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?
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:
Kurella Tamura M, Yaffe K. Dementia and Cognitive Impairment in ESRD: Diagnostic and Therapeutic Strategies. Kidney Int. 2011;79(1):14-22.
Murray AM, Tupper DE, Knopman DS, et al. Cognitive impairment in hemodialysis patients is common. Neurology. 2006;67(2):216-223.
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.
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.
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.
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.
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.
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.
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.
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 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.
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:
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.
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.
Kurella Tamura M, Yaffe K. Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies. Kidney Int. 2011;79(1):14–22.
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.
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.
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.
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.
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.
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.
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.
Yamamoto R, Nagasawa Y, Shoji S, et al. Cognitive impairment in chronic kidney disease. Clin Exp Nephrol. 2012;16(1):7–14.
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.
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.
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.
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.
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.
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.
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.
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.
Yamamoto R, Nagasawa Y, Shoji S, et al. Cognitive impairment in chronic kidney disease. Clin Exp Nephrol. 2012;16(1):7–14.
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.
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.
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
From AI Dalla-E Prompt “sketch cognitive decline dialysis patients”
This morning I received in my email the Fresenius Medical Care Newsletter – February 2023 Issue. In it, there is an article entitled Cognitive Dysfunction in Kidney Disease from the Global Medical Office Dialogues. It started off by stating “People with chronic kidney disease (CKD) often present with cognitive dysfunction ranging from mild impairment to dementia.” That got my attention. The article went on to report, inter alia, that some 70-83% of dialysis patients suffer cognitive dysfunction. Since I fall in the general population of those on dialysis, I dug deeper into this topic. Following is what my personal bot had to say. The emphasis is mine. The entire video from the aforementioned dialogue is at the blog end. Hank
Introduction
Dialysis is a treatment for patients with end-stage kidney disease. It removes waste and excess fluid from the blood when the kidneys can no longer perform these functions. While dialysis can prolong the lives of patients, it can also cause cognitive decline. According to studies, up to 70% of dialysis patients suffer from cognitive impairment, with varying degrees of severity. This blog post will discuss the causes and effects of cognitive decline in dialysis patients, as well as potential treatments.
Causes of Cognitive Decline in Dialysis Patients
The exact cause of cognitive decline in dialysis patients is unknown, but it is believed to be multifactorial. One possible cause is the accumulation of toxins in the blood. When the kidneys are not functioning properly, waste products build up in the blood, which can affect brain function. Additionally, dialysis patients often experience fluctuations in blood pressure, which can also impact cognitive function. Other factors that may contribute to cognitive decline include anemia, hypoxia, inflammation, and oxidative stress. Furthermore, depression and anxiety are common in dialysis patients, and these conditions can lead to cognitive impairment.
Effects of Cognitive Decline in Dialysis Patients
Cognitive decline can have a significant impact on the quality of life of dialysis patients. Patients may experience memory loss, difficulty concentrating, and slowed thinking. These symptoms can make it challenging to complete everyday tasks, such as managing medications, preparing meals, and paying bills. Additionally, cognitive decline can increase the risk of falls and accidents, as well as reduce the ability to perform activities of daily living independently. Furthermore, cognitive impairment has been associated with increased mortality in dialysis patients.
Diagnosis of Cognitive Decline in Dialysis Patients
The diagnosis of cognitive impairment in dialysis patients can be challenging because it may be difficult to differentiate cognitive decline from other causes of mental impairment, such as depression or delirium. Neuropsychological testing can be used to assess cognitive function, and imaging studies can help identify structural brain abnormalities. Additionally, screening tools such as the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) can be used to detect cognitive impairment in dialysis patients.
