For the integrated multidisciplinary approach to patient care

Return to the Southern Medical Journal

Current User S2 Access Level: -1 ()
CAN NOT ACCESS LEVEL 2
Expired CME Article

Hemodialysis for the Non-nephrologist

Mitchell H. Rosner, MD
Volume: 98 Issue: 8 August, 2005

Abstract:

Hemodialysis is now routinely provided to more than 300,000 patients in the United States. An epidemic of end-stage renal disease will nearly double this number by 2010. Patients undergoing chronic hemodialysis have high morbidity and mortality rates. Given these facts, most medical providers will be involved in the care of patients undergoing hemodialysis and it is thus important to have an understanding of the dialysis procedure and its attendant risks. This review discusses the basic physiology of the dialysis procedure and its associated complications.


Key Points


* The basic physiology of the dialysis procedure and its associated complications are discussed.


* What is meant by adequate dialysis?


* What are the complications associated with dialysis?

Article:

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

Images:

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

References:

1. US Renal Data System, USRDS 2004 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and KidneyDiseases, 2004.
 
2. US Renal Data System, USRDS 2003 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2003.
 
3. Boure T, Vanholder R. Biochemical and clinical evidence for uremic toxicity. Artif Organs2004;28:248–253.
 
4. Vanholder R, De Met, R, Glorieux G, et al. Review on uremic toxins: classification, concentration, and interindividual variability. Kidney Int 2003;63:1934–1943.
 
5. Malluche HH, Mawad H, Monier-Faugere MC. The importance of bone health in end-stage renal disease: out of the frying pan, into the fire? Nephrol Dial Transplant. 2004;19(Suppl 1):i9-i13.
 
6. Rao M, Muirhead N, Buonocristiani U. Management of anemia. Contrib Nephrol 2004;145:69–74.
 
7. National Kidney Foundation/K-DOQ1 Clinical practice guidelines: hemodialysis adequacy: peritoneal dialysis adequacy. Am J Kidney Dis 1997; 30(Suppl 2): S1–S136.
 
8. Gottschalk CW, Fellner SK. History of the science of dialysis. Am J Nephrol 1997;17:289–298.
 
9. Kolff WJ. Lasker Clinical Medical Research Award: the artificial kidney and its effect on the development of other artificial organs. Nat Med 2002;8:1063–1065.
 
10. Scribner BH. Lasker Clinical Medicine Research Award: medical dilemmas: the old is new. Nat Med2002;8:1066–1067.
 
11. Blagg CR. The early years of chronic dialysis: the Seattle contribution. Am J Nephrol 1999;19:350–354.
 
12. McFeeley T. The Price of Access. Boston, MA, MDL Consulting Associates, 2001.
 
13. Ronco C, Clark W. Factors affecting hemodialysis and peritoneal dialysis efficiency. Semin Dial2001;14:257–262.
 
14. Bowry SK. Dialysis membranes today. Int J Artif Organs 2002;25:447–460.
 
15. Spalding E, Farrington K. Hemodiafiltration: current status. Nephron Clin Pract 2003;9:c87–c96.
 
16. Locatelli F, Manzoni C, Di Filippo S. The importance of convective transport. Kidney Int Suppl2002;80:115–120.
 
17. Hoenich NA, Levin R. The implications of water quality in hemodialysis. Semin Dial 2003;16:492–497.
 
18. Association for the Advancement of Medical Instrumentation. ANSI/AAMI RD52:2004: Dialysate for Hemodialysis. Arlington, VA, Association for the Advancement of Medical Instrumentation, 2004.
 
19. Ahmad S. Manual of Clinical Dialysis. London, UK, Science Press, 1999.
 
20. Garred LJ, Canaud BC, McCready WG. Optimal hemodialysis: the role of quantification. Semin Dial1994;7:236–240.
 
21. Depner TA. Prescribing Hemodialysis: A Guide to Urea Modeling. Boston, MA, Kluwer Academic, 1991.
 
22. Gotch FA, Sargent JA. A mechanistic analysis of the National Cooperative Dialysis Study (NCDS).Kidney Int 1985;28:526–534.
 
23. Owen, Jr, WF Lew, NL, Liu Y, et al. The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 1993;329:1001–1006.
 
24. Lowrie EG, Laird NM, Parker TF, et al. Effect of the hemodialysis prescription on patient morbidity: report of the National Cooperative Dialysis Study. N Engl J Med 1981;305:1176–1181.
 
25. Lowrie EG, Laird NM. Cooperative dialysis study. Kidney Int 1983;23(Suppl 13):S1–S122.
 
26. Eknoyan G, Beck GJ, Cheung AK, et al. Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002;347:2010–2019.
 
27. Himmelfarb J. The HEMO study-where do we go from here? Curr Opin Nephrol Hypertens2003;12:587–591.
 
28. ABC. Clinical Practice Guidelines for Vascular Access: National Kidney Foundation–Dialysis Outcomes Quality Initiative. Am J Kidney Dis 1997;30(Suppl 3):S154–S191.
 
