Can we improve the mortality for patients with ESRD on Hemodilaysis.docx

Brief communication

1. Can we improve the mortality for patients with End-Stage Renal Disease on hemodialysis?
Jafar Alsaid M.B.CHB. MD. FASN. FACP
Introduction :
The reason this question is crucial in current nephrology practice is that the mortality of patients
on hemodialysis is unacceptably high and has not improved over 4 decades. Only forty percent
of patients starting dialysis will live for 5 years and thirty percent annual mortality, which is
three times higher than any cancer, heart disease, or stroke. (1)
Nephrologists were pioneers in using technology to replace an organ. Since Willem Kolff
introduced the first hemodialysis technique in 1943,(2) followed in 1960 by Scribner envisioning
the AV shunt,(3) hemodialysis has been a process that can offer a better quality of life for patients
with End Stage Renal disease. However,  over the past 65 years, we continued the same basic
methods, depending on two needles, an external filter, and 3-4 visits to a dialysis center each
week. From the patient's perspective, they must spend about 5-7 hours three times weekly in the
dialysis center. If they could be spared from having fluctuation in blood pressure, cramps, and GI
symptoms, most patients by the end of the dialysis are exhausted and will spend long hours in
bed till they can cope back to an acceptable quality of life. Imagine that his cycle must happen
three times every week for the rest of the patient’s life or until he/she is fortunate to get a
transplant. Not to mention ED visits and access comorbidities.
How many nephrologists during the monthly round in our dialysis units have looked beyond
weight gain, potassium, phosphorus, or KT/V? How many asked, “How do you feel after
dialysis? or What can I do to improve your quality of life?
Although we agree that the ESRD population has high comorbidities, it could not be higher than
Acute MI, hemorrhagic stroke, or metastatic cancer. In all these fields, the patient outcome had
improved, the mortality and morbidity had been lowered by 25-40% over the same 4 decades
when we were still celebrating our hemodialysis invention a century ago.
There is no doubt that nephrologists are highly involved with their patients and continue to
provide all aspects of medical care required for their patients, but this is not translated into
improving outcomes. Where is the problem, and is there a way we could change the outcome of
patients getting hemodialysis? This remains a question that needs further discussion.
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2. References:
1.https://usrds-adr.niddk.nih.gov/2024/end-stage-renal-disease/6-mortality
2.https://www.sgkpa.org.uk/main/history-of-the-kidney-disease-treatment
3.Couser W.G: In memorial. Kidney Int. 2003 Oct:64(4):1155-6
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