What is it like to live with dialysis?

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In the United States at least 217,000 patients need to live with dialysis. This represents national costs for over $11 billion dollars every year. This procedure needs to take place when the kidneys are unable to filter fluids and their full capacity is lost. Sometimes, patients who need to live with dialysis have to do so because they were born with a kidney condition and they cannot afford a kidney transplant.

Statistically speaking, this is a dramatic situation for thousands of people in the United States. However, most patients seem to believe that dialysis is not such a terrible thing and they have adapted to a “new normal life”. But, what does it means to live with dialysis? In this article, Joe Cosgrove will share some details related to the way patients learn to have regular lives while they depend on dialysis to survive.

The Experience

First of all, when a patient decides that it is time to go under dialysis treatment it is because its kidneys are not able to do their job. This means that dialysis becomes the only alternative to survive. Keeping this in mind makes it easier and more motivating to people who need to go under treatment.

During a regular dialysis routine, the patient needs to come to the dialysis clinic and meet the nurse at the counter. Papers and forms will be filled out and a short checkup will take place. Since most patients have done this a thousand times, the process usually doesn’t take long.

After the checkup, the patient settles into one of the comfortable recliners inside the room where the process usually takes place. The patient may be the only one in the room or not, depending on the day and time it decides to go and get the treatment.

After settling, the patient will need to prop its left arm, allowing the technician to slip a couple needles into its blood vessels (close to the wrist). One of the needles is in charge of removing the blood and the other one is in charge of taking it back to the body. These needles are attached to plastic tubes that at the same time are connected to the dialysis machine.

For the next three hours, the needles will do their job and the patient’s blood will be filtered. All this is possible thanks to the dialysis machine that stands still next to the patient’s recliner. Most patients bring a book or spend this time watching a movie or a TV show on Netflix. Sometimes, this is even the perfect moment to take a nap.

Besides from the initial moment of the procedure, when the needles need to be stuck on your veins, the dialysis process doesn’t hurt. Sometimes patients may feel dazed and their blood pressure can drop. But, other than that, the process takes place in a comfortable way.

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Living with dialysis is supposed to make things easier for patients with End Stage Renal Disease (ESRD). However, the mortality rates in the United States remain to be considerably high compared to those in Japan or Europe since many patients choose to skip the procedure or don’t accept it to last for too many hours.

Related: How To Make The Most Out Of Your Time On Dialysis

How Dialysis Works

The best way to describe the dialysis process is as an artificial kidney. This means that dialysis should be able to do what your kidneys cannot do anymore. There are two different forms of dialysis: hemodialysis and peritoneal dialysis. At least 90% of the patients in the United States who live with dialysis choose to go under the hemodialysis treatment. This is the procedure that was described in the experience above.

When patients live with hemodialysis, their blood needs to be circulated outside of the body with the help of a hemodialysis device. This device cleanses the blood and then returns it back to the body of the patient.

Not everyone is a right candidate to get hemodialysis. This is why every patient needs to have the doctor’s approval before having an entrance or access (a minor surgery on the leg, arm or neck to access the blood vessels). This access is called fistula and the patient will need to keep it clean and usable for as long as it needs to go under dialysis treatment.

The fistula is something dialysis patients need to learn how to live with since it is the only way doctors have to access the blood in a fast and effective way. Fistulas are joints between arteries and veins located under the skin that form a larger vessel where needles are inserted.

When patients don’t need to live with dialysis and only go under a temporary treatment, they can get a catheter on their neck and there is no need for them to go under this minor surgery. In the case of the fistula, the wound needs to heal before the dialysis treatment takes place. However, in case patients use a catheter, they can go under the dialysis treatment right away and the procedure is slightly different.

Benefits and Disadvantages of Dialysis

When we have healthy kidneys our bodies work perfectly. Water retention is out of the table, we have healthy urine and our body simply never collects waste –at least not because of our kidneys. As the body is a machine where each part plays a vital role, a proper kidney function will also help regulate our blood pressure and mineral levels in the bloodstream. Meaning that our body will keep safe levels of different substances without the risk of intoxication.

