Know some of the most common side effects of dialysis

People suffering from renal failure who must experience dialysis sessions know that it is not a pleasant experience. Although this procedure lengthens their life, side effects may occur they should know them in advance for minimizing them, in some cases, in order to completely avoid them.

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Related: Everything you need to know about Dialysis Disequilibrium Syndrome

Sessions are tough. Each process lasts four hours, and it’s three times a week. Sometimes it is not easy to hold. Renal patients should be connected to the machine to successfully clear their blood. The hemodialysis machine collects the toxic substances from the blood stream through an efficient filter that cleans it and injects it back again.

During that process, some alterations may be present in the patient’s body: the blood pressure suddenly changes, some cramps may occur, an overload of fluids sometimes, numbness in legs and arms, etc. Some of the most common side effects are nausea (sometimes with vomit), itching, headaches, and involuntary muscle movements, like nervous tics. This, without considering problems that may take place with fistulas, needles or bleeding.

To this extent, it is perfectly normal that patients get exhausted after each session. It is normal to feel weak and shaky. Obviously, everything may differ in intensity every time, or, in some cases, they may even not occur. Remember that every organism is different and shows different reactions.

Because of the normal side effects, doctors recommend rest after dialysis sessions. Physical exercises or tasks that require concentration, such as driving, can bring adverse outcomes. After an hour (though it’s variable for each patient), everyday tasks can be performed normally, even those requiring efforts, such as sports or some physical work. The important thing is to keep a positive attitude and remembering that the sensations produced as side effects are transitory.

Actually, doctors often recommend performing physical activities during the days in which the patient should not attend dialysis sessions. It is well-known that physical exercise enhances the beneficial effects of dialysis and reduces the side effects. However, it is important that the patient doesn’t perform extremely intense activities (extreme sports, for example) and, on the other hand, in all circumstances patients must protect the limb vascular access.

It is normal to leave a dialysis session with a little less weight because the liquid excess is removed from the body. A possible side effect is to finish the session with less weight (more than the expected amount) and then suffer from hypotension, extreme fatigue, and severe muscle cramps. Therefore, it is important to consume the amount of liquids that doctors recommend (not more, not less.) “Between dialysis sessions, patients should not drink more than two liters of liquid because it would increase their overweight significantly and would bring several difficult problems that could be avoided by following this simple advice,” says Joe Cosgrove, Chairman, President and CEO of Pentec Health.

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The reactions of patients are mainly due to the awareness of their bodies to ethylene oxide and to the cellulosic membranes which are not biocompatible (cuprophane or its derivatives, for instance). Nevertheless, there may be more sensitive reactions during the dialysis session that the already described above, and they happen due to other substances in the dialysis process, such as an anaphylactic allergy because of polysulfone biocompatible membranes.

This kind of reactions usually begin within a few minutes into the hemodialysis; immediately after contacting the blood dialysis circuit with the patient’s body. In some cases, the reaction may be delayed more than half an hour from the beginning of each treatment. More severe reactions can cause shortness of breath, loss of consciousness, hypotension, cardiac arrest and even death.

Traditionally adverse reactions happen in four out of approximately 100,000 dialyses. It is known that one in twenty to one in fifty patients could be susceptible to present an anaphylactic reaction with a new dialyzer simultaneously, while the risk of reaction in a single dialysis is approximately one in 1000 to one in 5,000. These reactions are not related to a particular type of membrane, a particular dialyzer, a particular dialysis technique or a priming procedure, but in those few patients suffering from repeated reactions, the problems can be avoided by increasing the volume of salt in the wash initial dialyzer or by simply changing the type of membrane.

Finally, other side effects that can occur (actually more unpredictable), are related to the mental health of patients. Several patients who undergo hemodialysis have symptoms of depression. In many cases, there suffer from panic attacks and the anxiety and stress levels may increase a lot. The first thing to consider is that these reactions are normal due to chemical changes in the bodies of patients and stress levels produced by long sessions. It is best to visit a psychiatrist who is aware of the dialysis treatment, to avoid a dangerous deterioration in the mental health of the patient.

