How to plan your next vacation despite dialysis?

While on dialysis, many may not plan any trips or vacations to avoid inconveniences during their treatment. Despite the obvious concerns that you may have, it really isn’t necessary to deprive yourself of the opportunity to get away from it all. In fact, it is actually of benefit to travel. So, why not get around those concerns and find out what you have to keep in mind to travel safely.

Image courtesy of Ralf Κλενγελ at Flickr.com

It takes planning

Like any other trip, it requires solid planning, but even more so in this case. The first task is to research everything available about dialysis centers in the destination you are traveling to. You could also go to your dialysis center to see if they can help you in the search or if they have any experience in helping their patients prepare for a trip. If not, you can definitely do it on your own, as long as you make sure to cover all the bases. Since you do have more to plan for than your regular trips, it is important to start planning at least 7 to 8 weeks before the travel date.

Do your research

If you’re traveling to a city where you have friends and family, try to get them to find out locally the contact information for dialysis centers. If not, then get online and start your search. A good place to start is Globaldialysis.com, where all you need to do is type in the city and country to get a list of all of the dialysis clinics in that area. Once you have narrowed your options, start contacting them to see which one is the right fit.

Getting the details

You should have a long talk with your temporary dialysis center and find out as much information as you can to ensure you feel completely comfortable and safe. Understanding their policies on the reuse of dialyzers and bloodlines, the types of dialyzers they use, the type of dialysis machine they use (high flux capability, conventional), or if they routinely provide lidocaine is important. Besides these inquiries, you could also find out about the treatment itself like the duration, the scheduling, conditions during the treatment like if you are allowed to eat or drink while on dialysis or if they have an ice machine available for patients. Finally, in terms of logistics, find out what schedules would be available to you, although most traveling patients are set up in the evening shifts between 7:30 pm and 2:00 am. Other information that you feel is relevant is also key like transportation to arrive at the center which could influence your decision, since you will be in a new city.

The most important thing is to make sure you ask everything you need to know to feel comfortable with your decision.

Image courtesy of Jim Forest at Flickr.com

Details you’ll need to give

Most dialysis centers will require certain information from you to ensure they provide a safe dialysis service. So, when making arrangements be sure to have this information at hand. First of all, have identified which dates you need the dialysis treatment on. From there they will request all of your personal information like name, address and numbers, as well as your medical history and recent physical exam results. Any exam done recently will be important to include in your documentation like lab results, EKG or chest x-rays. They will need your dialysis prescription and at least 3 recent treatment records. When informing them of your history be sure not to leave out any special needs or dialysis requirements you may have or information about your general health and any medications you are taking. Finally, insurance information is necessary, as well as where you’ll be staying at in the city. Just keep in mind that the more information they have about your medical history and health in general, the better service they can provide.

Prepare for the unexpected

Whether you are traveling or sitting at home, you have the possibility of getting sick. Being realistic is important, because it will help you plan more effectively. Obviously, take care of yourself while on vacation, be sure to keep a diet, and not overdo it with sightseeing. If it gets to the point of requiring hospitalization, remember that this is something your temporary doctor has considered, so he will be prepared. So, just in case make sure your family knows where you’re traveling to, and which center you are being treated at. Have handy any contact information of people you may need to reach out to in case of emergency like your regular doctor or dialysis center. If you are traveling with more people, make sure they know about your condition, where you keep your medical history, as well as information on your medical needs. Finally, always carry any medications you may need and make sure you have enough for the whole trip along with a few extras just in case of emergency.  

Dialysis to go, all you’ll need is a belt.

In November last year, Dr Victor Gura spoke at the Kidney Week 2015 at the American Society of Nephrology Annual Meeting, about his wearable kidney device which has now passed its third proof of concept trial. The latest breakthrough was that six out of seven trial patients remained hemodynamically stable for 24 hours and fluid removal was consistent with the prescribed ultrafiltration. Mean blood flow was 42 ± 24 and dialysate flow was 43±20 ml/min with no laboratory evidence of hemolysis. Mean BUN, creatinine, and phosphorus clearances were 21 ± 13, 20 ± 11, and 22 ± 12 ml/min respectively during the first hour of treatment. Patients were told to eat foods that are high in phosphorous, and all the electrolytes remained stable, even in the absence of phosphate binders.

Image courtesy of duncan c at Flickr.com

Dr Gura, a nephrologist at the Cedars Sinai Hospital in Los Angeles and the David Geffen School of Medicine at the University of California, says “The draconian impositions we make on these patients in terms of not only being tethered to a machine (‘doing time’ as patients say) but also the limitations of diet — two glasses of orange juice and a bag of potato chips is enough to kill these patients — don’t make for a very good life” and “We do not do a good job at answering the unmet needs of our dialysis patients”

So that is why he invented this wearable artificial kidney device (WAK), which is nine-volt battery operated and easy to carry on your waist as a belt. It gives patients freedom to move around by reducing the functions of a 300 pound dialysis machine into just 11 pounds. It also uses just half a liter of water instead of the 40 gallons normally needed during a hemodialysis session.  The WAK has been tested in laboratories and clinics since 2001 by medical clinicians, biomedical engineers and other medical researchers. It is manufactured by Blood Purification Technologies in Beverly Hills.

The device was awarded a special FDA fast track to market status in April, 2012 as one of three products related to end stage renal disease; thanks to the support of a program called Innovation Pathway, a system designed to help medical devices reach patients in a safe, timely and collaborative manner.

Chuck Lee was the first U.S. patient supplied with the WAK. Now 73, he has been struggling with diabetes for 40 years and been on traditional dialysis three times a week for more than two years.

