I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: okarol on July 09, 2009, 01:50:54 PM
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SHORT REPORTS
Stimulated sweating in chronic renal failure
Br Med J. 1978 July 15; 2(6131): 172–173.
Concentrations of urea and potassium in the sweat of normal subjects
and patients with chronic renal failure (CRF) are higher than serum
concentrations.'1 Water loss from the skin may exceed two litres per
hour in hot environments.2 4 It would therefore be interesting to
examine the extent to which stimulated sweating in patients with CRF
could compensate for loss of renal function. We describe a patient on
chronic intermittent haemodialysis who was used to taking sauna
baths. Serum concentrations of urea and potassium were low and
weight gain between haemodialysis sessions was small compared with
those of other patients undergoing intermittent haemodialysis. Losses
of urea, potassium, and water in sauna and hot baths) were measured
to investigate whether they could account for the observed low serum
concentrations of these substances and for the stable fluid balance in
this patient.
Patient, methods, and results
A 52-year-old anuric man started to take sauna baths three times a week
on days when he was not undergoing dialysis six months before our study.
Before the sauna baths the patient took a lukewarm shower and brushed his
skin to remove formerly excreted solids. The air temperature in the sauna
was 70 C, and he bathed for one to two hours. After each sauna bath his
body weight decreased by 1 5-2 kg. During the study the sweat that dripped
from his bended head while in the sauna was collected in 20-ml samples, and
total losses of urea and potassium were calculated from weight loss and
sweat concentrations. The patient was also studied in hot water baths of
42-C.5 He was immersed in water up to his neck in an impermeable plastic
bag, which contained 20 litres of distilled water. Fluid from the bag was
sampled before and after the baths and duplicate 1-litre portions were
concentrated tenfold by distillation. This permitted us to calculate more
accurately the total loss of urea and potassium than in the sauna bath.
The figure shows predialysis serum concentrations of urea and potassium
in the patient and in 16 controls on chronic intermittent haemodialvsis.
Results were corrected for differences in dietary intake related to body
weight. After six months serum urea and potassium concentrations were
significantly lower in the patient than in the controls (P< 0 001; t-test). The
sweat to serum urea ratio was 2 0 in two sauna baths and 1-8 in two hot water
baths. Sweat to serum potassium ratio was 2 5 for both sauna and hot water
baths. Sweat rates in sauna and hot water baths were 21 and 33 mllmin
respectively. Urea clearances in hot water baths were therefore higher than
in sauna baths-56 and 40 ml min respectively. Calculated losses of urea and
potassium in sweat were 43 and 12 mmol h (2 6 g 'h and 12 mEq, h) compared
with 117 and 20 mmol/h (7-0 gHh and 20 mEq h) by haemodialysis. Total
excretion of urea and potassium in sweat averaged 215 and 60 mmol/week
(12 9 g/week and 60 mEq week) respectively, which amounted to 19 11 and
3000 of the total quantity removed by haemodialysis. These figures fully
explain the observed falls in serum concentrations of urea and potassium of
23 0, and 35 (, respectively.
Comment
These findings indicate that stimulated sweating can be used as a
valuable adjunct to chronic intermittent haemodialysis. In our patient
a 30-minute hot water bath every day was as effective as a two-hour
sauna bath three times a week. In patients with CRF control of fluid
BRITISH MEDICAL JOURNAL 15 JULY 1978 173
Serum urea Serum potassium
40
8-0
30
6-0
-E6 20 E ~2~3~~~~~~~~~0
4*0
10
_______ 1 _______2.0
Before After Before After
Serum urea and potassium concentrations in patient
with CRF before (e) and six months after ( o) period
when he took sauna baths three times a week. His diet
contained 55 g protein, 50 mmol potassium, and 800 ml
fluid before and 60 g protein, 90 mmol potassium, and
a free fluid intake after six months. Mean results (+ SD)
(n -14) are compared with values in 16 control subjects
(n= 140; shaded area). Patients who needed polysterene
sulphonate to control serum potassium were not
included. All values were measured before dialysis and
were converted to 70 kg of body weight, 100 g daily
protein intake, and 70 mmol potassium intake.
Conversion: SI to traditional units-Urea: 1 mmol/l
6 mg/100 ml. Potassium: 1 mmol/l- 1 mEq/l.
balance, uraemia, and hyperkalaemia can be facilitated by this mode
of treatment, which might obviate the need for strict dietary regulations
and thereby improve quality of life in these patients.
We thank Professor J de Graeff and Dr M A D H Schalekamp for their
advice and criticism.
IDittmer, D S, (editor), Blood and Other Body Fluids. Federation of the
American Society for Experimental Biology, 1961.
2 Schwarts, I L, in Mineral Metabolism, ed C L Comar and F Bromer,
part I, section A, p 346. New York, Academic Press, 1960.
3 Snyder, D, and Merrill, J P, Transactions of the American Society for
Artificial Internal Organs, 1966, 12, 188.
4Kuno, Y, Human Perspiration. Springfield, Illinois, Thomas, 1956.
5Fujishima, K, and Kosake, M, Nagoya Medical Journal, 1971, 17-I, 25.
(Accepted 30 March 1978)
Department of Internal Medicine I, University Hospital, Erasmus
University, Rotterdam
A J MAN IN 'T VELD, MD, medical registrar
Department of Internal Medicine, Division of Nephrology, University
Hospital, Leiden
J H VAN MAANEN, MD, PHD, medical registrar
I M SCHICHT, MD, consultant physician
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1606288&blobtype=pdf
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Interesting. A timely article that ties into some recent posts.
