Advice to Dialysis Patients

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1)Get vaccinated for Hepatitis B, check the dates. Maintain a record of vaccination. Please share a copy of details with Dialysis unit for purpose of record.

2)Get all the necessary investigations done before maintenance hemodialysis and maintain a record of these investigations, one with you and one with dialysis unit.

A copy of Discharge summary and medications, be carried with you always and keep one with Dialysis unit.

3)Make sure that you get an AV Fistula done within the first 3 sessions of Maintenance hemodialysis, to avoid time delay and complications of catheters.

4)Ask dialysis staff to check the catheter each time and get it dressed if necessary. Avoid wetting the catheter area and make sure to attend immediately if you feel dressing is getting peeled off.

5)Always remember to keep exercising your hand with fistula ball to make sure fistula matures well and remains patent. Avoid pressure on the fistula.

6)Make sure your Hemoglobin is between 10-11 and if needed check iron levels to make sure iron level is OK. Iron needs to supplemented if levels are low. Erythropoetin is needed in all cases.

7)Make a note of the erythropoetin you are taking, dose and interval between doses. You need to understand that there are molecular differences between injections you are taking and others are taking. If there is inadequate response, these doses may be increased or intervals reduced or totally shifted to other molecules. Dose adjustments are needed to maintain Hb between 10-12gm/dl.

8)All medications prescribed to be taken regularly without skipping doses. B.P drugs should be counted and taken as scheduled. B.P to be maintained between 120/80- 140/90, not less and not more. Any deviations from this, doctor has to be informed and doses adjusted as advised.

9)Once in three months uric acid, calcium, phosphorous and LFT along with viral markers have to be checked. PTH should be checked once in 6 months.

10)It is a must for Every patient to undergo 3 sessions per week for good outcome. Patients who undergo less than 3 sessions fare poor overtime.

11)Patients who do not have any urine output should not increase weight beyond 1kg-1.5kg between sessions.

12)All patients should undergo cardiac evaluation and get a CAG if needed as most patients on dialysis die of cardiac complications.

13)All patients should consume a healthy and clean diet.

14)Any patients from outside dialysis facility willing to undergo HD at our unit need to undergo HCV-RNA PCR test.

15)For good quality of life, you should undergo good dialysis with high blood flows, maintain BP in specified ranges, HB to be between 10-12g/dl and a weight gain between sessions not more than 1-1.5kg.

Patients with poor cardiac status do poorly despite all these measures and may be advised to go for peritoneal dialysis.