Potential Treatments for Cognitive Decline in Dialysis Patients
There is no cure for cognitive decline, but there are several treatments that may help slow its progression. One potential treatment is improving dialysis efficiency. Studies have shown that patients who receive more efficient dialysis have better cognitive function. Additionally, treating depression and anxiety can improve cognitive function in dialysis patients. Pharmacological agents, such as antidepressants and anxiolytics, may be used to treat these conditions. Finally, regular exercise has been shown to improve cognitive function in the general population, and may also be beneficial for dialysis patients. Furthermore, nutritional interventions, such as vitamin supplementation and dietary modification, have been proposed as potential treatments for cognitive decline in dialysis patients.
Conclusion
Cognitive decline is a common problem for dialysis patients, with a significant impact on their quality of life and increased mortality. The exact cause of cognitive decline is unknown, but it is believed to be multifactorial. Diagnosis can be challenging, but neuropsychological testing and imaging studies can be used to assess cognitive function. While there is no cure for cognitive decline, there are treatments that may help slow its progression. Improving dialysis efficiency, treating depression and anxiety, regular exercise, and nutritional interventions are potential treatment options. By addressing the cognitive decline in dialysis patients, we can improve their quality of life, reduce the risk of accidents, and help them live more independently.
The full video interview of the session that gave rise to this blog entry is provided below for your edification. It is roughly 28 minutes long. May you not be in this population. Hank
When it comes to dialysis, it’s not just about the physical aspects of the treatment. Mental health and social well-being are also crucial, and incorporating social fitness and mindfulness practices can greatly improve the quality of life for those on dialysis. Dialysis is a lifesaving treatment for those with kidney failure, but it can also be a challenging experience both physically, mentally, and socially.
Midfulness
Social Fitness
Social fitness involves engaging in physical activities with others, which not only promotes physical health but also helps build meaningful connections. For dialysis patients, social fitness can be challenging due to the restrictions of their treatment schedule and physical limitations. However, there are still ways to incorporate social fitness into their routine, such as joining a walking group or participating in chair exercises with other patients during treatment. These activities not only provide physical benefits but also create a sense of community and support.
One example of a social fitness program for dialysis patients is the Kidney Health Initiative’s “Fit for Dialysis” program. This program provides exercise videos and resources for patients to engage in physical activity during their treatment sessions. By participating in these activities, patients not only improve their physical health but also reduce feelings of isolation and improve their overall well-being.
Mindfulness
Mindfulness is the practice of being present and fully engaged in the current moment. For dialysis patients, mindfulness can help reduce stress and anxiety associated with treatment. Mindfulness can involve simple practices such as deep breathing exercises or meditation. Additionally, some dialysis centers offer mindfulness-based stress reduction programs that teach patients techniques to manage their emotions and improve their mental well-being.
One study published in the Clinical Kidney Journal showed that a mindfulness-based stress reduction program improved the mental well-being of dialysis patients. The program included breathing exercises, body scans, and mindfulness meditation. After participating in the program, patients reported lower levels of anxiety, depression, and stress.
Dialysis
Dialysis can be a challenging experience for patients, both physically and mentally. Patients may experience physical discomfort or pain during treatment, which can lead to feelings of anxiety or stress. Additionally, the strict treatment schedule and dietary restrictions can be isolating and difficult to manage.
Incorporating social fitness and mindfulness practices can greatly improve the overall quality of life for dialysis patients. By engaging in physical activities with others and practicing mindfulness techniques, patients can not only improve their physical health but also reduce stress and anxiety associated with treatment.
Conclusion
Social fitness and mindfulness practices are crucial for maintaining the mental and physical well-being of dialysis patients. By incorporating these practices into their routine, patients can improve their quality of life and create a sense of community and support. It’s important for healthcare providers to recognize the importance of social fitness and mindfulness and offer resources for patients to incorporate these practices into their treatment plans. To date, my Fresenius Team has not broached this subject matter with me at all. As research continues to show the benefits of these practices, it’s important to continue to explore new ways to support the mental and physical well-being of dialysis patients. Writing this blog is one outlet for me. Hank
Last Monday when I visited my cardiologist he suggested that it was time to again check my carotid arteries. In the past, they have been partially blocked but not to an extent to cause grievous concern. Recall that I was subjected to a triple bypass in 2015 so we keep a close watch on my pump and its associated plumbing. Yesterday I went back to his office where a tech conducted the carotid ultrasound test. Other than having the goop spread over my neck, it went well. It will be days before I hear back from the doc, if at all until the next appointment some 8 months down the road
Thought I would entertain us with what the chatbot would have to say about this test. I input “carotid ultrasound” and below is what was returned.
