Dialysis most common complications

The procedure known as dialysis has been created so that the elimination of toxins and the excess of liquids in the body is possible; a function that, in healthy patients, carries out the renal system (kidneys, in particular.) Even though dialysis is so far the best-known option to treat kidney disease, and despite the fact that the biomedical technology makes all its efforts in considerably improving this system, it is still not possible to execute processes of error-proof dialysis. Unfortunately, complications can occur during the process, which can even negatively affect the health condition of patients. In this post, we will talk about the most frequent complications that can occur during dialysis.

In extracorporeal dialysis, the processes in which blood is removed from the body, complications are not as common. However, it is possible that an arteriovenous fistula infection may occur. Since the fistula is punctured three to four times a week to purify the blood, the risk of infection by bacteria in the puncture site is high. In addition, there is the possibility that thrombi form that obstructs the blood vessel and renders it unusable for dialysis. However, as a general rule, a surgical intervention allows the thrombus to be removed and the fistula to be unblocked.

In peritoneal dialysis, in which the blood is purified inside the body, there is a risk of inflammation of the peritoneum. Bacteria enter the peritoneal cavity through the catheter and cause a painful infection that, under certain circumstances, may endanger the life of patients. Normally, this inflammation responds well to treatment with antibiotics, but sometimes it is not that simple.

People with severe kidney disorders and kidney failure must pay great attention to their diet since many of the complications suffered by dialysis patients are related to food. Since the kidneys are not able to carry out their function of purification and excretion, in many cases those affected can only drink a limited amount of liquid. In addition, they must be careful with the contribution of protein and potassium, since an excess of these substances may lead to serious metabolic disorders in dialysis patients.

Read also: Baxter ShareSource System: A New Dialysis Option for You, by Joe Cosgrove

People with impaired renal function often have a high concentration of phosphate in the blood which may cause damage to blood vessels, such as arteriosclerosis. When the concentration of this is too high, despite having a low phosphate diet, so-called phosphate binders are helpful, they bind to the phosphate ingested with food in the gastrointestinal tract and are subsequently excreted. There are various types of phosphate binders, for example, containing aluminum or calcium, or free of both, which effectively improve the altered balance of minerals in dialysis patients. According to recent scientific findings, it seems that calcium-free phosphate binders are the ones that cause fewer side effects. Nowadays, the use of phosphate binders with aluminum content is no longer recommended due to the adverse effects that they may cause. A treatment with this type of medicine – for many years – may produce an accumulation of aluminum in the brain and bones which leads to worsening brain function and movement limitations.

In order to prevent possible infections of hepatitis B and C, and even HIV, through dialysis, the medical centers in which this treatment is carried out meet the strictest hygienic standards for the cleaning of dialysis machines. People suffering from these type of infections are treated in their own dialysis machines which are not used with any other patients. In addition, active vaccination against hepatitis B is recommended to all dialysis patients.

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There are other complications related to hemodialysis. Intradialytic arterial hypertension is less frequent than arterial hypotension, but it has relevant prognostic implications. Fever and chills in patients on hemodialysis should be attributed to endovascular infections, especially in those who have vascular access through a high-flow venous catheter. Likewise, fever at the end of the hemodialysis treatment is suggestive of endovascular infection.

On the other hand, hypervolemia is a complication that occurs regularly. This happens when the patient consumes more fluid than the one he manages to eliminate thanks to dialysis. Hypervolemia can also develop in response to sodium retention in the body due to impaired electrolyte excretion. In nephrological practice, hypervolemia due to sodium retention is observed in acute ophthalmic syndrome, in the oliguric phase of acute renal failure, due to the consumption of large amounts of fluid and obstruction of the urinary tract with volume-dependent hypertension. This problem usually leads to weight gain, and, when not treated in time, can be deadly because heart failure may occur.

Taking into account that during the last decades there has been an increase in cases of renal replacement therapy for different diseases, and, additionally, considering the increase in infections that are difficult to treat, mainly due to the widespread abuse of analgesics by professionals and patients who self-medicate (and who do not know how to differentiate a virus from a bacterial infection,) it is vital to know the different treatment modalities in these patients as well as the complications that can occur in practice.

