From the Research
Hemodialysis should be initiated in chronic kidney disease (CKD) patients when kidney function significantly declines, typically at an estimated glomerular filtration rate (eGFR) below 15 mL/min/1.73 m², or when severe symptoms develop, such as uremic symptoms, refractory fluid overload, persistent hyperkalemia, and metabolic acidosis unresponsive to treatment, as recommended by the most recent study 1.
The main indications for starting hemodialysis include:
- Estimated glomerular filtration rate (eGFR) below 15 mL/min/1.73 m²
- Severe uremic symptoms (e.g., nausea, vomiting, fatigue, cognitive impairment)
- Refractory fluid overload
- Persistent hyperkalemia (potassium >6.5 mEq/L) despite medical management
- Metabolic acidosis unresponsive to treatment Dialysis may also be considered earlier if there's rapid decline in kidney function or persistent protein-energy wasting, as suggested by 2.
Complications of hemodialysis can be acute or chronic. Acute complications include:
- Hypotension during dialysis
- Muscle cramps
- Dialysis disequilibrium syndrome
- Access-related issues such as infection or thrombosis Chronic complications encompass:
- Cardiovascular problems (e.g., accelerated atherosclerosis, left ventricular hypertrophy)
- Bone mineral disorders
- Anemia
- Malnutrition
- Increased infection risk Dialysis-related amyloidosis can occur with long-term treatment. Psychosocial issues, including depression and reduced quality of life, are also significant concerns for dialysis patients, as highlighted by 3 and 1.
Early recognition and management of these complications are crucial for improving outcomes and quality of life in hemodialysis patients. Regular monitoring of dialysis adequacy, nutritional status, and overall health is essential for optimal care, as emphasized by 1 and 2. The decision to start dialysis should be a shared decision between physician, patients, and family members, and should be tailored to the individual patient's needs, taking into account their symptoms, signs, and overall health status, as recommended by 2.