The Importance of Strict Regimens for End Stage Renal Disease Patients on Hemodialysis

It is estimated that twenty-six million people in the United States have Chronic Kidney Disease and another twenty million are at risk of developing it (Dr. Ganjoo). When diagnosed with End Stage Renal Disease otherwise known as ESRD, patients not only face the psychological effects of the disease, but also must adapt to a lifestyle of strict regimens. Adherence to dietary guidelines, fluid restrictions, as well as proper attendance to receive prescribed dialysis treatments can be the difference between life and death for patients. Some of the most common factors and regimens associated with End Stage Renal Disease and hemodialysis will be explored and explained.

Background

End Stage Renal Disease (ESRD), as defined by A.D.A.M Medical Encyclopedia:

Is the complete or almost complete failure of the kidneys to function adequately. The main function of the kidneys is to remove wastes and excess water from the body. End Stage Renal Disease occurs when the kidneys are no longer able to function at a level needed for day to day life. It usually occurs when Chronic Kidney Disease (CKD) has worsened to the point at which kidney function is less than ten percent of normal function. End Stage Renal Disease almost always follows Chronic Kidney Disease. A person may have gradual worsening of kidney function for ten to twenty years or more before they officially progress into End Stage Renal Disease. Patients who have reached this stage of kidney disease will need to undergo hemodialysis or receive a kidney transplant. Without dialysis or a kidney transplant, death will occur from the buildup of fluids and waste products in the body (A.D.A.M. Medical Encyclopedia).

Most people have two kidneys each about the size of a fist, and they play a key role in maintaining a healthy body. According to Board Certified Nephrologist Dr. Jesse Ganjoo at The Kidney Care Center in Washington, Pennsylvania, "Kidneys are very smart and an intelligent part of the body." The kidneys work as a filter, removing harmful toxins while re-circulating important minerals such as potassium, sodium, calcium, and phosphorous throughout the body. Our kidneys also make urine and red blood cells, remove extra fluids from the body, control blood pressure and keep bones healthy. To date there is no cure for End Stage Renal Disease, but when factors that attribute to, and lead to kidney disease are controlled and treated, the progression to End Stage Renal Disease can be prevented or slowed down. Two of the most common contributing conditions leading to kidney failure in the United States are: Type 2 diabetes, otherwise known as adult onset diabetes, and long term unregulated high blood pressure. Dr. Ganjoo states, "Patients do not die of kidney failure, because there are so many options out there. Most die of heart disease, which manifests itself from high blood pressure." Important steps that are beneficial in treating high blood pressure are weight loss, regular exercise, careful dietary considerations, and medication. Control and monitoring of blood sugar levels in diabetics will help prevent complications that contribute to kidney disease, as well as coronary heart disease and stroke which are also associated with kidney disease and diabetes (National Kidney Foundation).

Hemodialysis

Like healthy kidneys, dialysis keeps the body in balance. During a dialysis treatment, a machine is used to clean the body's blood. The machine pushes the blood at a predetermined rate of speed through tubing to a special filter known as a dialyzer. As blood passes through the dialyzer waste, salt and extra water is removed and passes into a dialysate fluid. The dialysis machine also maintains the correct level of sodium, potassium, and bicarbonate in the blood and monitors and controls blood pressure (LORAC. 2009).

In order for one to receive dialysis, an access or entrance must be surgically made through the skin of an arm or leg and into one's blood vessels. There are three common types of dialysis access known as a fistula, graft, or catheter. A fistula is created by joining an artery to a vein under the skin to make a larger blood vessel. When blood vessels are not adequate to create a fistula, a graft may be created. This is when a soft plastic tube is used to join an artery and a vein under the skin. Occasionally a catheter access is created by the insertion of a narrow plastic tube into a large vein in the neck. Most often this particular type of access is only used temporarily until a graft or fistula can be successfully created (NKF. 2011). During each dialysis treatment two needles are inserted into the access site and then hooked up to the tubing on the dialysis machine. In-center dialysis treatments are performed on a Monday, Wednesday, Friday basis, or a Tuesday,