Dialysis

Hemodialysis, Peritoneal Dialysis and other modalities.

GREAT COMPREHENSIVE BROCHURE – OPTIONS FOR KIDNEY FAILURE

Hemodialysis, Peritoneal dialysis or any other option?! Are you confused? Do you have many questions?

It is natural to have fears, questions, concerns and hesitation.
End Stage Renal Disease National Coordinating Center, ESRDNCC.
This is the best support center for End Stage Renal Disease, ESRD, patients and families. Both, Hemodialysis and Peritoneal Dialysis follow the biochemical concept of diffusion through a semi permeable membrane. Hemodialysis is more commonly chosen in the United States as an option for kidney failure treatments. YOU, and only you, with understanding of your circumstances and weighing each factor with your own scale, can determine the value and the burden of the pros and cons of each modality and decide. Over 90% of Nephrologists would choose a home dialysis modality if they needed renal replacement therapy. HOW ABOUT YOU?
Dialysis or kidney transplantation — which is right for me? (Beyond the Basics)

We hope that THE VIRTUAL NEPHROLOGIST can ease the difficulty of making a decision.

Choices

All treatment options should be fully reviewed and discussed with your Nephrologist.

OPTIONS ARE:

1. All available Dialysis modalities. Brochure from National Kidney Foundation
2. Kidney Failure treatment options – Detailed Brochure from TVN
3. Not starting Dialysis and continuing conservative management.
4. A time-limited trial of Dialysis.
5. Stopping Dialysis with expectation of death.

This is the best support center for End Stage Renal Disease, ESRD, patients and families: End Stage Renal Disease National Coordinating Center, ESRDNCC.

Hemodialysis HD

Here are a few links and articles that are a necessity for all new patients to Hemodialysis.  Keep in mind: 

• Fistula First-LINK
• GO ahead and have your Hemodialysis access, preferably a native AV Fistula, placed as early as recommended by your physician, there is plenty of evidence to support that:
• Early creation of hemodialysis access, delays the progression of CKD-EVIDENCE 1
• Early creation of hemodialysis access, delays the progression of CKD-EVIDENCE 2
• Early creation of hemodialysis access, delays the progression of CKD-EVIDENCE 3
• HEMODIALYSIS VASCULAR ACCESS: FACTS SHEET
• Understanding Your Hemodialysis Access Options-Brochure
• Understanding Your Hemodialysis Options-Brochure
• Understanding High Phosphorus and Your Treatment Options
• How to Stay in the Potassium Safety Zone
• Patient information: Hemodialysis (Beyond the Basics)

Peritoneal Dialysis PD

Here are few links and articles that are a necessity for all new patients to Peritoneal Dialysis, PD.

• Peritoneal Dialysis, PD, Basic Brochure from NKF
• Understanding Your Peritoneal Dialysis Option
• Understanding Peritoneal Dialysis, Brochure
• Hemodialysis, HD, compared to Peritoneal Dialysis, PD
• Adjusting to Peritoneal Dialysis
• Patient information: Peritoneal Dialysis (Beyond the BASICS)

STOP Dialysis

Patients with Chronic Kidney Disease who elect dialysis generally experience progressive functional decline over months to years, punctuated by episodes of life-threatening complications. Elderly or chronically ill patients with co-morbid diseases, at the initiation of dialysis, can be expected to have greater complications and a shorter survival. Poor prognostic factors such as older age, low serum albumin, poor functional status, and co-morbid illnesses such as diabetes and cardiovascular disease can be used to estimate prognosis. Anuric patients, who elect to not initiate or discontinue dialysis, typically survive for 7-14 days. The prognosis is longer for patients with residual renal function who continue to make urine. Here are a few references to help with the decision making:

• Clinical Practice Guideline on Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis
• Which patients choose to stop Dialysis
• What happens if someone stops Dialysis
• The role of Palliative Medicine in the Initiation and Withdrawal from Dialysis
• Understanding and communicating prognosis
• Death as a result of  Withdrawal From Dialysis

It is a difficult decision. Our hope is that we were able to help you in making the decision process easier.

Conservative Approach

Reaching the academic and insurance approved guidelines to start Dialysis, and meeting the GFR (kidney function) to have the diagnosis of Renal Failure or End Stage Renal Disease, ESRD; these two milestones are not a reason to be trapped in the world of Dialysis.

Certainly, there is plenty of evidence in the medical literature to support starting Dialysis as soon as you reach these milestones, but the ” literature” does not know about the unique “YOU” in particular, i.e. your personal preference, your life style, how you feel in general, other illnesses you might have, your social support etc…

If you reach the milestone needing Dialysis, the first thing you need to do is to STOP, take a breath and talk to yourself first, your Primary Care Provider, your Nephrologist and all individuals involved in providing you with support.

Do not forget also to visit the Dialysis center, talk to the staff and to a patient that you know personally and ask plenty of questions. After you conclude your evaluation and all your questions are answered, then STOP AGAIN, and talk to yourself to make a decision. Any decision you make is the best decision you make for YOURSELF, because you know yourself the best.

Nobody should have any authority to order you to follow a certain approach. THIS IS YOUR LIFE.