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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Let’s talk about Kidney Cell-Based Therapy

One of the biggest public health problems at the moment is the increase of the number of patients suffering from kidney disease. It is a sad reality that even preventive treatments and campaigns to reduce the rates each year are not enough to keep numbers in a certain balance. For this reason, dialysis treatments are also on the rise, considering that other options, such as kidney transplantation, are usually complicated.

Likewise, medical science is always in search of alternative therapies, taking into account that dialysis, although it is the best option so far, also represents many problems for patients, starting with the fact that dialysis is essentially a control treatment, not a cure. One of the options that are currently being developed is stem cell therapy. The great genetic discoveries regarding stem cells could be one of the main areas of development in the future of nephrology.

One of the great hopes in this field is cell regeneration. The possibilities offered by this therapy are countless because the renal function is not being carried out by a machine, as in the case of hemodialysis, nor is necessary to transplant an organ from a human being to another, but rather the objective is to regenerate the damaged organ, so that it recovers its functions completely, following a natural process. The idea with this therapy, in a nutshell, is to perform a transplant of renal precursor cells, so that, they become perfectly functional in the kidney tissue, so that a satisfactory recovery is achieved.

This treatment has not been reached yet. It is still in the experimentation stage, despite the fact that great advances have been made in this subject. In ideal conditions, renal precursor cells could be transplanted directly into the renal parenchyma, and this means a great challenge in medical terms. Some think that the precision that must be obtained for this procedure could only be really achieved through the use of robots, which is a strong trend in the research of biomedical engineering right now. Kidneys are very complex organs, which, in addition to the complications they may have – which are innumerable, by the way – have quite solid tissues that make it hard to transplant cells. The kidney is composed of groups of cells called nephrons. The nephrons are organized in clusters, and each of them fulfills a function of filtering the blood.

Read also: An Alternative To Dialysis: The Nanofiber Web, by Joe Cosgrove

Well, what happens when a patient suffers from kidney disease, is that the speed with which these cells die is much faster than the ability of the kidney to recover them. In this way, while the time progresses, kidneys lose the ability to perform their functions, and because they cannot regenerate, the body no longer finds a way to filter the blood and eliminate excess fluid. It is at this point that cell regeneration therapy comes into play. Because hemodialysis and other medical treatments cannot do much to prevent the death of the nephrons, it is necessary to find a way in which the kidney of the same patient recovers effectively.

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Another major challenge with this therapy is that it is not easy to get enough precursor cells for a single treatment. Not only because stem cell treatments have huge policy obstacles in several countries, but it is expensive to isolate these cells for keeping them alive in the lab.

The experiments behind the development of this therapy have been carried out, first of all, in mice. What the researchers have done is to transplant kidney precursor cells at specific points in the kidney tissue. The kidneys of rats are very similar to ours, especially when they suffer from critical kidney damage. What has been seen is that, although the transplanted cells are not fully integrated into the tissues of the kidney, the organs manage to recover the replacement rate of useless nephron cells with new ones somehow. This prevents the occurrence of necrosis, and, therefore, a series of harmful consequences for the organism.

In this regard, one of the fundamental points to develop these therapies is to identify exactly which stem cells are useful for the tissue of the kidneys to regenerate. That is why it is key to know the repair processes that the body carries out naturally, o that researchers can just boost them up.

One of the observations which has drawn the attention of the medical community is that the kidneys of mammals, compared with those of other animals, have a lower regeneration capacity. However, it has been noted that both in mice and in humans, the organism has a small stock of stem cells in case the kidney is not able to balance the loss of nephron cells. To this extent, medical science has focused on enhancing this process in the body. For many people, stem cell treatments are controversial. However, what science has shown in recent years is that it is a natural process that does not interfere with the way in which it works and balances in our body.

Recommended: Challenges and opportunities for stem cell therapy in patients with chronic kidney disease

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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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