Background:
The Fresenius Liberty Cycler has well-documented problems with its drain cycle. Just do a Google and find out for yourself. I am currently experiencing sleep-shattering alarms more than 50% of the time. Last night I had drain alarms on the second and third drains and had to get out of bed and stand upright until the drain was complete before I could go back to bed. Countless dialysis patients have experienced the klaxon-like blare of alarms going off during the drain cycle. This seemingly constant sleep deprivation is akin to the outlawed methodology used by our CIA in illegal intelligence-gathering efforts.
The go-to solution to the alarm situation advised by Fresenius personnel including my Team is to use laxatives such as Miralax. The concept on their part is that blockage in the colon leads to interruption of fluid flow which in turn leads to alarms. Clean intestines, no alarms.
I’m using ClearLAX by “equate” from Walmart as a cost-effective alternative to Miralax. ClearLAX has several Label Warnings including “Do not use if you have kidney disease, except under the advice and supervision of a doctor” and “use not more than 7 days.” I quizzed my team nurse about the latter warning and was informed to continue using the laxative, that “it was OK.”
Recently (February 22, 2023) I ran across an article in CNNHealth titled “Laxative use may be linked to dementia risk, study says.” The article is linked to CNNHealth. This produced yet another “itshay” moment on my behalf. Here I am, on Peritoneal Dialysis which is strongly associated with Cognitive Decline. Here I am on Peritoneal Dialysis while a stage two diabetic which is more strongly associated with Cognitive Decline. And here it goes yet again. I am on Peritoneal Dialysis and told to take laxatives so a company’s dialysis machine will operate. But emerging research suggests a strong and positive correlation between laxative use and Cognitive Decline. In football, this is called “piling on.” Just how many bullets can I take before I go down the primrose path with Cognitive Decline and end up in LaLa Land?
OK? So I felt a need (when younger I had a need for speed which is why I raced Porsches) to look into the subject of laxatives, dialysis, cognitive decline, etc. further. I perturbed my ever-present and all-knowing bot Notion, and the following with modest editing resulted. Be advised. Be aware. Be.
Notion has this to say:
Cognitive decline is a common concern among aging adults, and there is growing evidence that dialysis patients may be at even greater risk for cognitive impairment. I previously blogged about this. Additionally, many dialysis patients experience constipation, which often leads to the use of laxatives. (Such use has been prescribed for me by my Fresenius Dialysis Team.) However, recent research has suggested that the use of laxatives may contribute to cognitive decline in dialysis patients. In this blog post, we will explore the link between cognitive decline and laxative use in dialysis patients.
The Link Between Cognitive Decline and Dialysis
Dialysis patients are at an increased risk for cognitive decline due to a variety of factors. One of the most significant factors is the accumulation of toxins in the blood, which can occur when the kidneys are not functioning properly. These toxins can cross the blood-brain barrier and cause damage to brain cells, leading to cognitive impairment.
Other factors that may contribute to cognitive decline in dialysis patients include changes in blood pressure and blood sugar levels, as well as the use of medications that can affect brain function. These factors can all interact to create a perfect storm for cognitive impairment.
The Risk of Laxative Use in Dialysis Patients
Constipation is a common problem among dialysis patients, and laxatives are often used to alleviate symptoms. However, recent research has suggested that the use of laxatives may actually contribute to cognitive decline in these patients.
One study published in the Journal of Renal Nutrition analyzed data from 271 dialysis patients and found that those who used laxatives had a significantly higher risk of cognitive impairment than those who did not use laxatives. The researchers also found that the use of certain types of laxatives, such as stimulant laxatives, was associated with an increased risk of cognitive impairment.
Another study published in the Journal of the American Society of Nephrology followed 1,361 dialysis patients for two years and found that those who used laxatives had a 50% higher risk of developing dementia than those who did not use laxatives. The study also found that the use of laxatives was associated with a decline in cognitive function over time.
The mechanisms underlying the association between laxative use and cognitive decline are not yet fully understood. However, it has been suggested that the dehydration caused by laxatives may lead to a decrease in blood flow to the brain, which can damage brain cells and contribute to cognitive impairment. Additionally, some types of laxatives, such as stimulant laxatives, may disrupt the balance of neurotransmitters in the brain, which can also contribute to cognitive decline.
Alternative Treatments for Constipation in Dialysis Patients
While laxatives may be effective in relieving constipation, there are alternative treatments that may be less harmful to cognitive function. One option is to increase dietary fiber intake, which can help regulate bowel movements. Another option is to use stool softeners, which can make bowel movements easier and more frequent without the risk of dehydration.
In some cases, laxatives may still be necessary to manage constipation in dialysis patients. In these cases, healthcare providers should be cautious when prescribing laxatives and consider alternative treatments whenever possible. It may also be helpful to monitor cognitive function in patients who use laxatives regularly to detect any signs of cognitive decline early on. (For me, this has not happened at all. Nada, Zip, Zero.)
Conclusion
Cognitive decline is a serious concern for dialysis patients, and the use of laxatives to alleviate constipation may exacerbate the problem. While it is important to manage constipation in dialysis patients, healthcare providers should be cautious when prescribing laxatives and consider alternative treatments whenever possible. By taking steps to prevent cognitive decline, healthcare providers can help dialysis patients maintain their quality of life and cognitive function.
The bottom line if there is one:
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