What risks may happen during dialysis treatment?

The limitations of medical science in the field of dialysis are still quite notorious. Although giant steps have been taken to carry out the therapies that we currently have to treat patients with chronic kidney disease, every day, great research and experimentation efforts are made to reduce the risks. Sadly, patients undergoing dialysis have many potential risks that could worsen their health situation. If we add some of the problems of contemporary medicine, such as antibiotic-resistant bacteria, things can get even worse. In this post, we are going to analyze some risks that have recently been discovered.

Low Uric Acid

There is not only a directly proportional relationship between uric acid levels and chronic kidney disease but with something even worse. It has been found that the significant decrease in uric acid levels in the body of patients undergoing dialysis is directly related to the risk of death. The uric acid is a residual substance, product of the processing of the purines which are that eliminated by the liver, by the intestines, and by the renal function of the body through the kidneys in form of urine. It is known that when the glomerular filtrate decreases, the concentration of uric acid tends to rise. However, Japanese researchers have also discovered that low uric acid aggravates the symptoms of chronic kidney disease to very dangerous levels. It is still an unresolved mystery, but statistics don’t lie.

High Iron levels

Likewise, an imbalance in iron levels may also mean a high risk for patients with chronic kidney disease subject to both peritoneal dialysis and hemodialysis. The main reason for this is that there is a direct relationship with cardiovascular problems that can trigger a cardiac arrest. It is an undeniable fact that patients have problems with normal iron levels in the blood. Naturally, due to the drastic change of diet and a decreased absorption of the intestines, the lack of this mineral in the body is just evident and expected. To prevent anemia and weakening of the immune system, doctors generally prescribe iron supplements. The problem occurs when the side effects of it are seen in the body. This is known as oxidative stress, and it means a direct and serious impairment of kidney function.

Read also: Learn more about the basic dialysis medicines and cares, by Joe Cosgrove

Sudden cardiac death

There is an alarming issue here. Of, approximately, half a million patients who must be treated for chronic kidney disease, almost two hundred and fifty thousand of them die from problems related to the cardiac system. Although no conclusive answers have been reached about why this phenomenon happens, doctors know that it is important to take care of the cardiovascular health of patients on dialysis because there is a high rate of sudden cardiac deaths among them. However, there are several ongoing investigations that seek to unravel this mystery of the human body to find effective solutions.

The most difficult thing is that sudden cardiac death has no clear early symptoms that can lead to a successful prevention so that doctors can act with enough anticipation. In addition, when the first symptoms of an imminent cardiac death appear, there is very little time to take actions to stop it. Actually, patients who show symptoms of sudden cardiac death (such as arrhythmias and ventricular tachycardia) die almost in an hour.

One of the known facts about this mysterious correspondence is that the risk of heart failure is closely related to the age of the patients and the time during which they have been undergoing dialysis therapy. This is one of the reasons why many doctors invest so much money and time in researching alternative means to treat chronic kidney disease or to improve dialysis failures and allow patients to have a better standard of living after they have lost their kidney function.

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Phosphates

Another major risk experienced by patients undergoing dialysis is the eventual presence of phosphate in the bloodstream. This is the cause of vessel damage due to the buildup of plaque, fats, and cholesterol in the arteries, which can harden and partially or completely block them. For this reason, when the amount of phosphate in the blood is high, doctors prescribe phosphate binders, which allow a later elimination of this compound, so that the organism of the patients remains in balance. Nevertheless, it is known that these phosphate binders may produce side effects in the patient’s body, such as the accumulation of aluminum in the brain and the bone system, which means a loss of mobility.

Peritonitis

Peritonitis is the inflammation of the lining of the abdominal cavity (or peritoneum) that occurs in those who receive peritoneal dialysis. The main cause of peritonitis related to this therapy is the presence of bacteria during the dialysis procedure in the place where the procedure is conducted. For this reason, patients, doctors, and nurses should be very careful with the disinfection of the area and their own hands, and, on the other hand, patients should not abuse antibiotics so that the bacteria do not generate tolerance to these measurements.

