Lifesaving dialysis a lifelong commitment

[okarol]

Lifesaving dialysis a lifelong commitment

Monday, September 15, 2008

I have type 2 diabetes, and my high blood sugar levels have damaged my kidneys. I'm doing my best to lower my blood pressure and blood sugar with diet, exercise and medication, but my doctor says I may need dialysis. What does dialysis entail?

A: Dialysis is not a one-time treatment. Most people who start dialysis must continue it for life unless they receive a kidney transplant. You should continue every effort to improve or stabilize your condition, but if your kidney function continues to decline, dialysis can literally be a lifesaver.

Your kidneys do two important things: They eliminate waste and help regulate levels of certain hormones and chemicals in your blood. Kidney failure occurs when they can no longer handle these tasks.

Acute kidney failure occurs suddenly but may be reversible. Chronic kidney failure develops slowly over a number of years; it can be slowed and even halted if diagnosed early enough. The most common cause of chronic kidney failure is diabetes, followed by high blood pressure.

Kidney failure can be deadly. Without treatment, toxins accumulate to dangerous levels, and the balance of certain chemicals in the blood becomes abnormal. This can cause fatal heart rhythms, neurological damage and other serious problems.

The introduction of dialysis in the mid-1940s revolutionized the treatment of kidney failure. The first method invented, and since improved upon, is hemodialysis. During this procedure, blood circulates from one of your arteries into a machine (the "artificial kidney") that removes toxins before the blood returns to your body. The other method, peritoneal dialysis, places a special fluid in the abdomen so it can leach toxins from the body.

A hemodialysis treatment usually takes about four hours and is done three times a week. During treatment, you sit in a chair or lie on a bed while you are hooked up to the artificial kidney. Treatment takes place in a hospital or dialysis center.

Although it works well, hemodialysis takes some adjustment. The treatment may make you dizzy or nauseated, and it often means spending considerable time in a hospital.

Before starting hemodialysis, your doctor performs minor surgery to provide access to your blood through a fistula, graft or catheter. A fistula is a structure created when an artery and a vein are joined, which is done to allow sufficient blood flow to the hemodialyzer. If your blood vessels aren't healthy or large enough to support a fistula, your doctor will insert a graft, or soft plastic tube, to do the job.

For peritoneal dialysis, the doctor surgically inserts a catheter into your abdomen. During treatment, you run a cleansing solution (called the dialysate) through the catheter into your abdomen (the peritoneal cavity). The dialysate stays in place for several hours, drawing excess fluid and waste out of the arteries and veins lining the peritoneal cavity.

The process of draining used solution and replacing it with a fresh batch is known as an exchange. An exchange takes about a half-hour, and several exchanges must be done each day. Many people prefer peritoneal dialysis, even though it's done frequently, because they can do it at home. Drawbacks include bouts of abdominal bloating and the potential for infection known as peritonitis.

Regardless of the type of dialysis you choose, you will need to change your diet. Your doctor will tell you how much protein to eat and how much fluid to drink. You may also need to limit salt and potassium to ease the workload on your kidneys, and take iron and vitamin supplements.

Of course, you might be able to avoid dialysis by better controlling your diabetes. Start by reducing your consumption of simple sugars and concentrated sweets. Eat less saturated and trans fats and more fruits, vegetables and high-fiber foods. If you're like most type 2 diabetics, you'll need to lose weight. Cut down on calories and add 30 minutes of moderate physical activity a day. Even losing 5 percent to 10 percent of your weight will help. And be sure to take the medications your doctor prescribes. Often, these include an ACE inhibitor to lower blood pressure and protect the kidneys, and metformin and/or insulin to lower blood sugar.

Although people learn to cope with the challenges of dialysis, consider yourself lucky. You have the opportunity to take charge of your health through diet and exercise. Even better, as you control your diabetes, you may help prevent a host of other problems, including heart disease.

http://www.reporternews.com/news/2008/sep/15/no-headline---harvard/