[Care of the hemodialysis patients by the family physician].

Cooperation between the family physician and the kidney-center begins with the recognition of a renal disease and pre-dialysis treatment. Our patients usually are sent for the preparation of an arterio-venous shunt operation (Cimino or modifications) when serum creatinin levels amount to 8 to 10 mg/100 ml. Peripheral veins on both forearms should be reserved for these procedures early in the course of renal disease and vascular punctures should be avoided. Dialysis treatment is performed either at the kidney-center, at one of our partner-centers, at the central self-care facility operating under the care and supervision of the kidney-center or as home-dialysis-treatment. Each patients continues to receive technical and medical services of the center. Central self-care dialysis as well as home-dialysis are organized by the Kuratorium for Heimdialyse e.V. in this area. This organization also provides an on-cell-service of technicians. Nurses and physicians take regular rotations to staff the dialysis- and the self-care-units. The family physician takes care of the hemodialysis patinet in cooperation with the hospital. In case of medical problems the patient is transferred to the kidney-center. The patient must be well instructued on problems and complications which might occur during hemodialysis, either due to the basic disease or in connexion with hemodialysis. In some cases of complications patients must be admitted to the center without delay. Emergency situations usually can be avoided as technical standard of dialysis equipment and standard of training of patients or their parners is high. Medications, such as phosphate binders (aluminium hydroxide), iron vitamins and allopurinol are provided if necessary. Patients are advised to limit intake of fluids and potassium containing foods. The sodium intake depends on blood pressure-values. In case of hypertension there will be salt restriction, in case of hypotension the salt intake is increased. Chronic intermittent hemodialysis treatment can result in successful rehabilitation. Further improvement concerning personal and medical problems can only be expected from kidney transplantation.