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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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 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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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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Is automated peritoneal dialysis recommended?

Many patients who need a dialysis treatment to control kidney failure must decide between two options. The first one, best-known as ‘hemodialysis,’ is the first image that pops into the minds of people when it comes to dialysis. This procedure consists of connecting the patient to a machine that fulfills the same functions as the kidneys: filtering the blood and eliminating the excess of fluids from the body. For this reason, it is necessary that patients go a couple of times a week to a hospital or to a specialized center, and lay down while the machine does its work. This is not the only option, though. There is also peritoneal dialysis. Despite this treatment does not differ essentially from hemodialysis, offers certain conveniences to patients that hemodialysis cannot allow. One of them is that patients do not have to plug into a machine or move to a hospital for doctors to monitor their health status.

Automated peritoneal dialysis is fundamentally not different from traditional peritoneal dialysis. This system uses the same type of catheters, and the kidney function is carried out in the same way. The difference is related the way in which the process is carried out. In automated peritoneal dialysis, a machine controls the development of the renal function. This means how much liquid gets into the bag and is ejected when the filtration process is over. In this way, patients do not have to worry about how much liquid they have added to the bag, and the machine is responsible for reminding patients when they should start a cycle in advance.

The filtering process takes about eight hours, but it may extend to ten, especially when patients are sleeping. One of the functions of the machine, in addition to calculating the amount of liquid that gets into the bag, is measuring the time of infusion, permanence, and drainage, and in a very safe way, which gives a lot of peace to both patients and doctors.

Read also: Dialysis most common complications, by Joe Cosgrove

The machines used for this procedure are not large. The biomedical engineering that has worked been behind the studies of automated peritoneal dialysis has made these machines fit in a small suitcase, which, although it may be heavy, has wheels and can be carried anywhere. The machine can be used almost anywhere (an airplane, for example.) One of the great advantages of this system is that the machine keeps a record of the activity from the beginning of the treatment, which can be observed by the doctor even without the patient moving to the hospital. This system is connected to the Internet. This means, in a few words, that the machine is permanently gathering information from the patient and transmitting it through the cloud. The doctor only has to use a device with an Internet connection to check the patient’s condition (it may be an app in his or her smartphone.)

The latter is a great advantage for doctors because the patient does not have to make any report. The system is responsible for producing the necessary information for the doctor to evaluate the patient’s conditions. Even some software systems are designed so that the machine tells the doctor if the patient is presenting problems that must be resolved urgently (the first symptoms of peritonitis, for example) and that patients may not detect in time, meaning this a great danger to their health.


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Automated peritoneal dialysis, in addition to being very useful for the health of patients, is also useful for medical research in this field. Because the number of patients suffering from kidney failure increases every year, doctors are very concerned about finding new ways to solve this problem. For this, it is tremendously important to have a large amount of information available.

Some doctors wonder if this system is recommended. The truth is that it is. There are studies showing that automated peritoneal dialysis is related to a much higher survival rate than the traditional peritoneal dialysis system. The reason for this is that the machines can calculate much more accurately the amounts of liquid that the patients need, as well as the filtering and expulsion times. The medical community knows that the more customized the treatments, the results will be much better since every organism is different and may react differently to the general conditions of any treatment. This is the case. On the other hand, one of the main problems that occur in peritoneal dialysis are infections, which has been resolved in a large percentage thanks to automation and its monitoring. The behavior of blood pressure is also another problem, and the study mentioned above shows that medical science is ready to reduce this issue to almost the minimum. There is still much to be discovered in terms of peritoneal dialysis, but the truth is that it is progressing so fast thanks to the data provided by patients. Let’s hope for the best.

Recommended: Do Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis Have the Same Clinical Outcomes?

* Featured Image courtesy of Franck Genten at Flickr.com