Dialysis and The Elderly: Solution or Mistake?

The elderly seem to depict some degree of declivity soon after they start dialysis. Although dialysis is perhaps one of the world’s most renowned medical development, nursing home individuals and patients who undergo dialysis in hopes of treating any sort of kidney disease showed sustained and evident declivity in their mere ability to perform basic activities. Joe Cosgrove has previously covered the topic of dialysis from different angles; however, it is important to mention the possible complications of starting dialysis in later stages of life.

According to a study, patients with end-stage renal disease worsened within three months soon after starting the treatment: A year after starting the treatment, almost 60% of patients in the aforementioned study passed away, and only 12% still manage to have a decent life—at the same level—as they did prior to undergoing dialysis. In short, and resorting to the findings, although dialysis has been linked to extending the lives of patients and individuals at nursing homes, it does not, however, seem to bring back the kidneys to their initial functional status. The elderly and nursing home residents under dialysis are clearly open to suffering a sustained and evident decline in their kidneys, which also raises the question about whether it does increase the rate of mortality.

An increasing number of elderly individuals with end-stage renal disease in America are starting dialysis: nursing home individuals account for almost 5% of new end-stage renal disease patients and almost 12% of them are above the age of 75. Although dialysis is a viable treatment for individuals with renal disease—at least to some extent—, the benefits and the perks commonly associated with the treatment seem to be uncertain in elderly patients. According to the study, the rate of mortality in the first year soon after starting the treatment surpasses the 35% among patients older than 75 years of age and surpasses 55% among those individuals older than 85 years of age. Additionally, the alleged benefits on the quality of life and the extent to which the treatment seems to extend the patient’s lifespan, especially in the elderly, are still to be determined.

Researchers and physicians gathered information from a national databank of patients currently undergoing dialysis with that from a national databank of nursing home and elderly patients to identify up to 3,700 different individuals who started the treatment between 1998 and 2000. The functional performance of the subjects was initially measured using a monthly-based scale; however, researchers deemed more suitable a 3, 6, 9 and 12 months scale to measure the alleged effects of the treatment on nursing home patients. After assessing the findings, the scores were compared to a previous assessment made soon before they started the treatment.

The period before and after the beginning of the treatment is definitely the riskier stage, for the vast majority of subjects and patients have increasingly tough conditions, and many end up passing away in the following months.

Efforts to offset the risk commonly associated with the treatment, and efforts to make special emphasis on the goals of actually improving the quality of life of the patients ought to be addressed during this period rather than after individuals have started to undergo the treatment. Be that as it may, these findings are not 100% conclusive, for the lack of a control group may have resulted in the inevitable misinterpretation and underestimation of the functional declivity that occurs after the beginning of the treatment. Nonetheless, many physicians and clinicians assume that starting a somewhat conservative therapy is basically a death sentence for all those nursing home patients and the elderly; however, they also acknowledge that there have been small studies that suggest that both mortality and the aftermath of the treatment is quite similar in both demographics, and even in those elders who start the treatment and those who do not.

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Prior to starting dialysis, the study concludes, nursing home patients and elderly individuals must acknowledge the real benefits of starting the treatment at such age, and they must be informed about the possibility of choosing a different approach aside from dialysis, for the risk, in light of the findings of the study is quite high. According to a recent survey, almost 95% of patients irrespective of their age and their families want to be given clear and concise information about the benefits of starting the treatment and whether or not their lifespan will be extended. As mentioned in previous articles, nephrologists and physicians must discuss these issues with their patients, for there is a really high percentage of clinicians who never address the possibilities their patients have at hand. Providing the elderly with precise information may mark the difference between having a good end or making it a nagging, excruciating, time.

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Dialysis: Almost 70 decades of hard work and progress

Like many other medical procedures and aids, dialysis has been around for a while. For the past 70 decades, it has helped thousands (if not millions) of individuals whose kidneys stopped working properly.

Kidneys can fail due to a wide variety of reasons. Sometimes genetics get in the way and make them stop working, or certain environmental conditions or experiences change the way they work and lead individuals to a kidney failure or a chronic kidney disease. This has happened to humans for as long as they have existed and it will probably keep on happening for as long as we are on earth.

Regardless the reason why kidneys fail, for those whose bodies are not able to filter the waste that runs in the blood, undergoing dialysis procedures becomes necessary.

Nowadays, this is a solution easy to picture. But, has anyone asked how we managed to make it until this point? Years of sacrifice and medical progress had to get in the way for us to be able to know dialysis as it works today.

In this article, Joe Cosgrove will share some historical facts related to dialysis.

Back in the 40’s

Dialysis is a 20th-century invention. It was first invented by Dr. Willem Kolff back in 1943 when this young doctor from the Netherlands decided to construct the first artificial kidney or dialyzer.

The process of developing this kidney was long and took Dr. Kolff more than 10 years. It started when he was a student at the University of Groningen Hospital, in his natal country. Kolff watched how a young man died in a painful and slow way because his kidneys fail and there was nothing to be done. This situation inspired Kolff and moved him to create an artifact that could work as the kidneys.

Kolff read every book available at the University’s library that talked about the kidneys and how the filtered waste from the blood. This is how bumped into an article written in 1913 by a famous pharmacologist named John Abel. In this article, Abel described the hemodialysis process in animals. Abel’s work inspired Kolff to create an artificial kidney.

When Kolff was doing his first experiments, the World War II started, forcing him to work at a Dutch hospital in a remote location once the Nazis overtook the country. This hard conditions never stopped him and he kept on working on the artificial kidney project.