You can see an interview where he discusses his experience in this clinical trial and with the Wearable Artificial Kidney here: https://www.youtube.com/watch?v=IkRhnjDVZzE

One of the things he most enjoyed was that “…during the trial I just ate whatever I felt like, like I had a double order of macaroni and cheese for dinner, I ate Cheetos all night long, I drank orange juice and tomato juice which are both high in potassium, which is another one you have to watch out for, it was just like gosh this is so great!”

Dr Gura stated that “The limiting factor to have patients using this device is money, but we have now proven the concept in Italy, London, and now Seattle, and it’s time to get serious and make things happen, and we will.”

Despite the fact that the commercial availability of this device is probably many years away, the news is very promising as a possible life changer for many patients. Currently, the only treatment available for patients on dialysis is a kidney transplant, and only a small amount of these patients get one due to the lack of kidney donors. And unfortunately, the number of kidney failure patients is growing in the U.S., according to the U.S. Renal Data System 2015 Annual Data Report. So the reality is that a treatable fatal disease may now go either untreated or poorly treated.

Other alternatives to dialysis that have been proposed to date are “xenotransplanted kidneys”, supported by the Starzl Institute at the University of Pittsburgh; “bionic” kidneys; and simplified dialysis regimens. Dr. Eli Friedman, a distinguished teaching professor from the Downstate Medical Center in Brooklyn, New York invented a “suitcase kidney” that could be taken on trips and was easy for patients to use. However patients who took it home and on trips with them reported it to be bulky and burdensome and preferred going to a dialysis center for treatments.

That is why Dr Gura and others have worked on making the device lighter and simpler to be used as a portable device that subjects can wear while living something close to a normal lifestyle.

Image courtesy of AJC ajcann.wordpress.com at Flickr.com

At this point, there are many studies being carried out to help improve these patients’ lives. Such as using Nanotechnology to create an implantable artificial kidney, that can imitate a kidney and remove enough waste products, salt and water to keep patients off dialysis. And also probiotic bacteria that patients can take orally and it would digest the retained wastes of uremia and detoxify patients with end stage renal disease.

3 amazing tips for your first dialysis

Doing a dialysis for the first time may be a scary situation and not everybody knows how to get prepared for it. A dialysis is a process that helps clean the body of different waste that is in your blood and normally it would get removed by the renal system, when the kidneys are not working correctly. A doctor may appoint a dialysis if there is renal failure and, although this is usually a permanent condition, it may be because of an infection and will only last until the infection is removed. So if it is your first time having a dialysis is better to be well informed of the process and prepare appropriately for the procedure.

Image courtesy of Jim Forest at Flickr.com

There are two kinds of dialysis, the first one is called hemodialysis and the second one is called peritoneal dialysis. Hemodialysis is when the blood is extracted and clean and then sent back to the body, it also reduces the excess of liquid in the body. Peritoneal dialysis does the same but in a different way, it inserts a solution into the peritoneal cavity and it cleans the blood. Hemodialysis is more effective, but peritoneal dialysis is easier to perform and needs less equipment and experience.

When you already know what type of dialysis you will have, you have to do some preparation for it to be easy and effective. Now we will list some things that may help you during your dialysis process:

• Improve your lifestyle: You should make changes in your diet and your lifestyle; you have to make sure the body is as clean as it can be and this can only be done by controlling what enters your body in very different ways. First, you have to make sure all your vaccines are up to date and you do not have any pending health issues, as this can complicate the dialysis process. You need to make some changes to your habits and part of your lifestyle. Smoking is completely out of the question and if you are a frequent smoker you should inform your doctor of this first.  You should have a really balanced diet, making sure you have all the vitamins and the components necessary to have a healthy body, you should also avoid unhealthy food, and this way there will be less waste to clean from your body. That hamburger may look delicious but it is better for the body not to eat it, and especially before a dialysis. Make sure you get enough and good sleep, you should be well rested for the procedure, as it will make the recovery process easier.

• Keep careful watch of your body: Make sure your body is clean and the catheter entry has healed properly and is clean for the next dialysis. This is extremely important as it will make the procedure safer, as there is less possibilities of an infection. You should have really good hygiene to avoid different kind of infection that may occur during the recovery process. You should be conscious of all the information of your body, especially blood pressure and you should be able to control it with medicaments, different diets and exercise. Having high blood pressure may derive in different problems not related to the renal system, like heart disease. Another important step is making sure to control the liquid intake, some doctor will tell you to control your liquid intake or to carefully keep track of how much liquid you consume.
  

  Image courtesy of Alex Proimos at Flickr.com

• Prepare for what comes later: Your body will experiment changes during and after the dialysis, you should be physically and mentally prepared to what you may experience during this process.  You should be prepared to some discomfort, even though the dialysis process is not painful, you may encounter some adverse side effects. This side effect are different in every person, some physical side effects may include cramps and your skin may itch, the reason for the cramps is not really known but adjusting sodium intake may help reduce the intensity of the cramps. Other side effects may include high or low blood pressure, and these may lead to even other side effects; another heart related side effect is pericarditis, or the inflammation of the muscle around the heart, this should be treated as it may lead to a stroke or a heart attack. Anemia is also a known side effect and if you start feeling any of the symptoms of anemia, you should speak to your doctor.

Remember, you should be prepared for your first dialysis and is better if you take into account all the risks and side effects you may get. These side effects may vary from person to person but following the different advice we talked about should at least reduce the intensity of them and help you cope with them easily. Remember, before doing anything that may affect your dialysis you should check first with your doctor.