I join hemodialysis facility in 1989, there was 10 beds making three shifts per day. The dialysis machines were basic without any options. I remember the tow dialyzers which was used, Allegro and Nephrows and the plate dialyzer for patients with bleeding tendency.
The acetate solution (dialysate path) was in use with its side effect for few patients. I remember the arguments between the staff about the required TMP (Transmembrane pressure) for some patients.
Sometimes we get frustrated because one patient does not lose weight as required. I still have the image of one alpha injection in my head to be given at the end of dialysis sessions.
Unfortunately, I do not have an image of how the water treatment unit was, but of course it was not as todays.
In that days the only problem faced by the patient was the cost of the transportation, it was resolved by social workers by getting special ID for the patients to use public transportation as free of charge.
All of us nursing staff, medical staff and all the patients were big family; mutual respect and trust in nursing staff among all the patients.
We really enjoyed working in such environment, most of us were working partial time in private sectors.
Now, every day we go to work, we will gets upset, stressed, anxious, and overwhelmed how the things became.
In that days, the patients behave as treatment seeker, his only concern is to get treatment, and they listen to the staff’s instructions and advice.
The nursing staffs were respected from everyone. Now I’m sorry to tell that but it’s real, the patient has been a figure, once the new dialysis patient comes, they will ask how much you will earn from me, how much the hospital will earn from me, why isn’t the doctor here, I have several sessions and I’m not getting cured, you’re not dialyzing me properly and starting to complain they’re not coming back healthy as they were few years ago, and they behave as they own the hospital.
Same thing for other people, they think we earn extra money, the hospital earns extra money so they create obstacles and frustration to us.
They deny what we suffering r when working in such stressful, unsafe, anxious, unstable environment.
The one who never work in dialysis will think that we connect the patients to the machines and rest for 3 or 4 hours until the termination, they do not believe once you have a single patient on dialysis you will become restless and anxious until the termination which is more stressful than working in ICU.
The objects and goals for any effort put on renal replacement therapy especially dialysis units should be to decrease morbidity and mortality and improving patient’s life style. We as dialysis staff welcome it and will be happy for this.
Unfortunately, dialysis become the most matter that everyone puts their nose in, I mean when you take a taxi, the driver will become professor in dialysis. I think this is the critical reasons why the outcomes are becoming undesirable in spite of modern technology of manufacturing dialysis, high quality treated dialysis water and the availability of modern medications, mortality and morbidity going high and lifestyle is coming down.
I think the basic thing to resolve this, is trust. The patient will not medically improve if he’s not trusting the therapist. So, we should work on building trust among our patients.
The first step in this is having trust in ourselves as a nursing staff. How the patient would trust his unit staff while hearing bad things from others, how he could be confidant that he receive the optimal care while others are seeking and encouraging the patient to write complains about his unit.
The dialysis patients are long-term patients, their psychology is altered as his body, not as acute patient one or two days.
As renal failure is multi organ disorder, it need multi discipline management physical, social, spiritual, motional, ets.
We believe that the life of our patient is our responsibility, we don’t save any effort they need, and we feel as nurses, we need psychology help when our patient passes away regardless the place of death.
Our biggest concern is the patient’s benefit and keeping in mind that God knows our actions and will asking us.
Ok everyone likes money but we spend money sometimes from our own pockets to help patients either to escort to/from the units or for urgent medications. We don’t care about how many patients we get (less is better), we as professional adapt for increasing the referral patients number from MOH, who require dialysis treatment to sustain life.
As we said, renal failure is multi organ disorder, syndrome, the whole body will be affected, the skin color contour is changed, the thump stamp will be slightly erased and it will be different than pre-dialysis (high fluid volume) and post dialysis (balance fluid volume) so the stamp will be different.
I think that no patient will skip dialysis sessions because they will get tired, even if they skip one day, they will be present in the next day asking for urgent help. I think if they can dialyze daily, they will not saying no as they hear from others that in many countries they dialyze on daily basic, some of them require 4 times dialysis per week, so mostly all of them dialyze 3 times/per week.
So how we will decrease morbidity, mortality and improving life expectancy and improving lifestyle for this community?
I think the first thing is the early prediction of the disease. I wish you share this link for you all and for the public.
https://kidneydiseaseclinic.net/gfrr/Calculate%20Kidney%20Function.php
Second thing which is very important is improving the blood access which is the first cause for morbidity and mortality.
Unfortunately, now a days about 40% of patients are on temp catheters which is source of infection and give poor blood flow in sometimes and it is not comfortable for patients either males for females worsening depression state.
This percentage should not be more than 15%. In USA, it’s about 10% with good blood access many disorders will improve this arise need for permanent access as AV fistula or graft which need vascular surgeon
Second cause of morbidity and mortality is cardiovascular which can be controlled by doing echocardiogram at least yearly to be managed early.
This also can be controlled by administration IV one alpha 2microgram at the end of dialysis.
By giving bolus IV of one alpha we can minimize of calcium and phosphorus deposition in arteries (causing atherosclerosis) and in skin causing persistent itching.
For me, I believe that, (the one who says injection is as tablets in pharmacology view not accepted), one alpha injection have big impact in metabolic bone disease by affecting the parathyroid gland to stop releasing parathyroid hormone which shift Ca from bone to the blood causing osteoporosis
Correction of anemia due to the bone marrow needs stimulant to produce red blood cells, this mainly secreted by the kidney, in renal failure the kidney becomes shrink and have less mass, so the amount of this stimulant called erythropoietin (erythro -RBC, poietin – synthesis) decreased so the bone ma not efficiently producing RBC which develops.
Anamia (Hb less than 12) but in renal patients may reach less than 8mg/dl.
This require administration of Eperix or the new drugs Aranesb which is more effective but its costly (maybe cost effective). By the correction of anemia, the PT would improve his lifestyle and morbidity and morality as well.
I get tired from writing so in summary, I would make a statement; we as dialysis staff spend our life in service of dialysis patients and during all these years our services are markable without any human supervision just God , so leave it as it.
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