Nevertheless, when our kidneys stop working like they should, medical intervention is needed. The most common procedure that takes place for patients with kidney disease is dialysis. This procedure helps the body perform its regular functions thanks to the artificial aid it provides. It helps our bloodstream to keep regular waste levels since it is constantly cleaning the blood and removing whatever that may accumulate in it and poison the body. Dialysis gives patients with kidney disease the chance to treat the problems that might be affecting their kidneys. However, there is more to this treatment. As any other artificial solution, it represents different benefits and disadvantages that need to be acknowledged before deciding to go with it.

In this article, Joe Cosgrove will share a list of benefits and disadvantages related to dialysis. First, the two types of dialysis will be defined and later a list of fundamental benefits and risks related to each one of them will be presented. It is important to keep in mind that any type of dialysis is meant to clean the blood and give patients the chance to have a normal life.

Hemodialysis

This is the most common type of dialysis among patients with kidney disease. A machine called a hemodialyzer operates as an artificial kidney, removing waste and harmful substances from the blood. The regular procedure includes a medical intervention where the doctor creates a vascular access to your bloodstream. This access will allow your blood to flow through your body while the dialysis treatment takes place. Having a wider access helps a larger amount of blood to be filtered and purified in one session.

Most hemodialysis treatments are done at a hospital or dialysis center and last less than five hours. Treatment sessions need to be done at least three times per week. However, sometimes shorter sessions can be done as long as they take place more frequently.

Benefits of hemodialysis

For long-term treatment, dialysis can be done at home. This means patients won’t have the need to go to the hospital three times per week but will have the chance to give themselves the dialysis treatment at home.

Another benefit associated with hemodialysis is the periodicity in which the treatment is done. Patients only need to be plugged to the artificial kidney three times per week instead of having a daily treatment. This allows them to have regular lives and activities.

If you go to the hospital for a dialysis session, you will always get help from healthcare professionals. This is ideal for patients with dementia or any physical limitation who cannot perform dialysis for themselves.

Disadvantages of hemodialysis

Patients going under the hemodialysis treatment will have for sure dietary restrictions. This means some foods will be allowed and recommended, but some others will be banned from your diet. Fluid consumption is also vital in order to have a successful dialysis treatment.

If you are not going under a long-term treatment, you will need to travel three times per week to the hospital. This can be often uncomfortable for patients.

If you need to go to the hospital three times a week this will limit your capacity to travel to another country. Usually, patients who need to get the treatment done every day don’t have the chance to have a regular life or visit other places.

There are some health conditions associated with hemodialysis as well. Low blood pressure, anemia, cramps, difficulty sleeping or depression are some of the most common side effects related to this time of dialysis that need to be kept in mind by patients.

Related: Dialysis

Peritoneal Dialysis

This type of dialysis involves a surgical procedure to implant a catheter into your belly area. It works in a way that a special fluid called dialysate is injected into your bloodstream through the abdominal cavity to draw waste out of the blood. Once the fluid has removed all the waste substances, it is removed from the body.

There are two different types or peritoneal dialysis which are most commonly used today. One is called Continuous ambulatory peritoneal dialysis or CAPD and allows patients to keep a portable equipment that increases the freedom of movement for patients with renal disease. The other type is Automated peritoneal dialysis or APD, which includes a machine that needs to be kept at home but can perform the dialysis treatment at night while the patient is sleeping.

Benefits of peritoneal dialysis

The most significant benefit of peritoneal dialysis is the comfort and simple use of the dialysis equipment. It can be carried at home and doesn’t need the patient to go to the hospital in order for the dialysis to occur.

Dietary restrictions are also easier to handle compared to hemodialysis.

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Disadvantages of peritoneal dialysis

There is a high risk of getting an infection due to the abdominal implantation of the catheter.

There are some health conditions related to peritoneal dialysis. Abdominal muscle weakening, weight gain, and high blood sugar are some of the problems that may affect patients going under dialysis treatment.

One of the biggest disadvantages of peritoneal dialysis is that it needs to be carried every day. This may be uncomfortable for most patients.

Kidney transplantation as an alternative treatment for chronic kidney disease

In this post, we’ll make a thorough review of kidney transplantation as a treatment alternative for patients with ESRD.

Kidney transplantation in the treatment of CKD

Kidney transplantation as an alternative treatment for chronic kidney disease

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Numerous studies have shown that renal transplantation is a therapy that improves long-term survival when compared with maintenance dialysis.

