Dialysis

• It is beginning of new life, it is the only treatment after kidney transplant, to replace the nonfunctional kidneys, to sustain patient’s life.
• No one without the kidneys can be alive, it is necessary procedure in which some not all kidney functions can be restored.
• By dialysis, patients can survive and continue living with some constrains and few life style modifications, it is obligatory to do life style modifications to be healthy and avoid misalliance unwanted results.
• Everyone have to do changes in his life style according to his age, social position, and of course after marriage, if he do not, he get troubles, same for end stage kidney disease, they should do changes in their life style to stay healthy.
• Dialysis it is not the end of life, patients, family, and friends should not think when somebody do dialysis, he is will expire soon or he will be sick all the time. Dialysis patients have high life expectancy and most of them are active, productive with normal living. With modern medical approach the distinguish dialysis patients in society is not easy.

• Dialysis is not fantastic treatment, no one enjoy with it, but reconsider most renal disease have multi systemic disorders affect them continuously and needs continuous follow up medical treatment, while after starting dialysis they sure will become healthier and improved general condition.
• Keep in mind the main causes of kidney failure, themselves are main causes of sudden death, cerebrovascular accident, cardiac ischemic diseases, which lead to death or disability.
• The benefit of staring dialysis
• By doing three times per week, he will under closed medical supervision all dialysis time.
• By three times dialysis, extra fluid will be eliminate every other day. This improve respiratory status, improve o2 saturation and treat dyspnea.
• By doing three time dialysis, heart gradually be powerful, enhance cardiac contractibility and improve ejection fraction.
• By doing three time dialysis, electrolytes return to normal value, mainly kalium which cause cardiac arrhythmias, muscular pain especially in lower limbs
• By doing three time dialysis, blood acidosis will be corrected, enhance over all general conditions.
• By doing three time dialysis, important medications are surly taken.

• Signs and symptoms treated by dialysis
• Low blood pressure (hypotension).  will improve with improvement of cardiac ejection fraction
• Muscle cramps and numbness. Usually improve by rebalance of the body electrolytes 
• Itching.  This is the most annoying complain, may improve by regular dialysis and correcting calcium phosphorous
• Sleep problems. It will less problem, may elevated by time.
• Anemia. Medical staff will explore the causes and treat by available medications, at mean time frequent uremic and toxic materials removed by regular dialysis improve half-life of red blood cells, patient appetite will improved 
• Bone diseases. Calcium, phosphorus can be corrected by dialysis , in addition to medical staff will monitor Calcium, phosphorus, parathyroid hormone level and give the necessary medication.
• High blood pressure (hypertension). Frequent dialysis can cure blood pressure, in addition of removal extra body fluid on every other day and prescribing antihypertensive medications on demand can surly correct high blood pressure
• Fluid overload. Extra fluid is removed by dialysis, helping the patients from many related complains.
• Inflammation of the membrane surrounding the heart (pericarditis). Uremia can cause pericarditis, by intensive no heparin can be treated.
• High potassium levels (hyperkalemia). This dangerous state which usually led to death can be easily treated by short dialysis.
• In summary, most kidney failure signs and symptoms can be corrected by regular dialysis

What the most trouble Challenges dialysis patient face on affect outcomes

The one, and the only one challenge face the dialysis patients is the blood access.

It is role of the thump, good blood access good dialysis general condition patients

The blood access in dialysis patients is the most cause of morbidity and mortality among dialysis patients, it cause the multiple effect on their health status.

Blood access effect on dialysis patients:

• Simply, un-functioning blood access, there is no good dialysis, insufficient urea, toxic materials removal, lead to uremic symptoms, insufficient fluid removal lead to hypervolumia symptoms, inability to restore electrolyte, pH balance leading to critical medical condition.
• Infected blood access, led to septicemia, septic shock needs urgent medical care in intensive care unit. Infections are the second leading cause of death and hospitalization among haemodialysis patients.
• Blood access the leading cause of hospitalization among haemodialysis patients.

Types of blood access in dialysis patients

Arterio-venous fistula (AVF) is the preferred access for patients who require regular Hemodialysis and the preferred site is the wrist, preferably in the non-dependant arm. A standard Arteriovenous fistula (AVF) is created from anastomosis of cephalic vein with radial artery at the wrist.

Tunneled dialysis catheters are used for temporary vascular access in patients awaiting placement or maturation of a permanent vascular access (AVF or AV graft). They are also required for long-term access in patients who have exhausted all options for placement of a permanent access in all four extremities. They are usually placed in a central vein in the chest, most commonly in the internal jugular vein, and less commonly in the subclavian vein. However, they can be used also in femoral veins whenever indicated and due to their proximity to the groin; one would anticipate they would be more prone to problems with low dialysis blood flows, loss of patency, and catheter-related bacteremia.

(KDOQI) recommend use of arteriovenous (AV) accesses (native fistulae or synthetic grafts) for hemodialysis over using the venous catheter as they provide higher blood flow rates than do venous catheters and are associated with lower rates of infection, thrombosis, septicemia, and central venous stenosis which are common complications of the venous catheters.

KDOQI Guidelines further recommend fistulae over grafts, as most studies have found fistulae to have fewer complications.⁵ Other complications of AVF include thrombosis, infection, bleeding, increased venous pressure, arterial insufficiency, aneurysm, carpal tunnel syndrome, distal ischemia and even heart failure.

AVF Versus AVG

AVF vascular access is preferred to AVG because of its superior long-term patency and morbidity/mortality outcomes as compared with a synthetic AVG or a tunneled central venous catheter (CVC). AVF is considered the preferred type of vascular access in hemodialysis patients.9 Once they have matured sufficiently to be cannulated for hemodialysis, AVFs have secondary patency that is superior to that of AVGs, and require less frequent interventions to maintain long-term patency.10 Timely creation of AVFs has been shown to reduce the mortality rate by 1.72 times.11,12 Early evaluation of patients with CKD for an AVF placement and avoidance of initiation of hemodialysis with a CVC to reduce morbidity, mortality, and healthcare costs is recommended as per the guidelines set by several national renal societies

Stenosis and infection are the most common complications of the vascular access. DM is an important risk factor for the incidence of infection. Other risk factors for dialysis CRBSI include older age, low serum albumin, high BUN and decreasing the duration of dialysis