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Related Concept Videos

Hemodialysis III: Nursing Management01:25

Hemodialysis III: Nursing Management

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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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Dialysis01:27

Dialysis

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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).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
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Dialysis01:15

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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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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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Hemodialysis II: Procedure and Complications01:24

Hemodialysis II: Procedure and Complications

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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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Acute Kidney Injury V: Interprofessional Care01:20

Acute Kidney Injury V: Interprofessional Care

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Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
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Decision-making around Commencing Dialysis.

Indu Ramachandra Rao1, Nandini Vallath2,3,4, Y J Anupama5

  • 1Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Indian Journal of Palliative Care
|June 30, 2021
PubMed
Summary

Initiating dialysis requires careful consideration, not a default approach for advanced kidney failure. Individualized decisions through shared patient-nephrologist discussions are crucial for optimal renal replacement therapy.

Keywords:
Dialysisend-stage kidney diseasepalliative carerenal supportive careshared decision-making

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Area of Science:

  • Nephrology
  • Geriatrics
  • Internal Medicine

Background:

  • Advanced renal failure necessitates renal replacement therapy (RRT).
  • Dialysis is often considered the default treatment for end-stage renal disease.
  • Patient-specific factors can influence the appropriateness of dialysis.

Purpose of the Study:

  • To emphasize that dialysis is not a universal default for advanced renal failure.
  • To highlight the importance of individualized treatment decisions for dialysis initiation and modality.
  • To advocate for comprehensive predialysis education and shared decision-making.

Main Methods:

  • Review of current practices and ethical considerations in dialysis initiation.
  • Emphasis on shared decision-making between nephrologists and patients.
  • Discussion of conservative care as an alternative to dialysis.

Main Results:

  • Dialysis initiation decisions are complex and require individualized assessment.
  • Shared decision-making involving patients and nephrologists is essential.
  • Withholding dialysis may be appropriate for select patients, particularly the elderly with comorbidities.

Conclusions:

  • Renal replacement therapy should not be the default for all patients with advanced renal failure.
  • Individualized, shared decision-making is paramount for dialysis initiation and modality selection.
  • Comprehensive conservative care is a vital option when dialysis is not pursued.