Dialysis is the life saving medical treatment that sustains patients whose kidneys have failed.
Dialysis treatments are also called 'renal replacement therapy' as dialysis replaces (most) of the functions of the kidney, which is called the renal organ.
Hemodialysis is the form of dialysis most often used in both hospital and out patient settings. Hemodialysis uses a filter to help provide the blood-cleansing action lost when the kidneys are diseased or injured.
The kidneys are two organs in the low to mid back behind the abdominal cavity, that clear the bloodstream of waste products such as urea and salts. The kidneys serve several other important functions including helping to maintain normal blood pressure. The kidneys also produce a hormone important to regulating the red blood cell count. Patients with kidney failure often become anemic as the kidneys stop producing the hormone erythropoeitin (EPO). The kidneys also produce the active form of Vitamin D, which is deficient when the kidneys fail.
Dialysis is a means of clearing the blood of waste products and excess water that builds up between dialysis treatments. Hemodialysis filters the blood using special artifical kidneys, known as dialyzers, through which the blood circulates during treatments. Dialysis can also be done through a catheter placed in the abdominal cavity (peritoneal cavity), which is called peritoneal dialysis. Hemodialysis treatments are most often performed in a hemodialysis out-patient center center, with hemodialysis treatments performed for approximately four hours three times per week (treatment times may vary). Some patients perform home dialysis, most often using peritoneal catheters. Home hemodialysis and in-center nocturnal hemodialysis are newer hemodialysis delivery methods preferred by some kidney patients.
The best mode or type of dialysis for a patient may change over time. Dialysis is often a long term process, which involves cooperation, input and management between the patient and the dialysis providers.
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New Feature from Hemodialysis.com: Hemodialysis or Chronic Kidney Disease Abstract of the Week
Association of Cumulatively Low or High Serum Calcium Levels with Mortality in Long-Term Hemodialysis Patients.
Am J Nephrol. 2010 Sep 3;32(5):403-413.
Miller JE, Kovesdy CP, Norris KC, Mehrotra R, Nissenson AR, Kopple JD, Kalantar-Zadeh K.
Harold Simmons Center for Kidney Disease Research and Epidemiology,Torrance, Calif., USA.
Abstract
Background: The outcome-predictability of baseline and instantaneously changing serum calcium in hemodialysis patients has been examined. We investigated the mortality-predictability of time-averaged calcium values to reflect the 'cumulative' effect of calcium burden over time. Methods: We employed a Cox model using up-to-5-year (7/2001-6/2006) time-averaged values to examine the mortality-predictability of cumulative serum calcium levels in 107,200 hemodialysis patients prior to the use of calcimimetics, but during the time where other calcium-lowering interventions, including lower dialysate calcium, were employed.
Results: Both low (<9.0 mg/dl) and high (>10.0 mg/dl) calcium levels were associated with increased mortality (reference: 9.0 to <9.5 mg/dl). Whereas mortality of hypercalcemia was consistent, hypocalcemia mortality was most prominent with higher serum phosphorus (>3.5 mg/dl) and PTH levels (>150 pg/ml).
Higher paricalcitol doses shifted the calcium range associated with the greatest survival to the right, i.e. from 9.0 to <9.5 to 9.5 to <10.0 mg/dl. African-Americans exhibited the highest death hazard ratio of hypocalcemia <8.5 mg/dl, being 1.35 (95% CI: 1.22-1.49). Both a rise and drop in serum calcium over 6 months were associated with increased mortality compared to the stable group.
Conclusions: Whereas in hemodialysis patients cumulatively high or low calcium levels are associated with higher death risk, subtle but meaningful interactions with phosphorus, PTH, paricalcitol dose and race exist.
Hemodialysis | Kidney Disease | Dialysis Resources and Educational Materials
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Here's an in-depth, quick-reference, problem-solving resource for those involved in the care of dialysis patients. More than 120 world-class authorities discuss dialysis techniques, mechanical considerations, and complications related to various diseases for both pediatric and adult patients. Selected annotated references and excellent cross-referencing between chapters help you find answers fast, and more than 100 photos, drawings, charts, and tables, mostly in color, clarify complex topics. Providing practical, immediately useful guidelines that can be applied directly to patient care, this book is a "must-have" for all dialysis caregivers.
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