’s delicate balance of fluids and electrolytes, such as sodium, potassium, and calcium. They also produce hormones that regulate blood pressure, stimulate red blood cell production, and help maintain bone health.
Chronic Kidney Disease (CKD) describes a condition where kidney function progressively declines. This gradual loss means the kidneys become less efficient at filtering waste and balancing essential substances. As CKD advances, it can lead to end-stage kidney failure, also known as End-Stage Renal Disease (ESRD), where the kidneys have lost nearly all their ability to function. At this point, waste and fluid becomes life-threatening, necessitating treatments like dialysis or a kidney transplant.
Medical Criteria for Dialysis Initiation
Healthcare providers use measures to determine kidney function and assess the need for dialysis. The Glomerular Filtration Rate (GFR) is a primary indicator, estimating how well the kidneys filter blood. A healthy GFR is typically above 90 mL/min/1.73m², but as kidney disease progresses, this number decreases.
For individuals with end-stage kidney disease, dialysis is often considered when the GFR falls below 15 mL/min/1.73m². However, guidelines suggest dialysis may be initiated when the GFR is 5 to 9 mL/min/1.73m², especially if symptoms are present. GFR alone is not the sole determinant, as other factors also play a role.
Other laboratory values provide insights into kidney function and waste product buildup. Blood Urea Nitrogen (BUN) and creatinine are waste products that accumulate when kidneys are not filtering effectively. Elevated levels indicate the body struggles to clear metabolic wastes. Imbalances in electrolytes, such as high potassium or phosphorus, can signify severe kidney impairment, as kidneys can no longer regulate these minerals.
Recognizing Symptoms of Advanced Kidney Failure
As kidney function declines, individuals experience symptoms due to toxin and excess fluid accumulation. Persistent fatigue and weakness are common, resulting from toxin buildup and anemia, a frequent complication of kidney failure. Nausea, vomiting, and loss of appetite can also occur as waste products irritate the digestive system.
Fluid retention manifests as swelling, particularly in the legs, ankles, or around the eyes. Excess fluid can also lead to shortness of breath if it accumulates in the lungs. Muscle cramps, difficulty sleeping, and changes in mental sharpness, such as trouble concentrating, indicate kidneys are no longer effectively clearing waste. Itchy skin can be a bothersome symptom, often linked to mineral and waste product imbalances.
The Collaborative Decision to Begin Dialysis
The decision to begin dialysis involves a collaborative discussion between the patient, their family, and the healthcare team, particularly a nephrologist. This shared decision-making approach ensures treatment aligns with the patient’s individual circumstances and preferences. The patient’s overall health status and any co-existing medical conditions are considered, as these can influence the potential benefits and challenges of dialysis.
Personal preferences, lifestyle, and quality of life goals are central to this discussion. Patients explore how dialysis might impact their daily routines, independence, and overall well-being. The healthcare team provides information about different types of dialysis, such as hemodialysis and peritoneal dialysis, allowing patients to understand available options without delving into technical specifics.
Open communication is encouraged to address concerns and ensure the decision reflects the patient’s values. Understanding the implications of starting treatment, including the commitment involved, is part of this process. This aims to make an informed choice that supports the patient’s quality of life and well-being.