Heart disease is the major problem in dialysis

A general plan for kidney disease care often includes:

1. Screen high risk patients for potential kidney disease.
2. Prevent or delay dialysis by early detection, diagnosis and management of chronic kidney disease.
3. This involves staging and developing an action plan.
4. Patients should receive education regarding measures to save their arm veins for future access.
5. Try to contain blood sugar control in diabetics, blood pressure, cardiovascular risks, underlying disease processes.
6. This includes lifestyle - diet and cigarette smoking.
7. As disease progresses identify and manage anemia, acidosis, hypoalbuminemia and calcium disorders.
8. In addition to fluid and mineral balance and ridding the body of wastes, the kidneys make a product that stimulates the formation of red blood cells and prevents anemia. It also is responsible for the activation of vitamin D.
9. Due to abnormalties in calcium and vitamin D metabolism, patients develop elevated parathyroid hormone levels.
10. Patients need to understand that their metabolism of medication changes when their kidney function decreases.
11. Inflammation, vascular calcification and anemia are also risk factors for kidney disease.
12. Assist the patient in deciding whether to choose hemodialysis or peritoneal dialysis.
13. The patient will also need to make a decision regarding transplantation.
14. Occasionally a patient can preempt dialysis altogether and receive a transplant early.
15. An AV fistula should be placed early so that it will mature and be ready in time for dialysis.
16. Serum potassium can rise late in the course of kidney disease and needs to be monitored.
17. Optimally patients can start dialysis with their hemoglobin, serum albumin and blood pressrue in target.
18. During dialysis dialysis adequacy and access function will need to be monitored on a regular basis.
19. Fluid management, blood pressure, weight gains will be monitored closely while on dialysis.
20. Anemia, serum albumin, metabolic acidosis, serum potassium, serum phosphorus, parathyroid levels are among the tests that will be measured regularly during dialysis.
21. Dialysis patients receive a synthetic factor that promotes the formation of red blood cells, a vitamin D analog, vitamins. They may also require additional medications known as calcimimetics to control the parathyroid disease.

For further information see the NKF K/DOQI Clinical Practice Guidelines