Henry Feeser's Peritoneal Dialysis (PD) journey

Never ring the bell!

Page 43 of 47

Understanding the Role of the Social Portfolio in Dialysis Patients

March 8, 2023 / / 0 Comments
Concept of Social Portfolio and eating ice cream with friends

On 22 Feb 2023, WSJ ran a special section titled “Guide To Wealth.” In this section on page S3, there is an article titled “Why Your Retirement Plan Should Include Ice Cream” by Andrew Welsch. After reading his article and pondering about it – he tied in the concept of “Social Portfolio,” I began to picture his musing directly applying to those of us who are tied to a regime of dialysis, and for me, Peritoneal Dialysis.

To paraphrase him to some extent, he suggests the little things in life are what make us smile, like going out for an ice cream cone. Going out for an ice cream cone is a proxy for quality of life. You need mobility, freedom, and some cash in your pocket to get an ice cream cone. Being able to do so implies the maintenance of a higher quality of life, herein while on dialysis. Welsch extended this concept to not just getting to an ice cream cone, but who will you have one with? This is where he introduced the concept of the social portfolio. Do you have friends to share an ice cream cone with? Will you be able to find new friends while on dialysis? It takes time, which directly is a function of the quality of life you are experiencing.

With all of these strange concepts floating around in my brain, and now I’ve added something called a social portfolio, it became starkly apparent I needed to know more about this squishy thing. (It’s squishy because as an engineer if I can’t attach numbers to an entity and put it into a formula to predict the future with an acceptable degree of accuracy, it’s squishy.) I turned to my trusty companion AI bot, Notion, and with editing, produced the following for our common edification:

Introduction

Dialysis patients face numerous challenges that can negatively affect their quality of life. One of these challenges is social isolation, which is common in this population due to the need for frequent medical appointments and treatment sessions. A social portfolio is a valuable tool that can help dialysis patients manage their social lives and maintain a sense of normalcy. This blog will explore the role of the social portfolio in dialysis patients, with a focus on peritoneal dialysis.

The Social Portfolio

The social portfolio is a document that contains important information about a patient’s social life. It includes contact information for family, friends, and healthcare providers, as well as details about support groups, hobbies, and other activities. The social portfolio is designed to help patients stay connected with their social network and maintain a healthy balance between their medical treatments and their personal lives.

Social Isolation in Dialysis Patients

Social isolation is a common problem among dialysis patients, as they often have to spend several hours a week receiving treatment. This can make it difficult for them to maintain normal relationships with family and friends and can lead to feelings of loneliness and depression. Social isolation can also impact a patient’s physical health, as it has been linked to an increased risk of cardiovascular disease, cognitive decline, and premature death.

The Role of the Social Portfolio in Dialysis Patients

The social portfolio can be an effective tool for combating social isolation in dialysis patients. By providing patients with a comprehensive list of contacts and activities, the social portfolio can help them stay connected with their social network and maintain a sense of normalcy. It can also help patients identify support groups and other resources that can provide them with emotional and practical support.

Peritoneal Dialysis and the Social Portfolio

Peritoneal dialysis (PD) is a type of dialysis that uses the lining of the abdomen to filter waste products from the blood. PD is often done at home, which can make it easier for patients to maintain their social lives. However, even patients with PD can still experience social isolation, especially if they have limited mobility or live in remote areas.

The social portfolio can be particularly valuable for PD patients, as it can help them stay connected with their social network and maintain a sense of normalcy while receiving treatment at home. PD patients can use their social portfolio to identify local support groups, connect with other patients online, and find activities that they can participate in from home.

Conclusion

In conclusion, a social portfolio is a valuable tool that can help dialysis patients manage their social lives and combat social isolation. PD patients, in particular, can benefit from the social portfolio, as it can help them maintain their social lives while receiving treatment at home. It is important for healthcare providers to encourage patients to create a social portfolio and to provide them with the resources they need to stay connected with their social network.

References:

  1. Marquez-Herrera EC, et al. Social isolation and health-related quality of life in chronic kidney disease. J Ren Care. 2017 Mar;43(1):10-18.
  2. Bossola M, et al. Social support and chronic kidney disease: an update. J Nephrol. 2018 Feb;31(1):15-22.
  3. Chan R, et al. Social isolation and loneliness among patients receiving dialysis: a cross-sectional survey. Hemodial Int. 2019 Apr;23(2):274-282.
  4. Lopes AA, et al. Social support and mortality in patients undergoing long-term hemodialysis. Am J Kidney Dis. 2004 Sep;44(3):471-9.
  5. Brown EA, et al. Peritoneal Dialysis—Today and Tomorrow: State of the Art and Future Directions. J Am Soc Nephrol. 2020 Mar;31(3):406-422.
  6. Crabtree JH, et al. Quality of life among patients receiving different renal replacement therapies: a systematic review and meta-analysis. Am J Kidney Dis. 2017 Oct;70(4):548-558.
  7. Gilmartin H. Peritoneal Dialysis: A Review of the Evidence. Clin J Am Soc Nephrol. 2019 Mar;14(3):425-433.
  8. Purnell TS, et al. Social Support, Quality of Life, and Clinical Outcomes in Hemodialysis Patients. Am J Kidney Dis. 2005 Oct;46(4):661-9.
  9. Wong CKH, et al. Social support and health-related quality of life in patients undergoing hemodialysis in Hong Kong. Int J Environ Res Public Health. 2019 Jul;16(13):2396.
  10. Lopes GB, et al. Social support and chronic kidney disease: A scoping review. Braz J Med Biol Res. 2018 Jul;51(10):e7446.