Recommended: Association of Dialysis with the Risks of Cancers

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Learn more about the basic dialysis medicines and cares

Chronic kidney disease is not only a major concern for many countries around the world because of the increase in patients suffering from this illness, but also because the public spending involves billions of dollars, both in research and in dialysis treatments per year. However, the main concerns are related rather on the individual than on the collective level. The sufferings of dialysis patients, as well as the limitations that this treatment implies, mean a great change for the patients themselves as well as for the families, which, although it may be an opportunity to overcome obstacles and overcome oneself, it is still a tough situation to deal with.

For this reason, the basic care and medications of dialysis patients improve permanently. Let us know what these basic nursing care are, as well as the medicines that a patient must take in hemodialysis therapy. Do not forget to share this information with your contacts if you are aware of their interest in this sensitive subject.

The basic medicines of a patient undergoing dialysis are basically six. First off, iron. This element, which is so important in our diet, is a crucial aid for the organism because, thanks to it, the body can produce hemoglobin, and this means to counteract a possible anemia derived from a food deficiency or a significant blood loss. Since dialysis patients have particularly strict diets, and, in them, the consumption of red meat is especially restricted – an important source for the supply of iron in the bloodstream – patients undergoing dialysis should consume iron capsules. In a complementary way, the possible anemia in patients is treated with the consumption of Epogen, which is always present in the basic medicines that nephrologists prescribe.

On the other hand, vitamin D is a must. It provides, in turn, a series of necessary nutrients which the body eliminates as a side effect during dialysis sessions. Normally, vitamin D deficiency is related to sedentary lifestyle, low exposure to sunlight, and, in general, to inadequate nutrition habits.

Similarly, due to the amount of medication a patient with chronic kidney disease should take, doctors usually prescribe feces softeners to relieve the constipation that normally occurs in these patients. Due to the low intake of liquids, as well as sedentary lifestyle, and the consumption of other drugs, the body hardly eliminates the feces, and that makes it necessary to relieve the constipation that is commonly present in these cases.

Read also: Exercise during dialysis: an option you should really consider, by Joe Cosgrove

Additionally, dialysis patients should regularly consume a phosphate binder, which greatly facilitates the absorption of phosphorus from foods that the dietitian prescribes for the patient’s diet. One of the main functions of the kidney must be fulfilled by compounds like this.

Finally, as a measure to avoid an irremediable problem, the patient is given heparin. This prevents the formation of blood clots in the dialysis equipment. This was, it is worth clarifying, one of the most frequent problems when this therapy began in the forties, and, actually, it was the cause of several deaths. As it usually happens in medical science, sometimes only the efficient results come after a long series of failures. This is an example of it.

Now, the most basic nursing care has to do especially with the ability of nursing diagnoses in subjects undergoing dialysis. The main ones are related to the excess of fluids, with the poor elimination of urine, with the significantly decreased physical mobility, as well as hypothermia, fatigue, erectile dysfunction, deterioration of the sensory perception, and insomnia. Nurses specialized in dialysis patients must learn to identify the symptoms of a worsening in the quality of life of the patient immediately. The notification of these symptoms to specialists, when done on time, is key to avoid subsequent problems that may be simply irreversible.

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In addition, nurses must learn to identify signs of depression in patients, and thus help them to undergo dialysis when they show no interest in the therapy whatsoever. To educate them to be diligent in the consumption of medicines, as well as to make some physical activity on a regular basis, it is another of the fundamental tasks of a nurse.

As long as the conditions allow it, it is really helpful that the attention of the nurses to the patients is personalized. When the nurses know the patients under their care more closely (taking into account that each organism and patient is different,) the attention that may be given to them will be of a higher quality. This personalized treatment is not limited to the patient but should be extended to the relatives, indeed. For this reason, the nurse must be available to any report made by the family members regarding the patient’s health status. Considering that doctors have several patients under their care, nurses could be the first choice of the family members (and, of course, of patients) when there is an urgent contingency to be resolved.

Recommended: Patient education: Hemodialysis (Beyond the Basics)

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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.

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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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