Henry Feeser's Peritoneal Dialysis (PD) journey

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the concept of cognitive reserve and how it may apply to
those on dialysis

March 20, 2023 / / 0 Comments
Cognitive Reserve – More is better!!

The Monday 3/13/2023 WSJ page A17 had an article by Allysia Finley titled “President Biden and the Science of Aging.” It was not so much about the President, as it was about the science of aging. The following is excerpted from this article: “ Alzheimer’s has also been linked to shorter telomeres. but puzzlingly, some people have all the
pathological hallmarks of the disease in their brains but don’t suffer symptoms. Scientists suspect these people have a higher cognitive reserve—that is, resilience to brain damage—which is associated with higher education mentally demanding occupations, and healthy lifestyles.” Emphasis on cognitive reserve added.


Here we go again with more unrecognized terminology, specifically Cognitive Reserve. Just what is this thing? Is it good? Should I go out and buy some? Is it like Canadian Reserve, the whiskey? So let’s get into this concept and ascertain how if at all, it applies to dialysis patients such as myself. But first, we are going to define just what the term Cognitive means, before talking about any Reserve.

The Definition of Cognitive

Cognitive refers to the mental processes involved in the acquisition, processing, and utilization of knowledge. These processes include perception, attention, memory, language, problem-solving, and decision-making. The cognitive perspective emphasizes how people think, perceive, remember, and learn. It is a multidisciplinary field that draws on psychology, neuroscience, linguistics, philosophy, and computer science to understand the complex workings of the mind.

Perception

Perception is the process of interpreting and organizing sensory information from the environment. It involves the detection of stimuli through the senses and the interpretation of those stimuli in the brain. Perception can be influenced by factors such as attention and expectations. For example, if you are looking for your friend in a crowded room, you are more likely to notice people who match your friend’s description.

Attention

Attention is the ability to focus on a particular stimulus while ignoring other stimuli. It is an essential component of cognitive processing because it allows us to filter out irrelevant information and concentrate on what is relevant. Attention can be influenced by factors such as motivation and emotion. For example, if you are highly motivated to complete a task, you are more likely to be able to focus your attention on that task.

Memory

Memory is the process of encoding, storing, and retrieving information. It is critical for learning and is involved in all aspects of cognition. Memory can be influenced by factors such as attention and rehearsal. For example, if you pay close attention to a lecture and review your notes afterward, you are more likely to remember the information.

Conclusion

In conclusion, cognitive processes are essential for understanding how the mind works. Perception, attention, and memory are just a few of the many cognitive processes involved in our daily lives. By studying cognitive processes, we can gain a deeper understanding of how we learn, think, and behave.

With this background into the many facets of “Cognitive,” let’s delve into Cognitive Reserve.


Abstract:
The concept of cognitive reserve has gained attention in recent years as a way to understand why some individuals may have better cognitive function despite brain damage or aging. Cognitive reserve refers to the brain’s ability to maintain cognitive function despite damage, injury, or aging. This blog explores the concept of
cognitive reserve and its application to individuals on dialysis. Dialysis patients are at a higher risk of cognitive impairment due to several factors, including comorbidities and the effects of dialysis. See several previous blogs on this subject. The blog will also examine the potential cognitive benefits of interventions that can increase cognitive reserve in dialysis patients, such as cognitive training and physical exercise.

Introduction:
Cognitive reserve refers to the brain’s ability to maintain cognitive function despite damage, injury, or aging. This concept has been studied extensively in the field of neurology to understand why some individuals may have better cognitive function despite brain damage or aging. The concept of cognitive reserve suggests that
individuals who engage in mentally stimulating activities, such as reading, playing games, or learning new skills, can build up a cognitive reserve that can help them maintain cognitive function even in the face of damage or aging. Dialysis is a treatment for individuals with end-stage kidney disease. While dialysis can
extend the lives of these patients, it is associated with several adverse effects, including cognitive impairment. Dialysis patients are at a higher risk of cognitive impairment due to several factors, including comorbidities and the effects of dialysis. Studies have
shown that up to 70% of dialysis patients have some form of cognitive impairment, ranging from mild cognitive impairment to dementia.


The concept of cognitive reserve may have important implications for dialysis patients. Interventions that can increase cognitive reserve may help dialysis patients maintain cognitive function and improve their quality of life. The purpose of this blog is to explore the concept of cognitive reserve and its application to individuals on dialysis.


Cognitive Reserve:
The concept of cognitive reserve suggests that individuals who engage in mentally stimulating activities can build up a cognitive reserve that can help them maintain cognitive function even in the face of damage or aging. This cognitive reserve is thought
to be the result of the brain’s ability to adapt and reorganize itself in response to new experiences and challenges. Individuals who engage in mentally stimulating activities, such as reading, playing games, or learning new skills, are thought to build up a cognitive reserve that can help them maintain cognitive function even in the face of damage or aging.


