Mental health issues in kidney disease patients

Dialysis treatments are hard experiences for both patients and relatives close to them. Since patients depend on a machine from that moment on (or on other devices) to live, dialysis means a very drastic change in their lives. This is not easy mentally speaking. It means adapting to completely unknown conditions, a lot of fear, and, above all, fear to what life will be like from that moment on. Worst of all, the stress, anxiety, and depression may be so severe sometimes, that it may even worsen the current health status of patients. There is an additional problem: many people still underestimate the extent of depression and other mental problems. These people are doctors (sadly) as well as patients and their relatives. It is true that depression is a delicate issue that requires immediate and sufficient answers, and, for this reason, there are social workers and psychologists who are aware of the mental and emotional state of patients with kidney disease in several centers where dialysis treatments are carried out.

The main causes of anxiety, depression, and high levels of stress are fear of death, fear of relying on a machine, fear of suffering, and, especially, fear of change. Many people believe that dialysis means the end of a great cycle. That’s not true at all. Although dialysis does mean a big change in patients’ routines, patients are able to live perfectly normal lives. They can keep pursuing their dreams; they can keep working on their careers and go beyond their limits. In this post, we will talk about depression and anxiety in dialysis patients, as well as some basic tools to combat them.

The first thing to understand is that we all face many changes throughout life. Life, in essence, is about that: a great succession of changes. Some of those changes are more pleasurable than others, and, therefore, it is a so naïve idea to think that things will always stay the same way. This is the first step to face depression in the middle of a dialysis treatment: to take dialysis as one of many great changes in life. One of many limitations that can bring out the best (or the worst) of ourselves.

Read also: What is it like to live with dialysis?, by Joe Cosgrove

Secondly, it is very important to count on the support of professionals. A good psychotherapy, in which, if necessary, the patient receives prescription antidepressants, could be of tremendous help to overcome depression. In addition to the above, it is just key that patients remain active. Performing different activities that make them feel better, besides helping them to significantly increase the level of physical and mental energy, could help them to let go of the negative thoughts of depression, and learn to face them when they arrive. Physical exercise, hobbies, relaxing activities such as meditation, gardening, fishing, volunteer work, etc., may be great alternatives to feel useful and help you understand that dialysis treatment is not the end of anything.

On the other hand, it is very important that therapists help kidney disease patients to increase their self-esteem. Although this may sound hard to believe, self-esteem is a kind of immune system of the mind to resist different mental problems such as anguish, anxiety, existential dread, and fear of the unknown. A fundamental practice for developing self-esteem is to identify and learn to eliminate self-critical thoughts. After all, when it comes to depression, the main antagonist is the patient himself, especially when guilt, and other recurring thoughts, make the patient feel that there are no choices left.

It is also very important to develop assertiveness. Assertiveness is the human capacity to know how to defend oneself in a non-aggressive way in the face of pressure, demands or abuse from others or from oneself. Assertiveness is an intermediate point between aggression and calmness. It is very important to learn to be assertive in the midst of depression; and, to be assertive it is necessary to strengthen self-esteem in the first place. It is very common to find patients with depression, in particular, those who are undergoing dialysis treatment, in whom there is a high level of escape from problematic situations. This is not just a psychological problem that may increase depression and anxiety even more: it could be dangerous. Many patients, due to the fear of dealing with dialysis, avoid going to health centers to undergo dialysis. This behavior, in addition to self-destructive, is absurd from any point of view. It’s understandable, but it does not make any sense.

Finally, patients should not feel guilty for suffering from depression. It is perfectly normal that they are going through that, and it is necessary to call things by their name. Depression is an illness, and nobody decides to suffer from it. There are solutions for this, and it is not the end of the road. It’s just a station.

I hope this post has been useful in some way. Remember to share it with someone who is going through this situation.