29. Rubens F, Wellington JL. Brachiocephalic fistula: a useful alternative for vascular access in chronic hemodialysis. Cardiovasc Surg 1993;1:128–130.
 
30. D’Cunha, PT, Besarab A. Vascular access for hemodialysis: 2004 and beyond. Curr Opin Nephrol Hypertens 2004;13:623–629.
 
31. Konner K, Nonnast-Daniel B, Ritz E. The arteriovenous fistula. J Am Soc Nephrol 2003;14:1669–1680.
 
32. Yeager RA, Moneta GL, Edwards JM, et al. Relationship of hemodialysis access to finger gangrene in patients with end-stage renal disease. J Vasc Surg 2002;36:245–249.
 
33. Warnock DG, Tolwani AJ, Gallichio M, et al. Vascular grafts for hemodialysis: types, sites and techniques. Contrib Nephrol 2004;142:73–93.
 
34. Konner K. Complications of the vascular access for hemodialysis. Contrib Nephrol 2004;142:193–215.
 
35. Haruguchi H, Teraoka S. Intimal hyperplasia and hemodynamic factors in arterial bypass and arteriovenous grafts: a review. J Artif Organs 2003;6:227–235.
 
36. Bush RL, Lin PH, Lumsden AB. Management of thrombosed dialysis access: thrombectomy versus thrombolysis. Semin Vasc Surg 2004;17:32–39.
 
37. Abularrage CJ, Sidawy AN, Weiswasser JM, et al. Medical factors affecting patency of arteriovenous access. Semin Vasc Surg 2004;17:25–31.
 
38. Ryan SV, Calligaro KD, Dougherty MJ. Management of hemodialysis access infections. Semin Vasc Surg 2004;17:40–44.
 
39. Leitch RE, Ouwendyk M, Lindsay RM. Vascular access. Contrib Nephrol 2004;145:48–54.
 
40. Kovalik EC, Schwab SJ. Treatment approaches for infected hemodialysis vascular catheters. Curr Opin Nephrol Hypertens 2002;11:593–596.
 
41. Ifudu O. Care of patients undergoing hemodialysis. N Engl J Med 1998;339:1054–1062.
 
42. Sherman RA. Intradialytic hypotension: an overview of recent, unresolved and overlooked issues.Semin Dial 2002;15:141–143.
 
43. Zucchelli P, Santoro A. Dry weight in hemodialysis: volemic control. Semin Nephrol 2001;21:286–290.
 
44. van der Sande FM, Kooman JP, Leunissen KM. Intradialytic hypotension: new concepts on an old problem. Nephrol Dial Transplant 2000;15:1746–1748.
 
45. Leypoldt JK, Cheung AK. Evaluating volume status in hemodialysis patients. Adv Ren Replace Ther1998;5:64–74.
 
46. Perazella MA. Pharmacologic options available to treat symptomatic intradialytic hypotension. Am J Kidney Dis. 2001:38(Suppl 4):S26-S36.
 
47. Horl MP, Horl WH Hemodialysis-associated hypertension: pathophysiology and therapy. Am J Kidney Dis. 2002;39:227–244.
 
48. Meier P, Vogt P, Blanc E. Ventricular arrhythmias and sudden cardiac death in end-stage renal disease patients on chronic hemodialysis. Nephron 2001;87:199–214.
 
49. Pastan S, Bailey J. Dialysis therapy. N Engl J Med 1998;338:1428–1437.
 
50. Arieff AI. Dialysis disequilibrium syndrome: current concepts on pathogenesis and prevention.Kidney Int 1994;45:629–635.
 
51. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med.2003;20:1123–1133.
 
52. Ward RA. Chloramine removal from water used in hemodialysis. Adv Ren Replace Ther 1996;3:337–347.
 
53. Bregman H, Daugirdas JT, Ing TS. Complications of hemodialysis. In Daugirdas JT, Ing TS, eds.Handbook of Dialysis. Philadelphia, PA, Lippincott Williams & Wilkins, 1994.
 
54. Tielemans C, Gastaldello K, Goldman M, et al. Acute haemodialysis membrane-associated reactions. Nephrol Dial Transplant. 1996;11(Suppl 2):112–115.
 
55. Salem M, Ivanovich PT, Ing TS, et al. Adverse effects of dialyzers manifesting during the dialysis session. Nephrol Dial Transplant. 1994;9(Suppl 2):127–137.

CME:

Portions of this issue may be available for CME credit. Please email education@sma.org for a complete listing of current Southern Medical Journal activities, as well as other SMA educational offerings.

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

Permissions