Dialysis most common complications

The procedure known as dialysis has been created so that the elimination of toxins and the excess of liquids in the body is possible; a function that, in healthy patients, carries out the renal system (kidneys, in particular.) Even though dialysis is so far the best-known option to treat kidney disease, and despite the fact that the biomedical technology makes all its efforts in considerably improving this system, it is still not possible to execute processes of error-proof dialysis. Unfortunately, complications can occur during the process, which can even negatively affect the health condition of patients. In this post, we will talk about the most frequent complications that can occur during dialysis.

In extracorporeal dialysis, the processes in which blood is removed from the body, complications are not as common. However, it is possible that an arteriovenous fistula infection may occur. Since the fistula is punctured three to four times a week to purify the blood, the risk of infection by bacteria in the puncture site is high. In addition, there is the possibility that thrombi form that obstructs the blood vessel and renders it unusable for dialysis. However, as a general rule, a surgical intervention allows the thrombus to be removed and the fistula to be unblocked.

In peritoneal dialysis, in which the blood is purified inside the body, there is a risk of inflammation of the peritoneum. Bacteria enter the peritoneal cavity through the catheter and cause a painful infection that, under certain circumstances, may endanger the life of patients. Normally, this inflammation responds well to treatment with antibiotics, but sometimes it is not that simple.

People with severe kidney disorders and kidney failure must pay great attention to their diet since many of the complications suffered by dialysis patients are related to food. Since the kidneys are not able to carry out their function of purification and excretion, in many cases those affected can only drink a limited amount of liquid. In addition, they must be careful with the contribution of protein and potassium, since an excess of these substances may lead to serious metabolic disorders in dialysis patients.

Read also: Baxter ShareSource System: A New Dialysis Option for You, by Joe Cosgrove

People with impaired renal function often have a high concentration of phosphate in the blood which may cause damage to blood vessels, such as arteriosclerosis. When the concentration of this is too high, despite having a low phosphate diet, so-called phosphate binders are helpful, they bind to the phosphate ingested with food in the gastrointestinal tract and are subsequently excreted. There are various types of phosphate binders, for example, containing aluminum or calcium, or free of both, which effectively improve the altered balance of minerals in dialysis patients. According to recent scientific findings, it seems that calcium-free phosphate binders are the ones that cause fewer side effects. Nowadays, the use of phosphate binders with aluminum content is no longer recommended due to the adverse effects that they may cause. A treatment with this type of medicine – for many years – may produce an accumulation of aluminum in the brain and bones which leads to worsening brain function and movement limitations.

In order to prevent possible infections of hepatitis B and C, and even HIV, through dialysis, the medical centers in which this treatment is carried out meet the strictest hygienic standards for the cleaning of dialysis machines. People suffering from these type of infections are treated in their own dialysis machines which are not used with any other patients. In addition, active vaccination against hepatitis B is recommended to all dialysis patients.

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There are other complications related to hemodialysis. Intradialytic arterial hypertension is less frequent than arterial hypotension, but it has relevant prognostic implications. Fever and chills in patients on hemodialysis should be attributed to endovascular infections, especially in those who have vascular access through a high-flow venous catheter. Likewise, fever at the end of the hemodialysis treatment is suggestive of endovascular infection.

On the other hand, hypervolemia is a complication that occurs regularly. This happens when the patient consumes more fluid than the one he manages to eliminate thanks to dialysis. Hypervolemia can also develop in response to sodium retention in the body due to impaired electrolyte excretion. In nephrological practice, hypervolemia due to sodium retention is observed in acute ophthalmic syndrome, in the oliguric phase of acute renal failure, due to the consumption of large amounts of fluid and obstruction of the urinary tract with volume-dependent hypertension. This problem usually leads to weight gain, and, when not treated in time, can be deadly because heart failure may occur.

