dialyisis and the heart

[nycrtst85]

I know your heart works that much harder to pump blood while on the dialysis machine but is this in long trems cause heart problems or heart attacks???

[Rerun]

Yes.

I'm sorry to say that it will finally affect even the best of hearts.  But, exercise and watching your diet helps.

And you have to remember you could get hit by that truck tomorrow!


           

[Jie]

That is one of many reasons that dialysis patients are death with about 20% rate a year. Over half of these deaths are heart-related. So, taking care of heart is a very important task for a longterm survival of a dialysis patient. If you can, fast walk or slow run daily will help.

[monrein]

The creation of an AV fistula for hemo can lead to left ventricular hypertrophy in dialysis patients and this can in turn result in ventricular arrythmias.  The fact that our hearts are made more vulnerable by D makes it even more important that we eat as healthily as possible AND make exercise an integral part of our lives.  I think that this is true for everyone but crucial for us.  I don't spend any time worrying about the added risks that we face as a result of doing what we need to do to stay alive, that is dialysis, and taking a fistful of meds, but I do focus heavily on doing whatever I can personally to NOT add more risk to the situation.   Exercise can be very difficult when we are ill but some type can usually be done.  Even in hospital, laps around the ward, seated exercises and stretching, leg raises in bed are what I try to do...I don't feel like doing this necessarily but I think of it as my job.  If I can't walk, then I use my arms to wheel myself around in a wheelchair.

[MooseMom]

It is my understanding that it is the constant build up and then extraction of fluid that causes the walls of the left ventricle to thicken, thus leading to increased risk of cardiac problems.  I am not sure how the creation of an AV fistula contributes to this problem, so I'd really be curious to know more about this.  I am led to believe that slower, more frequent dialysis would be better for the heart because you do not get the greater buildup and pulling off of as much fluid as you do on thrice weekly in center dialysis.

[MooseMom]

I just want to add a bit more after thinking further.  About a year and a half ago, I had to have a hysterectomy.  I wanted to educate myself as much as possible, so I sent away for an information booklet.  When it arrived, I was horrified to read a page and a half filled with all of the terrible things that could result from surgical menopause.  I was waiting for the part where they'd tell me that my toes would eventually fall off.  Seriously, I looked in the mirror and saw myself turning into a crazed old woman before my very eyes.  Well, guess what.  Out of that page and a half of potential side effects, I experienced exactly ONE, and that single side effect was actually directly caused by my kidney problem.  So, as you do your research on dialysis, keep in mind that not all you learn will be revelent to you.

I'm sure it is true that 20% of people on dialysis die each year, but, unfortunately, many dialysis patients have not had good pre-dialysis care and don't have adequate access to medical services.  Many have long term illnesses that in and of themselves contribute to heart problems.  Many are not educated about exercise and good nutrition until they find themselves already on dialysis.  I'd bet that those 20% are already vulnerable before they are put on dialysis.

[monrein]

http://www.nature.com/ki/journal/v54/n68s/full/4490553a.html

Here's one reference to left ventricular hypertrophy and it's common occurence in hemodialysis patients.  If you do a Google search of the terms hemodialysis and left ventricular hypertrophy you will find many links to articles about this , including some discussion about whether to close off a fistula post transplant (which I don't plan to do btw).

You are correct also Moose Mom that the fluctuations in fluid retention and removal are very hard on the heart and of course that's another very good reason to watch the fluids between sessions.

I always read the list of side effects (only to be aware of what they are) and then I carry on with full trust that I won't deal with any of them and usually I have no trouble.  I never get crazed because I decided a long time ago to only get activated by the stuff I can do something about.

As for the LVH, I became aware of this  just last year, when my dialysis neph was looking over the results of my echocardiogram and expressed much surprise.  I asked why and he said that most of his patients had some degree of it, and he only became worried if it was beyond a certain point.  I asked what point I was at and was told that his surprise was because my heart showed no evidence of ever having been on D, although I had done, in total, just under 6 years.  I asked if exercising regularly was a factor and he just laughed and said "Whatever it is you're doing, could you get all my patients to do it".   

I also fully agree that nocturnal hemo is the best and gentlest modality and 5 or 6 nights a week is optimal.

I pay zero attention to statistics regarding my health since there is no way I can have any effect on what happens to others.  At 8 months old I was given 6 weeks to live and I turn 57 this year so I strive only to be the exception to trends and probabilities.

[MooseMom]

That's a good attitude, monrien, because now that I have done a little more research into LVH, I'm convinced that I am going to die from it tomorrow.  It all makes for depressing reading.  I just got a new laptop and I can't figure out how to cut and copy a link, but after reading several articles, it seems that even those patients with pre-dialysis CKD who are not even hypertensive probably have LVH.  No doctor has ever expressed concern about my heart, but I have an echocardiogram coming up soon as part of my transplant eval which may tell a very different story.  Now I'm nervous.
I did learn some things, one being that it is important to treat anaemia and high BP and to get good pre-dialysis care.  And I learned just how closely related renal function is with cardiac health (or lack of it).
Now I'm really depressed...

