Fluid Balance

Dialysis is a type of treatment that repeats many of the functions of the kidneys. It is often used to treat cases of kidney failure, which is also known as end-stage renal disease. This is where the kidneys have been severely damaged and lost almost all of their ability to function. Healthy kidneys clean the blood by removing excess fluid, salt and wastes. When they fail, harmful wastes build up, blood pressure may rise, and the body may retain excess fluid. When this happens, treatment ??“ dialysis or a kidney transplant – is needed to replace the work of the failed kidneys, which is known as end-stage renal failure.
There are two main types of dialyse haemodialysis and peritoneal dialysis. Haemodialysis is the most common method that most people are aware of. It involves inserting a needle, which is attached by a tube to a dialysis machine, into a blood vessel. Blood is transferred from your body and into the machine, which filters out waste products and excess fluids. The clean blood is then transferred back into your body.
Peritoneal Dialysis is a form of renal replacement therapy. It involves instilling dialysis fluid into the peritoneal cavity via a dialysis catheter. Dialysis takes place by diffusion of uremic toxins through the patients peritoneal capillaries, down a concentration gradient into the dialysis fluid. Water is removed from the circulation by varying the concentration of osmotic agents (normally glucose) in the dialysis fluid to draw water through the capillary membranes. The fluid is repeatedly removed and replaced with fresh solution. Dialysis is an artificial way of doing the work of the kidneys, but it cannot replace the natural efficiency of the kidneys.
If you are on dialysis you need to carefully regulate your diet. Weight loss is a problem that causes particular concern in kidney failure. This is usually because patients are not eating enough protein and energy-providing food. Malnourished people lose weight and muscle mass. Malnutrition can develop with patients on either haemodialysis or peritoneal dialysis. Dieticians monitor renal patients for any signs of malnutrition.
Some patients lose their appetite and you may be asked to increase your food intake to prevent malnutrition from developing. Phosphate and calcium affect the health of the bones. When a person has kidney failure, the calcium level in their body tends to be too low and the phosphate level too high. Treatment for kidney patients aims to raise blood calcium levels and lower blood phosphate levels. These aims can be achieved by moderating the phosphate content of your diet, by adequate dialysis, and by the use of a phosphate binder taken with meals. However, it is difficult to cut down on phosphate intake without also lowering protein intake. Haemodialysis patients might have to avoid such high-potassium foods as chocolate, and moderate their intake of other potassium-containing foods such as bananas.
Peritoneal dialysis patients rarely need to restrict their potassium intake. Protein is an essential nutrient that enables the body to build muscles and repair itself. It also helps the body to fight infection. The main sources of protein in our diet are meat, fish, dairy products, eggs, and vegetables such as peas, beans, and lentils. Low levels of protein can lead to malnutrition, fluid retention and a reduction in the bodys ability to fight infections. When protein is digested waste products are formed and enter the blood. One of these wastes is called urea. Normal healthy kidneys are good at getting rid of urea. Failing kidneys are not good at this, but kidney patients should still eat protein. Haemodialysis patients often have greater restrictions on fluid intake than peritoneal dialysis patients, and therefore need to be very careful about salt. This is because a salty diet can make a patient thirsty and may increase blood pressure. Vitamins B and C are lost during dialysis. Your doctor may prescribe vitamin supplement tablets.
People with kidney failure can lead happy normal lives. Regular exercise is strongly advised to so that patients can begin to feel better and healthy. People who do regular exercise get results. Regular exercise can make muscles stronger and joints more flexible. That means it will be easier to reach, bend stoop, and do other daily activities. People may begin to feel that dialyse is taking over their life. Some people get very depressed because they may have had to give up work. It can be very exhausting and you can have headaches after it.
The fluid restriction diet only allows a patient to consume 500mls of liquids a day. This can affect people in many ways for example going out. One bottle of small drink would be enough for your whole daily allowance. This can be very hard to get used too. It means that you have to think about and plan every meal you??™re going to have and what you are going to drink. If a patient is going on holiday and is receiving dialyse then if you travel in the EU it is possible that you can receive your treatment while abroad. This is an advantage to dialyse patients as it allows them to do freely what they did before although you couldn??™t go away for long periods. If a patient is in a hot country then it would be difficult as it would be very warm and they would become thirsty but because of the fluid restriction then they wouldn??™t be able to have as much fluids and might have to suck on an ice cube as an alternative. Some people never receive a transplant and are on dialyse for life. People are often embarrassed to go out in public as the also sweat a lot, the medication has side effects and you have to arrange your activities around dialyse. Patients have to avoid eating slats/crisps as they will make the patients thirsty.
People living with the condition live relatively normal lives. Although, adjusting to the effects of ESRF and the time spent on dialysis can be difficult. Aside from the ???lost time??™ (dialysis can take six to eight hours a day) most patients feel they have less energy. Many need to make changes in their work or home life, and can feel depressed when starting the process, or after several months of treatment. They are still able to carry out all the activities of daily living such as cleaning, shopping, cooking, doing the housework and looking after themselves in general. Both haemodialysis and peritoneal dialysis cause side effects. This is because of the way dialysis is carried out, and because dialysis can only compensate for the loss of kidney function to a certain extent. Fatigue is a common side effect on dialyse. There are several treatment options that may be of some use in helping to improve the symptoms of fatigue. You should consult your dietician because your diet may need to be adjusted in order to boost your energy levels. Second, research has shown that regular aerobic exercise can improve the symptoms of fatigue. One of the most common side effects of haemodialysis is low blood pressure (hypotension). Low blood pressure can be caused by the drop in fluid levels that occurs during dialysis. Low blood pressure can cause nausea and dizziness. Some people experience muscle cramps, usually in the lower legs, during a haemodialysis session. It is thought that this is because the muscles react to the fluid loss that occurs during haemodialysis. Many people receiving haemodialysis experience itchy skin. It is thought that this is due to a build-up of potassium in the body. Even though all these side effects may be experienced patients still lead a normal life and sometimes people they know don??™t even know that they are on dialyse.