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.

* Featured Image courtesy of Pixabay at Pexels.com

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The mildly-invasive procedure that helps end-stage renal disease patients

As previously described by Joe Cosgrove, there are several stages of renal disease; there are, in fact, different treatments for each patient. However, to all those patients currently undergoing hemodialysis after being diagnosed with end-stage renal disease, unrestrained and free blood circulation is practically the whole world for them.

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The process of hemodialysis, as previously mentioned in this blog is all about having a machine replace an individual’s kidneys. It mimics the human kidney function by pumping blood from an individual’s body all the way through a series of tubes, thusly cleansing it by getting rid of all the accumulated waste so that it can be returned to the body via an additional tube. This machine, also commonly referred to as a hemodialyzer, requires an additional procedure in order to create an easy access into the patient’s blood flow. When a vein or an artery develops a blockage while providing or carrying blood from or to an individual’s dialysis access area—which is usually a leg or an arm—, the process becomes less efficacious and successful, and, in turn, patients are more prone to experience all sorts of difficulties.

Nonetheless, an almost minimally invasive treatment for all those patients who require long-term management of vein access while undergoing dialysis has been developed. The procedure, also known as an angioplasty and stent, poses a very good opportunity for all those individuals who have to undergo the dreary effects of being on dialysis. It is, in short, the perfect opportunity to improve an individual’s quality of life.

In America, there are up to 470,000 people who have any sort or degree of irreversible kidney failure or end-stage renal disease. Most of them need as soon as possible either constant dialysis or, even worse, a transplant in order to survive. The vast majority, all those patients undergoing dialysis, require somewhat of an additional maintenance procedure: either an angioplasty and stent—the process being described in this article—, or a balloon angioplasty. They are required to undergo this additional procedure up to twice a year in order to keep the body with a proper and adequate blood flow to access the entry area.

The main issue relies on a physician’s ability to perform successful percutaneous interventional procedures, or, better said: any catheter-based interventional proceeding. If an individual is to improve their quality of life when undergoing this type of dialysis heavily relies on this. Prior to developing catheter-based procedures, individuals suffering from any degree of end-stage renal disease would come into operating rooms for different procedures such as open procedures that would leave patients weak, thusly making the healing process long and dreary, not to mention that patients would need to stay at the clinics. That was, of course, not the best case scenario for those individuals on dialysis thrice or four times a week. This serves as the most plausible and accurate explanation for such high dropout rates: it was quite easy, not to say understandable, for them to abandon the process.

Additionally, all of these catheter-based proceedings allow physicians to easily and seamlessly access any sort of blockage or narrowing (also known as stenosis) that could be reached through another process or routine operation. In the past, many of these blockages ended up being untreated due to the impossibility for a physician to access them; however, as a result, the scientific community decided to create a much better dialysis access with its own blood flow so that blockages would be left untreated.

This mildly-invasive procedure, in term of time, seems to be a much fitter choice for individuals under the aforementioned conditions. Patients require only a few hours of their time in the clinic. Not to mention that the outcome surpasses in adaptability the old-fashioned way: it is much more adaptable and adequate to an individual’s lifestyle. After several trials in the past, patients seem to be much happier in comparison with the resulting outcome of the old way.

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During the procedure, or, rather, during its course, physicians must accurately determined whether they are facing a blockage or a narrowing. This suggests that the procedure demands a lot of decision-making skills from a nephrologist. They must also determine the degree of the scenario they are facing: how severe it is and, most importantly, which seems to be the best way to open it and, moreover, keep it open. In addition, they also have to ponder what catheter they need or seem to be more adequate for that specific case; however, be that as it may, patients, regardless of complications—everything has got complications and physicians are required to avoid them—, the possibility of improving an individual’s quality of life is compelling enough for them to consider consulting with their primary nephrologist. Dialysis and renal disease are perhaps amongst the least satisfactory scenarios; however, there have been many developments and advancements regarding this topic: today, people have more than just one option to treat their conditions.

