In the early days of dialysis, the thought was that the person would not be living a very interesting or fun life – that they would only face clinic visits, doctors and nothing more. This is not true any longer, especially in those patients who are otherwise healthy and active. There is an estimated 217,000 Americans who are going through dialysis on an ongoing basis, with a cost of just over 11 billion dollars.
The amount of dialysis that you have to do, the length of time that it will take for each treatment and the dietary restrictions that you will have will vary from patient to patient and will be determined by the doctor and nutritionist based on lab values for your blood and urine. In addition, your weight and the stage of your kidney disease or the type of kidney disease that you have will determine how often or how long your treatments will take. There are two types of kidney dialysis: hemodialysis and peritoneal dialysis, with the majority (90%) of patients having the former. During this type of treatment, the blood is circulated outside of the body to a machine which cleans and extracts the waste products before it is returned to the body.
To get started with dialysis, especially hemodialysis, the doctor will make a fistula, or entrance, via minor surgery in the leg, arm or neck. In some cases, especially with smaller or younger patients, a small plastic graft will be added to make a larger vessel for access. The blood is then circulated through the machine and back to the body after passing through a special fluid called dialysate, which removes the impurities and waste products.
During the other type of dialysis, the patient is more involved in the procedure, making them more accountable for their own health and wellbeing. It is accomplished by using the peritoneal membrane as a filter. This membrane is a sac that surrounds the abdominal organs and is semi-permeable. The small particles of waste products go through the membrane but blood cells cannot. The problem with this type of dialysis is that the patient is responsible for introducing the dialysate fluid through a catheter and then draining it back out after three to four hours, adding in new fluid at this point. Draining takes about half an hour and is then done about five more times per day. While the patient is freed from having to go to a clinic for several hours a day, it can be a problem for some to keep up the schedule on their own, requires careful washing to prevent infection and also may not be an option for those who are very large.
Prevention, Diet and Good Nutrition for Kidney
During the five stages of kidney disease, the dietary needs will change. During the earliest stages, the changes may be only minor. In the secondary stages, the protein and other nutrients will be reduced to keep the disease from progressing. In the final stage, also known as end stage renal disease, the need for protein is increased, even higher than what is considered to be a normal amount. The right amount of protein must be determined for each patient – too much or too little can be dangerous.
For instance, some of the diets that have been popular in the past, including the high-protein diets, can be dangerous to the kidneys and can cause other problems to the health as well. Some protein sources, especially those suggested by these diets, can be high in fat and calories, making them even more problematic as well. Even when protein is recommended, it should be from healthy sources, including plants and healthy protein supplements instead of the higher fat animal proteins.
Working with a nutritionist becomes very important during every stage of kidney disease so that the kidneys can be protected as much as possible. A healthy diet also prevents other health conditions from getting worse and creating further problems for the kidneys. For instance, a healthy, low-fat and low-salt diet can help to control the blood pressure, which is a number one factor in developing or worsening kidney disease. A healthy diet also works to keep the weight regulated as well. Being overweight can also cause a strain on the kidneys and makes other conditions more serious as well. Simply losing a few pounds can help to regulate the blood pressure and other conditions of the body.
Another factor that must be considered is the amount of fluids that are included in the diet. The average person is typically slightly dehydrated on a normal basis – the thinking of most doctors is that if you are feeling thirst, you are already dehydrated or well on the way to it. On the other hand, having too many fluids in the body can be a problem as well, diluting the amount of the important electrolytes that are needed. An electrolyte imbalance can lead to mental confusion or cloudy thinking, aches and pains and heart rhythm irregularities. In some people with kidney disease, the amount of fluids that are allowed will be restricted because the kidneys are not removing enough of the excess from the body, leading to swelling in and around the organs.
Diet, Dialysis Options and Lifestyle: Two Case Studies
Shelley and Byron are both facing dialysis: Shelley will be using hemodialysis, while Byron will be using peritoneal dialysis at his own home. Shelley, a stay-at-home mother and student, schedules her dialysis for times when her children are at school as much as possible and brings her own schoolwork with her while she is undergoing treatment. Byron, who works full time outside his home, begins his treatment at home and completes the other steps throughout the day. His watch’s alarm feature goes off whenever he needs to drain. His boss is very sympathetic and allows him the time that he needs to complete the process.
