To start dialysis in chronic kidney disease patients, many subjective and objective criteria should be considered by the patient and his clinician
INDICATIONS FOR DIALYSIS INITIATION IN CHRONIC KIDNEY DISEASE
To start dialysis (DX) in chronic kidney disease
(CKD) patients, many subjective and objective criteria should be considered by both
the patient and his/her clinician. This decision cannot be established via an
absolute laboratory figure by which an indication for dialysis is urgently
required. Many factors have been involved such as how the patient perceive this
decision and the magnitude of the associated anxiety about commencing a complicated,
potentially life-long approach therapy. Furthermore, the physician’s
interpretation about the patient’s current health condition, renal function
deterioration, and the expected adverse effects of this approach of therapy may
guide the suggested time of commencing RRT (renal replacement therapy). To
summarize, the decision of when to commence DX is obviously one of the most serious
decisions that both the patient and his clinician have been implicated.
INDICATIONS
Clinical indications that invite the need to start
DX in a CKD patient may include:
1)
Pericarditis (inflammation of the heart pericardium) or pleuritis (inflammation
of the lung pleura) (urgently indicated)
2)
Neurological complications e.g. advanced uremic encephalopathy or
neuropathy, associated with certain signs e.g. confusion, tremors, dropped
wrist/foot, or, in advanced cases, presence of convulsions (urgent indication)
3)
Clinically significant bleeding tendency related to uremia (urgently
indicated)
4)
Permanent metabolic alterations that’re resistant to medical treatment;
including hyperkalemia, metabolic acidosis, hypercalcemia, hypocalcemia, and
hyperphosphatemia
5)
Fluid overload that’s resistant to diuretic therapy.
6)
High blood pressure (BP) with poor response to antihypertensive drugs.
7)
Resistant nausea and vomiting to medical therapy.
8)
Current criteria of malnutrition
The 1st 5 of this list are potentially life-threatening
and must not be allowed to appear before DX institution in CKD patients under nephrology
supervision. The last 2 manifestations may appear slowly and can be attributed
to other co-morbidities or due to medications-associated adverse effects. They cannot
be considered less serious.