Recommended: Infections in Patients Undergoing Chronic Dialysis

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Tips On How To Treat Children With Kidney Disease: A Parental Approach

Many children are diagnosed with some degree of kidney disease every day. Given the nature of this disease, as depicted in previous articles by Joe Cosgrove, it is quite hard for parents to digest such complication when kids are the ones affected. Their concerns about the whole thing are no less than legitimate; and feelings such as stress easily tend to appear; however, it is quite normal. When it comes to children suffering from chronic kidney disease, parents are somewhat forced to accept such reality without hesitation; nonetheless, they can also develop a practical way to cope with the daily complications and the very nature of the disease. The following words of advice were developed in hopes of providing families with helpful elements so that they can keep moving forward irrespective of the nature of their kid’s disease:

Get Familiar With What The Disease Is About

Learning about the disease, getting acquainted with the complication and its possible treatments is key. The basic word of advice would be: learn as much as possible about the disease and how it has been treated. Moreover, it is of high importance to convey this information to children: they actually understand a lot—and they are more receptive than the vast majority of adults.

Aside from the aforementioned idea, parents should spare no efforts in encouraging their children to ask questions to their doctors and nurses and pretty much every other health professional involved in the treatment. There is a myriad of aspects parents can learn from this, as they often abstain themselves from asking some questions just because they think they sound somewhat dumb. Having children ask whatever comes to their minds embodies a source of information and ideas that often go unnoticed by both parents and physicians.

In that sense, kids should not be given more than what they can handle and understand. This does not suggest, however, that parents should lie to their children. Be clear about the procedures and the treatments they are about to undergo. Therefore, try to help children understand that all the people—doctors, nurses, dietitians, nephrologists, social workers, etc.—are on their side. That all they want is to help them get better and healthier, even if it involves nagging treatments that may cause a certain degree of discomfort.

Be Proactive And Get Involved In the Kid’s Care

As a parent, it is not easy to see children suffer. Most parents tend to engage in pointless discussions with health professionals simply because they refuse to accept reality and the nature of the treatments that should be followed. Parents, the vast majority of times, are led by emotions—and all they want is for their children to get healthier. Thus, in order to more easily achieve the latter, parents should develop a sense of respect and cooperation with physicians. A good idea is to keep a detailed track about the kid’s medical history, paying special attention to dates. This comes in handy whenever children are referred to a new doctor. The idea is to make things easier.

Additionally, although seeing children suffer from chronic or any type of kidney disease is stressful and discomforting enough, parents should strive to be with their children as much as they possibly can during both treatments and possible hospitalization. Make sure kids are surrounded by their favorite things: books, toys, a special cushion or blanket, etc.

Teach Children How To Take Control Of Their Illness

Even though these might seem the worst days ever—and they possible are—, the idea is to keep a daily routine even during possible hospitalization. In the meantime, it is important to help children understand what doctors, nurses, machines are supposed to do and that they are for. For a kid, it can get really annoying to be in a room full of people and intimidating machines. By clearly explaining and helping them get acquainted with their surroundings, parents can help eliminate a part of their children’s legitimate fears. For such matter, it is quite useful to come up with a creative way to have children participate in their own care. By having them feel more in control they provide them with a sheer array of opportunities.

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Strive To Be Clear About Food Restrictions From The Very Beginning

Many children are forced to make drastic changes in their nutrition, and many just refuse to easily accept them. Kids are not used to the word «diet»; however, by developing a creative way to explain to them that they must adapt to a new nutritional plan, the likelihood of them accepting these changes is far higher than in the vast majority of adults. Have children make a list of their favorite foods and they assess it with a dietitian to determine whether they can be included in the new plan. Be that as it may, avoid forcing children to unquestionably accept these changes: this tactic rarely pays off.

