Navigating the journey of chronic kidney disease can be daunting, one of the most critical decisions to make is determining the best time to start dialysis.This decision is influenced by various factors, including your overall health, kidney function, and personal preferences.
Understanding Chronic Kidney Disease and Dialysis
Chronic kidney disease is a progressive condition where the kidneys gradually lose their ability to filter waste and excess fluids from the blood.
When kidney disease advances to end-stage renal disease dialysis becomes necessary. Dialysis is a treatment that replaces the function of healthy kidneys, removing waste products and excess fluid from the bloodstream.
There are two main types of dialysis:
- Hemodialysis: This involves circulating the patient’s blood through a hemofilter that filters out waste products and excess fluid. It’s typically performed three times a week in a dialysis center.
- Peritoneal dialysis: This method uses the lining of the abdomen (the peritoneum) as a natural filter. A cleansing solution is infused into the abdomen, which absorbs waste and excess fluid. The solution is then drained out. This can be done at home, often daily or overnight.
Symptoms Indicating the Need for Dialysis
The decision to start dialysis isn’t solely based on glomerular filtration rate which is a measurement for kidney function. Symptoms play a crucial role too. When kidney function declines, waste products build up in the body, leading to a range of symptoms.
- Fatigue and weakness
- Nausea or vomiting
- Loss of appetite
- Swelling in the hands or feet
- Shortness of breath
- Persistent itching
- Mental confusion
- Difficulty sleeping
Remember, everyone is different. Not everyone will experience all these symptoms. And some people may start dialysis before symptoms appear, based on their glomerular filtration rate and other health factors.
The question of when to start dialysis is a topic of ongoing debate among medical professionals. Some advocate for early initiation, while others argue for a more conservative approach. The decision is complex and depends on various factors.
Early initiation of dialysis, when the kidney function is around 10-15% of normal, is thought to help maintain a better quality of life. It can alleviate symptoms like fatigue, nausea, and fluid overload. However, some studies suggest that starting dialysis too early may not improve survival rates and could even lead to complications.
On the other hand, timely initiation of dialysis, when symptoms become severe or laboratory results indicate a critical need, may reduce unnecessary treatment. It’s a delicate balance between managing symptoms and avoiding potential risks. Ultimately, the decision should be personalized, taking into account the patient’s overall health, lifestyle, and preferences.
Dialysis Frequency and Duration: What to Expect
Typically, patients undergoing hemodialysis can expect:
- Frequency: Hemodialysis is usually performed three times per week.
- Duration: Each session typically lasts between 3 to 5 hours.
For those opting for peritoneal dialysis, the schedule can be more flexible. It’s often performed daily, but the duration can vary. It’s important to discuss your individual needs and preferences with your healthcare team.
Preparing for Dialysis: Diet, Medication, and Vascular Access
Preparing for dialysis involves more than just scheduling your first session. It’s a comprehensive process that includes dietary changes, medication management, and preparing for vascular access.
Key steps in preparation include:
- Dietary Changes: A diet low in sodium, potassium, and phosphorus is often recommended for patients preparing for dialysis.
- Medication : Certain medications may need to be adjusted or stopped before starting dialysis.
- Vascular Access: For hemodialysis, a vascular access point needs to be created in advance. This involves a minor surgical procedure.
Remember, preparation for dialysis is a collaborative process. Always discuss your concerns and questions with your healthcare team.
Finally determining the best time to start dialysis is a complex process. It involves understanding your health condition, considering your lifestyle, and making informed choices. Remember, you are not alone in this journey. Your healthcare team is there to guide you every step of the way.
For more detailed information, consult your healthcare provider or a nephrologist. Stay informed and proactive in managing your health.
References
- National Kidney Foundation. (n.d.). [Top 10 Tips for Dialysis Patients] (https://www.kidney.org/news-stories/top-10-tips-dialysis-patients).
- National Kidney Foundation. (n.d.). [Demystifying Dialysis: Understanding Treatment Options and Life Changes] (https://www.kidney.org/news-stories/demystifying-dialysis-understanding-treatment-options-and-life-changes).
By: Dr.Yasser Mahmoud Farid
Professor of Internal Medicine/ Nephrology