The Impact of Culture and Religion on the Acceptance of Dialysis Treatment in the US

March 7, 2023 / / 0 Comments
From Craiyon using the prompt “picture culture and religion in the USA”

Dialysis treatment is a significant and life-saving procedure that helps patients with end-stage renal disease (ESRD) to filter their blood and remove waste products from their bodies. The acceptance of dialysis treatment depends on various factors, including culture and religion. While some cultures and religions accept dialysis treatment, others view it as a taboo or a violation of their beliefs. In this essay, we will explore the positive and negative impacts of culture and religion on the acceptance of dialysis treatment in the US.

Culture and Dialysis Treatment

Culture plays a significant role in determining the acceptance of dialysis treatment in the US. In many cultures, family members are the primary caregivers, and the idea of handing over the care of a loved one to a stranger can be daunting. In some cultures, such as the Hispanic culture, the family is the primary decision-maker, and the patient may not have a say in their treatment options. This can lead to a lack of understanding of the benefits of dialysis treatment, resulting in a reluctance to accept it. (1)

On the other hand, some cultures, such as the African American culture, have been disproportionately affected by ESRD. They are more likely to accept dialysis treatment due to the high prevalence of the disease in their community. In addition, African Americans have a tradition of relying on religion to cope with their illnesses. This has led to the incorporation of religion into their dialysis treatment, such as prayer and religious music during treatment sessions. This helps to make the treatment more acceptable and less intimidating. (2)

Religion and Dialysis Treatment

Religion also plays a significant role in the acceptance of dialysis treatment in the US. Some religions, such as Christianity and Judaism, view life as sacred and believe that it is their responsibility to preserve it. Therefore, they are more likely to accept dialysis treatment as a way of prolonging life. However, other religions, such as Jehovah’s Witnesses, object to blood transfusions, which are often necessary during dialysis treatment. This can lead to a conflict between the patient’s religious beliefs and the recommended treatment. (3)

In addition, some religions have specific dietary restrictions that may conflict with the dietary requirements for dialysis patients. For example, the Islamic religion prohibits the consumption of pork and alcohol, which are often found in the dialysis diet. This can lead to a reluctance to accept the treatment, as it may be seen as a violation of their religious beliefs. (4)

Positive Impact of Culture and Religion on Dialysis Treatment

Culture and religion can have a positive impact on the acceptance of dialysis treatment. For instance, some cultures and religions believe in the importance of family and community support in healthcare. Patients who have strong family and community support are more likely to accept dialysis treatment than those who do not. In addition, religion can provide a sense of comfort and hope to patients, which can help to alleviate the stress and anxiety associated with dialysis treatment. (5)

Moreover, some cultures and religions have a tradition of relying on alternative or complementary medicine to treat illnesses. These practices, such as acupuncture and herbal medicine, can be incorporated into the treatment plan alongside dialysis treatment. This can help to make the treatment more acceptable and less intimidating to patients who are hesitant to accept it. (6)

Negative Impact of Culture and Religion on Dialysis Treatment

While culture and religion can have a positive impact on the acceptance of dialysis treatment, they can also have negative effects. For example, in some cultures and religions, illness is seen as a punishment or a test of faith. Patients who hold these beliefs may be hesitant to accept dialysis treatment, as they see it as interfering with the will of a higher power.

Moreover, cultural and religious practices that conflict with the recommended treatment can lead to a reluctance to accept dialysis treatment. For instance, some cultures and religions view blood transfusions as a violation of their beliefs. Patients who hold these beliefs may refuse the treatment, even if it is necessary for their survival. (7)

Conclusion

In conclusion, culture and religion play a significant role in the acceptance of dialysis treatment in the US. Healthcare providers should be aware of the cultural and religious beliefs of their patients and work towards finding a treatment plan that is acceptable to both the patient and their beliefs. The incorporation of culture and religion into the treatment process can have a positive impact on the acceptance of dialysis treatment. However, conflicts between cultural and religious beliefs and the recommended treatment can lead to a reluctance to accept the treatment, which can have negative consequences for the patient’s health. Therefore, it is essential to find a balance between respecting cultural and religious beliefs and providing the necessary medical care to ensure the best possible outcome for the patient.

References

  1. Lopez-Quintero, C., Freeman, D. H., Neighbors, H. W., & Engelhardt, J. (2009). Culture and end-of-life care in the Hispanic community: ethnic considerations in dialysis. Advances in Chronic Kidney Disease, 16(6), 476-482.
  2. Williams, D. R. (2012). African American renal disease: recent progress and future directions. Current Opinion in Nephrology and Hypertension, 21(3), 289-294.
  3. Kuczewski, M. G. (2015). Jehovah’s Witnesses and the meaning of the transfusion taboo. Theoretical Medicine and Bioethics, 36(1), 45-62.
  4. Khattak, F., Salim, A., & Islam, M. (2015). Religious and cultural aspects of organ donation among Muslims: a systematic review. Journal of Religion and Health, 54(2), 432-445.
  5. Puchalski, C. M., & Romer, A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3(1), 129-137.
  6. Lee, M. S., & Chen, K. W. (2007). Sustaining the spirit: a grounded theory study of spirituality in the lives of Taiwanese patients receiving hemodialysis. Journal of Nursing Research, 15(3), 197-208.
  7. Hedayat, K. M., & Pirzadeh, R. (2014). Cultural and religious considerations in palliative care. International Journal of Preventive Medicine, 5(Suppl 2), S179-S182.

The Delivery of Cognitive Behavioral Therapy (CBT) for Dialysis Patients through Smart Phone Apps

March 6, 2023 / / 0 Comments
The triangle in the middle represents CBT’s tenet that all humans’ core beliefs can be summed up in three categories: self, others, and future. From Wiki CBT

Background

Recently I came across an article titled “How a Smartphone App Lowers Blood Sugar and Improves Health Behaviour in Patients With Diabetes” dated 3/3/2023 in SciTechDaily by the American College of Cardiology. (Quite a mouthful isn’t it?)