A carotid sonogram, also known as a carotid ultrasound, is a non-invasive imaging test that uses high-frequency sound waves to create images of the carotid arteries in the neck. These arteries are located on either side of the neck and are responsible for supplying blood to the brain.
During the test, a technician will apply a gel to the skin over the carotid arteries and use a handheld device called a transducer to send sound waves through the skin and into the arteries. The sound waves bounce off the blood vessels and create images that can be viewed on a monitor.
The images can help doctors evaluate the flow of blood through the carotid arteries and look for signs of narrowing or blockages, which can increase the risk of stroke. Carotid sonograms are often used as a screening tool for people who are at risk for stroke or who have symptoms such as dizziness or weakness on one side of the body.
Not too bad a description. I did not edit anything at all. I next did a Google on the subject and received a massive amount of hits. One of the hits, from Webmd, had this to say:
The carotid arteries are major blood vessels in the neck that supply blood to the brain, neck, and face. There are two carotid arteries, one on the right and one on the left. In the neck, each carotid artery branches into two divisions:
The internal carotid artery supplies blood to the brain.
The external carotid artery supplies blood to the face and neck.
Like all arteries, the carotid arteries are made of three layers of tissue:
Intima, the smooth innermost layer
Media, the muscular middle layer
Adventitia, the outer layer
The carotid sinus, or carotid bulb, is a widening of a carotid artery at its main branch point. The carotid sinus contains sensors that help regulate blood pressure. The carotid artery pulse can normally be felt in the neck by pressing the fingertips against the side of the windpipe, or trachea.
So now we all know more about carotids than we ever need to know. Tomorrow more on social fitness and what’s coming up more often in the popular press about this concept.
A couple of days ago I reported that by moving the tubing layout on my stomach catheter I had resolved the constant (seemingly) problem of cycler alarms while draining. Alas, such is not the case; I went a record four nights without any alarms, then for the last four, without significant alteration of the tubing configuration, I have had alarms. Looks like we’re back to the drawing board.
Last night was a bad night anyway because the constant intake of the “keep your bowels cleaned out to improve draining adage” caught up with me and I was up several times during the night confined to the bathroom. Luckily for us, I can reach both a potty and a shower while tethered.
There is an interesting article in the Wall Street Journal’s 2/21/23 issue page A11 entitled “Friends Found a Radical Cure For Loneliness: the Phone Call” by Julie Jargon. In it, she references the eight decades of research from Harvard that suggests close relationships are the most critical component of health, happiness, and longevity more so than exercise and a good diet. I blogged about this research not too long ago.
Being lonely leads to chronic stress and has been found to be more detrimental to health than being obese. Read that again and take these words of wisdom to heart!
One of the women she studied, a Ms. Doulton Wiltshire, made it a goal to have one phone call, one video call, and one in-person meetup with friends each week. I think people on Dialysis should embrace this concept. We actually receive most of our interpersonal relationships mainly with our Dialysis Team and other attending physicians. Enlarging our social circles to include reaching out to past friends and associates seems to be a way to increase engagement on our part and in so doing perhaps increase our access to the finite pool of happiness we’re all given at birth. I’m going to give it a shot.
The only viable alternative to going on dialysis is a kidney transplant. The whole deal on kidney transplants is nontransparent seeming by design. Dylan Walsh writing in the March 2023 issue of Wired Magazine lays out the ins and outs of the kidney transplant world. I have provided a link to his article therein titled “Sell your kidney, save my life.” I strongly suggest you read and study the article for a closer look at this phenomenon. Hank
