Indication, Initiation and Monitoring of Hemodialysis

Y. Kandarini
Division of Nephrology and Hypertension, Department of Internal Medicine
University of Udayana- Sanglah General Hospital Denpasar

Abstract
Hemodialysis (HD) is one of renal replacement therapy (RRT) modalities which is
indicated for Stage 5 Chronic Kidney Disease (CKD) patients. Number of patients receiving RRT
have risen over the last decade. This increasing number of patients receiving RRT is caused by
complex of factors such as diabetes mellitus incidence and prevalence that may lead to End-Stage
Renal Disease (ESRD), besides the effectiveness of CKD management to slow the progression to
ESRD.
Hemodialysis is the main renal replacement therapy in most countries. Currently more than
2 million patients are treated with HD in about 28,500 dialysis units worldwide. Based on
Indonesian Renal Registry report in 2017, there were 9335 dialysis machines and 77892 patients
on HD. Regardless of substantial advances in CKD understanding and dialysis technology
improvements, the annual mortality of HD patients varies from 5% to 25% internationally,
depending on demographic and possibly genetic factors.
Indications for dialysis initiation in Stage 5 CKD patients are as follows: uremic
pericarditis, encephalopathy, muscle cramps, anorexia, nausea, malnutrition, electrolyte
abnormality (hyperkalemia) and refractory fluid overload after other medicine. The aim of the HD
system is to deliver blood in a safe manner from patient to the dialyzer, to allow removal of uremic
toxins and excess fluid, and to deliver clean blood back to the patient. An adequately treated HD
patient is characterized as physically active, well nourished, euvolemic, and normotensive with a
maintained good quality of life and life expectancy. In order to reach the goal of HD, every HD
patient has to do regular monitors toward clinical status, laboratory, nutrition standards and
clearance status. Patients also have to be checked for medical complications due to HD or CKD
itself.
Keywords: Chronic Kidney Disease (CKD), hemodialysis, indication.