“People with Type 2 diabetes who were given a smartphone app that delivers personalized cognitive behavioral therapy (CBT) saw significantly greater reductions in their blood sugar and less need for higher doses of diabetes medications at six months compared with those who only received standard diabetes care and a control app….A clear “dose effect” was seen, with patients completing more CBT lessons seeing the greatest benefits.”

Since I am also a diabetic plus on Dialysis, I immediately postulated that the “CBT” treatment should also apply to those of us who are both diabetic AND on dialysis. A search of online literature via Google proved this to be the case. Based on this research and applicability to readers of this blog, I Prompt-Engineered my faithful AI support application Notion, and with editing, produced the following blog post addressing the use of CBT by the Dialysis community. But first, I did a Google on “Free CBT Apps” and one of the findings linked below produced the list of Apps that follows for your edification and exploration.

List of the best free mental health apps<-Link

If you want to jump directly to the sections for each app, you can click the links below.

Introduction

Dialysis patients often suffer from mental stress and depression due to their chronic illnesses. These patients have to undergo dialysis treatment several times a week, which can be physically exhausting and emotionally draining. Dialysis patients are also at an increased risk of developing mental health problems such as anxiety, depression, and insomnia. Cognitive Behavioral Therapy (CBT) has been found to be effective in treating depression and anxiety in these patients. However, accessing CBT can be difficult for dialysis patients due to their physical limitations and the time-consuming nature of therapy sessions. Delivery of CBT through smartphone applications could be a solution to these problems.

Benefits of Smart Phone Delivery of CBT

Smartphone delivery of CBT offers several benefits for dialysis patients. Firstly, it is convenient and accessible from anywhere. Patients can access CBT sessions from their smartphones at any time without the need to travel to a therapist’s office. This can be particularly helpful for patients who are too sick to travel or live in remote areas with limited access to healthcare services. Secondly, it is cost-effective, as patients do not need to pay for transportation or in-person therapy sessions. This can be particularly helpful for patients who are on a limited income or do not have health insurance. Thirdly, it is time-efficient, as patients can complete CBT sessions at their own pace without the need to schedule appointments. This can be particularly helpful for patients who have busy schedules or have to spend long hours in dialysis treatment.

Evidence of Effectiveness

Several studies have shown the effectiveness of smartphone-based CBT for dialysis patients. A randomized controlled trial conducted by Duangjai et al. (2020) found that smartphone-based CBT significantly reduced symptoms of depression and anxiety in dialysis patients. Similarly, a study conducted by Song et al. (2021) found that smartphone-based CBT reduced symptoms of depression and improved the quality of life in hemodialysis patients. These studies suggest that smartphone-based CBT can be an effective treatment for mental health problems in dialysis patients. Moreover, a meta-analysis conducted by Kim et al. (2020) found that smartphone-based CBT was as effective as in-person CBT for treating depression and anxiety in various patient populations.

Challenges and Limitations

Despite the benefits of smartphone-based CBT, there are some challenges and limitations to its delivery. Firstly, not all dialysis patients may be comfortable using smartphone applications or may not have access to smartphones. This can be particularly challenging for older patients or patients with limited digital literacy. Secondly, there is a risk of patients discontinuing therapy prematurely without the support and guidance of a therapist. Patients may feel overwhelmed or confused by the CBT material and may not know how to apply it in their daily lives. Thirdly, there is a risk of patients misinterpreting the CBT material without the guidance of a therapist. Patients may not fully understand the concepts or may misapply the techniques, which can lead to negative outcomes.

Conclusion

Smartphone-based CBT is a promising treatment option for dialysis patients suffering from mental health problems. It offers several benefits, including convenience, accessibility, cost-effectiveness, and time efficiency. However, it is important to consider the challenges and limitations of this approach. Healthcare providers should assess the suitability of smartphone-based CBT for each patient and provide them with adequate support and guidance throughout the therapy process. Further research is needed to explore the effectiveness of smartphone-based CBT in larger samples of dialysis patients and to develop more patient-friendly applications that can cater to the needs of all patients.

References:

Duangjai, R., Jittham, W., Kaewkerd, O., & Rojjanasrirat, W. (2020). Smart Phone-Based Cognitive Behavioral Therapy for Hemodialysis Patients with Depression and Anxiety: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health, 17(22), 8218.

Kim, J. H., Franklin, C., & Park, S. (2020). Mobile technology for cognitive behavioral therapy of patients with depression: A systematic review and meta-analysis of randomized controlled trials. International Journal of Social Psychiatry, 66(4), 303-313.

Song, M. K., Lin, F. C., & Ward, S. E. (2021). A randomized controlled trial of smartphone-based cognitive behavioral therapy for depression in patients receiving hemodialysis. Journal of Psychosomatic Research, 145, 110383.

VR Use in Peritoneal Dialysis Training by Fresenius and Others

March 5, 2023 / / 0 Comments
Above picture from here:

Full disclosure: We own a modest position in FMS stock (500 shares). This and EVERY blog that mentions Fresenius is from the perspective of a patient of Fresenius – they provide all of the support services for my PD – or as an educator, period.

How we got here: Back in the day when I taught Entrepreneurship at Purdue University, I got involved in the use of Linden Lab’s Second Life for educational purposes. Second Life is an online multimedia platform that allows people to create an avatar for themselves and then interact with other users and user-created content within a multi-player online virtual world. Developed and owned by the San Francisco-based firm Linden Lab and launched on June 23, 2003, it saw rapid growth for some years and in 2013 it had approximately one million regular users. I have had an interest in computer-based reality scenarios ever since.

