Chronic Kidney Disease and a Career in Nephrology

Dialysis is a medical treatment where a machine filters the blood, taking the place of the kidneys. It can extend the life of people who have kidney disease for decades. It also helps people survive acute kidney injuries. A dialysis nurse’s job is to help administer this important treatment.

As part of the larger field of nephrology nursing, dialysis nurses rely on detailed knowledge of many kidney conditions. These nursing professionals medicate, support, and monitor patients who are on dialysis. They also educate them on kidney diseases and the lifestyle choices that will make it easier to keep their disease under control.

The majority of dialysis nurses are RNs or advanced practice nurses, or APRNs. Most of them work in a hospital or a dialysis treatment center. Because dialysis centers tend to have regular business hours, the schedule may not be as frenetic as working in other hospital settings.

The long-term job market for nephrology is promising. The prevalence of chronic kidney disease is expected to rise by 27% by 2030 for adults over 30. That makes it an intriguing field for incoming nurses, or for nurses considering a career change.

What is chronic kidney disease (CKD)?

Chronic kidney disease is a long-term condition where the kidneys lose function over time. Many things can cause CKD, including high blood pressure and diabetes.

The kidneys work by passing blood through filters called nephrons. These filters are made of tiny, specialized blood vessels. When they don’t get enough blood flow, they get damaged and wear out. This process can take months or even years. Over time, this damage means that the kidneys lose their ability to remove toxins and excess fluid.

Blood work can detect CKD, Regular testing is important, because CKD can last for years without symptoms. By the time symptoms do show up, it usually means that CKD has progressed to later stages, which makes it much more challenging to live with.

Chronic kidney disease cannot be cured, but it can be treated. A special, kidney-healthy diet and medications can slow its progression. However, the kidneys will eventual fail. This is called end-stage renal disease (ESRD), and it is life-threatening. However, there are two treatments. One is a kidney transplant. The other is dialysis, which performs the kidney’s function for it.

How does dialysis work?

There are several types of dialysis. Each of them require different things from the nurses who tend to them. Most people get hemodialysis treatments at hospital or a special center. But that’s not the only choice.

  • In-center hemodialysis is far and away the most common kind of dialysis. Hemodialysis removes blood through a surgically-placed access site and runs it through a machine. The machine has a chamber for blood, and a chamber for a cleaning fluid called dialysate. The two are separated by a thin membrane. The membrane allows toxins, excess fluid, and waste to be removed, but keeps other, necessary elements in the blood. The cleaned blood is then returned to the body. This usually happens 3 times a week for about 4 hours, but the schedule varies depending on need.
  • Home hemodialysis provides a very similar treatment, but from the comfort of home. People who dialyze at home tend to do so more often, for shorter period of time. This has been linked to improved health outcomes, but is still less common than in-center dialysis.
  • Peritoneal dialysis uses the person’s stomach lining as a filter to substitute for the kidneys. A catheter is implanted into the abdomen. The person introduces dialysate fluid into their abdomen through the catheter. The dialysate is cycled over the course of several hours, to keep the flow fresh, clean fluid going. Then the fluid is drained, through the catheter.

What does a dialysis nurse do?

Nurses who work in dialysis centers (or in hospitals) have to administer the dialysis treatments, as well as monitor the patients. You’ll track vital signs and recommend changes to treatment or diet. If you work with chronic kidney patients, you’ll be managing as many as 30 patients at a time, as part of a team. If you work with acute patients, you’ll be focused on 1 or 2 at a time, with more independence to make decisions on your won. But the patients will need a lot more care and attention.

Nurses who focus on home dialysis will do a lot of monitoring, as well, in checkups and through conversations with patients. The job involves a lot of diagnostic work and care plan management. You’ll also be responsible for a lot of education. People will come to you at a frightening moment in their lives, and need help learning how to take care of themselves in a new and scary way. They’re going through an enormous life change, and you’ll be responsible for educating them through it. It’s difficult, but it can be very empowering. In the end, you’re helping them take control of their treatment.

Is dialysis nursing for you?

Being a dialysis nurse has a lot to recommend it. The field is expanding, and it offers a more reliable schedule than many nursing jobs. The treatment you provide is lifesaving in a very real, immediate way. It’s a relatively steady job and a good way to know that you’re making a difference.
That said, there are certainly stressful elements. You’re dealing with people with a chronic, terminal illness. That carries a certain emotional weight. It can take a special kind of caretaker to pursue this work. But if you do, it can be very rewarding. In the end, you’re the best judge of your own preferences and personality. And now that you know more about the job, you’re better equipped to make the right decision for you.