Several factors have been identified as potential contributors to cognitive reserve, including education, occupational complexity, social engagement, and physical exercise. Education has been identified as a significant contributor to cognitive reserve,
with higher levels of education associated with better cognitive function in later life. Occupational complexity, or the complexity of an individual’s job, has also been identified as a potential contributor to cognitive reserve. Individuals with more complex jobs, such as lawyers or doctors, may have a greater cognitive reserve due to the
mental challenges of their work. Social engagement, or the extent to which an individual interacts with others, has also been identified as a potential contributor to cognitive reserve. Individuals who engage in social activities, such as volunteering or participating in clubs, may have a greater cognitive reserve due to the mental challenges of social interaction. Finally, physical exercise has also been identified as a potential contributor to cognitive reserve. Studies have shown that regular exercise can improve cognitive function in older adults and
may help to build cognitive reserve.


Cognitive Reserve and Dialysis:

Dialysis patients are at a higher risk of cognitive impairment due to several factors, including comorbidities and the effects of dialysis. Comorbidities, or other medical conditions, are common in dialysis patients and can contribute to cognitive impairment. The effects of dialysis, including changes in blood pressure and the accumulation of toxins, can also contribute to cognitive impairment in these patients. As a result, up to 70% of dialysis patients have some form of cognitive impairment, ranging from mild cognitive impairment to dementia. However, interventions that can increase cognitive reserve may help dialysis patients maintain cognitive function and improve their quality of life. Cognitive training, for example, has been shown to improve cognitive function in dialysis patients. Cognitive training involves engaging in mentally stimulating activities, such as memory exercises or problem-solving tasks, to improve cognitive function. One study found that dialysis patients who participated in cognitive training had significant improvements in cognitive function compared to those who did not participate in the training. Physical exercise has also been identified as a potential contributor to cognitive reserve in dialysis patients. Regular exercise can help to improve cognitive function in older adults and may help to build a cognitive reserve in dialysis patients. One study found that dialysis patients who engaged in regular physical exercise had better cognitive function than those who did not exercise regularly.


Conclusion:
The concept of cognitive reserve suggests that individuals who engage in mentally stimulating activities can build up a cognitive reserve that can help them maintain cognitive function even in the face of damage or aging. Dialysis patients are at a higher risk of cognitive impairment due to several factors, including comorbidities and the effects of dialysis. However, interventions that can increase cognitive reserves, such as cognitive training and physical exercise, may help dialysis patients maintain cognitive function and improve their quality of life. Further research is needed to determine the
most effective interventions for increasing cognitive reserve in dialysis patients and understanding the underlying mechanisms of cognitive reserve in this population.

References:

  1. Stern Y. Cognitive reserve in aging and Alzheimer’s disease. The Lancet
    Neurology. 2012;11(11):1006-1012. doi:10.1016/S1474-4422(12)70191-6
  2. Kurella Tamura M, Yaffe K. Dementia and cognitive impairment in ESRD: diagnostic
    and therapeutic strategies. Kidney international. 2011;79(1):14-22.
  3. Drew DA, Tighiouart H, Scott TM, Lou KV, Shaffi K, Weiner DE, Sarnak MJ.
    Cognitive function and all-cause mortality in maintenance hemodialysis patients.
    American Journal of Kidney Diseases. 2015;65(2):303-311.
  4. Wu YH, Huang JW, Chen CY, et al. Cognitive training on hemodialysis patients: a
    randomized controlled trial. American Journal of Kidney Diseases. 2012;60(2):252-
    259.
  5. Johansen KL, Painter PL, Sakkas GK, Gordon P, Doyle J, Shubert T. Effects of
    resistance exercise training and nandrolone decanoate on body composition and
    muscle function among patients who receive hemodialysis: a randomized,
    controlled trial. Journal of the American Society of Nephrology. 2006;17(8):2307-
    2314.
  6. Kitzman DW, Brubaker PH, Herrington DM, et al. Effect of endurance exercise
    training on endothelial function and arterial stiffness in older patients with heart
    failure and preserved ejection fraction: a randomized, controlled, single-blind trial.
    Journal of the American College of Cardiology. 2013;62(7):584-592.
  7. Cheng YH, Tsai YC, Tung CW, Chen YC, Chang HH, Lee YC. The effects of
    exercise on cognitive function in older adults with cognitive impairment: a
    systematic review and meta-analysis of randomized controlled trials. Journal of
    Clinical Medicine. 2019;8(2):217.
    Untitled 5
  8. Schmidt R, Hofer E, Bouwman FH, Buerger K, Cordonnier C, Fladby T, Galimberti
    D, Georges J, Heneka MT, Hort J, et al. EFNS-ENS/EAN Guideline on concomitant
    use of cholinesterase inhibitors and memantine in moderate to severe Alzheimer’s
    disease. European Journal of Neurology. 2015;22(6):889-898.
  9. Valenzuela M, Sachdev P. Brain reserve and dementia: a systematic review.
    Psychological Medicine. 2006;36(4):441-454.
  10. Andrade LP, Gualano B, Delfino LD, Rodrigues RN, Santos PC, Lima FR, Roschel
    H, Benatti FB, Bonfa E, Artioli GG. Effects of exercise training on neurovascular
    function and cognition in hemodialysis patients. American Journal of PhysiologyRenal Physiology. 2018;315(6):F1659-F1668

Impact of dialysis on marriages: Does dialysis correlate with divorce?