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Kidney Disease in Children

As per discussed in previous articles by Joe Cosgrove, kidney disease can affect individuals in various ways. Children, nonetheless, are not the exception. Just like with adults, kidney disease can affect children in different ways, ranging from treatable, to some extent, conditions or disorders without the already mentioned lasting consequences to really life-endangering complications. Kidney disease, especially acute kidney disease, comes out of nowhere, may even last a short amount of time, may also be serious enough for it to leave children with long-lasting consequence, or may go away after treatment. Chronic kidney disease, however, does not fade away so easily, and it tends to worsen as time passes by. Chronic kidney disease (CKD) eventually evolves into kidney failure, end-stage kidney disease or even end-stage renal failure when dialysis is involved.

Children with chronic kidney disease actually are forced to face many tough and dreary challenges. Some of them include a really negative self-image, some relationship problems, behavioral issues, learning disorders, trouble focusing on what is important, delayed language and motor skills development, amongst others. Children suffering from CKD have shown a much slower growth rate in comparison to their peers; urinary incontinence is also very common.

Are there causes for kidney disease in children?

Kidney disease, regardless of its nature, in children can be caused by several causes: birth defects, hereditary conditions, infections, systemic diseases, trauma, nephrotic syndrome, reflux or urine blockage. From birth to age 5, hereditary conditions alongside birth defects are the most leading causes of kidney diseases and kidney failure. Between ages 6 and 15, kidney failure has been associated mostly with hereditary diseases, the aforementioned nephrotic syndrome and other systemic diseases. After that, between ages 16 and 20, several diseases that affect the glomeruli are the leading cause of acute kidney disease and chronic kidney disease. Hereditary diseases seem to be less common in comparison to early stages of life.

The most common causes explained:

Birth defects and conditions

The term birth defects suggests that a problem has happened while the baby is developing in the womb. Birth defects can range from renal agenesis, to renal dysplasia, and even to ectopic kidneys, just to mention several. These are mainly abnormalities of size, position, and structure of the organs. Generally speaking, children with these diseases can get to live full and healthy lives; nevertheless, some children end up facing much higher odds of developing a much worse kidney disease.

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Hereditary conditions

Hereditary conditions or hereditary kidney diseases are those that are passed from parent to children through genes. One example is the commonly referred to as polycystic kidney diseases or PKD, which is often characterized by the presence of many grapelike groups of cysts (fluid-filled cysts, in this case) that make both organs much larger over time. The cysts often destroy the individual or the children’s working healthy and kidney tissue as time passes by. Alongside PKD, Alport Syndrome, which is often caused by a mutation in a gene, is also common in children. The disease leads to scarring of the organ. This syndrome generally appears in early childhood, and it seems to affect boys more than women. Besides, it evolves into, or causes, hearing and vision issues in addition to the original affection.

Infection

Aside from the aforementioned syndrome, infections also may end up causing other syndromes as well. Acute post-streptococcal glomerulonephritis and hemolytic uremic syndrome are kidney conditions that can develop in children after the presence of a tough infection. The latter is rather a rare condition that is often generated by the E. coli bacteria—mostly found in contaminated foods—. Hemolytic uremic syndrome starts to form when E. coli gets to the digestive tract and the toxins are allowed into the host’s bloodstream. The toxins start to attack the individual’s red blood cells and damage blood vessels while at it. Most children who have E. coli infection often suffer from ongoing episodes of vomiting, stomach cramps and bloody diarrhea for up to three days. They also become pale and show tiredness and irritability. The former, acute post-streptococcal glomerulonephritis, often occurs after episodes of both skin infection or strep throat. The streptococcus bacteria does not go straight for the kidneys; it starts by confusing the immune system, prompting it to produce antibodies in excess. Antibodies are proteins created by the immune system. The immune system is responsible for protecting individuals from different infections by assessing and subsequently identifying and destroying bacteria, viruses and other foreign threats. When the body over produces antibodies and these get to the blood and finally end up being allocated in the glomeruli, the kidneys are at open to suffering heavy damage. Most cases develop within 3 weeks after having suffered an untreated infection. It is nonetheless treatable; however, kidney damage may last forever.

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