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Actually, I did a search for the topic of saunas, sweating and renal failure. Two articles (this one from 1978 and another from 1966) are the ones that came up over and over.
The 1966 article called SAUNA BATHS IN THE TREATMENT OF CHRONIC RENAL FAILURE Donald Snyder; Merrill, John P. can be viewed here http://journals.lww.com/asaiojournal/Citation/1966/04000/SAUNA_BATHS_IN_THE_TREATMENT_OF_CHRONIC_RENAL.40.aspx - I haven't tried to download it.
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However I don't think it is intended to replace Dialysis if I understand this correctly. Wouldnt someone have to spend 12 hours a day in the sauna for it to compensate for any significant percentage of dialysis, if at all?
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However I don't think it is intended to replace Dialysis if I understand this correctly.
Correct. It was used in conjunction with dialysis.
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I think it is interesting that it maybe used with dialysis.
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Thank you so much okarol, (I knew I could count on you)
I knew you'd find us some info.
I don't know how to act on the article yet but it was an interesting read to say the least.
I do agree that at this stage of the development it is not a replacement for dialysis but for me it will be to danagerous to try because of the high bloodpresure warning.
Thanks again
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I find that it lowers my blood pressure, which is not surprising because it lowers your uremic load, water load, and increases blood flow to extremities. I'd encourage you to try it with supervision.
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So, apparently a one-to-two hour sauna bath three times a week is 19% as effective at removing urea and 30% as effective at removing potassium; and the same is true for a 30-minute hot bath every day. I wonder if my PD nurse has any suggestions for making baths acceptable given that it's pretty much banned for exit site concerns.
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Oh PLEASE make having a bath something we're supposed to do. I so miss having a lovely hot deep bath. I still do actually - but it's an occasional treat now cos I'm not supposed to at all. I really think something should be done. If we can put people on the moon surely we can invent a dressing that'll keep my exit site safe??
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I've been thinking about baths. I think the safest thing to do would probably be to add salt to the bathwater to bring it up to seawater-salty. The only problem is that it would cost about $10 in salt each time, even if you buy bulk pool salt.
Another option is to dress the exit site with a hypertonic saline compress, and cover with a waterproof dressing. That way, even if some "unsafe" bathwater does get in, the saline dressing keeps it safe.
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In the summer I'll go sit in my hot car and sweat so I can come in and have a cold glass of water and not feel guilty. I do so much better with my fluid in the summer because I can really sweat.
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I find I did not sweat while on dialysis up until I went on Nocturnal dialysis. I did not sweat even on hot, hot days here in California, now I sweat at the drop of a hat.
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There's one other thing to consider and that is the subject (if I read correctly, sorry I'm new to thins medical) was already on dialysis, therefore his blood was already being cleaned by dialysis. I wonder how much more waste would have come by sweating if he wasn't on dialysis. In other words if you run a vacuum over a dirty carpet you get more dirt than one that's already been cleaned. The test might have shown even more dramatic results.
Interesting to think about.
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I wonder if that is why John has lasted so long without having to go on dialysis, he has a hot bath every day, as both of us hate showers.
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Several months ago, I went a few times to a saunacenter, at the recommendation of a former patient who has been on dialysis for more that 11 years. He took a sauna every week, during the weekend, and said he felt good. I did not notice a spectacular improvement myself upon returning from the sauna, but I remember generally feeling good. I also remember my lab results the day after were slightly better (less potassium and phosphorous).
A few months ago I was on holiday in Turkey, for the first time since starting dialysis in December 2007. FYI, I have PKD. In Turkey, my wife and I were staying in a luxury hotel, with superb wellness facilities, including hot sauna (100° Celsius). So I started taking a sauna every day, even before going to dialysis. The sauna consisted of three sessions of 10 minutes each, followed by a cold shower and some rest, so alltogether up to 2 hours.
After 3 or 4 days I started feeling a lot better, even like I used to feel before having any kidney related problems, not being tired all the time. I even went for a swim several times a day. So taking a sauna has its benefits, no doubt. I'm not sure however that taking a sauna will be enough to get rid of the excess fluids of a dialysis patient. I noticed that, even after taking a sauna before going to dialysis in the evening, I still had my normal weight before dialysis, so up to 2 kg had to be taken off during dialysis. And no, I did not drink more while on holiday :)
So, in a nutshell, taking a sauna can help a dialysis patient to get rid of toxins in the blood, and you will feel better since the buildup of toxins and waste in the blood is slowed considerably, but it will never replace dialysis.
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There's one other thing to consider and that is the subject (if I read correctly, sorry I'm new to thins medical) was already on dialysis, therefore his blood was already being cleaned by dialysis. I wonder how much more waste would have come by sweating if he wasn't on dialysis. In other words if you run a vacuum over a dirty carpet you get more dirt than one that's already been cleaned. The test might have shown even more dramatic results.
Interesting to think about.
Dialysis only takes out some toxins. Even after dialysis the blood is still full of toxins and creatinine for most is still off the charts when compared to what is normal. So even with dialysis your blood isnt exactly "clean".
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Then saunas and dialysis can be the one two punch. That's moving in the right direction.
Also what if sweating is even more effective than dialysis. The skin is much more complex than
a man made machine. I hope one day it gets researched by modern medicine.
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Its not more effective than dialysis and studies bear that out.
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I've been thinking about baths. I think the safest thing to do would probably be to add salt to the bathwater to bring it up to seawater-salty. The only problem is that it would cost about $10 in salt each time, even if you buy bulk pool salt.
Have you looked for water softener salt? Here in the UK it costs £10 for 25kg. You would need 3.5kg for a 100litre bath as salty as sea water, costing the equivalent of $2.30