Editing Kidney dialysis (section)

==Impact==

=== Effectiveness ===
Even though it is not a cure for kidney failure, dialysis is a very effective treatment.<ref>{{Cite web |title=Dialysis |url=https://www.kidney.org/kidney-topics/dialysis |access-date=2024-09-27 |website=National Kidney Foundation |language=en}}</ref> Survival rates of kidney failure are generally longer with dialysis than without (having only conservative kidney management). However, from the age of 80 and in elderly patients with comorbidities there is no difference in survival between the two groups.<ref name="pmid345075542">{{cite journal |author=Buur LE, Madsen JK, Eidemak I, Krarup E, Lauridsen TG, Taasti LH |display-authors=etal |year=2021 |title=Does conservative kidney management offer a quantity or quality of life benefit compared to dialysis? A systematic review. |journal=BMC Nephrol |volume=22 |issue=1 |pages=307 |doi=10.1186/s12882-021-02516-6 |pmc=8434727 |pmid=34507554 |doi-access=free}}</ref>

=== Quality of life ===
Dialysis is an intensive treatment that has a serious impact on those treated with it. Being on dialysis usually leads to a poor [[Quality of life (healthcare)|quality of life]]. However, there are strategies that can make it more tolerable.<ref name=":1">{{Cite journal |date=18 September 2024 |title=Dialysis for kidney failure: evidence to improve care |url=https://evidence.nihr.ac.uk/collection/dialysis-for-kidney-failure-evidence-to-improve-care/ |journal=NIHR Evidence |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_63287}}</ref> Receiving [[Home hemodialysis|dialysis at home]] might improve people's quality of life and autonomy.<ref name=":1" />

=== Scheduling and adherence ===
Dialysis is typically on a regular schedule of three times a week.

Given that dialysis patients have little or no capacity to filtrate solutes and regulate their fluid volume due to kidney dysfunction,<ref name="pmid19212421">{{cite journal |vauthors=Anderson AH, Cohen AJ, Kutner NG, Kopp JB, Kimmel PL, Muntner P |date=June 2009 |title=Missed dialysis sessions and hospitalization in hemodialysis patients after Hurricane Katrina |journal=Kidney International |volume=75 |issue=11 |pages=1202–1208 |doi=10.1038/ki.2009.5 |pmid=19212421 |doi-access=free}}</ref> missing dialysis is potentially lethal. These patients can be hyperkalaemic leading to [[Arrhythmia|cardiac dysrhythmias]] and potential [[cardiac arrest]],<ref>{{cite journal |vauthors=Hunter RW, Bailey MA |date=December 2019 |title=Hyperkalemia: pathophysiology, risk factors and consequences |journal=Nephrology, Dialysis, Transplantation |volume=34 |issue=Suppl 3 |pages=iii2–iii11 |doi=10.1093/ndt/gfz206 |pmc=6892421 |pmid=31800080}}</ref> as well as [[Pulmonary edema|fluid in the alveoli of their lungs]] which can impair breathing.<ref>{{cite journal |vauthors=Campos I, Chan L, Zhang H, Deziel S, Vaughn C, Meyring-Wösten A, Kotanko P |date=2016 |title=Intradialytic Hypoxemia in Chronic Hemodialysis Patients |journal=Blood Purification |language=english |volume=41 |issue=1–3 |pages=177–187 |doi=10.1159/000441271 |pmc=6109968 |pmid=26765143}}</ref>

Some medications can be used in the short term to decrease serum potassium and stabilise the cardiac muscle so as to facilitate stabilisation of acute patients in the setting of missed dialysis. [[Salbutamol]] and [[insulin]] can decrease serum potassium by up to 1.0mmol/L each by shifting potassium from the extracellular space into the intracellular spaces within [[Skeletal muscle|skeletal muscle cells]], and [[calcium gluconate]] is used to stabilise the myocardium in hyperkalaemic patients, in an attempt to reduce the likelihood of lethal arrhythmias arising from a high serum potassium.<ref>{{cite journal |vauthors=Ahee P, Crowe AV |date=May 2000 |title=The management of hyperkalaemia in the emergency department |journal=Journal of Accident & Emergency Medicine |volume=17 |issue=3 |pages=188–191 |doi=10.1136/emj.17.3.188 |pmc=1725366 |pmid=10819381}}</ref>

=== Survival without dialysis ===
People who decide against dialysis treatment when reaching end-stage chronic kidney disease could survive several years and experience improvements in their mental well-being in addition to sustained physical well-being and overall quality of life until late in their illness course. However, use of acute care services in these cases is common and intensity of end-of-life care is highly variable among people opting out of dialysis.<ref name="pmid352859152">{{cite journal |author=Wong SPY, Rubenzik T, Zelnick L, Davison SN, Louden D, Oestreich T |display-authors=etal |year=2022 |title=Long-term Outcomes Among Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis: A Systematic Review. |journal=JAMA Netw Open |volume=5 |issue=3 |pages=e222255 |doi=10.1001/jamanetworkopen.2022.2255 |pmc=9907345 |pmid=35285915}}</ref><ref name="PMID35285925">C. K. Liu, M. Kurella Tamura: ''Conservative Care for Kidney Failure-The Other Side of the Coin.'' In: ''JAMA network open.'' Band 5, Nummer 3, März 2022, S.&nbsp;e222252, {{doi|10.1001/jamanetworkopen.2022.2252}}, PMID 35285925.</ref>

===Cost===
The average annual total cost per dialysis patient varies between countries, for example in South Korea 19,812 USD, in New  Zealand 26,479 USD and in Netherlands 89,958 USD, according to an 2021 article.<ref name="d836">{{cite journal | last=Pockros | first=Benjamin M. | last2=Finch | first2=Daniel J. | last3=Weiner | first3=Daniel E. | title=Dialysis and Total Health Care Costs in the United States and Worldwide: The Financial Impact of a Single-Payer Dominant System in the US | journal=Journal of the American Society of Nephrology | volume=32 | issue=9 | date=2021 | issn=1046-6673 | pmid=34362835 | pmc=8729831 | doi=10.1681/ASN.2021010082 | doi-access=free | pages=2137–2139}}</ref>