In addition to the dialysis, Shelley and Byron will both be working with a nutritionist very carefully so that they can both understand the dietary needs that they have now and may face in the future. For Shelley, she is in a later stage of kidney disease than Bryon is, so her protein need is much higher. She is not only encouraged to get quite a bit of protein from food sources, but is also going to use protein supplements to make sure that she gets the right amount.
Byron, on the other hand, is being told to reduce his protein intake slightly at this point in his disease. In addition, he is being asked to reduce the amount of salt and fat in his diet. Using the DASH (Dietary Approaches to Stop Hypertension) diet will be beneficial to him, not only to reduce the salt intake and control his blood pressure but also to help him keep his weight in check at the same time. Instead of higher fat protein foods, Byron will be using protein supplements, keeping his calorie count down but his protein intake where it is supposed to be.
Both Shelley and Byron will be using a protein supplement which gives them high-quality, highly digestible protein in many fruit-based flavors for added palatability. The size of each serving is remarkably small and the calorie count is equally as small (100 per serving).
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Gone are the days when kidney dialysis patients had no life except to visit their physicians or hospitals for treatments. These days, those who are receiving dialysis treatments are doing the things they always did before beginning their treatments, especially those who, aside from needing dialysis, are otherwise healthy and active. There are hundreds of thousands of Americans who are dealing with kidney disease, and more than 215,000 are currently going through dialysis treatments.
No two dialysis patients are alike, and the amount of treatments that are needed for each patient, the length of time for the treatments, and dietary restrictions are different for every patient. In fact, a patient’s weight, as well as how advanced their kidney disease is, are both factors in the amount of treatments that will be needed. A physician will be able to advise patients as to what their dietary needs are, depending on blood and urine samples taken at that time.
Types of Dialysis Treatments
There are two types of kidney dialysis treatments, hemodialysis and peritoneal dialysis. The more common of the two treatments is hemodialysis, with about 90% of all patients undergoing this type of treatment. Hemodialysis is a treatment that allows the blood to circulate outside of the body into a machine. This machine cleans the blood and removes any waste product before returning the blood back to the patient’s body.
With peritoneal dialysis, the patient must be more hands-on with their own treatment. This is done by using the peritoneal membrane as a filter for the blood, and the waste filters through, leaving the clean blood behind. Patients are expected to do this type of dialysis themselves, and are required to put the dialysate fluid into a catheter, draining it after three or four hours, and then refilling it. The draining process takes about one half hour, and must be done four or five times daily. Because this type of treatment requires careful cleaning around the area to avoid any infections, this may not be the optimal procedure for those who are extremely obese.
Both types of dialysis treatments will begin with a physician performing a minor surgery to make a small entrance in the leg, arm or neck. Some patients may receive a plastic graft added on to make access for dialysis easier. This is especially common in children and senior citizens. Once the entrance has been created, dialysis treatments of either type may begin.
The Proper Nutrition For Good Kidney Health
There are five stages of kidney disease, and each stage has different nutritional requirements for patients. There may only be a few minor changes in the beginning stages, and as the disease progresses, especially in the secondary stage, the intake of protein and other necessary nutrients is actually reduced, which can help to keep the disease from progressing any further.
By the time the patient reaches the final stages of the disease, their protein intake will be increased greatly, although it is still possible for patients to get too much protein. Too much or too little can cause adverse health effects, and it is best that patients use a diet plan that is specifically created for them by a physician, dietitian or nutritionist. It is advised that patients do not use popular fad diets, especially those that are high in protein, as they often are also high in fat and calories. Specialized diet plans often use such dietary sources of protein as vegetable protein. (Soy is terrific)
One of the biggest causes of kidney diseases, and something that can worsen existing kidney disease, is high blood pressure. A diet that is high in protein but low in fat and sodium will help keep blood pressure in check as well as regulate weight, which also plays a role in kidney disease.
