How is the decision made to start dialysis?

The Chronic Kidney Disease Solution™ By Shelly Manning The information provided in this write-up about The Chronic Kidney Disease Solution, a guide, helps in motivating people to get rid of the chronic problems on their kidneys without using any harmful methods. It eliminates your kidney problem by focusing on the poor health of your gut and inflammation.

The decision to start dialysis for individuals with chronic kidney disease (CKD) or end-stage renal disease (ESRD) is typically made based on a combination of clinical factors, the patient’s symptoms, lab results, and their overall health status. The goal is to assess whether kidney function has deteriorated to the point where dialysis is needed to sustain life and manage symptoms. Here are the key considerations that help guide the decision-making process:

1. Kidney Function (Glomerular Filtration Rate – GFR)

The glomerular filtration rate (GFR) is a measure of kidney function, estimating how well the kidneys are filtering waste products from the blood. It is calculated using blood tests (such as creatinine levels) and other factors like age, sex, and race.
Dialysis is generally recommended when the GFR drops to 15 mL/min/1.73m² or lower (indicating severe kidney failure). At this stage, the kidneys are no longer able to maintain homeostasis, and waste products begin to accumulate in the body.

2. Symptoms of Kidney Failure

Uremic symptoms (a result of waste buildup in the blood) are a major factor in the decision to start dialysis. These symptoms can include:
- Fatigue
- Nausea and vomiting
- Loss of appetite
- Itching
- Difficulty concentrating
- Fluid retention leading to swelling, shortness of breath, or high blood pressure
If a patient experiences severe symptoms that cannot be managed through medical therapy alone, dialysis is often initiated to alleviate these symptoms.

3. Blood Test Results

Elevated blood urea nitrogen (BUN) and creatinine levels are indicators of kidney function. When these levels are significantly elevated and associated with symptoms, it may signal that dialysis is necessary.
Electrolyte imbalances (e.g., high potassium or low calcium) that cannot be corrected by medications or diet may also prompt the initiation of dialysis, as these imbalances can be life-threatening.

4. Fluid and Electrolyte Imbalances

Dialysis is used to remove excess fluid and correct dangerous electrolyte imbalances (e.g., high potassium, sodium, or acid-base disturbances) that the kidneys can no longer manage. If these imbalances are severe and not responsive to medications or diet changes, dialysis may be started.

5. Presence of Other Health Conditions

The presence of other comorbidities, such as heart failure, diabetes, or hypertension, can affect the decision to start dialysis. For example, if a patient is experiencing severe fluid retention due to heart failure or uncontrolled blood pressure due to kidney dysfunction, dialysis may be necessary to help manage these complications.
Cardiovascular complications and other organ damage from kidney failure are considered when deciding on dialysis, as starting it may help prevent or treat these conditions.

6. Patient’s Overall Health and Quality of Life

The patient’s overall health, age, and life expectancy play an important role in the decision. Dialysis is typically recommended for patients whose life expectancy and quality of life would benefit from it.
If a patient’s other health conditions (such as cancer or advanced heart disease) make it unlikely that they would benefit from dialysis, the decision may be to forgo dialysis and focus on comfort and symptom management instead.

7. Patient’s Preference

Patient preference is a crucial factor. Patients with CKD are often given the opportunity to participate in shared decision-making with their healthcare team. This includes discussing the risks, benefits, and potential outcomes of dialysis versus conservative management.
Some patients may choose to undergo dialysis, while others may prefer to focus on symptom management or consider palliative care depending on their quality of life and personal values.

8. Rate of Kidney Decline

In some cases, dialysis is started as a preventive measure when kidney function is rapidly declining. This might occur in acute kidney injury (AKI) that does not resolve, or when a patient with CKD experiences a sudden deterioration in kidney function due to illness, medication, or dehydration.

9. Dialysis Access Considerations

The timing of dialysis also depends on establishing a dialysis access site, which can be a fistula, graft, or catheter. Creating a fistula (a surgically created connection between an artery and a vein) is typically preferred for long-term dialysis access because it provides the best blood flow and has fewer complications. A fistula requires time to mature, so it’s often planned well in advance of starting dialysis if a patient is expected to need it.

10. Assessing the Benefits of Dialysis

Benefits vs. risks: Dialysis can improve symptoms and extend life expectancy for patients with ESRD, but it also has risks, including infections, cardiovascular complications, and the emotional and physical toll of frequent treatments. The decision to start dialysis weighs the potential benefits against the patient’s prognosis and quality of life.

Conclusion:

The decision to start dialysis is multifaceted, involving clinical assessments of kidney function, symptoms, lab results, and the patient’s overall health. It is often made when kidney function has severely declined, and the patient is experiencing symptoms or complications that cannot be controlled by other means. Ultimately, shared decision-making between the patient and healthcare team, considering the patient’s personal preferences and long-term goals, is essential in determining the timing of dialysis initiation.

The Chronic Kidney Disease Solution