renal dialysis how it works, diet and lifestyle

Renal dialysis: how it works, diet and lifestyle




    Introduction to dialysis
    Is dialysis painful? Do you have any side effects?
    The different types of dialysis
    Hemodialysis
        Peritoneal dialysis
        Dialysis and diet
    Influence of dialysis on lifestyle
        fatigue

Introduction to dialysis

Dialysis is a therapy that partially replaces renal function and becomes necessary when the kidneys are no longer able to work normally (renal failure), particularly when the renal function of the patient is compromised by 85-90% (GFR less than 15). If left untreated, patients with renal failure will experience a dangerous accumulation of toxins and rejection substances in the blood, as well as fluids, causing symptoms to become more and more debilitating until they become fatal.

The treatment filters out water and waste substances from the blood, allowing a great improvement in the well-being of the patient suffering from kidney disorders.

The different types of dialysis were introduced in the mid-forties, but only a few decades after the practice actually entered the clinic, becoming a standard procedure worldwide, allowing thousands of patients to live better and longer .

Dialysis, just like healthy kidneys, contributes to maintaining the health and balance of the organism. In fact it serves for:

    remove waste substances, mineral salts and excess fluids, preventing them from accumulating in the body,
    maintain the balance of certain substances in the blood, such as potassium, sodium and bicarbonate,
    help keep your blood pressure under control.

Renal failure is not always definitive, some acute forms regress after therapy. In some cases it may be necessary to continue dialysis for a short time even after the kidneys begin to heal.

In chronic or severe renal failure the kidneys do not heal and the patient will have to resort to dialysis for life. Dialysis only partially replaces renal function and is not a therapy to cure kidney disease. You will have to perform dialysis for life, unless you are able to get a kidney transplant.

To date, survival in dialysis, unless kidney transplantation, is estimated in about 20 or more years for patients who start between 20 and 30 years, while it reduces significantly with increasing age. We emphasize that these are average values, therefore dependent on many variables.
Is dialysis painful? Do you have any side effects?

The patient generally feels a slight discomfort at the time of inserting the needles, otherwise dialysis is a completely painless therapy.

The most common side effect of dialysis is a lowering of blood pressure, which is generally corrected by adequate fluid intake (as indicated by the nephrologist).

Nausea and vomiting are two symptoms often related to kidney disease in general, but are worsened by low blood pressure and excessive fluid.

Other less common side effects are related to problems of dry and itchy skin, restless legs syndrome and muscle cramps, but they are usually bothersome and improve.

Unfortunately, the feeling of tiredness and fatigue is very common.
The different types of dialysis

Dialysis can be performed in a hospital, in a specialized center or at home. Together with your doctor, you decide which is the best place to do it, depending on your health and preferences.


There are two types of dialysis, hemodialysis and peritoneal dialysis.
Hemodialysis
Dialysis

Hemodialysis is the most common form of dialysis; during the procedure a tube is attached to a needle inserted in the arm and the blood thus extracted is passed into an external device capable of filtering, before returning to the arm through a second needle.

It is usually required to undergo three sessions a week, with a duration of about four hours each, which take place in a hospital environment.

This is an approach suitable for anyone who is not able to personally manage the peritoneal dialysis that we will see later.

The main advantage is that of guaranteeing 4 days completely free, which allow a planning of the patient's life with greater elasticity.

On the other hand, it can cause some discomfort when moving, which requires careful planning of the sessions; another disadvantage is that the patient is required to strictly comply with a scrupulous diet, including the amount of liquids he can drink.

Finally, among the main risks we mention:

    low blood pressure (due to the fluids removed during hemodialysis), which can also have nausea and dizziness;
    sepsis, a dangerous infection of the blood;
    muscle cramps, probably caused by fluid removal,
    itch,
    sleep disorders,
    bone and joint pains,
    reduction of desire and erectile dysfunction,
    dry mouth,
    anxiety.

Click here to learn more about hemodialysis.
Peritoneal dialysis

Peritoneal dialysis uses the internal lining of the abdomen (peritoneum) as a filter, instead of an external filter. Like the kidneys, the peritoneum contains thousands of small blood vessels that make it a good natural filter alternative.

Before the beginning of the treatment an incision is made near the navel and the surgeon places a thin tube (called a catheter) in the space inside the abdomen (peritoneal cavity); this is left in a permanent position, so it is a procedure that is performed only once before starting the dialysis path.

Through the positioned catheter a specific hospital-supplied fluid is introduced into the peritoneal cavity and, when the blood passes through the blood vessels lining the cavity, the waste products and the excess liquids are extracted from the blood and collected in the dialysis fluid.

The used fluid is discharged in a bag a few hours later and replaced with fresh liquid.

Fluid replacement typically takes 30-40 minutes and should normally be repeated four times a day; alternatively these exchanges can be managed by a machine during nighttime rest.

The main advantage of this approach is that the procedure can be managed independently by the patient, without transfers to the hospital; the devices are so large that they can be transported with relative ease in case of vacation or transfer for other reasons.

Finally, there are fewer dietary restrictions than those imposed on hemodialysis patients.

The main disadvantage is that the procedure should be performed every day, without exception, in addition some patients are uncomfortable with the fixed device at the abdominal level.

