Dialysis and Renal Nursing

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    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.

    Dialysis and Renal Nursing

    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 a 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. Thru the use of specially formulated solution, 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. It also usually encompasses treatment of hypertension as this is one of the main reasons patients end up with chronic kidney disease.

    Education Requirements
    • Registered Nursing license or
    • Licensed Practical Nursing license or
    • Dialysis technician certification

    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.

    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.

    Resources for Further Information

    American Nephrology Nurses Association
    Offers certification for nurses and advanced practice nurses. They are also the organization that lobbies for support of dialysis care in the US. They have several forums and are a good resource for new dialysis nurses.

    Kidney Disease: Improving Global Outcomes
    A consortium of medical professionals that have researched and organized best practices for the care of renal patients.

    Renal Network
    The national organization that oversees care of patients in outpatient dialysis units. They provide a conduit for patients to verbalize concerns and address issues in specific dialysis units.
    Last edit by traumaRUs on Jun 15, '18
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    About traumaRUs, MSN, APRN, CNS Admin

    TraumaRUs is an advanced practice nurse who has been a nephrology APN for 7 years. She has been a nurse for 20 plus years and has experience in ER and ICU

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  3. by   BrandonLPN
    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.
  4. by   traumaRUs
    You are correct Brandon. One of the initiatives my practice uses is aggressively treating HTN so that it doesn't lead to ESRD.
  5. by   blondesareeasy
    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.
  6. by   madwife2002
    We really need to do more about HTN prior to ESRD! This should be a focus in preventing or delaying pts getting onto dialysis
  7. by   madwife2002
    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
  8. by   traumaRUs
    @blondes you are correct. The problem with HTN is that it is silent until you get to end organ damage.

    @madwife - go for it.....
  9. by   traumaRUs
    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.
  10. by   madwife2002
    I am jealous!
  11. by   SHGR
    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.
  12. by   traumaRUs
    @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.
  13. by   SHGR
    Quote from traumaRUs
    @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.
  14. by   traumaRUs
    You must live in a big city. I go to four dialysis units and they are 11, 25, 55, 62 miles from my house.