March 19, 2023 / / 0 Comments

In the March 18-19, 2023, issue of WSJ, page C3 of the REVIEW section ran an article titled “For Long-Term Health And Happiness, Marriage Still Matters.” In this article by Brendan Case and Ying Chen, a new Harvard study shows that getting married is linked to significantly better physical and mental health for women. They also studied staying married versus getting divorced and found divorce was associated with consistently worse subsequent health and well-being, including greater loneliness and depression and lower levels of social integration. The research article published in the journal Global Epidemiology is linked here.

This got me musing about the correlation, if any, between dialysis and being married and/or getting divorced because of dialysis. I searched Google using terms like “marriage, divorce, and dialysis” and combinations without any real results – some feel-good articles, but nothing research worthy. I’m signed up for Chatbot 4.0 and asked it. With some editing on my part, this is what AI had to say.

Dialysis can significantly impact marriages due to the physical, emotional, and financial strain it puts on patients and their families. However, it’s important to note that while there may be a correlation between dialysis and divorce, correlation does not necessarily imply causation.

  1. Physical impact: Dialysis patients often experience fatigue, reduced energy levels, and restricted diets. This may limit their ability to participate in activities they used to enjoy with their spouse, which could potentially strain the relationship.
  2. Emotional impact: The stress of managing a chronic illness, attending frequent medical appointments, and facing an uncertain future can lead to anxiety and depression for both the patient and their spouse. Emotional support is crucial, but both partners may struggle to cope with the changes in their lives.
  3. Financial impact: The cost of dialysis treatments, medications, and related healthcare expenses can significantly burden a family. This may lead to disagreements over finances and additional stress within the marriage.
  4. Time commitment: Dialysis treatments can be time-consuming, especially for in-center hemodialysis patients. This may reduce the quality time couples spend together, negatively affecting their relationship.
  5. Intimacy and sexual health: Dialysis can change body image, self-esteem, and sexual function. These factors may contribute to decreased sexual intimacy, which can strain a marriage.

Not all marriages experience these challenges to the same extent, and some couples may become even stronger and more resilient in the face of adversity. Support from family, friends, and healthcare professionals, as well as open communication and empathy, can help couples navigate the difficulties of living with dialysis.

While it’s difficult to pinpoint a specific correlation between dialysis and divorce, research has shown that chronic illness, in general, can increase the risk of marital dissatisfaction and divorce. Each marriage is unique, and various factors contribute to the success or failure of a relationship. Therefore, it’s important to consider the individual circumstances of each couple when examining the impact of dialysis on their relationship.

References

  1. Kimmel, P. L., Cukor, D., Cohen, S. D., & Peterson, R. A. (2007). Depression in end-stage renal disease patients: A critical review. Advances in Chronic Kidney Disease, 14(4), 328-334.
  2. Kimmel, P. L., Peterson, R. A., Weihs, K. L., Simmens, S. J., Alleyne, S., Cruz, I., & Veis, J. H. (2000). Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney International, 57(5), 2093-2098.
  3. Song, M. K., Lin, F. C., Gilet, C. A., Arnold, R. M., Bridgman, J. C., & Ward, S. E. (2011). Patient perspectives on informed decision-making surrounding dialysis initiation. Nephrology Dialysis Transplantation, 26(11), 3739-3744.
  4. Finkelstein, F. O., West, W., Gobin, J., Finkelstein, S. H., & Wuerth, D. (2010). End-of-life care for the end-stage renal disease patient: A nephrologist’s perspective. Clinical Nephrology, 74(Suppl 1), S61-S65.
  5. Trief, P. M., Grant, W., Elbert, K., & Weinstock, R. S. (1998). Family environment, glycemic control, and the psychosocial adaptation of adults with diabetes. Diabetes Care, 21(2), 241-245.
  6. Schmaling, K. B., & Sher, T. G. (2000). The psychology of couples and illness: Theory, research, and practice. American Psychological Association.

These references should provide some background information on the impact of chronic illness, including end-stage renal disease, on relationships. For the most recent and directly related research, I recommend searching academic databases like PubMed, Google Scholar, or similar platforms.

Followup to Yesterday’s Blog re Dialysis

March 17, 2023 / / 1 Comment

I did jinx myself. Last night my Liberty Cycler on the first drain blared its klaxon horn and I had to get out of bed for 5 minutes or so until the indicated drain volume was over 1700 mL. At this point, I got back into bed and it remained mute for the remainder of the night. Just as five nights in a row without alarms does not a whole story make, so does a single alarm on a given night not indicate a trend. I still maintain that Fresenius knows full well the problems with their Cycler (notice that I refer to the cycler/problem as “theirs”) and not the dialysis patient’s problem to correct with MiraLAX or other nonconventional workarounds.

The weather in North Texas tends to be sinusoidal in the Spring, with broad swings between cool/cold and warm weather. The last couple of days we had fronts coming through from the West, and now the temperature is in the forties. In a couple of days, it will be back in the 70s/80s. The trick is to time your planned outside activities accordingly. One thing I can plan but not around the weather is walking our Golden Retriever Dickens. Come rain, shine, heat, cold, he gets his due exercise, and by association, I get mine. I read yesterday in the WSJ not less than 20 minutes of brisk walking at my seniority is necessary and sufficient exercise. Thanks to Dickens, which is why I agree to raise yet another Golden, I am getting my exercise in.

