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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