A major risk related to this form of dialysis is the possible development of peritonitis, an infection of the membrane that lines the abdominal cavity; some patients are also forced to switch to hemodialysis after a few years of peritoneal dialysis due to the gradual and progressive appearance of thickening and scarring on the peritoneum.




Finally we remember the possible appearance of fatigue and sometimes malnutrition, due to the reduction of proteins in the blood.

Among the main risks and side effects we find:

    peritonitis, a serious infection of the peritoneum characterized by pain, high fever, chills, ...;
    appearance of hernia,
    weight gain.

To learn more about peritoneal dialysis click here.
Dialysis and diet

A scrupulous diet is really able to make the difference in terms of well-being perceived by the patient, with the aim of reducing the consumption of those foods that can favor the appearance of waste substances and toxins, but above all a dangerous accumulation of liquids , which may be due to:

    swelling and weight gain between dialysis sessions,
    important fluctuations in blood pressure,
    greater difficulties of cardiac work,
    accumulation of fluid in the lungs and worsening of breathing.

Here we report some very general indications, useful to get a general idea, but stresses the need to plan the diet with their doctors.

    Liquids. Your doctor will help you understand how much fluid you need to drink per day. Excess fluid can increase pressure, hinder heart work and increase organic stress due to dialysis. Remember that different foods, such as soups, ice cream and fruit, contain a lot of water. Ask the doctor how to control thirst.
    Potassium. Potassium is found in various foods, especially in fruits and vegetables. Potassium helps regulate the heartbeat, so taking it in excess can be very dangerous for the heart. To keep blood potassium levels under control you can avoid oranges, bananas, tomatoes and nuts. It is possible to reduce the amount of potassium in potatoes and other pelandole vegetables and soaking them in a pot of water for several hours, and then boiling them.
    Phosphorus. Phosphorus, when consumed in high doses, can weaken bones and cause itching. Controlling phosphorus may be even more important than regulating calcium levels to prevent bone disease and related complications. Foods such as milk, cheese, dried and fresh vegetables, cola, nuts and peanut butter are rich in phosphorus and should be avoided. You will probably need to take a phosphorus ligand together with food to keep your blood phosphorus levels under control in breaks between dialysis sessions.
    Cooking salt (sodium chloride). Most of the stored or frozen foods contain large amounts of sodium, excess sodium increases thirst, and when you drink more than usual, the heart has to work harder to pump blood into the body. With time, hypertension and congestive heart failure may occur. Try to eat many sodium-free foods and look for products with the "low sodium" label on the label.
    Protein. Before starting dialysis, your doctor probably advised you to follow a low protein diet to preserve kidney function. Now that you have started dialysis, your nutritional needs have changed. Most dialysis patients are advised to follow a diet that is as rich in protein as possible. Proteins help to train muscles and repair damaged tissues, but produce urea (ureic nitrogen, or BUN) as waste. Some protein sources, the so-called high quality proteins, produce fewer waste substances than simple proteins. The high quality proteins are those contained in meat, fish, poultry and eggs. Getting most of the protein from these sources can decrease the amount of urea in the blood.
    Calories. Calorie is the unit of measurement of the energy necessary for the organism. Some dialysis patients need to get fat, so they must devise ways to add calories to the diet. Vegetable oils, such as olive or seed oils, are good sources of calories and do not cause cholesterol imbalances. Even sweets, sugar, honey, jam and jellies provide calories and energy. If you suffer from diabetes, however, be very careful to eat sweets. Diabetic patients must follow the dietician's instructions carefully.



Food supplements. When the diet requires to avoid different foods, there may be deficiencies of vitamins and minerals. Furthermore, dialysis also removes part of the vitamins from the body. Your doctor may then prescribe a food supplement designed specifically for patients with renal impairment. Take it on the day of dialysis, after treatment. Never make the mistake of buying and taking supplements for sale without a prescription, as they may contain vitamins or harmful minerals.

Influence of dialysis on lifestyle

Many patients manage to have a completely normal life, except in moments to be dedicated to therapy.

Dialysis will normally make you feel better, because it helps alleviate many of the problems related to renal failure.

You and your family will need some time to get used to the rhythms of dialysis, but generally a dialysate patient is allowed:

    continue to study or work (only in the case of physically demanding work could some difficulties arise),
    to drive,
    practice physical activity,
    to swim,
    going on holiday (the centers where dialysis can be found more or less everywhere, even abroad, and the therapy is standardized).

fatigue

An important sense of tiredness and fatigue is quite common in those who undergo dialysis, due to the following aspects:

    inability of the kidneys to do their job,
    effect of dialysis on the organism,
    dietary restrictions associated with dialysis (especially hemodialysis),
    stress and anxiety related to the situation.

Regular physical activity is not only permitted, but consistent with one's state of health, it is often encouraged by doctors to counter this possible side effect.

Main sources:

    kidney.org
    Hemodialysis (NIH)
    Peritoneal Dialysis (NIH)
    Eating & Nutrition for Hemodialysis (NIH)

Adapted from English by Elisa Bruno
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Scientific review and correction by Dr. Guido Cimurro (pharmacist). The information contained in this article should in no way replace the doctor-patient relationship; it is recommended, on the contrary, to seek the advice of your doctor before implementing any advice or indication given.