My last follow-up concerns the Egyptian Goose/Geese that built a nest on a valley of our roof. Below are four pictures. The first shows the pair out in front of our home when they were casing the joint. The remaining three are in-session closeups of the nesting female. All of the shots were made with my new – to me Samsung S23-Ultra phone which has a 200-megapixel lens and great zoom capability. What does this have to do with Dialysis you ask? Part of smelling the coffee and Mindfulness, for don’t you see?

A Little of This, a Little of That re Dialysis

March 16, 2023 / / 0 Comments
Egyptian Goose

Look at this as an unstructured chat about whatever comes to mind that’s taking place in my universe as we speak.

Yesterday Fresenius made a delivery of Dialysate for the next thirty days. They started with the delivery of several boxes of manual Dialysate, which is not usable in the Liberty Cycle Dialysis Machine I am currently using. I had to refuse delivery, get on the line with Fresenius Custom Service, and reorder several boxes of Dialysate. What happened doesn’t matter. Perhaps I screwed up the order when I placed it using the PatientHub app, or Fresenius. Regardless, a corrected order is now scheduled for 3/27/23. My Dialysis Nurse through the backdoor got involved and called to make certain I have enough Dialysate to last until delivery which I think I do.

The bottom line here is that Fresenius is taking care of me. I have seen gripes that Fresenius is not responsive which I find NOT to be the case.

For the past five nights, I have not received ANY Drain Alarms!!!!! So what is different? After constant probing by my Dialysis Team, I finally started taking MiraLAX daily. I took the cover off the plastic line leading from the Cycler to my catheter, and I rerouted the line on my stomach that leads from the catheter outbound to the Cycler – three changes that appear to be working. I’ll keep you posted. Hope I haven’t jinxed my current success by reporting the same.

I’ve been thinking about Mindfulness, and how we can apply this concept to our daily lives. As a starting point, during my morning walk with our Golden Retriever Dickens, I have with malice of forethought paused several times, just to “smell a rose,” listen to morning sounds of birds chirping, mowers mowing, PickleBall balls going whack, and in general, being more observant and at peace with our surroundings. It is working. I seem to be less tense and more in tune with nature.

Speaking of Nature, we have an Egyptian Goose that has laid eggs on the roof dormer over our master bedroom. The pair paraded around our and our neighbor’s yards for several weeks. They went missing for several days, and a neighbor who faces our bedroom side of the house said he has been watching them come and go on the leaf and stick nest they mashed up on our roof. Looks like we will be blessed with little geese running around our yard in the near future. Worse things could certainly happen.

Lastly, before my kidney failure, my fighting weight was around 162 pounds, and stayed there for years and years. As my kidneys started failing and my eGFR became lower and lower, I started losing weight. Just before I started Dialysis, I was down to 137 pounds. Once I started on Dialysis, initially I did not gain any appreciable weight. In the last month or so, I have been able to start gaining weight again and am up to about 150 pounds. There is a God.

Exploring the economic and financial implications of dialysis and its impact on society

March 15, 2023 / / 0 Comments
And they keep on rising!

Abstract:

Dialysis is a medical procedure that is critical for the survival of patients with end-stage renal disease (ESRD). This blog explores the economic and financial implications of dialysis and its impact on society. The cost of dialysis treatment is high, and the burden of the cost falls on both patients and society. In this blog, we analyze the various costs associated with dialysis treatment, including direct and indirect costs. Additionally, we examine the economic impact of ESRD on individuals and the broader society. We also discuss the financial implications of the increasing prevalence of ESRD, including the impact on healthcare systems and insurance providers. The findings of this blog suggest that the cost of dialysis is significant and that the increasing prevalence of ESRD has significant economic and financial implications for individuals and society.

Introduction:

Dialysis is a medical procedure that is essential for patients with end-stage renal disease (ESRD). ESRD is a condition in which the kidneys lose their ability to function adequately, and dialysis is necessary to remove waste products and excess fluid from the body. Dialysis treatment is costly, and the cost burden falls on both patients and society. According to the National Kidney Foundation, the cost of dialysis treatment in the United States is approximately $90,000 per year per patient (National Kidney Foundation, 2021).

Direct and Indirect Costs of Dialysis:

The cost of dialysis treatment includes direct and indirect costs. Direct costs include expenses related to dialysis treatment, such as the cost of equipment, supplies, and medication. Indirect costs refer to the expenses associated with ESRD, such as lost wages and productivity, transportation costs, and caregiver costs. A study conducted by the University of Michigan found that the average annual cost of dialysis treatment in the United States was $86,600, of which 44% were indirect costs (Erickson et al., 2019).

