Considerations in the optimal preparation of patients for dialysis

Abstract

| Every year, more than 110,000 Americans are newly diagnosed with end-stage renal disease and in the overwhelming majority, maintenance dialysis therapy is initiated. However, most patients, having received no predialysis nephrology care or dietary counseling, are inadequately prepared for starting treatment; furthermore, the majority of patients do not have a functioning permanent dialysis access. Annualized mortality in the USA in the first 3 months after starting dialysis treatment is approximately 45%; this high rate is possibly in part due to inadequate preparation for renal replacement therapy. Data from the Dialysis Outcomes and Practice Patterns study suggest that similar challenges exist in many parts of the world. Implementation of strategies that mitigate the risk of adverse consequences when starting dialysis are urgently needed. In this Review we present a step-by-step approach to tackling inadequate patient preparation, which includes identifying individuals with chronic kidney disease (CKD) who are most likely to need dialysis in the future, referring patients for education, timely placement of dialysis access and timely initiation of dialysis therapy. Treatment with dialysis might not be appropriate for some patients with progressive CKD; these individuals can be optimally managed with nondialytic, maximum conservative management.

How to Overcome Barriers and Establish a Successful Home HD Program

“…Recent data suggest that use of iterative CKD education that engages the patient and family and involves patients treated with different dialysis therapies can be successful at increasing the use of home dialysis (84)(85)(86). Moreover, even in patients with unplanned acute-start dialysis, patient education has been associated with successful transition to home dialysis (87).…”

“…Proper patient communication and education require skills, compassion, and empathy to understand the unique needs of home dialysis patients. Nurses must be trained in best practices for managing home HD programs in order to adequately train patients, such that patients feel secure performing dialysis at home (85).…”

Transition of care from pre-dialysis prelude to renal replacement therapy: the blueprints of emerging research in advanced chronic kidney disease

“…We have identified six major categories of transitions of care during advanced CKD as shown in Table 1 [23]: (1) transition from non-dialysis-dependent CKD to de novo dialysis therapy with different subtypes according to dialysis modality (hemodialysis versus peritoneal dialysis), dialysis format (in-center versus home) and dialysis treatment frequency [infrequent (e.g. once to twice-weekly hemodialysis) [24], conventional (thriceweekly hemodialysis) and frequent (four or more times per week hemodialysis)] [25]; (2) transition from non-dialysisdependent CKD to pre-emptive transplantation; (3) transition among or across dialysis modalities, formats and frequency (hemodialysis to peritoneal dialysis or vice versa, in-center to home, and less to more frequent, also known as incremental or progressive dialysis therapy [26]); (4) transition from dialysis therapy to kidney transplantation; (5) transition from a gradually failing kidney transplantation back to dialysis therapy; and (6) transition from any of the above stages to partial or full…”

Factores asociados a mortalidad intrahospitalaria de una población en hemodiálisis en el Perú

“…Hemos encontrado que no hay diferencias en la mortalidad entre los pacientes con evaluaciones previas por un nefrólogo, las que, contrariamente, se han relacionado con mejores resultados en diálisis en otros reportes (22)(23)(24)(25)(26) . Es probable que los pacientes evaluados por un nefrólogo en nuestro hospital estén en peor condición clínica, de tal forma que eso explique que no haya diferencias con aquellos pacientes sin control previo.…”