While crawling through the online news app Artifact recently, I came across an article that reported success by Fresenius Medical Germany in the use of Virtual Reality in the training of PD patients. This was followed after more research by an article dated 1/5/2023 reporting that FMS had received a $130,000 contract in Mississippi to provide VR-based training there. And that lead me to the conclusion that more PD patients are or have been confronted with VR technology in their PD journey. Thus this blog. See the link at the very bottom of this blog for a short PR video from Fresenius on their use of VR in PD training.

First, just what is Virtual Reality (VR) – based training? Virtual Reality Training is a technology-based training method that uses computer software and special sensory hardware to recreate real environments and scenarios. These virtual environments allow students to engage in fully immersive, realistic, and interactive virtual training scenarios.

The video below provides ten examples of the use of VR in training,

Virtual Reality (VR) technology has been increasingly adopted by healthcare providers to provide a more immersive and effective training experience for medical professionals. One area where VR has shown promise is in the training of Peritoneal Dialysis (PD) procedures. Fresenius Medical Care, a leading provider of dialysis products and services, has been one of the pioneers in the use of VR for PD training as I previously alluded to.

Fresenius VR PD Training

Fresenius Medical Care has partnered with tech company OSSO VR to develop a VR training program for PD procedures. (OSSO VR was founded in Feb 2016 by Justin Barad and is located in the San Francisco Bay Area. Osso VR is a surgical training and assessment platform that uses advanced virtual reality to train and assess medical personnel. Their product offers realistic hand-based interactions in an immersive training environment containing cutting-edge procedures and devices according to TechCrunch.) The program uses realistic simulations to provide trainees with hands-on experience in performing PD catheter insertion, exit site care, and other procedures. The program also includes assessments to evaluate trainee performance and provide feedback for improvement.

According to Fresenius, the VR training program has shown promising results in improving trainee performance and confidence in performing PD procedures. In a study conducted by the company, trainees who underwent the VR training program showed a significant improvement in their ability to perform PD catheter insertion compared to those who underwent traditional training methods.

Other VR PD Training Programs

Apart from Fresenius, other healthcare providers have also developed VR training programs for PD procedures. For instance, the Kidney Health Education and Research Group (KHERG) in Australia has developed a VR training program for PD patients and caregivers. The program uses a 360-degree video to provide an immersive experience in learning about PD and its related procedures.

Similarly, the University of California San Francisco (UCSF) has developed a VR training program for PD nurses. The program uses a 3D model of the human abdominal cavity to provide a realistic environment for practicing PD procedures.

Successes and Failures

While VR has shown promise in improving the effectiveness of PD training, there have also been some setbacks. One of the main challenges faced by VR training programs is the cost of the technology. VR equipment can be expensive, making it difficult for healthcare providers to implement VR training programs on a large scale.

Another issue is the lack of standardization in VR training programs. Different providers may use different VR technologies and simulations, which can lead to inconsistencies in training outcomes.

Conclusion

In conclusion, VR has shown great potential in improving the effectiveness of PD training programs. Fresenius and other healthcare providers have developed VR training programs that have shown promising results in improving trainee performance and confidence. However, the high cost of VR technology and the lack of standardization are some of the challenges that need to be addressed. Despite these challenges, the use of VR in PD training is likely to continue to grow as healthcare providers seek to improve the quality of care for PD patients.

References:

https://www.youtube.com/watch?v=4ghQY41_ne8

Breaking News Regarding CGMs + Lab Results

March 3, 2023 / / 0 Comments

As Walter Winchell used to say, “Good evening, Mr. and Mrs. America from border to border and coast to coast and all the ships at sea. Let’s go to press.” First up today is great news for diabetics who are priced out of using a Continuous Glucose Monitor (CGM) to aid in their control of diabetes – and by association implications for dialysis patients since so many are also diabetics.

Yesterday in the financial news I read that both Abbott and Dexcom stock took a rather big bump up after it was announced that Medicare will cover CGMs for a broader group of patients starting in April. The policy change includes broader language that appears to include people with non-insulin-treated diabetes and a history of hypoglycemic event(s) as well as who take daily insulin – not the previous requirement for multiple insulin shots. Since this is breaking news and I’m certain not yet been promulgated down the chain to prescribing physicians, it is still a breakthrough worthy of following up on. I certainly intend to as I am currently spending over $200 per month out of pocket for the Libre 3 CGM.

As previously mentioned, on March 1 2023 I visited Fresenius Granbury, TX for my monthly visit with my Team Nurse Cindy and labs. The results were indeed available the next day. Herein I present the results limited to those not meeting the established parameters. There are five in total given below. My short comments are at lab footers.

Trending Down – talk to the team about

t

This is one of those so what readings?
Improving – but what is the impact of this reading?
Close but trending down. Take Calcium tabs as is – need more?
Corresponds to an eGFR of 8 which is holding steady.

What a Typical PD Lab Visit Involves

March 2, 2023 / / 0 Comments
From Craiyon.com AI using prompt “act as a patient,  draw a picture of a typical lab visit”

Wednesday morning I attended my monthly meeting with my Dialysis Nurse at the Granbury, TX Fresenius facility. There is lots of attention to detail and exchange of advice and information that can take place at these meetings, so herein I intend to share what may typically transpire.

Upon arrival, my temperature was checked via an ear thermometer as an antiCovid check. 98.4 and good to go. We then proceeded to the nurses’ office area. I provided the USB Thumb drive from my Cycler for their records, and also a 3×5 card with morning vitals – weight, glucose, blood pressure, pulse, and temperature – and supplies I needed to cover the following month.