Economic Impact of ESRD:

ESRD has a significant economic impact on individuals and society. Individuals with ESRD face financial difficulties due to the cost of dialysis treatment, lost wages, and reduced quality of life. The economic burden of ESRD extends beyond individuals to the broader society. A study conducted by the American Kidney Fund found that Medicare spending on ESRD patients increased from $12.7 billion in 2000 to $35.9 billion in 2016 (American Kidney Fund, 2021). The same study found that the annual cost of ESRD to the US healthcare system was $114 billion in 2016.

Financial Implications of Increasing Prevalence of ESRD:

The prevalence of ESRD is increasing, and this trend has significant financial implications for healthcare systems and insurance providers. The Centers for Disease Control and Prevention (CDC) estimates that the number of people with ESRD in the United States will reach 1.5 million by 2030 (Centers for Disease Control and Prevention, 2021). As the prevalence of ESRD increases, the cost of dialysis treatment and the burden on healthcare systems and insurance providers will also increase. A study conducted by the University of Michigan found that Medicare spending on ESRD patients increased by 2.2% per year between 2006 and 2013 (Erickson et al., 2019).

Conclusion:

Dialysis is a critical medical procedure for patients with end-stage renal disease, but the cost of dialysis treatment is high, and the burden of the cost falls on both patients and society. The economic impact of ESRD on individuals and society is significant, and the increasing prevalence of ESRD has significant financial implications for healthcare systems and insurance providers. As the number of individuals with ESRD continues to rise, there is a pressing need to address the economic and financial implications of dialysis.

One approach to addressing the economic and financial implications of dialysis is to focus on prevention and early intervention. This could involve promoting healthy lifestyles, increasing awareness of the risk factors for ESRD, and improving access to screening and diagnostic tests. Additionally, efforts to develop new treatments and technologies that can improve the efficiency and effectiveness of dialysis could help to reduce the cost burden of this treatment.

In conclusion, the economic and financial implications of dialysis are significant and extend beyond individual patients to the broader society. Addressing these challenges will require a multi-faceted approach that involves prevention, early intervention, and innovative solutions. By working together to address these challenges, we can ensure that individuals with ESRD receive the care they need while minimizing the economic burden on patients and society.

References:

American Kidney Fund. (2021). The costs of kidney disease. Retrieved from https://www.kidneyfund.org/advocacy/the-costs-of-kidney-disease/

Centers for Disease Control and Prevention. (2021). Chronic kidney disease surveillance system. Retrieved from https://www.cdc.gov/kidneydisease/publications-resources/ckd-surveillance-system/index.html

Erickson, K. F., Winkelmayer, W. C., & Chertow, G. M. (2019). Cost of end-stage renal disease in the United States. Kidney international, 96(3), 580-585.

National Kidney Foundation. (2021). Cost of kidney disease. Retrieved from https://www.kidney.org/news/newsroom/factsheets/Cost-of-Kidney-Disease

World Health Organization. (2017). Global costs of non-communicable diseases. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/254731/WHO-NMH-NVI-17.9-eng.pdf?sequence=1&isAllowed=y

Mindfulness: How Practicing It Can Benefit You While On Dialysis

March 14, 2023 / / 0 Comments

Practicing mindfulness and gratitude can contribute to happiness while on dialysis. Mindfulness involves being present and aware of one’s thoughts and feelings without judgment. Dialysis treatments can be stressful, and it is easy to become overwhelmed by negative thoughts and emotions. However, practicing mindfulness can help to reduce stress and anxiety levels. Additionally, focusing on things to be grateful for can help to shift one’s perspective and create a more positive outlook. It can be as simple as being grateful for the healthcare team, supportive loved ones, or even the ability to receive life-sustaining treatments.

Mindfulness is the act of being fully present, aware of where you are and what you’re doing, and not being overwhelmed by what’s going on around you. It’s a simple yet powerful practice that can help you to manage your stress, increase your focus, and improve your overall well-being. All of us on Dialysis need mindfulness to the nth degree.

Benefits of Mindfulness

  1. Reduces Stress: Mindfulness has been shown to reduce stress levels by allowing individuals to focus on the present moment instead of worrying about the future or dwelling on the past. This can lead to a decrease in cortisol levels, which is a hormone that is released in response to stress.
  2. Improves Focus: Practicing mindfulness regularly can improve your ability to focus and pay attention. By staying present in the moment, you can improve your productivity and reduce distractions.
  3. Boosts Overall Well-being: Mindfulness has been linked to several physical and mental health benefits, including improved sleep, reduced anxiety, and lower levels of depression. It can also help individuals to develop a greater sense of self-awareness and compassion toward others.

How to Practice Mindfulness

There are many ways to practice mindfulness, and what works best for one person may not work for another. Here are a few common techniques to try:

  1. Meditation: Meditation is a popular mindfulness technique that involves sitting quietly and focusing on your breathing or a specific object. It can be practiced for just a few minutes each day and can have a significant impact on your overall well-being.
  2. Body Scan: A body scan involves lying down and focusing on each part of your body, starting with your toes and working your way up to your head. This can help you to become more aware of your physical sensations and can be a useful tool for relaxation.
  3. Mindful Eating: Mindful eating involves paying close attention to the experience of eating, including the taste, smell, and texture of the food. By doing so, you can develop a greater appreciation for your food and become more aware of your body’s hunger and fullness cues.