Recommended: Depression in dialysis patients

* Featured Image courtesy of Quintin Gellar at Pexels.com

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An Alternative To Dialysis: The Nanofiber Web

As per discussed in previous articles by Joe Cosgrove, the main role of the kidneys is to act as a filter capable of separating waste products from the blood, thusly turning them into urine. However, this process, although present in every individual’s daily life, might represent a dreary situation when their kidneys are compromised. Individuals who have kidney failure struggle at getting rid of the accumulation of waste products in the blood.

The process that helps them get rid of this build-up is called dialysis, which has been previously covered in this blog; however, dialysis is also a nagging process, oftentimes rather expensive, which is why not every single individual can access it easily.

Now, after years of research, physicians and researchers have created an alternative. They have come up with a nanofiber that may serve as a cheaper alternative to the process in question, thusly enabling a bigger of portion of individuals to access kidney treatment much easier.

Although kidney dialysis is perhaps the most famous and common treatment for individuals with any degree of kidney failure, it is also known that the very nature of the procedure involves the use of auxiliary machines, either at a medical facility or, in some cases, at home, that serves as an aid filtering the waste and toxins from a person’s blood, thusly mimicking a healthy, normal kidney. However, researchers at the International Center for Materials Nanoarchitectonics say that, given the fact that dialysis as people know it requires electricity for the machines to function properly, it is quite difficult to make it available in poorer locations and areas where electricity fluctuates. Besides, dialysis machines require careful maintenance, and sometimes it is rather impossible to either find someone capable of keeping the machines functioning or have someone commute from far away to do it.

Additionally, areas known for their natural disasters, such as Chile or Japan, require alternatives to the procedure for, in the aftermath of these eventualities, many individuals have to go without treatment until normal medical services are reestablished. Having this in mind, researchers at MANA embarked themselves on the journey to develop a much cheaper, wearable way of filtering toxins in the blood of individuals with any degree of kidney failure. As mentioned above, the result was the creation of a nanofiber web.

During the creation process, physicians and researchers first set out to combine blood-compatible polymers made from EVOH alongside a variety of zeolite and minerals mostly made of oxygen, aluminum, silicon and other materials. The aforementioned zeolites have microscopical structures capable of absorbing the toxins and the waste that accumulates in the blood. Afterwards, researchers put in practice a low-cost method commonly referred to as electrospinning—a method that uses electrical charges to develop the web.

After having tested the web on its ability to absorb several waste products such as creatinine from the blood, researchers and physicians discovered that for the web to properly serve as a reliable alternative, a specific combination of aluminum and silicon within the aforementioned zeolites is necessary for it to absorb the highest amount of waste products from the blood. This composition of fibers and materials have proven to have enough potential to be considered as a new, cheaper way to remove waste products from the bloodstream without the intricacies commonly associated to regular and traditional dialysis, and without the inexorable need of additional equipment and specialized machines.

And even though the web is still in early stages, the findings seem to be promising. Researchers assert that it is possible that the web could be tailored as a blood purification product that would be accessible for a larger portion of individuals suffering from kidney failure and any degree of kidney disease. Additionally, the device has been initially conceived as a wearable, much cheaper alternative, for the idea is to also save people money and time. Moreover, the team at MANA strongly believe this development is quite feasible, and that it would totally change kidney treatment as the world knows it for it would pose a different way to approach kidney failure treatments.

Alongside this web, there are other developments in progress given the complexity of making dialysis less nagging and more accessible for individuals with kidney failure. An artificial kidney, for instance, is in the works. It would be capable to extract waste from the bloodstream just like healthy kidneys do. Other institutions set out to explore other alternatives as the use of pig kidneys as the substrate to develop and build human kidneys by providing them with a shot of stem cells. Theoretically, the stem cells would “colonize” the pig kidney, thusly making it available for human transplant.

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Image courtesy of Pixabay at Pexels.com

Be that as it may, as dialysis becomes more and more expensive and difficult to access, the scientific community is working hard to come up with an alternative in hopes of making kidney treatments cheaper and less demanding in terms of time, consequences and quality of life.