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This is how Renal compensation for metabolic acidosis works

Metabolic acidosis is a primary reduction in bicarbonate, typically with a compensatory reduction in carbon dioxide partial pressure (Pco2); pH may be markedly low or slightly subnormal. Metabolic acidosis is categorized as high or normal anion gap based on the presence or absence of unmeasured anions in serum. The condition of metabolic acidosis occurs when the body produces excessive quantities of acid or when the kidneys are not removing enough acid from the body. This condition could lead to acidemia when blood pH is lower than 7.35. Symptoms may include chest pain, palpitations, headache, altered mental status such as severe anxiety due to hypoxia, decreased visual acuity, nausea, vomiting, abdominal pain, lethargy, hyperpnea (increased depth of breathing when required to meet metabolic demand of body tissue), altered appetite and weight gain, muscle weakness, bone pain and joint pain. People can develop pH imbalances as a result of metabolic disorders or breathing problems, like severe asthma that limits respiration. The condition may exhibit deep, rapid breathing, increasing the amount of carbon dioxide exhaled, lowering the serum carbon dioxide levels.

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And metabolic acidosis occurs when the body produces too much acid, or when the kidneys are not removing enough acid from the body due to the inability to generate sufficient bicarbonate. Renal compensation is an attempt by the kidneys to control the overall level of acidity, or pH, of blood serum. If it is too acidic or alkaline, the patient can develop health problems that will create a series of cascading reactions in the body. The metabolism and respiratory tract are involved in regulating internal pH through exchanging chemicals, excreting excess, and making sure the cells get the oxygen and nutrients they need. When the cells detect an imbalance, they respond by releasing chemicals to stabilize the body. If this is not successful, renal compensation may occur.

The kidneys are one of the lines of defense used to address acidosis or alkalosis. It can take several days for the renal compensation to kick in and stabilize the pH and the kidneys may not be able to maintain the desired value if the underlying cause of the problem is not addressed. The body regulates the acidity of the blood by four buffering mechanisms: The bicarbonate buffering system; intracellular buffering by absorption of hydrogen atoms by various molecules, including proteins, phosphates and carbonate in bone; respiratory compensation; and renal compensation. In situations where a metabolic acidosis develops rapidly and is short-lived, there is usually little time for much compensatory ventilatory response to take place.

Structures in the kidneys can determine if the blood is too alkaline or acidic, and decide which compounds to retain and which to excrete on this basis. They can change their absorption level of bicarbonate, for example, to control the level of acidity. Over the course of several days, the kidneys are able to filter the blood and restore balance. Changes in blood concentration result in the adjustment of excretion when renal functioning mass is acutely reduced

Renal compensation for a metabolic acidosis is hyperventilation to decrease the arterial carbon dioxide partial pressure. The metabolic acidosis is detected by both the peripheral and central chemoreceptors and the respiratory center is stimulated. The subsequent increase in ventilation causes a fall in arterial carbon dioxide partial pressure, which inhibits the ventilatory response. Beware when initiating ventilation in a patient with a significant acidosis, because the outcome could be fatal. The chemoreceptor inhibition acts to limit and delay the full ventilatory response until bicarbonate shifts have stabilized across the blood brain barrier. Joe Cosgrove explains that the expected pCO2 at maximal compensation can be calculated from a simple formula. A consistent relationship between bicarbonate level and pCO2 has been found. It can be estimated from the following equation:  Expected pCO2 = 1.5 (Actual [HCO3]) + 8 mmHg

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If a patient with a severe metabolic acidosis requires intubation and controlled ventilation in the hospital, the acidosis can markedly worsen unless the hyperventilation is maintained. The ventilation should be set to mimic the compensatory hyperventilation to keep the pCO2 low. Carbon dioxide crosses cell membranes readily so intracellular pH falls rapidly also, resulting in depression of myocardial contractility, arrhythmias and a rise in intracranial pressure.