Fluids are necessary as well, although depending on the patient, the intake of fluids may be restricted in order to avoid swelling in and around the organs. One great way for patients to get the protein and fluid they need is to use a liquid protein supplement.
Protein Supplements Can Help
In addition to protein shots there are other terrific protein supplements available, including protein powders, liquid protein and protein bars/snacks. Protein supplements are made from a variety of protein sources, including whey, casein, rice, soy and egg, some of which are complete proteins and some incomplete. A complete protein is one that contains all 22 of the essential and non-essential amino acids.
Protein Powders – This is the most versatile type of protein supplement and can be used in a number of ways. Protein powders are available in many delicious flavors, including chocolate and vanilla for shakes, berry and fruit punch for smoothies and slushies, and unflavored for adding to recipes. For a quick and easy protein smoothie, just blend two scoops of berry or fruit punch protein powder, one cup of orange juice, one cup of frozen berries and one banana.
Liquid Protein – Ready-made protein shakes and smoothies are available, which are portable and easy to take anywhere. Liquid protein supplements also make excellent meal replacements. They can be used to create your own drinks and can be added to certain recipes. Many liquid protein supplements are milk-based, so if you are allergic to milk or lactose intolerant, you should opt for a supplement made with soy or rice proteins.
Protein Bars/Snacks – There are many different delicious protein bars available that make great snacks as well as meal replacements. In addition to bars, there are many other types of snacks, including jerky. Remember that no matter what type of supplement is being used, it is always best to check with a physician before using them and before starting any type of diet plan, especially for patients with kidney disease.
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Dialysis careers are typically available at hospitals and private outpatient clinics. Dialysis workers in hospitals tend to work with very sick patients who might need around-the-clock care in addition to their dialysis. Workers in the private outpatient clinics are usually working with patients who are using dialysis as a maintenance procedure over the long haul.
A third option growing in popularity is to be a dialysis nurse working with patients who are learning to perform their own procedures at home. These nurses train patients in the hemodialysis process and then monitor them going forward. Dialysis careers in all three settings are wide open right now, as are most careers in the medical field.
Becoming a Dialysis Technician
One of the nice things about dialysis is that healthcare professionals can get their start as technicians with just a high school diploma. That’s all you need to begin earning your dialysis technician certification at a local community college, vocational school, nursing school or hospital training course. It helps to have a strong background in high school math and science, but it’s not absolutely necessary. As long as you can complete the necessary coursework, you can earn your certification pretty quickly.
Part of the certification process is hands-on training under the supervision of a registered nurse. If you can’t find a program offered by a local hospital or outpatient clinic, you might benefit through a direct-hire program that gives you on-the-job training. Under such a program you might take your classroom training through a local community college or a hospital class, then finish your hands-on training as an employee of that hospital or clinic.
Becoming a Dialysis Nurse
In most cases, a hospital dialysis unit is staffed by registered nurses (RNs) who have earned a college degree. If you want to be a dialysis nurse, plan on a minimum four-year bachelor degree program and passing a state licensing exam. As a registered nurse, you will most likely oversee a team of dialysis technicians and other nurses who work in your department or clinic.
For the right person, a dialysis career is a great choice. But it’s a unique kind of medical care that requires a special bedside manner and the ability to work with patients for extremely long periods of time. If this is something that interests you, you might want to talk to other dialysis workers and pick their brains. They are an invaluable source of information and advice when making your career choice.
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There are two primary types of kidney failure in humans. The first occurs fairly suddenly and is called “acute renal failure“. We’ll talk later about the causes of this condition. The second disease is more insidious and occurs over time. It is called “chronic renal failure“. This type of kidney failure has causes of its own. The treatment for both types of renal failure is roughly the same, with dialysis and kidney transplant being the most common treatments.
One of the most common causes of acute kidney failure, also called acute renal failure, is the sudden loss of blood flow to the kidneys such as seen in trauma, surgery, septic shock, heavy bleeding, burns or acute dehydration. Infections can cause kidney failure, especially if they cause the kidneys to be infected as well. More rarely, acute tubular necrosis can cause the disease.
