In medicine, dialysis is primarily used to provide an artificial replacement for lost kidney function (renal replacement therapy) due to renal failure. Dialysis may be used for very sick patients who have suddenly but temporarily, lost their kidney function (acute renal failure) or for quite stable patients who have permanently lost their kidney function (stage 5 chronic kidney disease).
For patients with stage 5, or End-Stage Kidney Disease (ESKD), the decline in kidney function occurred over a period of months to years until a level was reached at which treatment was needed for survival. Unlike Acute Renal Failure (ARF) (Acute Kidney Injury (AKI)), Chronic Kidney Failure cannot be cured or reversed and long-term treatments are needed to replace the lost functions of the kidney. The treatment for ESKD that most naturally replaces lost kidney function is a kidney transplant. However, some patients are not good candidates for a transplant due to medical or other reasons, some cannot receive a transplant because of the short supply of donor kidneys, and others simply decide that a transplant is not the best option for them. As a result, most patients with ESKD must rely on dialysis to replace the water and waste removal functions of the healthy kidneys.
The kidneys have important roles in maintaining health. When healthy, the kidneys maintain the body's internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulfate). Those acidic metabolism end products that the body cannot get rid of via respiration are also excreted through the kidneys. The kidneys also function as a part of the endocrine system producing erythropoietin and 1,25-dihydroxycholecalciferol (calcitriol). Erythropoietin is involved in the production of red blood cells and calcitriol plays a role in bone formation. Dialysis is an imperfect treatment to replace kidney function because it does not correct the endocrine functions of the kidney. Dialysis treatments replace some of these functions through diffusion (waste removal) and ultrafiltration (fluid removal).
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