Conclusion

Mindfulness is a simple yet powerful practice that can help you to manage stress, improve focus, and boost overall well-being. By incorporating mindfulness techniques into your daily dialysis routine, you can develop a greater sense of self-awareness and compassion towards others, and lead a more fulfilling life. So why not give it a try today? And be happy! See Ted-Talk below for more on Mindfulness please.

Understanding the Stigma Associated with Dialysis and How it Affects Patients’ Lives

March 13, 2023 / / 0 Comments

Since being on PD, I have observed people’s responses to being informed of my being subjected to this medical life-supporting procedure. Many appear not to know how to act. They don’t make eye contact. Say their sorry (whatever that means, sorry for me or glad it’s not them?). They both change the subject or perfunctorily address it and then move rapidly on. They appear to be uncomfortable as if they were coming into contact with a leper. It has reached a point where I am considering not even relating my situation to people at all. Keep in mind that dialysis has been a cloud over my head for upwards of thirty years because of an ever-declining eGFR, diabetes, etc.

That got me thinking this phenomenon is not unique to me. There have to be studies of this mainly social-interaction observation and thus this blog. I talked to my assistant Notion, and the following results provide insight to research in the area of the Stigma associated with Dialysis and its impact on Patients’ lives. There are actually two major types of Stigma, Social and Self. I’ve embedded a YouTube video from Kahn Academy at the blog’s end if you should desire to know more about the concept of Stigma in more depth.

Introduction

Dialysis is a life-saving procedure for patients with end-stage renal disease (ESRD). However, patients undergoing dialysis often face various challenges, including the stigma associated with the procedure. The stigma can have negative effects on the patient’s psychological and social well-being. This blog explores the stigma associated with dialysis and its impact on patients’ lives.

Stigma Associated with Dialysis

Stigma is defined as a negative attribute that marks an individual as different from others and leads to social rejection or discrimination. Patients with ESRD who undergo dialysis are often stigmatized due to the visible physical changes associated with the procedure. These physical changes may include loss of hair, weight gain, and fatigue, among others.

In addition to physical changes, dialysis patients also face stigmatization due to misconceptions and myths surrounding the procedure. This stigma is often perpetuated by the media and society at large. Patients undergoing dialysis may be viewed as weak or lazy, and this can lead to discrimination or social exclusion.

The stigma associated with dialysis is a complex issue that requires further exploration. A study conducted by Rothermundt et al. (2007) found that depression and anxiety were prevalent among patients on chronic hemodialysis. The study also identified several risk factors for depression and anxiety, including age, gender, and comorbidities. The findings suggest that the stigma associated with dialysis can have a profound impact on a patient’s psychological well-being.

Impact of Stigma on Patients’ Lives

The stigma associated with dialysis can have a significant impact on patients’ lives. Dialysis patients may feel ashamed, embarrassed, or shunned due to the stigma, which can lead to social isolation and withdrawal from society. This can, in turn, lead to depression, anxiety, and other psychological problems.

Moreover, the stigma associated with dialysis can also affect patients’ physical health. Patients who feel stigmatized may be less likely to adhere to their dialysis treatment regimen, leading to poor health outcomes. This can also lead to decreased quality of life and increased healthcare costs.

A study conducted by Brown et al. (2010) found that the quality of life on peritoneal dialysis was better than on hemodialysis for older patients. The study identified several factors that contributed to the difference, including greater flexibility and independence with peritoneal dialysis. The findings suggest that addressing the stigma associated with dialysis can improve patient’s quality of life.

Addressing Stigma Associated with Dialysis

There is a need to address the stigma associated with dialysis to improve patients’ psychological and social well-being. This can be achieved through education and awareness campaigns aimed at dispelling myths and misconceptions surrounding dialysis. Healthcare providers can also play a role in addressing stigma by providing support and counseling to patients.

In addition, patients can play an active role in addressing stigma by speaking out about their experiences and advocating for their rights. This can help to reduce the stigma associated with dialysis and improve patients’ lives.

A study conducted by Newman et al. (1997) found that a multidimensional anemia education program for dialysis patients improved patients’ knowledge and self-efficacy. The program also led to improvements in hemoglobin levels and reduced the need for erythropoietin-stimulating agents. The findings suggest that education programs can be an effective way to address the stigma associated with dialysis.

Conclusion

In conclusion, the stigma associated with dialysis can have significant negative effects on patients’ lives. It is important to address this stigma through education, awareness, and advocacy to improve patients’ psychological and social well-being. Healthcare providers, patients, and society at large can all play a role in reducing the stigma associated with dialysis.

Further research is needed to better understand the stigma associated with dialysis and its impact on patients’ lives. The findings can help inform the development of interventions aimed at addressing the stigma and improving patients’ quality of life.

