Dialysis and Renal Nursing

As the US population ages, renal disease is entering many families. There is a growing need for nurses skilled in caring for these often-times very complex patients. Many disease processes including hypertension, nephropathies, nephritis as well some congenital anomalies.

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Dialysis and Renal Nursing

Overview

When chronic kidney disease (CKD) or acute renal failure (ARF) intrudes on a patient's life, dialysis can provide a life-extending option. Hemodialysis involves cleaning the blood by means of a thrice-weekly treatment usually obtained at an outpatient hemodialysis unit. Other options for hemodialysis include home as well as nocturnal outpatient hemodialysis units. Hemodialysis is achieved via a perm-cath which is a central line meant for temporary access. Permanent hemodialysis access consists of an arteriovenous fistula (AVF) or gortex graft (AVG) placed under the skin usually in an arm. There are variations of these dialysis accesses.

Acute renal failure patients most often receive dialysis in a hospital, oftentimes in an ICU. Continuous renal replacement therapy (CRRT) is the means that patients are continually dialyzed. When a patient is very ill with uremia, sepsis, or shock, they may require CRRT and it is the dialysis nurse that monitors and often changes the systems.

Peritoneal dialysis (PD) cleans the blood by means of a catheter placed in the peritoneal space. Through the use of specially formulated solutions, waste products are cleared either by intermittent "dwell" cycles or via a "cycler" that is used at night.

Renal nursing is the care of the patient who has kidney disease. Also, it usually encompasses the treatment of hypertension as this is one of the main reasons patients end up with chronic kidney disease.

Work Environment

Outpatient hemodialysis usually takes place in a free-standing building. Dialysis in the US lasts for approximately four hours and there are usually three shifts of patients per day. This means that hours of operation can be from 0500 to 2200, Monday through Saturday.

Home hemodialysis and peritoneal dialysis require nurses to train and monitor these patients and support them with their home dialysis needs.

Acute dialysis nurses are based in one hospital but may travel to other hospitals depending on need. They are on-call 24/7 on a rotational basis for the needs of acute dialysis patients or chronic hemodialysis patients who are acutely ill.

Education Requirements

  • Graduate from accredited Registered Nurse (RN), Licensed Practical/Vocational Nurse, or Nurse Practitioner (NP) nursing program
  • Successfully pass NCLEX-RN or NCLEX-PN
  • Current, unencumbered RN or LPN/LVN license in U.S. state of practice

Certification (LPN, RN, NP)

The American Nephrology Nurses Association offers certification for the RN, LPN, and NP as well as Technicians. They are also the organization that lobbies for support of dialysis care in the United States. They are a good resource for new dialysis nurses.

Areas of Certification

  • Certified Nephrology Nurse (CNN)
  • Certified Nephrology Nurse-Nurse Practitioner (CNN-NP)
  • Certified Dialysis Nurse (CDN)
  • Certified Clinical Hemodialysis Technician (CCHT)
  • Certified Clinical Hemodialysis Technician-Advanced (CCHT-A)
  • Certified Dialysis LPN/LVN (CD-LPN/CD-LVN)

Opportunities for Dialysis and Renal Nurses

The outlook for dialysis and renal nurses is bright. Most hemodialysis patients receive their care via Medicare, regardless of their age. This is due to the high cost of treatments. As the US population ages, many people are now living to an age where renal failure is more common. And, as home dialysis care advances, there will be more opportunities for nurses able to train and monitor home dialysis patients.

Salary

According to salary.com, the average U.S. salary is $79,215. The range typically falls between $71,389 and $96,537.

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traumaRUs

About traumaRUs, MSN, APRN

Trauma Columnist

14-yr RN experience, ER, ICU, pre-hospital RN, 12+ years experience Nephrology APRN.

88 Articles   21,268 Posts

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It's sort of sad that it's obesity, diabetes and sedentary lifestyles that will be the driving force behind the job growth in this field. The government would save money in the long run by investing in community outreach programs and an emphasis on preventative care.

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Specializes in Nephrology, Cardiology, ER, ICU.

You are correct Brandon. One of the initiatives my practice uses is aggressively treating HTN so that it doesn't lead to ESRD.

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YOU are correct and way ahead of the game. It's the rare patient in my ICU that is there because of some non-self-contributory disease. I've heard that in England, you can't get a knee replacement if you're obese and I completely agree with that. After the surgery, historically you're going to be an overweight sloth that won't do what's necessary to recover.

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Specializes in RN, BSN, CHDN.

We really need to do more about HTN prior to ESRD! This should be a focus in preventing or delaying pts getting onto dialysis

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Specializes in RN, BSN, CHDN.

Plus Nephrologists need to get fistulas in prior to pts getting on dialysis, why because it just makes sense!

Thanks for this Article Trauma I think I will write something on access and outcomes soon myself as it is my life LOL

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Specializes in Nephrology, Cardiology, ER, ICU.

@blondes you are correct. The problem with HTN is that it is silent until you get to end organ damage.

@madwife - go for it.....

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Specializes in Nephrology, Cardiology, ER, ICU.

I am very fortunate that my position in this very large (17 MD, 5 mid-level providers) nephrology practice. We have four surgeons that do all our accesses and we do kidney/panc transplants too.

We are very proactive in placing fistulas in CKD pts.

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Specializes in RN, BSN, CHDN.

I am jealous!

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Specializes in nursing education.

The nephrology group that sees most of our CKD patients puts fistulas in at stage IV. I thought that was the norm. (as a CDE I see a lot of the CKD patients in primary care). This week I worked with a guy in stage IV who just had his fistula replaced because the initial one wasn't working right, and he told he they told him it would likely be two years before he will need it. I feel special emphasis on the HTN and DM patients who at high kidney risk (and other bad outcomes)- I feel it's so important to hold the damage steady if it's already started.

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Specializes in Nephrology, Cardiology, ER, ICU.

@heysuz - you are so right. Education needs to start with the diagnosis of DM and HTN. And with teens and pre-tens being diagnosed this is often falling to pediatric practices.

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Specializes in nursing education.
@heysuz - you are so right. Education needs to start with the diagnosis of DM and HTN. And with teens and pre-tens being diagnosed this is often falling to pediatric practices.

I love primary prevention best but I feel like I live in the dialysis capitol of the world- there are six facilities four miles from my house or less (two are less than one mile from my home). Secondary and tertiary prevention are just reality.

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