Accounting for Patient Symptoms in Hemodialysis Decisions

With José Morfin, MD

University of California, Davis School of Medicine, Davis, CA

Dr. Morfin draws from a wealth of experience interacting with dialysis patients as the Medical Director of Home Dialysis Services at Satellite Wellbound in Sacramento, California, to address the pervasiveness of patient symptoms and their consequences.1,2 Rather than normalizing these symptoms, he advocates working toward making therapy more tolerable.3,4

When it comes to quality of life metrics, he suggests in this presentation that intermediate outcomes need to be considered due to the lack of hard clinical studies. He then explores provider prioritization of outcomes and how they correlate to patient symptoms. Topics include intradialytic drops in blood pressure, recovery time, and volume management. 

He encourages clinicians to identify patients who are not able to tolerate three times a week dialysis, citing factors for consideration, and to look at other options to improve outcomes and symptoms, including more intensive hemodialysis. “We need to be thinking about the therapy because the therapy’s there for the patient. The patients aren’t there for the machines.”Any clinician who treats dialysis patients will find this presentation informative and enlightening, offering a fresh perspective on the role of dialysis therapy in helping patients thrive.

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  1. Caplin B, Kumar S, Davenport A. Patients’ perspective of haemodialysis-associated symptoms. Nephrol Dial Transplant. 2011;26(8):2656-2663. doi:10.1093/ndt/gfq763
  2. Rayner et al. Recovery Time, Quality of Life, and Mortality in Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis.:1513.
  3. Diaz-Buxo JA, Zeller-Knuth CE, Rambaran KA, Himmele R. Home hemodialysis dose: Balancing patient needs and preferences. Blood Purif. 2015;39(1-3):45-49. doi:10.1159/000368944
  4. Flythe JE, Brunelli SM. The Risks of High Ultrafiltration Rate in Chronic Hemodialysis: Implications for Patient Care. Semin Dial. 2011;24(3):259-265. doi:10.1111/j.1525-139X.2011.00854.x