Transplantation in a predialysis situation is an attractive option because it improves graft survival and reduces costs. It’s associated with a 25% reduction in graft failure and 16% in mortality, compared with the recipients that are transplanted after entering dialysis; although it is not possible to do this in every case, as it will depend on the blood group of the patient and the donor supply.

An appropriate kidney transplant is, therefore, the treatment of choice for patients with terminal IRC because it offers a better evolution of the disease and due to its lower costs.

Without there being any exact rules, once the chronic nature of the process of kidney disease appears, and once the decreased renal function is established -usually when the glomerular filtration rate reaches values of about 30 ml / min-, it is necessary to present the different options renal replacement therapy (RRT) to which we must resort when kidney function values are close to being truly insufficient. At that time, the patient should be evaluated by nephrologists in specific predialysis or clinical nephrology consultations, in which the different options of TRS will be presented. Among them, the techniques of peritoneal dialysis and hemodialysis and the two types of kidney transplantation: living donor and deceased donor.

Contraindications for kidney transplantation

Kidney transplantation as an alternative treatment for chronic kidney disease

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Absolute

  • Recent malignant neoplasm with metastatic activity
  • Active infections
  • Irreversible extrarenal disease with no rehabilitation or life expectancy of less than a year
  • Psychiatric disease with loss of autonomy or competence
  • Repeated therapeutic failure
  • Addiction to drugs or alcohol without potential for rehabilitation

However, today, it is difficult to speak of absolute contraindications, and each patient should be assessed individually and according to their particular situation.

Relative

  • Age, over 75 years
  • Cardiovascular disease
  • Advanced chronic liver disease
  • Urinary tract abnormalities
  • Previous malignancies
  • Underlying disease

Risk factors linked to the recipient

Age

There is no formal age limit for excluding a patient as a candidate for a transplant.

Age is one of the criteria that has been most relaxed by the aging of the general population and the dialysis. There are many studies that provide evidence of results in patients over 70, but those obtained in recipients over 60, are better than those that would be achieved by staying on dialysis, achieving an acceptable degree of long-term renal functions.

Elderly patients have higher morbidity with higher rates of hospitalizations for younger recipients and increased risk of cardiovascular disease, cancers, and infections, so the evaluation must be very rigorous. However, they also experience less rejection and require less aggressive immunosuppression.

Some groups consider very elderly patients as preferred to receive kidneys from cadaveric donors with criteria such as age, obtained in asystole, among others, or be double transplant recipients with this kind of donors.

Living donor transplantation in people over 65 poses special problems that must be solved with a strict respect for underlying ethical factors.

Obesity

Patients with a BMI (body mass index) greater than 30 kg / m2 have a higher incidence of surgical complications, delayed healing, which leads to longer hospital stays.

There are conflicting results regarding the association of obesity with decreased graft survival. However, obesity is a risk factor for the development of diabetes, cardiovascular disease, and post-transplant hyperfiltration.

So a significant weight loss before inclusion on the waiting list is recommended.

Cardiovascular disease

Ischemic heart disease is the leading cause of death in transplant patients and graft loss with appropriate functions.

The risk of cardiovascular disease is higher in patients with previous cardiovascular disease, diabetes, smokers, obese (BMI over 30), carriers of classic factors of cardiovascular risk, very prolonged evolution of renal failure, and in those who have a poorly controlled hypertension and left ventricular hypertrophy.

The evaluation of ischemic heart disease is very important, especially in diabetics, in whom the coronary disease is often asymptomatic. Asymptomatic, low-risk patients should have their modifiable factors treated before including them in lists, high-risk ones (previous infarction, old age, diabetes) even if they are asymptomatic, should be tested for stress tolerance (stress tests, ultrasound with dobutamine, dipyridamole thallium scintigraphy, MRI or CAT scan). Patients with positive, noninvasive tests and those with symptoms will be studied with coronary angiography.

Patients with severe and diffuse coronary artery disease not amenable to revascularization or severe heart failure, are not good candidates for renal transplantation, and according to the case, they may be assessed for double heart / kidney transplant.

If there is a previous history or presence of risk factors for cerebrovascular disease, carotid doppler and surgery should be performed if necessary. The Doppler is also used to assess peripheral circulation in diabetic patients or patients with intermittent claudication.

Related content

Read Joe Cosgrove’s “How you can know if you will suffer from kidney failure.”