Dialysis: Medical and psychological considerations

Abstract

Currently, 500,000 people in the United States are treated for stage 5 chronic kidney disease (CKD) or end-stage renal disease (ESRD) with dialysis, with this number increasing by 30,000 each year. In addition to in-center hemodialysis, in-home dialysis and peritoneal dialysis are gaining popularity. While the mortality rates for patients on dialysis have been improving with a 30% decline since 1999, it is still severalfold higher than age-matched cohorts in the general population. Adapting to the demands of dialysis can be difficult both physically and psychologically, further burdening patients with poorer quality of life and worse outcomes. Patients on dialysis suffer from increased rates of depression, anxiety, sleep disorders, and cognitive challenges. They are also at increased risk for suicide. Finally, there are important decisions to be made regarding initiation and discontinuation of dialysis. This chapter will describe the different renal replacement modalities available, the medical considerations of dialysis, the most important psychiatric implications and comorbidities in this patient population, relevant pharmacology, and special considerations regarding patient's decision to withdraw from dialysis.