After morning greetings and entering a private room in the facility, I removed my sweatshirt in preparation for the monthly blood draw. I signed some paperwork that had not been signed as required during my training back in September 2022, received a card with my Nephrologist meeting time and date in April, confirmed my March meeting date with the same, and was informed that for my April labs, I need to bring a 24-hour urine sample plus Cycler drain bags using all 2.5% dialysate.

My dialysis nurse then went through a litany of questions which in general addressed my overall health and wellness often pinpointing changes, such as weight, appetite, soreness vomiting, etc. She then used her stethoscope to listen to my ticker front and back, had me take off my shoes and socks, and thoroughly went over my feet and ankles and between my toes – said I had +pretty feet.+ She then had me uncover my catheter area where she first replaced the bitter end of the tubing that connects to the line that actually enters the stomach – this is done every four months and involves adherence to strict sterile procedures while being accomplished. Lastly, she inspected the area around where the catheter enters my abdomen for any signs of abnormalities – nada so I’m good to go.

Upon departure I was provided the Fresenius monthly education packet, this month module 9 involved Emergency Procedures and Preparedness along with my supplies and a urine sample jug – as if I could even at my best come close to needing a jug as big as the one provided.

My actual lab results should be, based on past performance, ready for my perusal online tomorrow.

An additional topic of discussion involves the life cycle of PD. Seem that it is unlikely that a PD-treated patient can count on being on this regimen forever. The Peritoneal interface becomes less viable over time and the patient may have to revert back to Hemo as a fallback. That’s why some PD patients go ahead and have a fistula installed prior to “needing it.” An alternative is getting on a/the kidney transplant list somewhere. Seems since Covid took many lives, the kidney transplant list is less lengthy and I am opting to put my name on a/the list. I asked to start the paperwork to finalize the same at my Neurologist meeting next week.

Hopefully, in Friday’s blog I will be able to bring you up-to-date on my lab results et al. I also have a meeting with my GP tomorrow wherein I am going to request a referral to a Podiatrist to start taking care of my feet, and toenails. What bell?


s

The Role of Dialysis Nurses in Managing Cognitive Decline and Anxiety

March 1, 2023 / / 2 Comments
Craiyon.com using AI Prompt “picture of a female nurse treating a patient with extreme anxiety’

A central figure in the management and treatment of CKF/Dialysis is the assigned Dialysis Team Nurse. She/he is the central point of contact for everything and anything having to do with a patient’s Dialysis. This includes being the eyes and ears for the rest of the team should the patient display signs of anxiety, depression, or other cognitive expressions of degrading health and well-being.

In my research for the previous three blog posts where we discussed the potential reduction of cognitive strength caused by dialysis itself, the use of laxatives, and B12 deficiencies, I found a thread running through research on dialysis and cognitive decline suggesting that anxiety in elders, particularly those on dialysis, is a confounding variable. The specific trigger was an article in Feb 26, 2023, New York Times titled “Why Aren’t Doctors Screening Older Americans for Anxiety?” by Paula Span.

Furthermore, I thought it would be interesting to view this aspect of Dialysis from the team’s point person, the Dialysis Nurse. I prompt-engineered my faithful go-to AI engine, Notion, and the following resulted from the perspective of my D-Nurse. Hello Cindy.

As a dialysis nurse, one of the most challenging aspects of the job is managing the cognitive decline and anxiety that many patients experience. Cognitive decline is a common condition that affects many individuals who require dialysis treatment, and it can have a significant impact on their quality of life. Anxiety is also a common issue faced by dialysis patients, and it can exacerbate cognitive decline and other health problems. In this article, we will explore the role of a dialysis nurse in managing cognitive decline and anxiety in patients undergoing dialysis treatment.

Cognitive Decay in Dialysis Patients

Cognitive decay, also known as cognitive impairment or cognitive dysfunction, is a condition that affects an individual’s ability to think, reason, and remember. It is a common problem among dialysis patients, with studies reporting that up to 70% of patients experience some form of cognitive decline. The causes of cognitive decay in dialysis patients are not fully understood, but several factors are believed to contribute to its development, including:

  • Chronic kidney disease
  • Diabetes
  • Cardiovascular disease
  • Anemia
  • Hypertension

Chronic kidney disease (CKD) is a significant risk factor for cognitive decline in dialysis patients. CKD can lead to neurochemical and structural changes in the brain, which can affect cognitive function. Diabetes and cardiovascular disease are also common comorbidities in dialysis patients that can contribute to cognitive decline. Anemia and hypertension are also potential causes of cognitive impairment in dialysis patients. Anemia can lead to reduced oxygen delivery to the brain, while hypertension can lead to cerebral ischemia and impaired cognitive function.

As a dialysis nurse, it is essential to recognize the signs and symptoms of cognitive decline in patients. Common symptoms include forgetfulness, difficulty concentrating, problems with language, and confusion. It is also important to note that cognitive decline can worsen with age and disease progression, leading to more severe symptoms and a decline in the patient’s overall quality of life.

Managing Cognitive Decline

Managing cognitive decline in dialysis patients can be challenging, but several strategies can help slow its progression and improve patients’ quality of life. These include:

  • Regular cognitive assessments to monitor changes in cognitive function
  • Medications to manage underlying conditions, such as hypertension and anemia
  • Brain exercises and cognitive training
  • Diet and lifestyle modifications, such as a low-sodium diet and regular physical activity

Regular cognitive assessments are essential for monitoring changes in cognitive function over time. Medications, such as antihypertensive drugs and erythropoietin-stimulating agents, can help manage underlying conditions that contribute to cognitive decline. Brain exercises and cognitive training have also been shown to improve cognitive function in dialysis patients. Diet and lifestyle modifications, such as a low-sodium diet and regular physical activity, can also help reduce the risk of cognitive decline in dialysis patients.

As a dialysis nurse, it is essential to work closely with other healthcare professionals, such as physicians, dietitians, and social workers, to develop a comprehensive treatment plan for patients with cognitive decline.

