From the Research
Hemodialysis in chronic kidney disease (CKD) is typically initiated when patients reach end-stage renal disease (ESRD) or experience severe complications of kidney failure, with the main indications including estimated glomerular filtration rate (eGFR) below 15 mL/min/1.73 m², severe uremic symptoms, refractory fluid overload, hyperkalemia, or metabolic acidosis, as supported by the most recent study 1. The decision to initiate hemodialysis is complex and should be based on a comprehensive assessment of the patient's symptoms, signs, and overall health status, rather than solely on eGFR levels 2. Some key points to consider when deciding to initiate hemodialysis include:
- The presence of severe uremic symptoms, such as nausea, vomiting, fatigue, or confusion
- Refractory fluid overload, which can lead to pulmonary edema and other complications
- Hyperkalemia (potassium > 6.5 mEq/L) unresponsive to medical management
- Metabolic acidosis, which can lead to serious complications if left untreated
- The patient's overall health status, including the presence of comorbidities and their ability to tolerate dialysis Complications of hemodialysis can be both acute and chronic, and may include:
- Acute complications, such as hypotension during dialysis, muscle cramps, dialysis disequilibrium syndrome, and access-related issues
- Chronic complications, such as cardiovascular disease, anemia, mineral and bone disorders, malnutrition, and increased infection risk
- Dialysis-related amyloidosis, which can occur with long-term treatment
- Psychological effects and reduced quality of life due to the time commitment and lifestyle changes required for regular dialysis treatments It is essential to carefully weigh the benefits and risks of hemodialysis for each individual patient, taking into account their unique needs and circumstances, and to involve patients and their families in the decision-making process 2. Additionally, patients with CKD should be monitored for complications, such as hyperkalemia, metabolic acidosis, hyperphosphatemia, vitamin D deficiency, secondary hyperparathyroidism, and anemia, and should be referred to a nephrologist if they are at high risk of CKD progression 3.