* Featured Image courtesy of Pixabay at Pexels.com

Is homeopathy a good idea to treat kidney disease?

Much has been said against homeopathy. Most of its critics say that this system for treating diseases is only a pseudoscience in which the naive fervently believe and that its benefits may be more related to the placebo effect than to real causes. In this post, I do not intend to give a concrete answer to this question but to leave on the table the different arguments of both positions on the subject.

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One of the main arguments of homeopathy’s contradictors, in addition to the fact that in the great majority of cases reviewed by medical specialists from different disciplines, there is a lack of scientific rigor in the studies that defend this system (and, therefore, it does not allow a large part of the medical community to rely on it by the most basic methods to determine objectivity,) there is, as mentioned, the presence of the placebo effect in patients. Of course, this raises other questions, especially from the side that defends homeopathy: If the effect of placebo is indeed positive, and in many cases, there is no evidence of side effects, what is wrong if people want to spend money on sugar pills? However, there are cases that prove that things are not so simple. Unfortunately, homeopathy may have surprising and dangerous side effects. Having nothing directly to do with some homeopathic medicine, in particular, there are indirect results when homeopaths replace doctors as a source of medical advice. For example, many homeopaths have a negative attitude towards vaccination, so parents who are in regular contact with a homeopath may be less likely to vaccinate their children. Homeopaths often tell anecdotes to prove that their system is effective, and yet there are cases that prove otherwise all the time.

According to an article by the Scientific American published earlier this year, there are hundreds of cases regarding children and babies who have suffered terrible effects because their parents have provided homeopathic medicines to solve simple problems as mitigating pain during dentition. In some cases, toddlers have stopped breathing, and it has been necessary to go to emergencies to hospitalize them. Sometimes, the article says, babies, end up dead. In the case of dialysis and renal disease, there have also been fatal cases that demonstrate that, in addition to preventive methods like a proper eating, sleep, and exercise habits, the best way to control kidney disease is traditional medicine ways, including dialysis.

Read also: The Best Eating Habits For Living In Dialysis, by Joe Cosgrove

On the other hand, the Russian Academy of Sciences has also performed studies to determine that homeopathy is a pseudoscience that does not offer evidence of its medical benefits, and that, on the contrary, has led even adult patients to death.

The problem is that, apparently, there are evidence sources that support both sides and confirm their arguments. The proponents of homeopathy, particularly in the case of kidney disease, have an interesting perspective. Homeopathy, according to them, can be supplied at the same time as a conventional medication since there are no incompatibilities in both fields. A renal patient is also a high-risk cardiovascular patient. Taking homeopathic medications may assure that there will be no interaction between both ills. Patients on dialysis can also benefit from homeopathy, always under the control of the specialist, though. Of course, there are some cases that support this view.

If this were true, this would mean that the use of homeopathy is actually effective in chronic renal pathologies, urinary tract infections, and recurrent nephritic colic, as well as for chronic renal patients. This would imply, among other things, that homeopathy would be right for all those people who, because of their deteriorated renal function, do not have good leaks and cannot take anti-inflammatory drugs or certain analgesics. In that case, we would be in the presence of a great step in medical terms, but both sides can never agree to operate in a complementary way.

It is not easy to take sides here. One might think of the benefits of taking natural medicines and think about the possibility of treating some diseases in the least invasive way possible. Nevertheless, things are not so elementary when it comes to homeopathy. The companies that produce this type of medicinal substances do not have to go through the strict filters by which companies that produce drugs do have to pass, which, in turn, have already approved a series of successful experiments that can be scientifically corroborated and verified through statistics. Homeopathic medicines seem harmless and the industry that produces them seems so aware of the environment and the good health of the population, but old-school doctors cannot trust it.

Indeed, it would be wonderful if homeopathy could solve many of the problems that traditional medicine cannot solve on a daily basis. Allergies, the side effects of several medications, the high costs of many treatments, as well as the anomalous behavior of certain diseases in some patients, makes it necessary to constantly think about technological improvements and more effective methods. And that is the question.