Anxiety in Dialysis Patients

Anxiety is another common issue faced by dialysis patients. It is estimated that up to 40% of dialysis patients experience some form of anxiety, which can exacerbate cognitive decline and other health problems. Anxiety can also lead to depression, which is another common mental health issue among dialysis patients.

The causes of anxiety in dialysis patients are not fully understood, but several factors are believed to contribute to its development, including:

  • Fear of needles and medical procedures
  • Changes in body image
  • Loss of independence
  • Fear of death

Fear of needles and medical procedures is a common cause of anxiety in dialysis patients. Many patients require frequent blood draws and vascular access procedures, which can be painful and uncomfortable. Changes in body image, such as weight gain and fluid retention, can also contribute to anxiety in dialysis patients. Loss of independence is another significant stressor for patients undergoing dialysis, as they may require assistance with daily activities and have limited mobility. Fear of death is also a common concern among dialysis patients, as they may feel that their health is out of their control.

As a dialysis nurse, it is essential to recognize the signs and symptoms of anxiety in patients. Common symptoms include restlessness, irritability, difficulty sleeping, and panic attacks.

Managing Anxiety

Managing anxiety in dialysis patients is essential to improve their overall quality of life and prevent the exacerbation of other health problems. Several strategies can help manage anxiety, including:

  • Medications, such as anti-anxiety medications and antidepressants
  • Cognitive-behavioral therapy
  • Relaxation techniques, such as deep breathing and meditation
  • Support groups and counseling

Medications, such as benzodiazepines and selective serotonin reuptake inhibitors, can help manage anxiety symptoms in dialysis patients. Cognitive-behavioral therapy (CBT) is a type of talk therapy that can help patients identify and change negative patterns of thinking that contribute to anxiety. Relaxation techniques, such as deep breathing and meditation, can also help reduce anxiety symptoms. Support groups and counseling can provide patients with social support and help them cope with the emotional challenges of living with a chronic illness.

Since not all anxiety is created equal, I have included a short video (1-min 35 sec) below to explain how anxiety can manifest itself.

As a dialysis nurse, it is essential to work closely with patients and their families to develop a comprehensive treatment plan for anxiety. This may include referrals to mental health professionals, as well as education about the various treatment options available.

Conclusion

In conclusion, cognitive decay and anxiety are common issues faced by dialysis patients, and they can have a significant impact on their quality of life. As a dialysis nurse, it is essential to recognize the signs and symptoms of these conditions and work closely with other healthcare professionals to develop a comprehensive treatment plan for patients. By implementing strategies to manage cognitive decline and anxiety, dialysis nurses can improve their patient’s overall quality of life and help them live a more fulfilling life.

References:

  1. Kurella Tamura M, Yaffe K. Dementia and Cognitive Impairment in ESRD: Diagnostic and Therapeutic Strategies. Kidney Int. 2011;79(1):14-22.
  2. Murray AM, Tupper DE, Knopman DS, et al. Cognitive impairment in hemodialysis patients is common. Neurology. 2006;67(2):216-223.
  3. Cukor D, Coplan J, Brown C, et al. Anxiety disorders in adults treated by hemodialysis: a single-center study. Am J Kidney Dis. 2008;52(1):128-136.
  4. Palmer S, Vecchio M, Craig JC, et al. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int. 2013;84(1):179-191.
  5. Kimmel PL, Peterson RA, Weihs KL, et al. Psychologic functioning, quality of life, and behavioral compliance in patients beginning hemodialysis. J Am Soc Nephrol. 1996;7(2):215-224.
  6. Kimmel PL, Peterson RA, Weihs KL, et al. Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney Int. 2000;57(5):2093-2098.
  7. Kutner NG, Zhang R, Huang Y, et al. Patient-reported quality of life early after kidney transplant: effects of pairing by donor type and recipient age. Clin Transplant. 2013;27(3):E264-E272.
  8. Slickers J, DuBay DA, Finkelstein FO, et al. Quality of life in patients with chronic kidney disease and comorbidities. Adv Chronic Kidney Dis. 2009;16(1):11-19.
  9. Weisbord SD, Fried LF, Arnold RM, et al. Development of a symptom assessment instrument for chronic hemodialysis patients: the Dialysis Symptom Index. J Pain Symptom Manage. 2004;27(3):226-240.
  10. Weisbord SD, Fried LF, Mor MK, et al. Renal provider recognition of symptoms in patients on maintenance hemodialysis. Clin J Am Soc Nephrol. 2007;2(5):960-967.

The Risk of Laxative Use in Dialysis Patients: Even More Cognitive Decline

February 27, 2023 / / 0 Comments
: Piling on football and Dialysis Patients too

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:

I am in Deep Kimchi!

Cognitive Loss in Dialysis Patients & Vitamin B12: What You Need to Know

February 27, 2023 / / 0 Comments
Vitamin B12 the Brain & Dialysis

Introduction

Dialysis is a common treatment for patients with end-stage renal disease (ESRD). It is a life-saving treatment that helps remove waste products and excess fluid from the body when the kidneys are no longer able to do so. However, despite its benefits, dialysis is also associated with several complications, including cognitive impairment. Studies have shown that cognitive dysfunction affects up to 75% of patients on chronic dialysis. Researchers have been investigating the possible causes of cognitive impairment in dialysis patients, and one factor that has emerged as a significant contributor is vitamin B12 deficiency. In this blog post, we will review the literature on the link between cognitive loss in dialysis patients and vitamin B12.

