Dialysis Could Be a Growth Industry for Nurses

June 23rd, 2012


By , BSN, RN

I was reading an article recently in the business section of my newspaper that said the kidney dialysis industry in this country includes about 4,200 dialysis centers and their combined annual revenue is about $18 billion. Wow!

I know in the Texas Medical Center alone there are numerous freestanding dialysis operations and of course, dialysis is being performed in our many hospitals around the clock. Since there are clearly a lot of people in need of dialysis, there must be a big need for dialysis nurses. Let’s take a look at what this is all about.

Chronic Kidney Disease

As of a 2010 survey, the Centers for Disease Control and Prevention (CDC) reports that more than 20 million, aged 20 years or older in the United States have Chronic Kidney Disease or CKD.

When your kidneys are healthy, they clean your blood. They also make hormones that keep your bones strong and your blood healthy. CKD is a condition in which the kidneys are damaged and cannot filter blood as well as they should. This damage can cause wastes to build up in the body and lead to other health problems, including cardiovascular disease (CVD), anemia, and bone disease.

People with early CKD tend not to feel any symptoms. The only ways to detect CKD are through a blood test to estimate kidney function, and a urine test to assess kidney damage. CKD is usually an irreversible and progressive disease.

When the kidneys begin to fail completely or reach less than 10 percent of normal function the patient is considered to have End Stage Renal Disease (ESRD). It may take 10-20 years of gradual worsening of kidney function before the problem progresses to ESRD.

Once detected, CKD can be treated through medication and lifestyle changes to slow down the disease progression, and to prevent or delay the onset of kidney failure.

The most common causes of ESRD in the U.S. are diabetes and high blood pressure.

  • CKD is more common among women than men.
  • More than 35% of people aged 20 years or older with diabetes have CKD.
  • More than 20% of people aged 20 years or older with hypertension have CKD.

The only treatment options for kidney failure are dialysis or a kidney transplant.

What is Dialysis

Dialysis is the process of cleansing the blood by passing it through a special machine. Dialysis can allow individuals to live productive and useful lives, even though their kidneys no longer work adequately. According to the National Kidney Foundation,  in the United States, there are more than 200,000 people who use dialysis techniques on an ongoing basis.

Hemodialysis and peritoneal dialysis have been done since the mid 1940s. Dialysis, as a regular treatment, was begun in 1960 and is now a standard treatment all around the world.

Indications for Dialysis

There are several symptoms of CKD and ESRD that indicate it is time to consider dialysis treatment:

  • Renal failure that can no longer be controlled by conservative management (i.e., dietary modifications and administration of medications to correct electrolyte abnormalities).
  • Worsening of uremic syndrome associated with End Stage Renal Disease (ESRD) (i.e., nausea, vomiting, neurological changes, pericarditis).
  • Severe electrolyte and/or fluid abnormalities that cannot be controlled by simpler measures (i.e., hyperkalemia, pulmonary edema).

Dialysis may take one of two forms, peritoneal or hemodialysis. Both types can be used for a short or long time, but they require specialized equipment and nurses with specific training. There are two main types of dialysis: hemodialysis and peritoneal dialysis. Both types filter your blood to rid your body of harmful wastes, extra salt, and water.

  • Peritoneal Dialysis – This is an indirect method of cleansing the blood of waste products using osmosis (the passage of water from the region of high water concentration through a semi permeable membrane to a region of low water concentration) and diffusion (passive transport involving the movement of small molecules from an area where they are highly concentrated to an area where they are less concentrated). The peritoneum functions as a semipermeable membrane. Excess fluid and waste products are readily removed from the bloodstream when a sterile electrolyte solution (dialysate) is instilled into the peritonea cavity by gravity via a surgically placed catheter. The dialysate is left in the cavity for a prescribed time interval and then is drained out by gravity, taking accumulated wastes and excess fluid and electrolytes with it.

    There are three different types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD), continuous cyclic peritoneal dialysis (CCPD), and intermittent peritoneal dialysis (IPD).

CAPD does not require a machine. Exchanges, often referred to as "passes," can be done three to five times a day during waking hours.

    CCPD requires the use of a special dialysis machine that can be used in the home. This type of dialysis is done automatically, even while you are asleep.

    IPD uses the same type of machine as CCPD, but treatments take longer. IPD can be done at home, but usually is done in the hospital.

  • Hemodialysis – This method uses a machine equipped with a semi-permeable filtering membrane (artificial kidney) that removed accumulated waste products and excess fluids from the blood. In the dialysis machine, dialysate fluid is pumped through one side of the filter membrane (artificial kidney) while the client’s blood passes through the other side. The processes of diffusion, osmosis, and ultrafiltration cleanse the client’s blood, and it is returned through a specially placed vascular access device (Gore-Tex graft, arteriovenous fistula, or hemodialysis catheter).

Dialysis Nurse

Dialysis nurses fall into the general category of nephrology nursing, the branch of nursing specializing in care for patients with kidney disorders and diseases.

Working as a dialysis nurse can mean being employed by a hospital or clinic, working or a large dialysis center corporation or even being a home health nurse since some forms of peritoneal dialysis requires nurses who make in-home visits.

The basic job requirements are the same. The nurse must have a complete understanding of the mechanics of dialysis, regardless of type; assessing vital signs; discussing patient concerns and answering questions relevant to care. The nurse oversees dialysis from start to finish and monitors patient reaction to treatment.

Because dialysis purifies the blood of toxins and balances body fluid make-up, dialysis nurses must interpret blood lab values, which reflect the impact of treatment. The treatment goal is to bring each patient's blood values as close to normal as possible.

While it is possible to go into dialysis straight out of nursing school, it is generally recommended that a nurse have at least a year of intensive care nursing under their belt before pursuing this specialty. Because CKD, ESRD, and the act of dialyzing the blood can affect so many body systems, it is wise to understand the critical values and changes that are involved and that comes from previous experience with critically ill patients.

This is an area of nursing that already employs many and is likely to continue to grow with the prevalence of obesity, diabetes, and hypertension in this country.

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