Caring for Patients with CRF: Rewards and Benefits

Patients with CRF usually progress through different stages before they reach ESRD and require special medical, social and psychological care and support during the pre-ESRD and following renal replacement therapy (RRT). Early referral of patients with CRF has the advantage of receiving adequate management and regular followup, with significant reduction in cardiovascular morbidity and mortality, attending an education program, prepared psychologically, participate in the decision of type of RRT, preemptive kidney transplantation, early creation of dialysis access, and adequate training in selected modality of RRT. During the early stages of commencement of RRT, psychological support and social care with rehabilitation program are mandatory. The degree of involvement and interaction must be individualized according to the needs of patient and type of RRT. A multidisciplinary team is crucial for implementation of a variety of strategies to help staff intervene more effectively in meeting the care needs of CRF patients

The value of pre-dialysis care

Chronic kidney disease (CKD) is one of the major health care burdens worldwide, with a significant increase in the number of patients and a huge increase in the financial demands in recent years. Patients with CKD usually progress through different stages before they reach end-stage renal disease. The rate and speed of renal function deterioration are variable, but uncontrolled hypertension and diabetes mellitus are major risk factors. Pre-dialysis care, with change of life style, blood pressure and glycemic control, the use of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers, lipid-lowering agents and management of anemia and mineral bone disorder can improve quality of life, preserve functioning nephrons and reduce cardiovascular morbidity and mortality with significant reduction in management costs. Early referral of patients with CKD to the nephrologist allows for adequate exposure to educational programs, psychosocial preparation, participation in the decision of type of renal replacement therapy (RRT), pre-emptive kidney transplantation, early creation of dialysis access and adequate training in selected modality of RRT. The degree of involvement and interaction must be individualized according to the needs of the patient and the type of RRT planned. A multi-disciplinary team is crucial for the implementation of a variety of strategies and to intervene more effectively in meeting the health care needs of CKD patients

Modalities of hemodialysis: Quality improvement

Hemodialysis (HD) treatment had, over many years, improved the survival rate of patients with end-stage renal disease. However, standard or conventional HD prescription is far from being optimal in replacing the function of normal kidneys. Its unphysiologic clearance pattern and inability to remove all types and sizes of uremic toxins results in inter- and intra-dialysis complications and an unacceptably high rate of cardiovascular morbidity and mortality. Efficiency of HD can be improved by increasing blood and dialysate flow rates, dialyzer size and surface area and duration and frequency of dialysis sessions. Home HD, where short daily or long slow nocturnal HD sessions can conveniently be performed, provides an excellent option for quality of life improvement and reduction in morbidity and mortality. Recent innovations in the specifications of HD machines and improvement in dialysis membranes characteristics and water treatment technology paved the way for achieving quality HD. These advancements have resulted in efficient implementation of adsorption, diffusion and/or convection principles using adsorption HD, hemofiltration, hemodiafiltration (HDF) and online HDF modalities in order to achieve optimum HD. Implementation of these innovations resulted in better quality care achievements in clinical practice and reduction in morbidity and mortality rates among HD patients

Aspects in Dialysis

Dialysis (clearance of uremic toxins and removal of excess fluids) is a broad term for different modalities of treatment for patients with acute and end-stage kidney disease. These modalities include peritoneal dialysis, hemodialysis, hemofiltration, hemodiafiltration, and continuous renal replacement therapy for critically ill patients with acute kidney injury. Dialysis is a lifesaving measure and can be conducted in hospitals, in dialysis clinics, and at home. Recently, dialysis techniques have witnessed tremendous improvements in technology and performance. The book Aspects in Dialysis covers important aspects of dialysis-related topics and is empowered with well-established and experienced authors, who have written clear and informative chapters. It covers various aspects of dialysis modalities supported by well-established clinical studies. Aspects in Dialysis can be considered as a guide for daily practice and a reference for medical and nursing staff involved in taking care of dialysis patients

Aspects in Continuous Renal Replacement Therapy

Continuous renal replacement therapy (CRRT) is a slow and smooth continuous extracorporeal blood purification process. It is usually implemented over 24 hours to several days with gentle removal of fluid overload and excess uremic toxins. CRRT, which is based on the physiological principles of diffusion, ultrafiltration, convection, and adsorption, can be performed as slow continuous ultrafiltration, continuous veno-venous hemofiltration, continuous veno-venous hemodiafiltration, and continuous veno-venous hemodialysis. Over many years, CRRT has been shown to be an effective dialysis therapy for hemodynamically unstable patients with acute kidney injury, brain injury, and/or multiorgan failure in intensive care units. Aspects in CRRT covers selected important topics with a practical approach to the management of different aspects of CRRT. All chapters have been updated and are well referenced, supported by well-illustrated figures and tables, and written by distinguished and experienced authors. Aspects in CRRT is considered as a guide to daily practice in intensive care units, and a reference for medical and nursing staff involved in taking care of critically ill patients with acute kidney injury, sepsis, and multiorgan failure