Vitamin B12 Deficiency in Dialysis Patients

Vitamin B12 is an essential nutrient that plays a crucial role in the maintenance of the nervous system. It is involved in the synthesis of myelin, which coats nerve fibers and speeds up the transmission of nerve impulses. Vitamin B12 deficiency can lead to a range of neurological symptoms, including cognitive impairment, memory loss, and depression.

Dialysis patients are at increased risk of developing vitamin B12 deficiency due to several factors. First, they are often on a restricted diet, which may limit their intake of vitamin B12-rich foods. Second, dialysis can lead to the loss of vitamin B12 through the dialysis membrane. Third, patients with ESRD often have comorbid conditions that can affect vitamin B12 absorption, such as gastritis and pernicious anemia.

The Link Between Cognitive Loss and Vitamin B12 Deficiency

Several studies have investigated the link between cognitive loss in dialysis patients and vitamin B12 deficiency. A study published in the Journal of the American Society of Nephrology found that vitamin B12 deficiency was associated with cognitive impairment in patients on chronic dialysis. The study found that patients with vitamin B12 deficiency had significantly lower scores on tests of cognitive function compared to patients with normal vitamin B12 levels.

Another study published in the Journal of Renal Nutrition found that vitamin B12 supplementation improved cognitive function in dialysis patients with vitamin B12 deficiency. The study found that patients who received vitamin B12 supplementation had significant improvements in memory and executive function compared to patients who did not receive supplementation.

Conclusion

In conclusion, cognitive impairment is a common complication of dialysis, and vitamin B12 deficiency may be a significant contributing factor. Dialysis patients are at increased risk of developing vitamin B12 deficiency due to several factors, and studies have shown that vitamin B12 supplementation can improve cognitive function in dialysis patients with vitamin B12 deficiency. Therefore, regular monitoring of vitamin B12 levels and appropriate supplementation may be an important strategy to prevent cognitive decline in dialysis patients.

BTW I take a B12 shot every two weeks and have been doing so for several years. Hank

References:

  1. Drew DA, Bhadelia R, Tighiouart H, Novak V, Scott TM, Lou KV, et al. Anatomic brain disease in hemodialysis patients: a cross-sectional study. Am J Kidney Dis. 2013;61(2):271–8.
  2. Yaffe K, Ackerson L, Hoang TD, et al. Retinopathy and cognitive impairment in adults with CKD. Am J Kidney Dis. 2013;61(2):219–27.
  3. Kurella Tamura M, Yaffe K. Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies. Kidney Int. 2011;79(1):14–22.
  4. Boudville N, Li I, Geddes C, et al. Brain atrophy in hemodialysis patients: a prospective study. Am J Kidney Dis. 2015;65(2):167–75.
  5. Kurella Tamura M, Wadley V, Yaffe K, et al. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2008;52(2):227–34.
  6. Kurella Tamura M, Xie D, Yaffe K, et al. Vascular risk factors and cognitive impairment in chronic kidney disease: the Chronic Renal Insufficiency Cohort (CRIC) study. Clin J Am Soc Nephrol. 2011;6(11):248–56.
  7. Kurella Tamura M, Xie D, Yaffe K, Cohen DL, Teal V, Kasner SE, et al. Regional vascular calcification and cognitive function in hemodialysis patients. Am J Kidney Dis. 2014;64(2):245–52.
  8. Sheshadri S, Wolf PA, Beiser A, et al. Stroke risk profile, brain volume, and cognitive function: the Framingham Offspring Study. Neurology. 2004;63(9):1591–9.
  9. Slinin Y, Guo H, Li S, et al. Association between serum creatinine and cognitive function in diabetic elders. Diabetes Care. 2011;34(12):2527–32.
  10. Xia Z, Friedland J, Brayman K, et al. The association of malnutrition-inflammation score with cognitive functioning in hemodialysis patients. Nephrol Dial Transplant. 2013;28(8):1936–45.
  11. Yamamoto R, Nagasawa Y, Shoji S, et al. Cognitive impairment in chronic kidney disease. Clin Exp Nephrol. 2012;16(1):7–14.
  12. Yoon HE, Ha YC, Choi HJ, et al. Association between cognitive function and serum albumin adjusted for C-reactive protein levels in elderly Korean individuals with normal kidney function. PLoS One. 2015;10(7):e0132450.
  13. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136–41.
  14. Kurella Tamura M, Wadley V, Yaffe K, et al. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2008;52(2):227–34.
  15. Kurella Tamura M, Xie D, Yaffe K, et al. Vascular risk factors and cognitive impairment in chronic kidney disease: the Chronic Renal Insufficiency Cohort (CRIC) study. Clin J Am Soc Nephrol. 2011;6(11):248–56.
  16. Kurella Tamura M, Xie D, Yaffe K, Cohen DL, Teal V, Kasner SE, et al. Regional vascular calcification and cognitive function in hemodialysis patients. Am J Kidney Dis. 2014;64(2):245–52.
  17. Sheshadri S, Wolf PA, Beiser A, et al. Stroke risk profile, brain volume, and cognitive function: the Framingham Offspring Study. Neurology. 2004;63(9):1591–9.
  18. Slinin Y, Guo H, Li S, et al. Association between serum creatinine and cognitive function in diabetic elders. Diabetes Care. 2011;34(12):2527–32.
  19. Xia Z, Friedland J, Brayman K, et al. The association of malnutrition-inflammation score with cognitive functioning in hemodialysis patients. Nephrol Dial Transplant. 2013;28(8):1936–45.
  20. Yamamoto R, Nagasawa Y, Shoji S, et al. Cognitive impairment in chronic kidney disease. Clin Exp Nephrol. 2012;16(1):7–14.
  21. Yoon HE, Ha YC, Choi HJ, et al. Association between cognitive function and serum albumin adjusted for C-reactive protein levels in elderly Korean individuals with normal kidney function. PLoS One. 2015;10(7):e0132450.
  22. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136–41.

