The Correlation Between Dialysis And Psychological Problems

As per discussed in a previous article by Joe Cosgrove, renal and chronic kidney disease is a motley, often multi-sphered issue which the vast majority of times, to say the least, affects patients in both physical and psychological ways. In fact, many things have been said about the correlation between the existent treatments for kidney disease and a sheer array of the aforementioned connotations. Actually, the scientific community stresses the importance of developing a multidisciplinary approach in order to manage these patients properly. Mental health professionals and nephrologists are now compelled to work hand in hand more than ever in order to come up with a somewhat holistic management approach for individuals suffering any degree of kidney disease.

As said earlier, a staggering amount of individuals suffering from renal and kidney disease oftentimes depict several psychological problems, most of which require individualized and non-systematic treatment. The most plausible reason behind the existence of these psychological issues might be related to the fact that patients and individuals suffering from renal failure find themselves dependant on a machine, a treatment or procedure and, additionally, a group of highly qualified health professionals for the rest of their life. In fact, no other medical condition depicts such a high degree of dependence for the treatment to be effective. It is no secret that a procedure such as dialysis is no less than stressful due to its nature, and it actually worsens every time patients do not have at hand proper education regarding the procedure and the possible aftermath. Besides, there is also a considerable amount of restrictions when it comes to foods and fluids, which, of course, contributes to the development of the aforementioned mental and psychological problems.

Individuals with kidney and renal disease often times also suffer from other conditions, which forces them to be on a sheer array of additional medications. The vast majority of these medications have been traditionally linked to causing psychiatric and mental issues: confusion and agitation, for example, have been linked with other medical conditions such as electrolyte imbalances, hypertension, hypoglycemia, aluminum poisoning, dialysis dementia and so on.

But be that as it may, the most common, sometimes traditional, psychiatric issue and complication occurring due to the pre-existence of renal failure is depression in the individual and anxiety, of course, in an associated partner should they have them. The vast majority of individuals undergoing dialysis who still keep their jobs rarely regain their full-time work schedule and activity. Psychologists often assert that work, or any similar activity, in addition to being the basic source of income, is often associated with a higher feeling such as accomplishment, self-esteem and other positive connotations in the vast majority of patients. The current, and widely accepted, treatment for something like depression would obviously include therapy, psychotherapy, and antidepressants. There are some special considerations when it comes to dealing with patients suffering from end-stage renal disease, as the use of antidepressants might interfere with the treatment.

Today’s pharma industry has managed to create a sheer array of antidepressant medications for the proper management of a condition such as depression; however, each of these may end up having different effects on an individual’s renal function, although the vast majority of these meds are safe to some extent. Likewise, no studies have compared depression in patients with ambulatory peritoneal dialysis and hemodialysis; but it seems that those undergoing the former experience milder depression symptoms.

If one were to explore the correlation between dialysis and depression much further, the subject of an existing suicidal behavior tendency would definitely appear. Several studies have found and subsequently shown that those individuals undergoing dialysis have higher suicide rates unlike the normal healthy population. It is also important to say that, when feeling the nagging discomfort of depression, those people on dialysis have at their disposal the most effective method of escaping such scenario: suicide. Just by missing several dialysis sessions or ingesting higher quantities of potassium can result in an inexorable death.

pharmaceutical_pills_Dialysis And Psychological Problems

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Aside from suicidal behavior, the second most common phenomenon observed in people undergoing dialysis is delirium, mostly explained by the existing electrolyte imbalance that often times occur after a dialysis session, often dubbed as the “dialysis disequilibrium syndrome”. The causes may definitely also include anemia, uremia, amongst others. As with depression, the adequate management depends on each case. Case-by-case allows physicians, psychologists, and psychiatrists to detect the existence of delirium much earlier. Some ameliorative medications and benzodiazepines are, to some extent, useful in this scenario.

Alongside delirium and suicidal behavior, dialysis patients also experience extreme anxiety—especially somatic symptoms such as faster palpitations, chest pain, shortage of breath, intense sweating and the known fear of dying; however, many times the aforementioned symptoms are not systematically related with a special trigger and may, on the contrary, occur all of a sudden.

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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

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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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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.

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