* Featured Image courtesy of Pixabay at Pexels.com

Is automated peritoneal dialysis recommended?

Many patients who need a dialysis treatment to control kidney failure must decide between two options. The first one, best-known as ‘hemodialysis,’ is the first image that pops into the minds of people when it comes to dialysis. This procedure consists of connecting the patient to a machine that fulfills the same functions as the kidneys: filtering the blood and eliminating the excess of fluids from the body. For this reason, it is necessary that patients go a couple of times a week to a hospital or to a specialized center, and lay down while the machine does its work. This is not the only option, though. There is also peritoneal dialysis. Despite this treatment does not differ essentially from hemodialysis, offers certain conveniences to patients that hemodialysis cannot allow. One of them is that patients do not have to plug into a machine or move to a hospital for doctors to monitor their health status.

Automated peritoneal dialysis is fundamentally not different from traditional peritoneal dialysis. This system uses the same type of catheters, and the kidney function is carried out in the same way. The difference is related the way in which the process is carried out. In automated peritoneal dialysis, a machine controls the development of the renal function. This means how much liquid gets into the bag and is ejected when the filtration process is over. In this way, patients do not have to worry about how much liquid they have added to the bag, and the machine is responsible for reminding patients when they should start a cycle in advance.

The filtering process takes about eight hours, but it may extend to ten, especially when patients are sleeping. One of the functions of the machine, in addition to calculating the amount of liquid that gets into the bag, is measuring the time of infusion, permanence, and drainage, and in a very safe way, which gives a lot of peace to both patients and doctors.

Read also: Dialysis most common complications, by Joe Cosgrove

The machines used for this procedure are not large. The biomedical engineering that has worked been behind the studies of automated peritoneal dialysis has made these machines fit in a small suitcase, which, although it may be heavy, has wheels and can be carried anywhere. The machine can be used almost anywhere (an airplane, for example.) One of the great advantages of this system is that the machine keeps a record of the activity from the beginning of the treatment, which can be observed by the doctor even without the patient moving to the hospital. This system is connected to the Internet. This means, in a few words, that the machine is permanently gathering information from the patient and transmitting it through the cloud. The doctor only has to use a device with an Internet connection to check the patient’s condition (it may be an app in his or her smartphone.)

The latter is a great advantage for doctors because the patient does not have to make any report. The system is responsible for producing the necessary information for the doctor to evaluate the patient’s conditions. Even some software systems are designed so that the machine tells the doctor if the patient is presenting problems that must be resolved urgently (the first symptoms of peritonitis, for example) and that patients may not detect in time, meaning this a great danger to their health.

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Image courtesy of Amber Case at Flickr.com

Automated peritoneal dialysis, in addition to being very useful for the health of patients, is also useful for medical research in this field. Because the number of patients suffering from kidney failure increases every year, doctors are very concerned about finding new ways to solve this problem. For this, it is tremendously important to have a large amount of information available.

Some doctors wonder if this system is recommended. The truth is that it is. There are studies showing that automated peritoneal dialysis is related to a much higher survival rate than the traditional peritoneal dialysis system. The reason for this is that the machines can calculate much more accurately the amounts of liquid that the patients need, as well as the filtering and expulsion times. The medical community knows that the more customized the treatments, the results will be much better since every organism is different and may react differently to the general conditions of any treatment. This is the case. On the other hand, one of the main problems that occur in peritoneal dialysis are infections, which has been resolved in a large percentage thanks to automation and its monitoring. The behavior of blood pressure is also another problem, and the study mentioned above shows that medical science is ready to reduce this issue to almost the minimum. There is still much to be discovered in terms of peritoneal dialysis, but the truth is that it is progressing so fast thanks to the data provided by patients. Let’s hope for the best.

Recommended: Do Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis Have the Same Clinical Outcomes?

* Featured Image courtesy of Franck Genten at Flickr.com