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Eventually, he came up with a device made with sausage skin, a washing machine, orange juice cans and other items that would allow him to filter waste from the blood. His invention took place under the Nazi domain and risking his life to make it possible.

By 1943, Kolff’s kidney was finished and ready to be tested. Until 1945, 16 patients were treated unsuccessfully. It wasn’t until that same year that a woman with a uremic coma was successfully treated and regained consciousness.

This is how Kolff’s dialyzer became the first one in history successfully used to treat kidney diseases. It became part of the standard treatment for kidney failure for the next 10 years.

There is hope in the 50’s

In the years to come, Kolff’s invention was improved to treat both acute renal failure and chronic stage renal disease. This was a rough path since most doctors in the 50’s believed that patients with kidney problems couldn’t undergo dialysis for long periods of time and that no man could come up with an artificial kidney that could replace the functions of a real one.

Another challenge that had to be faced back then was the strong damage veins and arteries of patients were suffering. This makes hard for patients to take the treatment for long periods of time.

It wasn’t until Professor Dr. Belding Scribner at the University of Washington came up with the idea of connecting plastic tubes to the dialyzer, and inserting one of these tubes into the patient’s arteries and veins, that would remain open for as long as the treatment lasted. These tubes had the shape of a U that would work as a bypass.

Later in time, this device was improved with a new material called Teflon and operated as a dialysis bypass that allowed patients to be treated for longer periods of time, extending their lives until an organ was available for a transplant.

From the 60’s to today

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Dialysis patients became numerous and facilities couldn’t serve all of them. Committees would decide who was going to dialysis and who had to wait. This is how bioethics committees were created and healthcare treatments became fairly available for many individuals who needed them. Portable dialysis machines were created and people could undergo dialysis at their homes.

During the past five decades, dialysis machines have been improved by technology. Kidney medicine has also evolved in a way kidney conditions can be treated with multiple alternatives. Some people use the peritoneal dialysis treatment and some other decide to undergo the hemodialysis one. Regardless the options, it is thanks to doctors like Kolff and Scribner that dialysis treatment became real.

How to reduce the chances of suffering renal failure

There is a worrying statistic in America: one in almost three Americans is on the verge of suffering any type of kidney disease due to diabetes, hereditary aspects, high blood pressure or kidney failure. Joe Cosgrove has previously pointed out several aspects on how to effectively reduce the chances of suffering any type of renal disease and how to cope with the dreary effects of both dialysis and other treatments for renal failure; however, here is a word of advice for those individuals who want to increase the chances of getting the most out of their kidneys while keeping them healthy.

First of all, and despite it being quite obvious, the vast majority of individuals are born with two kidneys. What people do not know, however, is that they can live just using one. On a daily basis, the kidneys can filter up to 200 liters of blood: in this process, they can also remove up to 2 liters of waste, water, and toxins. In fact, water and waste products often leave the body in the form of urine, thusly allowing the kidneys to regulate the body’s fluids and its levels. Kidneys are also responsible for producing and releasing hormones that are key in regulating blood pressure, producing more red blood cells and maintaining solid and healthy bones.

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Since the human body tends to wear off over time, the kidneys are not the exception. The kidneys stop working as they should slowly over the course of time, which is why most people often realize they suffer from any sort of kidney disease until it is too late. It is difficult to prevent it, since detecting it during early stages is no easy task. Thus, protecting the kidneys is something every individual should aim to irrespective of whether they have hereditary conditions or not:

Get Checked

Everyone is open to suffering from any type of kidney disease regardless of whether they keep a healthy lifestyle, or have hereditary conditions, or not. People who believe they are at risk for any type of kidney disease should not overlook the importance of getting their kidneys checked by their primary physician or a nephrologist. Since the kidneys do not show early symptoms of damage, most people tend to adopt a relaxed stance when it comes to taking the time to scheduling an appointment with their physicians. That is why prevention and checking often walk alongside each other.

Nonetheless, it is quite easy to check the kidneys. The first test is a urine test that aims to find the presence of albumin (a protein) in the fluid. Whenever an individual has got protein in their urine it is quite possible to assert that that individual is showing early symptoms of kidney failure. When there is just too much protein in the fluid, it means that the kidneys are failing and are starting to leak albumin or protein in this case. The second test aims to find creatinine in the blood flow. Creatine is one out of many different types of waste products that can be found in the body. It comes from muscle metabolism, and healthy kidneys remove it. This test is also used to determine an individual’s glomerular filtration rate, which is a statistic that is commonly used to reflect how well the kidneys filter waste products from the blood flow.

Control sugar levels

And control blood pressure as well. High blood pressure and diabetes are known for being two major causes of all sorts of kidney disease. Since the kidney is somewhat of a vascular organ—as it contains a myriad of different blood vessels—, diseases that affect these vessels such as diabetes and high blood pressure can ultimately inflict damage to the organs. In fact, even a minor degree of high blood pressure and diabetes can result in terrible kidney damage. As mentioned above, individuals, regardless of their current condition, should control both aspects in order to avoid falling victim of early kidney disease.

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Control weight

Keeping a healthy lifestyle is as important as the two aforementioned aspects. Weight plays a vital role in overall kidney health. Overweight, for instance, forces the body to work much harder in order for it to successfully filter all the waste products and meet metabolic needs. Besides, obesity and having excess weight can lead to the development of diabetes and pressure-related complications. Thus, it is quite important for individuals to maintain a healthy diet and a healthy lifestyle, working out from time to time and paying special attention to their weight. Weight loss and exercise is key when it comes to reducing the risk of developing both conditions. In fact, smoking also helps increase the chances of suffering any type of renal disease and high blood pressure, and it also worsens any condition. Quitting smoking, therefore, is crucial.

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