Taking into account that during the last decades there has been an increase in cases of renal replacement therapy for different diseases, and, additionally, considering the increase in infections that are difficult to treat, mainly due to the widespread abuse of analgesics by professionals and patients who self-medicate (and who do not know how to differentiate a virus from a bacterial infection,) it is vital to know the different treatment modalities in these patients as well as the complications that can occur in practice.

Recommended: Infections in Patients Undergoing Chronic Dialysis

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Tips On How To Treat Children With Kidney Disease: A Parental Approach

Many children are diagnosed with some degree of kidney disease every day. Given the nature of this disease, as depicted in previous articles by Joe Cosgrove, it is quite hard for parents to digest such complication when kids are the ones affected. Their concerns about the whole thing are no less than legitimate; and feelings such as stress easily tend to appear; however, it is quite normal. When it comes to children suffering from chronic kidney disease, parents are somewhat forced to accept such reality without hesitation; nonetheless, they can also develop a practical way to cope with the daily complications and the very nature of the disease. The following words of advice were developed in hopes of providing families with helpful elements so that they can keep moving forward irrespective of the nature of their kid’s disease:

Get Familiar With What The Disease Is About

Learning about the disease, getting acquainted with the complication and its possible treatments is key. The basic word of advice would be: learn as much as possible about the disease and how it has been treated. Moreover, it is of high importance to convey this information to children: they actually understand a lot—and they are more receptive than the vast majority of adults.

Aside from the aforementioned idea, parents should spare no efforts in encouraging their children to ask questions to their doctors and nurses and pretty much every other health professional involved in the treatment. There is a myriad of aspects parents can learn from this, as they often abstain themselves from asking some questions just because they think they sound somewhat dumb. Having children ask whatever comes to their minds embodies a source of information and ideas that often go unnoticed by both parents and physicians.

In that sense, kids should not be given more than what they can handle and understand. This does not suggest, however, that parents should lie to their children. Be clear about the procedures and the treatments they are about to undergo. Therefore, try to help children understand that all the people—doctors, nurses, dietitians, nephrologists, social workers, etc.—are on their side. That all they want is to help them get better and healthier, even if it involves nagging treatments that may cause a certain degree of discomfort.

Be Proactive And Get Involved In the Kid’s Care

As a parent, it is not easy to see children suffer. Most parents tend to engage in pointless discussions with health professionals simply because they refuse to accept reality and the nature of the treatments that should be followed. Parents, the vast majority of times, are led by emotions—and all they want is for their children to get healthier. Thus, in order to more easily achieve the latter, parents should develop a sense of respect and cooperation with physicians. A good idea is to keep a detailed track about the kid’s medical history, paying special attention to dates. This comes in handy whenever children are referred to a new doctor. The idea is to make things easier.

Additionally, although seeing children suffer from chronic or any type of kidney disease is stressful and discomforting enough, parents should strive to be with their children as much as they possibly can during both treatments and possible hospitalization. Make sure kids are surrounded by their favorite things: books, toys, a special cushion or blanket, etc.

Teach Children How To Take Control Of Their Illness

Even though these might seem the worst days ever—and they possible are—, the idea is to keep a daily routine even during possible hospitalization. In the meantime, it is important to help children understand what doctors, nurses, machines are supposed to do and that they are for. For a kid, it can get really annoying to be in a room full of people and intimidating machines. By clearly explaining and helping them get acquainted with their surroundings, parents can help eliminate a part of their children’s legitimate fears. For such matter, it is quite useful to come up with a creative way to have children participate in their own care. By having them feel more in control they provide them with a sheer array of opportunities.

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Strive To Be Clear About Food Restrictions From The Very Beginning

Many children are forced to make drastic changes in their nutrition, and many just refuse to easily accept them. Kids are not used to the word «diet»; however, by developing a creative way to explain to them that they must adapt to a new nutritional plan, the likelihood of them accepting these changes is far higher than in the vast majority of adults. Have children make a list of their favorite foods and they assess it with a dietitian to determine whether they can be included in the new plan. Be that as it may, avoid forcing children to unquestionably accept these changes: this tactic rarely pays off.

