Prediction of Adjustment to Chronic Hemodialysis

Abstract

Twelve years ago the number of patients on chronic hemodialysis was limited and treatment was available only to a minority of patients with terminal renal failure. Dialysis units, therefore, had to develop a policy or criteria for acceptance and rejection of patients. Some units attempted to allocate the limited facilities to patients with the best potential for adjustment and survival; in other words, an effort was made to predict adjustment. Although by now there is hardly ever a need to select patients, the importance of prediction of adjustment has not diminished. The ability to predict means that the major sources of stress, as well as the individual’s methods of handling these stresses, have been identified. This enables one to plan and carry out meaningful therapeutic interventions. Furthermore, on the basis of prediction, one can decide which of the modalities of treatment will be the least stressful for each patient, i.e., center dialysis, home dialysis, or transplantation. The purpose of the present report is to summarize a series of studies about prediction of adjustment to chronic hemodialysis.