Manual of Clinical Dialysis 2nd Edition PDF
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As the next millennium begins, we hope that in the years ahead the need for dialysis will be decreased by better preventive care, especially the control of hypertension during the early stages of chronic renal disease. An increase in the number of donated kidneys and a decrease in their rejection rate also seems possible. In the meantime, it is our goal as dialysis professionals to do the very best job we can to make dialysis treatments as effective as possible in terms of patient survival and rehabilitation. Despite the excellence of this manual, in terms of dialysis dose, one conclusion is inescapable: the current recommendation for dialysis dose, although recently revised upward, is still too low to support the well-being needed for rehabilitation. Indeed, at a urea reduction ratio of 65%, which is the current minimum set by Medicare, patients remain chronically uremic.
The author does not say this, but if you read between the lines, he is trying to tell the reader that it is true. Furthermore, this dosage is based on observed (often malnourished) body weight, whereas it should be based on ideal body weight to reflect more accurately the needed dose. Equally bad for patient well-being is the fact that there is no margin of safety built into this minimum. I believe a margin of safety is essential since the delivered dose is not checked with every dialysis; yet every aspect of dialysis procedures works against delivering the prescribed dialysis dose. For example, if adverse intradialytic events occur during a session, the time lost is seldom made up. It is important to point out that the higher the weekly dose of dialysis the better. No adverse effects have been encountered no matter how high the dose. Pierratos has shown, with seven nights per week of home dialysis, a marked improvement in well-being, using a dose so large that phosphate had to be added to the dialysate