References

1. Devins GM, Mendelssohn DC, Barré PE, Taub KJ, Binik YM. Predialysis psychoeducational intervention extends survival in CKD: a 20-year follow-up. Am J Kidney Dis 2005;46:1088-98.
1. Brown EA, Johansson L, Farrington K, Gallagher H, Sensky T, Gordon F, et al. Broadening options for long-term dialysis in the elderly (BOLDE): differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients. Nephrol Dial Transplant 2010;25:3755-63.
2. Finkelstein FO, Finkelstein SH. Depression in chronic dialysis patients: assessment and treatment. Nephrol Dial Transplant 2000;15:1911-3.
3. Goffman E. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice Hall; 1963.
4. Link BG, Phelan JC. Conceptualizing Stigma. Annu Rev Sociol 2001;27:363-85.
5. Martin-McDonald K, Rogers JR. Stigma and chronic kidney disease: stepping out of the shadows. Nephrol Nurs J 2011;38:291-8.
6. Newman SP, Blumenthal S, Revicki DA, et al. The effects of a multidimensional anemia education programme for dialysis patients. Nephrol Dial Transplant 1997;12:300-6.
7. Pifer TB, McCullough KP, Port FK, et al. Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS. Kidney Int 2002;62:2238-45.
8. Rothermundt C, Krüger B, Meran J, et al. Depression and anxiety in patients on chronic hemodialysis: prevalence, incidence, and risk factors. Kidney Int 2007;72:1081-8.
9. Weiner DE, Scott T, Giang LM, et al. Cardiovascular disease and cognitive function in maintenance hemodialysis patients. Am J Kidney Dis 2011;58:773-81.

Cognitive Burden and Dialysis: What research relates?

March 12, 2023 / / 0 Comments
From Craiyon with prompt “comic picture of person with cognitive burden”

Recently I read an article written by a Type 1 Diabetic about the use of a Continuous Glucose Monitor as a central tenant to their diabetic control. In this article, the author used the term “Cognitive Burden” several times. I am not familiar with this terminology due in part to my concentration on STEM courses in college to obtain Engineering degrees. When possible, I try to backfill this void in my education. The following is such an attempt, a modest research effort on what is behind the term “Cognitive Burden” and how, if at all, does it relate to my current situation – being on Dialysis?

Introduction:

Cognitive burden refers to the mental workload or demand imposed on an individual’s cognitive resources, including attention, memory, and decision-making capacity. Patients undergoing dialysis have a high cognitive burden due to the nature of the treatment, which involves long hours of treatment, multiple sessions per week, and strict dietary and fluid restrictions. The aim of this blog is to explore the cognitive burden experienced by dialysis patients and its impact on their quality of life.

Literature Review:

Dialysis is a life-saving treatment for patients with end-stage renal disease (ESRD) who have lost the ability to filter waste and excess fluids from their bodies. However, the treatment imposes a high cognitive burden on patients, which can affect their quality of life. The cognitive burden may be attributed to the following factors:

  1. Treatment duration and frequency: Dialysis treatment sessions can last for several hours-or every night in my case for PD patients, and patients may require multiple sessions per week. This can lead to fatigue, boredom, and reduced cognitive function.
  2. Dietary and fluid restrictions: Dialysis patients are often required to follow strict dietary and fluid restrictions to prevent fluid overload and electrolyte imbalances. This can be challenging for patients and requires constant vigilance and self-monitoring, which can add to the cognitive burden.
  3. Medication management: Dialysis patients often take multiple medications, including those for managing their kidney disease, comorbidities, and side effects of dialysis. Managing these medications can be complex and require careful attention to dosing, timing, and interactions with other medications. Using myself as an example, I am taking 16 different medications, all of which except one – OsteoBiflex, are prescribed. I take some at breakfast, some at night, one MWF, two every two weeks, etc. It gets complicated in a hurry.

Several studies have investigated the impact of a cognitive burden on dialysis patients’ quality of life. One study found that cognitive impairment was associated with poorer health-related quality of life and increased mortality in dialysis patients (Kurella Tamura et al., 2010). Another study found that cognitive function was a significant predictor of adherence to fluid restrictions among dialysis patients (Song et al., 2018). A systematic review also identified cognitive impairment as a common problem among dialysis patients and highlighted the need for further research to explore interventions to improve cognitive function in this population (Kurella Tamura et al., 2016).

Discussion:

The high cognitive burden experienced by dialysis patients can have significant implications for their quality of life and treatment outcomes. Patients may struggle with adhering to dietary and fluid restrictions, managing medications, and coping with the physical and emotional demands of dialysis. These challenges can lead to anxiety, depression, and reduced treatment adherence, which can, in turn, negatively impact their health and well-being.

To mitigate the cognitive burden experienced by dialysis patients, several interventions have been proposed. These include cognitive training programs, educational interventions to improve self-management skills, and technological solutions such as mobile apps and wearable devices to assist with medication management and monitoring of fluid intake. However, further research is needed to determine the efficacy and feasibility of these interventions in improving cognitive function and reducing the cognitive burden of dialysis.

Conclusion:

The cognitive burden is a significant challenge for dialysis patients, affecting their quality of life, treatment adherence, and outcomes. More research is needed to identify effective interventions to mitigate the cognitive burden experienced by dialysis patients and improve their cognitive function and quality of life. Healthcare providers should be aware of the cognitive burden imposed by dialysis treatment and work with patients to develop strategies to manage the cognitive demands of their treatment.