[MooseMom]

Oh joy, and I also learned that transplantation doesn't "cure" LVH.

OK, I have to stop thinking about this.  It's one more thing for me to worry about.

[MooseMom]

ok, let's see if this works...

www.touchcardiology.com/articles/prevention-cardiovascular-complications-dialysis-patients?page=0%2C1

[monrein]

Oh joy, and I also learned that transplantation doesn't "cure" LVH.

OK, I have to stop thinking about this.  It's one more thing for me to worry about.

MM  you (and me and all of us) do have to get a grip.  Without D, I'd have been dead at 26.  Dead, not worried, dead.  There are many things NOT in our control and this is true for every human being whether or not they realize it is so.  The only thing we can work at controlling is our reaction to things and our decision to make the healthiest choices and actually follow through on those decisions.  Some patients worry obsessively and others carry on as though the basic "rules" don't apply to them, they're invincible.  These positions are neither sensible nor useful.  I'm not saying it's easy...it isn't, but it affords a tremendous sense of peace and calm.   Anti-anxiety meds can be helpful for some people if being overwhelmed and worried sick (literally!) become constant states. 

The hardest thing right now, given where you are in the process, is that there is so much new info that it's hard to sort it into appropriate categories.  You've said you're a planner.  So am I.  The trouble is how to plan when nothing fully makes sense yet.  You're at the beginning of putting together a puzzle, the pieces will each make more sense as you go along and you'll soon start to see the fuller picture.  I say fuller because there is no "full" as such...the picture just keeps changing and we try to keep up as best we can.  Research is interesting but it isn't psychic, nor is it predictive, nor is it personal.  Like when you do a jigsaw, there are puzzle pieces that you look at, take note of and put away for later...when the picture fills out a bit more.

My goal is simple...be the healthiest person I possibly can be, look for and enjoy beautiful things wherever I find them, use common sense at every opportunity, learn all I can about every aspect of kidney disease and let go of unproductive worry and reduce whatever stress I can.
 

[MooseMom]

Oh, thank you so much for that, monrein.  I'm going to read your post whenever I need to get a grip.  You are absolutely right. Thank you for that slap upside the head!  I sooooo needed that.  Sometimes I can be my own worst enemy.

[Rerun]

 

[galvo]

monrein, that was well said!!!!

[nycrtst85]

Thanks Everyone for your answers,knowing all that information really helps.all We can do is Have faith in God,eat healhty,excercise and think positive.
-Some patients worry obsessively and others carry on as though the basic "rules" don't apply to them, they're invincible. -Tell me about it i was that person not eating what i was supposed to even though i was on dialysis and knew better.few months later i ended up almost paralysed with cramps and i tought i was gonna have a heart attack and was saying my last parayers,ended up in the E.R. for 4 days.i could barely pee,and i had trouble with number 2.But now i been following the diet excersising,looking at life in a whole different way thanks to God for giving everyone here strenght.a couple of months after that incident i have been peeing a lot more and number two also let me tell everyone here something,KIDNEYS DO REGENERATE,you have to follow the diet,excersise and have Faith.i know from experience.i still have kidney failure but now i noticed that my kidneys might be regenerating.

[nycrtst85]

I guess it's gonna be one short life,Better live as a wolf for one day than live like a sheep for a hundred days.Live fast die young.I envy the 90 year olds it's like they lived 3 live fast die young lives.

[CharmedMist]

It is very, very important you are careful with your fluids as that can affect it.

Here is how it was explained to us: Imagine your heart is like a balloon. You fill the balloon up with water, now, you can let the water out, but the balloon never has the same elasticity or shape or strength as it did before you used it. Now, do this, over and over and over again.... eventually, that balloon just can't take it any more.

That being said, the key is following doctor's orders.

Watch your fluids, your potassium, if you have the strength, do some exercise. Even 5 minute walks, etc, helps.

And don't ever give up.

[kevno]

you are right Renal patients never give up! We all go through so much. It's five years since i had a heart attack. But it was not caused by fluid overload. It was caused by being to dry I ended up having 3 liters of fluid being dripped into me. I now try to make sure i drink enough, but you need to drink more on hot days. Now i am never more than 0.5kg up before going on machine. Plus before you ask "I DO NOT PEE!"

I have got so use to not drinking now, i now have to make myself drink.

[CharmedMist]

Wow, you must be one of the few rare ones that get to drink as much as they want.   

[kevno]

Remember: I started dialysis when I was ten. So from a early age got used to not drinking a lot of fluid. But i have seen what happens to patients who drink to much and get overloaded. No easy answer   I have lost so many friends with being overloaded 

[Zach]

Regular exercise is also important to maintain a strong heart, as well as consuming the proper amount of protein.

[kevno]

Things change so much on the renal diet. When I was a child i was on a 20g protein diet. In those days they used to make up have as much sugar for energy as we could take.  We walked around with k at 7 or even higher. The doctors would panic if i had a k so high nowadays. Tin bread with no protein, special extra sugar biscuits. Now our unit does not even bother with protein diets. The only thing that never changes is the fluid intake or lack of it