Sudden blockage of the kidneys can result in acute kidney failure as does auto immune diseases and diseases that clot the small blood vessels of the kidneys. Some of these conditions include having a transfusion reaction, having malignant high blood pressure (extremely high blood pressure), scleroderma or bleeding disorders of pregnancy like an abrupted placenta or a placenta previa.
Symptoms of acute kidney failure are many. The most common symptoms are a stoppage or slowing down of urine production, swelling of the ankles and legs, fluid retention elsewhere in the body, decreased sensation of the hands or feet, change in mental status, high blood pressure or nausea/vomiting.
Chronic kidney failure affects the kidneys more slowly but results in many of the same problems with the kidneys. In fact, it can occur over several years. While there may be no symptoms in the beginning, eventually the disease is as symptomatic as acute renal failure. Symptoms occur when the kidney function is less than 10% of normal.
Chronic kidney failure occurs in 2 out of a thousand individuals in the US. The most common causes of the disease are diabetes and high blood pressure. These two diseases account for 65% of the cases of chronic kidney failure. Other diseases are more unusual and include glomerulonephritis, polycystic kidney disease, and conditions where blockage or back flow of the urine occurs on a regular basis. Kidney stones and recurrent infections can affect the condition as well as recurrent infections in the kidney.
Symptoms of chronic kidney failure include weight loss, nausea and vomiting, fatigue, headache, frequent hiccups and generalized itching. Eventually the symptoms are similar to acute kidney failure and one can see poor urine output, nighttime urination, easy bruising, decreased alertness (with drowsiness, lethargy, confusion or delirium), seizures, muscle twitching, poor sensation of the hands or feet and high blood pressure.
Both chronic and acute kidney failure result in the build up of fluid and waste products inside the body so that there is a buildup of nitrogen wastes in the body as well as other waste products. Almost all body systems are affected by kidney failure.
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The kidneys are vital organs within the body that are essential for sustaining life with their primary functions being to remove the waste products from our blood and excess fluids from our body, regulate our blood pressure, and produce certain hormones that are essential to our body for healthy blood and bones.
Unfortunately, for various reasons an individual can experience kidney failure that is a life threatening condition requiring medical treatment. Medical treatment for kidney failure consists of three options that can be chosen based upon a physician’s recommendation and the patient’s preference.
Treatment for kidney failure is optional and the patient has the right to refuse treatment which they may do for various reasons including their desire to not being burdened with the process of dialysis that may only prolong their suffering.
Hemodialysis and Peritoneal Dialysis
Hemodialysis and peritoneal dialysis are forms of dialysis treatment that replace the function of the failing kidneys by basically filtering the waste products from the blood. The basic difference between hemodialysis and peritoneal dialysis is that hemodialysis utilizes a machine – artificial kidney – to filter the blood while peritoneal dialysis utilizes the body’s own peritoneal membrane that is located in the abdomen.
In hemodialysis, the blood is removed from the body and pumped into a dialyzer that filters the blood and returns it back into the patient’s body. In peritoneal dialysis, a dialysate solution is infused into the abdominal cavity and waste products along with excess fluids will accumulate within the dialysate solution which is drained and then replaced periodically.
The decision as to what method is chosen is based upon many factors including the medical conditions and lifestyle of the individual. Hemodialysis is typically done at a dialysis facility outside of a hospital while peritoneal dialysis can be done at home.
Complications can occur with both procedures with the most common problem associated with hemodialysis being vascular access problems, and the most common problem associated with peritoneal dialysis being serious abdominal infection.
In certain situations where the kidneys have failed, the recommendation may be made for a kidney transplant in those patients who are considered to be a good candidate for kidney transplantation. If a live donor is not available such as a family member or friend who is a good match, the patient will be placed on a waiting list until a matching organ donor is found.
While this form of treatment is effective in most cases, the individual will have to take immunosuppressant medications for life to prevent their body from rejecting the new kidney. In some patients, kidney transplantation may not be considered if other medical conditions would cause the surgery to be extremely dangerous or is unlikely to be successful.
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