Dialysis, better sooner than later


Dr. Limber Rojas, Nephrologist.

Healthy kidneys take care of cleaning the blood and eliminating toxins, as well as excess fluid in the form of urine. In addition, they produce hormones necessary for the proper functioning of the body, regulate blood pressure, among other things.

When people develop kidney failure, in its advanced stages they need some type of replacement therapy, which can be hemodialysis, peritoneal dialysis or kidney transplant.

Hemodialysis helps manage uremic toxins and excess fluid accumulated by decreased urine formation in end-stage kidney disease.

It consists of passing the blood through an extracorporeal artificial kidney and after being filtered it returns to the patient through a vascular access.

The reluctance to start hemodialysis therapy after being indicated by the nephrologist is frequent in our health system due to different reasons raised by patients such as fear, ignorance about the therapy and taboos that have been developed in popular slang, leading the patient to seek different opinions and lose the opportunity to start therapy in the necessary time.

The late start of hemodialysis is related to important events and complications, such as acute pulmonary edema, severe anemia with cardiometabolic decompensation, encephalopathy and coma, hypertensive crisis, and arrhythmias.

The scheduled start of the same has advantages over the urgent that differ from the type of vascular access. In the emergency setting, a good caliber vein such as jugular, femoral or subclavian should be channeled to place a double-lumen catheter-type device in which high blood flow is obtained.

Procedures of this type that are performed in an emergency situation have a high rate of complications and mistreat the venous system for future access and transplantation possibilities.

Patients with catheters have a higher mortality rate from any cause, as well as a higher probability of hospitalizations and diseases associated with kidney failure. This is why a scheduled start of dialysis is recommended and under a close monitoring regimen in the prediallysis clinic.

It is important to know that there are other renal replacement treatment options, discussed throughout this article.

These include peritoneal dialysis and kidney transplantation, the latter being able to be performed in some cases, even preventively.

This is why in the first contact between the nephrologist and your chronic kidney disease, the appropriate approach is given to how, when and what options are the most appropriate in your case, to start renal replacement therapy.

How and when to start dialysis
It is an important question to be known by both the patient and his doctor.
In the first place, not all patients with advanced chronic kidney disease are aware of it, there is a growing percentage of patients who come to the nephrology consultation already in advanced and irreversible stages of kidney failure.

Where the first contact results in the terrifying phrase "you have to dialyze it."
As a general rule, and despite an apparently stable clinical situation, replacement therapy should be started when renal function is at 8-12%. Below these figures the deterioration will be very rapid and the probability of complications associated with the disease will be higher.

However, with close control there are patients who can be managed for months within this range in conditions close to normal. It is important that the patient begins therapy feeling well and not in a situation of malnutrition or with a lot of uremic symptoms.

If the patient is very ill and / or the tests are very altered, the time to start dialysis has now come. But if the analytics is not very altered and the patient can perform many activities of daily life, it could be expected.

In fact, there are situations where it can be beneficial to wait a bit. If the psychological state of the patient requires it or if the completion or maturation of a vascular or peritoneal access is pending.

Posted in Newspaper Today.

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