Indications for Dialysis and Adequacy of Dialysis



The major goals of dialysis (hemodialysis or peritoneal dialysis) are to maintain fluid and elec­trolyte balanceand to rid the body of waste prod­ucts. Dialysis is indicated in patients with severe abnormalities in fluid and electrolyte balance such as fluid overload, volumedependent hyper­tension, acidosis, or hyperkalemia; in patients with “uremic” symptoms such as pericarditis or encephalopathy; and in patients whose renal function is 5 per cent or less of normal regardless of symptoms. The adequacy of dialysis has not been clearly defined in quantitative terms. Ade­quacy, however, may be defined clinically by the well-being of the patient and correction of the reg­ulatory and excretory defects of the kidney. Di­alysis is not total renal replacement therapy. The endocrine abnormalities are not corrected by di­alysis. Uremic bone disease and neuropathy may persist and accelerate despite seemingly adequate dialysis. Diet and medication must be carefully monitored as discussed earlier. Owing to the time required for dialysis, the psychological adjust­ments to the presence of organ failure, and the dependence on machines to sustain life, the im­pact of endstage renal disease requiring chronic dialytic therapy on the life-style of an individual is significant. Management of dialysis patients therefore requires input not only from physicians, but also from individuals in nursing, dietary, so­cial work, and psychology services.