Dialysis Treatment: Diagnosis and Monitoring

Dialysis treatment is a medical process designed to compensate for the loss of kidney function in patients suffering from chronic or acute kidney failure. This treatment, which can be carried out through hemodialysis or peritoneal dialysis, helps remove waste and excess fluid from the blood. However, before starting dialysis, an accurate diagnosis is necessary, followed by continuous monitoring to ensure the safety and effectiveness of the treatment.

1. Diagnosis Before Dialysis

Diagnosis is a crucial step in determining whether a patient needs dialysis and which type of treatment would be most suitable. It involves several medical assessments:

Comprehensive Blood Test: One of the most important indicators is the level of creatinine and urea in the blood, key markers of kidney function. Elevated levels indicate an accumulation of toxins that the kidneys are unable to eliminate.
Glomerular Filtration Rate (GFR): The GFR measures the kidneys' ability to filter blood. A GFR below 15 ml/min/1.73 m² generally indicates the need to start dialysis treatment.
Clinical Symptoms: Symptoms of kidney failure, such as fatigue, shortness of breath, edema, and changes in urination, are also signals that can lead to the prescription of dialysis.
Medical Imaging: Tests such as kidney ultrasound or MRI can be used to observe the size and structure of the kidneys to detect any structural or functional abnormalities.

2. Monitoring During Dialysis Treatment

Continuous monitoring of dialysis patients is essential to adjust treatment, minimize complications, and improve the patient's quality of life. This monitoring occurs on several levels:

a. Monitoring Vital Signs

Before, during, and after each dialysis session, several vital signs are checked, including:

Blood Pressure: Blood pressure can vary significantly during dialysis due to changes in blood volume. Hypotension may occur and requires prompt intervention.
Heart Rate: The heart is particularly stressed during dialysis, especially during hemodialysis. Monitoring helps detect abnormalities such as arrhythmias or cardiac overload.
Weight: The patient’s weight is measured before and after each session to assess the amount of fluid removed. This helps adjust the fluid volume to be removed during the next session.

b. Monitoring Vascular Access

In the case of hemodialysis, vascular access is created to allow connection to the machines. This can involve an arteriovenous fistula, catheter, or vascular graft. These accesses must be regularly monitored to avoid complications such as:

Infections: Infections are common around vascular access sites and require immediate care.
Thrombosis: Clot formation can block the vascular access and compromise the effectiveness of dialysis.

c. Monitoring Biological Parameters

Regular blood tests are used to monitor key markers of kidney health and treatment effectiveness:

Electrolytes: Potassium, calcium, and phosphorus levels are regularly checked to prevent imbalances that could lead to cardiac or bone complications.
Creatinine and Urea Levels: These markers are analyzed to assess the success of toxin removal during dialysis sessions.
Hemoglobin and Hematocrit: Chronic kidney disease is often associated with anemia due to reduced erythropoietin production by the kidneys. Monitoring these parameters helps adjust anemia treatments.

d. Nutritional and Hydration Monitoring

Dialysis patients must follow a strict diet to limit the amount of toxins and fluids that their kidneys cannot eliminate. Nutritional monitoring helps control:

Protein Intake: While proteins are essential, their consumption must be controlled to avoid excessive accumulation of nitrogenous waste.
Fluid Intake: Patients must limit fluid intake to avoid overload, which could lead to pulmonary edema or hypertension.

3. Treatment Adaptation and Adjustment

Based on the results of monitoring, dialysis treatment can be adjusted. For example:

Session Duration: Depending on the accumulation of toxins and fluids, dialysis session duration may be increased or reduced.
Session Frequency: A patient may go from three sessions per week to more, depending on the progression of their disease.
Medication Adjustments: Medications may be adjusted to treat dialysis-related complications, such as hypertension or electrolyte imbalances.

4. Complications to Monitor

Despite rigorous monitoring, certain complications may occur that require immediate medical attention. These include:

Hypotension: A drop in blood pressure during dialysis is common, especially in fragile patients.
Muscle Cramps: Often caused by electrolyte imbalances or the rapid removal of fluid.
Extreme Fatigue: The dialysis process can be physically and mentally exhausting for some patients.

Conclusion

Dialysis treatment (traitement de dialyse) relies on accurate diagnosis and continuous monitoring to ensure its effectiveness and the safety of patients. Every step, from initial diagnosis to the monitoring of biological parameters and potential complications, plays a vital role in improving the quality of life of dialysis patients. A multidisciplinary team of doctors, nurses, dietitians, and technicians ensures the smooth running of the treatment and adapts care according to each patient’s needs.