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Some of the trends we can expect for dealing with chronic kidney disease

It’s sad but true: Chronic kidney disease progressively increases. In fact, in the registers of all countries, there is a constant increase in the population of patients who need dialysis as a substitute for their useless kidneys. The magnitude of this problem is serious when it comes to social health and, therefore, the finances of society. The reasons for this high mortality are indeed diverse but a significant factor here is the age of patients (considering that the population of old people is growing,) as well as a restoration with any kind of dialysis treatments of only fifteen to twenty milligrams per minute of renal function. Despite the advances that have been made in hemodialysis and peritoneal dialysis, there has not really been a clear improvement in the progress of patients’ conditions.

Considering the few advances in this field, but the accelerated pace of technology in general, the question that arises is very simple: What trends in terms of dialysis can we expect to treat (and, perhaps, eradicate) chronic kidney disease?

The conditions of patients on hemodialysis, in general, represents a tremendous sacrifice for relatives and close people, mostly because of all the physical and emotional suffering they experience and the constant traveling to dialysis centers three times (or more) per week. In addition, the amount of deadly cases, not too different than those of metastatic carcinoma of the breast, to carcinoma of the colon or to that of prostate cancer, this forces the medical community to move towards other ways to solve this problem.

Although there have been many cases of progress in the health of patients thanks to the effective implementation of traditional methods of dialysis, especially in what has to do with the quality of life of patients, dialysis is not it ceases to be a control procedure, which only keeps an impossible problem at bay. This is what has set in motion the gears of science to find definitive solutions.

Read also: Dialysis: Almost 70 decades of hard work and progress, by Joe Cosgrove

It is undeniable that peritoneal dialysis is a very practical method for the life of patients since they do not depend so much on contact with professionals, as well as on the displacement to dialysis centers. In particular, peritoneal dialysis, which has been working with intelligent mechanisms connected to the Internet, is one of the most recent advances and the most beneficial for the work of medical science, thanks to the constant monitoring, and, consequently, to the constant production of data, research in this field can go a long way to find definitive solutions, in which dialysis as such is no longer necessary.

On the other hand, there is another effective method. Online hemodiafiltration it’s a new dialysis system that allows a greater filtration than what is usually achieved with conventional hemodialysis. It is one of the techniques that aroused greater interest in patients nowadays, and the use of it will surely grow. It is a modality of dialysis that maintains the diffusion levels of hemodialysis by increasing the convection, so that, by infusing a greater quantity of water, a higher level of solutes can be carried from the blood to the dialysis fluid. The clearance that is obtained is greater.

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In hemodiafiltration, it is necessary to infuse a liquid of greater purity than that used for conventional modalities. This leads to using machines with very clean filters that, of course, are much more expensive. Although conventional hemodialysis guarantees very good results in the short term, in the long term it is a difficult experience for both patients and people around them. So this can be an excellent alternative.

However, hemodiafiltration online is not yet a widespread technique, and to make it massive is not a simple matter. Because there is still no study that states with total certainty that this option has clear advantages over conventional hemodialysis, there is still not much support from the governments of many countries. Although it is a technique that has shown advantages in some fields, It is very risky to consider that, definitely, it is the perfect replacement for the other types of dialysis.

The future of dialysis does not have much to do with the reduction of filtering times to which patients must submit. The current trend is to encourage techniques such as peritoneal dialysis, which dialyze more hours and more frequently since it is the way of working more similar to that of the kidney.

Embryonic stem cells could be an important trend too. These are undifferentiated pluripotent cells, isolated from the inner layer of the blastocyst, have the ability to differentiate into cells of different types: Mesodermal, endodermal, and ectodermal, depending on the culture conditions. It is, therefore, a type of cells that have a potential possibility of tissue regeneration.

It is necessary to be optimistic and continue investigating. If dealing with chronic kidney disease is a medical priority in several countries, the future of patients will be promising.

Recommended: Changes in the worldwide epidemiology of peritoneal dialysis

* Featured Image courtesy of scribbletaylor at Flickr.com