References:

  1. Kurella Tamura, M., Yaffe, K., Hsu, C. Y., Yang, J., Sozio, S., Fischer, M., … Go, A. S. (2010). Cognitive impairment and poor health literacy are associated with mortality in hemodialysis. Journal of the American Society of Nephrology, 21(11), 1970–1979.
  2. Song, M. K., Lin, F. C., Gilet, C. A., Arnold, R. M., Bridgman, J. C., Ward, S. E., & Dunbar-Jacob, J. (2018). Symptom clusters in patients with end-stage renal disease prior to starting dialysis. Journal of Pain and Symptom Management, 55(1), 153-160. doi: 10.1016/j.jpainsymman.2017.08.026
  3. Kurella Tamura, M., Xie, D., Yaffe, K., Cohen, D. L., Teal, V., Kasner, S. E., … Hsu, C. Y. (2016). Vascular risk factors and cognitive impairment in chronic kidney disease: The Chronic Renal Insufficiency Cohort (CRIC) Study. Clinical Journal of the American Society of Nephrology, 11(7), 1144–1153. doi: 10.2215/CJN.11951115

Results Meeting with Dialysis Team Friday 3-10-2023

March 10, 2023 / / 0 Comments
From Craiyon using prompt draw a comic picture of a dialysis team

As advertised I met with my Dialysis Team (monthly meeting) with myself, my nurse, my dietician, my neurologist, and the social worker in attendance. I met with my Dialysis Nurse ahead of the meeting and we went over several of my lab readings and in general, how’s it going kind of things. Now to the Discussion list i published in the last blog post:

  1. Get on the Kidney transplant list ASAP: The social worker provided me with folders with pertinent information from three kidney transplant centers in the general area. We briefly discussed using the VA also. Tha ball in now in my court to pour through the folders, decide with whom to apply, and start the process.
  2. Discuss Cognitive Decline and Dialysis. In general, this was not discussed. We did discuss dietary aspects to the extent I was provided with a protein bar to try out, and if I tolerated it OK, will be provided with a supply by Fresenius. Also, I am to receive a subscription to vitamins that are kind to kidneys. Nothing on testing, nothing on what to be on the watch for, re cognitive decline, briefly discussed Laxative Use but the Team’s position was it is still needed for the Liberty Cycler to operate properly. On B12 intake, it was the position of the team that it was the responsibility of my GP to handle all aspects of B12 which I’m OK with.
  3. Lab Results Discussion. On item c., the wKr/V goal is 1.7 or higher which I meet so I’m OK there. Regarding Calcium, there is a corrected value on the full lab report of 8.8 which puts my readings within goal limits. I was told, paraphrasing, that usually, corrected calcium is calculated whenever albumin levels are not in the normal range, thus allowing an estimate as if the albumin values were normal. Lastly, we discussed why I listed Creatinine – just for reference. Since I am on dialysis, creatinine results are not just what my kidneys are doing but impacted by dialysis also my nephrologist inputted.
  4. My Dialysis Nurse recorded all of my vitals, I was asked if I needed any supplies, and the dietician promised an additional listing of supplemental protein products which I have received.

The bottom line is I’m hanging in there and good to go for another month “Underway as before.”

Discussion Points Dialysis Team Meeting Friday, 3-10-23

March 9, 2023 / / 0 Comments

Going into this Friday’s Fresenius Dialysis Team Meeting starring me, last Monday I provided my Dialysis Nurse and Dietician the correspondence below in the form of an email. It, as you can see for yourself, provided specifics of what I anticipated, as a minimum be covered. Tomorrow’s blog will provide a synopsis of the results. My bottom line herein is that you have a responsibility to be an active participant in your care. Who can care better for you than yourself?

Discussion Points for 3/10/2023 Henry Feeser Dialysis Team Meeting

  1. Get on the kidney transplant list ASAP per discussion last week
  • Discuss Cognitive Decline & Dialysis:
    • Dietary Aspects – Specific areas to improve?
    • Testing – What does Fresenius do/support?
    • What be on the watch for? You? Me? Spouse?
    • Laxative Use – Linked to dementia risk?
    • Test for B12 – Complete Blood Count (CBC)? Am not aware of any testing to insure my adequacy?
    • Vitamin Supplements/Dietary Modifications to combat?
  • 3/1/2023 Lab Results Discussion:
    • Albumin was 3.4 and declined. 4.0 or higher. What do about it?
    • nPCR 1.2 or higher. (normalized Protein Catabolic Rate) Less than 0.8 equates to malnutrition but I am gaining weight and good appetite. BMI is just under 24.
    • wKr/V 1.95 goal 2.0 or higher (getting enough dialysis to adequately clean my blood) w=weekly?, K=clearance liters/minute, t=time duration of treatment, V=volume-amount of body fluid liters
    • Calcium 8.3 goal 8.5 to 10. Down from Feb reading. Increase Meds per our previous discussions?
    • Creatinine bouncing around low sixes which maps to an eGFR of 8. Recent VA/LabCorp was 9
  • Bottom Line: How am I doin’???? Active Management – I own IT!!!!

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