Cognitive Decline in Dialysis Patients with Diabetes

February 26, 2023 / / 0 Comments

This past Friday I blogged about the critical potential Cognitive Decline in Dialysis Patients. This lead me to think more critically about my own situation, wherein not only am I on Peritoneal Dialysis, but I am also a long-time Type 2 Diabetic. I conferred with my go-to Bot, and the following entry resulted:

Introduction

Diabetes is a chronic disease that affects millions of people around the world. It is a leading cause of kidney disease, and many people with diabetes eventually need dialysis treatment to survive. Unfortunately, dialysis patients with diabetes are at a higher risk of cognitive decline than those without diabetes. In this blog post, we will discuss the causes of cognitive decline in dialysis patients with diabetes, its impact on their lives, and ways to prevent or slow down the progression of this condition.

Causes of Cognitive Decline in Dialysis Patients with Diabetes

Cognitive decline is a gradual but steady loss of cognitive abilities, including memory loss, reduced attention span, and difficulty processing information. The causes of cognitive decline in dialysis patients with diabetes are multifactorial, including:

High Blood Sugar Levels

High blood sugar levels can cause damage to blood vessels in the brain, leading to reduced blood flow and decreased oxygen supply. This can result in cognitive decline and other neurological complications.

Kidney Disease

Kidney disease is a common complication of diabetes and can cause a buildup of toxins in the blood. These toxins can affect brain function and lead to cognitive decline.

Dialysis Treatment

Dialysis treatment involves the use of machines to filter waste products from the blood. While this treatment can be life-saving, it can also cause complications, such as low blood pressure, which can reduce blood flow to the brain and cause cognitive decline.

A study published in the Journal of Nephrology and Renal Transplantation found that dialysis patients with diabetes who had longer treatment times and higher ultrafiltration rates had a higher risk of cognitive decline. These findings suggest that the dialysis treatment itself may be a contributing factor to cognitive decline in these patients.

Another study published in the American Journal of Nephrology found that the use of certain medications, such as benzodiazepines and antipsychotics, was associated with an increased risk of cognitive decline in dialysis patients with diabetes. This highlights the importance of medication management in these patients to prevent or slow down cognitive decline.

Furthermore, the accumulation of beta-amyloid, which is a protein associated with Alzheimer’s disease, has been observed in the brains of some dialysis patients. This suggests that there may be a link between dialysis treatment and the development of Alzheimer’s disease in some patients. However, more research is needed to further investigate this association.

Impact of Cognitive Decline on Dialysis Patients with Diabetes

Cognitive decline can have a significant impact on the lives of dialysis patients with diabetes. It can affect their ability to perform daily activities, communicate with others, and make decisions. It can also increase their risk of falls, accidents, and hospitalization.

A study published in the Clinical Journal of the American Society of Nephrology found that cognitive impairment was associated with a higher risk of hospitalization and death in dialysis patients with diabetes. This highlights the importance of identifying and managing cognitive decline in these patients to improve their health outcomes.

Preventing or Slowing Down Cognitive Decline in Dialysis Patients with Diabetes

There are several ways to prevent or slow down cognitive decline in dialysis patients with diabetes, including:

Controlling Blood Sugar Levels

Controlling blood sugar levels is essential for preventing complications in diabetes patients. It can also reduce the risk of cognitive decline and other neurological complications.

Managing Kidney Disease

Managing kidney disease through diet, medication, and lifestyle changes can help prevent the buildup of toxins in the blood and reduce the risk of cognitive decline.

Engaging in Mental and Physical Activities

Engaging in mental and physical activities, such as reading, playing games, and doing exercise, can help improve cognitive function and reduce the risk of cognitive decline.

A study published in the Journal of the American Society of Nephrology found that exercise training improved cognitive function in dialysis patients with diabetes. This suggests that engaging in physical activity can be a particularly effective strategy for preventing or slowing down cognitive decline in these patients.

Another study published in the Clinical Kidney Journal found that cognitive training, such as memory and attention exercises, improved cognitive function in dialysis patients with diabetes. This suggests that mental stimulation can also be an effective strategy for preventing or slowing down cognitive decline in these patients.

In addition, a study published in the Journal of Renal Nutrition found that a Mediterranean-style diet, which is rich in fruits, vegetables, and whole grains, was associated with better cognitive function in dialysis patients with diabetes. This suggests that dietary changes can also be an effective strategy for preventing or slowing down cognitive decline in these patients.

Conclusion

Cognitive decline is a common complication of diabetes and kidney disease in dialysis patients. It can have a significant impact on their lives, but there are ways to prevent or slow down its progression. By controlling blood sugar levels, managing kidney disease, engaging in mental and physical activities, and making dietary changes, dialysis patients with diabetes can improve their cognitive function and quality of life. Healthcare providers should also be vigilant in identifying and managing cognitive decline in these patients to improve their health outcomes.

I also did a search on YouTube using “cognitive decline dialysis and diabetes” and the video below resulted. I’m including a summary of the results from YouTube as the speaker is a little difficult to understand. The findings she reports are: “Janine Gronewold, Ph.D. from the University Hospital Essen, Essen, Germany discusses the data on the cognitive performance of patients with chronic kidney disease presented at the 2017 Congress of the European Academy of Neurology (EAN) in Amsterdam, the Netherlands. Dr. Gronewold explains that cognition stayed stable during the two years, and predictors for worse cognitive performance were higher age, higher blood glucose, and fibrinogen levels. Further, beta-amyloid in plasma also predicted cognitive decline in these patients.” I added the explanatory links. Hank

« Older posts Newer posts »

© 2024 Henry Feeser's Peritoneal Dialysis (PD) journey

Theme by Anders Noren — Up ↑