Tips to Survive and Thrive on Dialysis

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Tips to Survive and Thrive on Dialysis
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KidneyTimes
By Philip J. Tuso. MD, FACP
 
Hemodialysis is the use of an artificial kidney to remove waste products, toxins, salt, and excess water from the blood. People with kidney failure require hemodialysis to maintain life. In general, the more you cooperate with the treatment you and your health team have agreed upon, the better you will feel, the better quality of life you will have, and the longer you will live. Patient who follow a few simple tips can prevent serious complications.
 
Tip # 1: Get optimal dialysis. Good dialysis means that the dialysis treatments you are receiving at the dialysis unit are sufficient to maintain your life and quality of life. Inadequate dialysis means that the dialysis treatments you are receiving at the dialysis unit are insufficient to maintain life. Good dialysis is partly determined by taking samples of kidney waste products in your blood before and after your dialysis treatment. By calculating the reductions in kidney toxins removed during dialysis your heath care provider can determine if the time you are on dialysis is adequate to keep you healthy. Complications from inadequate dialysis include higher than normal death rate, increased number of days per year spent in the hospital and loss of appetite.

Tip # 2: Minimize weight gain between dialysis treatments. When kidney function decreases, water consumed in your diet may not be removed by the kidneys and may remain in the body. Excess fluid and salt in the body may cause swelling and shortness of breath. The amount of fluid gained can be determined by subtracting your weight before dialysis from your weight at the end of dialysis. For most patients on dialysis, your weight at the end of dialysis is considered your dry weight because it represents the weight in which excess fluid has been completely removed from your body. Your weight gain could be considered excessive if you gain more than three kilograms of water weight between dialysis treatments. So if you are gaining more than three kilograms of weight between dialysis treatments you may be at risk for fluid overload.

Tip # 3: Maintain potassium in normal range. Potassium is an element that is involved in both electrical and cellular functions in the body. Potassium is found in human cells and most foods. Potassium plays a role in keeping your heartbeat regular and your muscles working properly. It is the job of the kidneys to keep the right amount of potassium in your body. When kidneys fail, the body has difficulty eliminating potassium. High levels of potassium in your blood can cause your heart to beat irregularly or to stop beating which could result in sudden death. Patients are vulnerable to high potassium levels if they consume large amounts of potassium containing foods (bananas, oranges, tomatoes). If your potassium levels are elevated ask your dietitian how you can adjust your diet so that the potassium you eat is equal to the potassium removed by dialysis.

Tip # 4: Maintain a normal phosphorus level. Phosphorus is another element involved in normal cell function. Like potassium, phosphorus is removed by our kidneys and accumulates in our body when kidneys fail. Excess phosphorus in our blood combines with calcium in our blood to form a calcium phosphorus complex that precipitates into skin and muscle forming microscopic bone like lesions. As a result, calcium levels in your blood are lowered and can result in irregularities of your heart. In addition, our bones release calcium to replace the calcium lost in our blood and that can result in weak bones. To prevent this cascade of events, keep your blood phosphorus and calcium levels normal by eating a diet low in phosphorus and by taking phosphate binders with your food.
 
Tip # 5: Use a fistula for dialysis access. Central venous catheters are used for dialysis access when arterio-venous fistulas or grafts fail or when a fistula is not feasible for medical reasons. Catheters can lead to scarring of veins and serious infections. If you are using a catheter for dialysis, discuss with your health care provider options for vascular access and how to care for your catheter to prevent infection.
 
Tip # 6: Avoid Infections: Each year, thousands of patients on dialysis are hospitalized for treatment of life threatening infections. The most serious infections are related to vascular access. Besides central venous catheter type infections, as mentioned above, patients on dialysis can have infections related to their fistula or graft. Most of the time these infections can be treated with intravenous antibiotics but sometimes serious infections will require removal of the fistula or graft and placement of a central venous catheter. To prevent infections of your fistula or graft, keep the skin over your vascular access clean by washing with soap and water before and after dialysis. In addition, alert your health care provider if you have fever or chills or notice any changes in color of the skin around your vascular access. Patients on dialysis are also susceptible to community acquired infections such as pneumonia and influenza. These types of infections can be prevented by immunization. Ask you your health care provider about putting you on a schedule for pneumonia and influenza vaccinations. Finally, patients on dialysis can help prevent and fight infections by preventing protein malnutrition. Protein is used for growth and building of muscles, maintenance and repair of all body tissues, and maintenance and repair of your immune system. Ask your dietitian if you are at risk for protein malnutrition. If your at risk for protein malnutrition, discuss with you dietitian how you can adjust your diet with foods high in protein or taking protein supplements designed for patients on dialysis.


About the Author
Philip Tuso, MD, is a nephrologist in Lancaster, CA. He is also founder of a non-profit organization called the Foundation to Improve Renal Nutrition (FIRN), whose mission is to eliminate malnutrition in dialysis. He has recently published two books, Save Your Kidneys, and How Do I Survive on Hemodialysis?
 
Last Updated October 2010
 
 
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