Haemodialysis

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The average patient on haemodialysis requires 3.5 h of dialysis three times per week to achieve adequate creatinine clearance. (81) Haemodialysis has enabled the survival of countless thousands of patients with chronic renal failure and provides a temporary management tool for patients on transplantation waiting lists. However, it is not a benign procedure, and has a number of potential neuropsychiatric complications. Patients on haemodialysis are at high risk for developing volume overload, pulmonary oedema, hyperkalaemia, hyperphosphataemia, and metabolic bone disease if compliance with restricted diet and fluid intake is not optimal. Patient adherence to these diet and fluid-intake protocols are used as a criterion for making decisions about appropriateness for transplantation. Psychiatric reasons for non-compliance should be addressed and are usually reversible, with the exception of personality disorders. These include mood disorders, phobias, panic disorder, substance-related disorders, adjustment disorder, and cognitive disorders.

Many patients on haemodialysis develop a progressive dementia beyond that expected from the severity of the uraemia alone. This has been termed 'dialysis dementia'.(89 Progressive encephalopathy, stuttering, dysarthria, dysphasia, impaired memory, depression, suspiciousness, myoclonic jerking, and seizures characterize this syndrome. 'Dialysis dementia' has been found to correlate with high levels of aluminium in the brain tissue of patients and with outbreaks in dialysis units where the water supply was contaminated with excess aluminium concentrations. Because water treatment in the United States now removes aluminium from dialysate water, the incidence of dialysis dementia has markedly diminished.

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