When the underlying disorder is treated, the serum pH corrects. Caution should be exercised in these patients when providing alkali for raising the pH much higher than 7.20 because an overshoot alkalosis may occur. Potassium citrate can be useful when the acidosis is accompanied by hypokalemia but should be used cautiously in the presence of renal impairment and must be avoided in the presence of hyperkalemia. Citrate salts are available in a variety of formulations, as mixtures of citric acid with sodium citrate and/or potassium citrate. Potassium citrate is useful when the acidosis is accompanied by hypokalemia but should be used cautiously in persons with renal impairment and must be avoided in those with hyperkalemia.

Everything you need to know about Dialysis Disequilibrium Syndrome

Everybody know dialysis patients are truly considered as tough patients for all the physical and psychological efforts they have to overcome. Finding a cure for them is not an easy task and yet they have the duty to remain calm, undoubtedly patient and wait for their treatment to have the effect and result they expect and have to wait for. The live of dialysis patients has to go on even though the treatment is not as simple as they would like, and even they routines change completely.

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The blood purifying treatment for their chronic kidney disease is already pretty aggressive, and it gets even tougher when this treatment gets unexpected complications.

One of the complications dialysis can have is the Dialysis Disequilibrium Syndrome, also called DDS. This complication is considered a life-threatening complication and very few cases are reported.

The first DDS case description was reported in the early sixties.

Dialysis Disequilibrium Syndrome is a very rare dialysis complication, nevertheless the possibilities for this syndrome to appear are real and will most likely occur in the first sessions of hemodialysis in pediatric and elderly patients with end-stage renal disease. Elderly and pediatric patients are more prone to develop this syndrome due to the smaller volume of distribution of urea. DDS has been defined as a clinical syndrome of neurologic deterioration.  It is attributed to cerebral edema or conditions such as malignant hypertension, hepatic encephalopathy or hyponatremia, although the causes for DDS are not fully understood. It is also commonly known that DDS occurs in dialysis patients with pre-existing CNS lesions, such as recent head trauma or stroke.

For more information on the consequences of hemodialysis, click here.

What are the most common signs and symptoms?

The most common signs and symptoms presented in dialysis disequilibrium disorder are restlessness, continuous headaches, episodes of mental confusion in the patient, occasional muscle twitching and sometimes patients have even presented a coma, along with a few reported cases of death. Patients will probably also have a bit of irritability, nausea, vomiting, blurred vision and delirium that can even last for a few days. In order to find out more of what is happening with the patient, normally, what doctors will recommend is to do a computed tomography and also an MRI of the head, not only to understand the Dialysis Disequilibrium Syndrome but also to make sure there are no more intracranial issues.

How can it be prevented?

In order to prevent Dialysis Disequilibrium Syndrome, the dialysis treatment should be reduced in patients that have been identified as a high risk, commonly due to their end-stage renal disease.  Patients will be asked to take in the so-called “Osmotically active agents” which are basically fructose, glucose and mannitol. Other recommended ways to prevent DDS is for patients to have gentler dialysis such as daily dialysis or nocturnal dialysis which are done in a more gradual, shorter and less aggressive way.

What is the most common treatment for DDS?

When Dialysis Disequilibrium Syndrome appears, the most recommended treatment is to stop the hemodialysis. If the dialysis cannot be stopped, it should be at least reduced. Prevention actions mentioned above can also be used as proper treatment for patients with this type of complications.

Recommendations for the patient and their family

Avery important recommendation for the patient to follow is to continue eating a healthy diet and having a healthy lifestyle. In terms of family support, it is always recommended for patients to be surrounded by family and people that may bring them joy and comfort. Due to the weakness they may present, it is good for the patient to avoid any physical effort.

Additionally, it is always a good thing to have close friends or family to be there every time the patient needs it. A positive environment will always bring a better attitude in people, especially when they need to be and to feel strong on the inside and the outside.

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The importance of support

A dialysis patient is a delicate patient. A Dialysis Disequilibrium Syndrome patient is an even more delicate patient that will need patience, love and understanding. A treatment like this will not only take time, but also a lot of positivity and can only be achieved with the support family and friends can offer.

Make sure you treat your ill loved one well and you will see how his recovery or treatment process will improve. In the end, the satisfaction will be there, by knowing the patient received all the love and support he needed.

To find out more about the advantages and disadvantages of Hemodialysis and Peritoneal Dialysis Joe Cosgrove recommends to click here