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Dialysis01:27

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Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
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Dialysis is a diffusion-based purification process that separates analyte molecules from a complex matrix. This is accomplished by allowing molecules in the solution to pass through a semipermeable membrane into a liquid on the other side. The membrane is usually made of cellulose acetate or cellulose nitrate, and the second liquid must be miscible with the solution. Ions (e.g., chloride or sodium) or organic molecules (e.g., glucose) can pass through the membrane pores, which generally have...
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Peritoneal dialysis (PD) is a medical process that removes waste products and excess fluid from the body using the peritoneal membrane as a natural filter.Peritoneal Dialysis MethodsSeveral methods can be used for peritoneal dialysis, including Acute Intermittent Peritoneal Dialysis, Continuous Ambulatory Peritoneal Dialysis, and Automated Peritoneal Dialysis, also known as Continuous Cyclic Peritoneal Dialysis.Acute Intermittent Peritoneal Dialysis (AIPD) is used for patients with uremic...
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DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
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Hemodialysis III: Nursing Management01:25

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The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this...
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Hemodialysis I: Introduction01:25

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Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
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Dialysis Regret: Prevalence and Correlates.

Fahad Saeed1, Susan A Ladwig2, Ronald M Epstein2,3

  • 1Department of Medicine, School of Public Health, Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, New York.

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Summary

Many dialysis patients regret starting treatment, especially if they felt pressured. Open discussions about life expectancy and advance care planning can reduce this regret.

Keywords:
agedattitudedecision makingdecisional regretemotionslife expectancyliving willslogistic modelsmarital statusodds ratioprognosisregretrenal dialysisrenal insufficiency, chronicshared dialysis decision-makingsurveys and questionnairesterminal care

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Area of Science:

  • Nephrology
  • Patient-centered care
  • Decision-making in healthcare

Background:

  • Patient regret regarding the initiation of dialysis is a recognized but understudied issue.
  • Factors influencing this regret, particularly modifiable ones, require further investigation to improve patient care.

Purpose of the Study:

  • To identify factors associated with decisional regret among patients who have started maintenance dialysis.
  • To explore the relationship between patient knowledge, treatment attitudes, end-of-life care preferences, and regret.

Main Methods:

  • A cross-sectional study involving 397 adult maintenance dialysis patients in Ohio.
  • Data collected via a 41-item questionnaire assessing decisional regret, knowledge of chronic kidney disease (CKD), attitudes toward CKD treatment, and end-of-life care preferences.
  • Multivariable logistic regression analysis used to identify predictors of regret.

Main Results:

  • Twenty-one percent of patients reported regret about starting dialysis.
  • Regret was significantly associated with initiating dialysis to please healthcare providers or family members (OR, 2.34).
  • Patients who discussed life expectancy with doctors (OR, 0.42) or had a living will (OR, 0.48) were less likely to report regret.

Conclusions:

  • Decisional regret concerning dialysis initiation is prevalent.
  • Demographic factors were not linked to regret, but modifiable care processes were significant predictors.
  • Improving communication regarding prognosis and facilitating advance care planning may mitigate dialysis regret.