Data from last night’s Cycler performance – screenshot
Recall from yesterday’s blog that Fresenius Tech Support recommended turning off alarms to solve my cycler throwing alarms consistently during most night’s cycler use. With alarms off, last night on drain one I received another alarm, this one with the Stop Button flashing and a warning not to stop the patient’s drain or something like that. I was 3/4 asleep on my feet. After pressing the OK button, and staying on my feet upright, the drain proceeded until about 1700 mL had been drained, at which point I got back in bed.
Referring to the screenshot at the blog top, fill times are pretty much right on the 10-minute spec. Dwell times, except the last one, are NOT on the 120-minute spec. Drain volumes are all over the place – disregard the Cycle 0 327 drain, that was left over from yesterday’s cycle. So we have drains of 1944, 1516, 1965, and 2217. Drain time of 36, 17, 25, and 20 where only the last meets spec of 20. Disregarding the 327 Cycle 0, we had UF (fluid left in gut) of -57, -485, -37, and + 292, for a net of -287mL. This is over a cup (236.6 mL) of fluid left. I expect when I hook up to the cycler tonight that drain 0, that is upon startup, there will be a drain of at least this amount.
Add to the above that my weight was up another pound to 154 this morning leads me to the conclusion that all is not right in my Fresenius-lead treatment at this point. I have passed this data on to my Team Nurse and we’ll have to see what falls out. The alarm panel is at the blog’s end.
CGM: Had a call this morning from my pharmacy ExpressScripts about another matter, and at the conversation close asked about the status of my Freestyle Libre 3 order. I was told that it had been approved and should ship somewhere around April 4, 2023. Until such time as I have firm shipping info, I’m not going to cancel my out-of-pocket order which is prudent given we ARE dealing with government resources!
VA: I happened to check the status of my request to the VA to up my kidney failure to 100% from 80% due to the fact that I am now on Dialysis. I saw that it had been approved and that the rating package with info on how they arrived at their decision was in the mail. I received the package and was informed that the monthly disability payment had been increased which I did not ask for or anticipate. Turns out that since with the new rating of 100% for being on Dialysis, and the fact that I have another non-related rating of at least 60% (actually have a triple-bypass at 60% plus a host of others), I now fall under Special Monthly Compensation tables which resulted in the unanticipated increase. Blind squirrels etc.
As stated in my blog entry last Friday, yesterday (Monday), I called Fresenius Tech Support concerning the seemingly continuous throwing of drain alarms by my Liberty Cycler. We spent over 20 minutes with the tech rep requesting data from various cycler screens. As of the phone call, the cycler was throwing drain alarms for exactly 50% of the evening dialysis treatments. Let me explain this so those not acquainted with the cycler have a little more insight into what I’m talking about.
The Cycler is a computer-controlled pumping device that controls the three phases of my evening dialysis treatment. After turning on and plugging my catheter into the cycler, it first checks to see if any fluid is left in my stomach cavity and if so pumps it out. It defaults to 50mL or more of such fluid. If there previously had been a “good” drain, the machine can’t remove at least 50mL of fluid so guess what, yes, it throws an alarm. You have to manually bypass this phase to move on.
From here on what takes place depends on what your nephrologist has ordered. From me, I am on 8000 mL total fluids, pumped in and out of my stomach lining 2000mL at a time, for four cycles total. So initially 2000mL is pumped in – called “fill,” which is left in my lining for two hours – called dwell, then pumped out – called a drain. Each fill is supposed to take 10 minutes, and each drain is 20 minutes. If you add up the total fill times 4×10=40 minutes and drain 4×20 = 80 minutes, you have 120 minutes or two hours ideally spent on fill and drain, plus 4×2 hrs = 8 hrs total dwell. So altogether, 10 hours in an ideal world. My best time is 10 hrs 11 minutes, and the worst is right at 11 hours. The problem is with the drain. For me, as previously stated, 50% or more of the time my system has problems with drains. Is it me, the cycler, or God knows?
On the me vector, I have been doing EVERYTHING my team has suggested. We tested my plumbing, and everything is working properly. I am on my second cycler; I have read that some patients have gone through more than 10 with drain problems. The internet is full of complaints by patients concerning drain problems with the Fresenius Cycler. The PR fluff Fresenius has released on their new cycler touts improvement in this area which is moot acknowledgment on their part of the cycler’s intrinsic problems with the current cycler. I guess other than the cycler, it’s in God’s bailiwick.
This morning I received a call from my Dialysis Team Nurse who had been contacted by Fresenius Tech Support. The bottom line is this: Tech Support’s solution to grossly excessive alarms is to turn them off. I was directed to a section in the Cycler manual called “Flow Alerts” wherein it states that if both flow alert and flow alert sound are set to “NO” the sound will not occur, but the cycler will display an alarm when you are draining or filling slowly. So I fired up my Cycler, went to the proper panel, and turned off the flow alert, defaulting the sound to N/A. Note the differences between what the manual stated needed to be accomplished and what took place on my Cycler.
Regardless, the alarm is now off, and we’ll soon know what effect this “fix” has. I’m going to watch what happens to the overall time I’m on the cycler. I suspect it will increase, perhaps drastically, because I’m not getting up to increase the drain flow as I have in the past. We’ll see, and I’ll report back.
CGM: Last week I had a conversation with my online pharmacy, ExpressScripts about an unrelated matter. Upon conclusion of this call, I inquired about their provision of Libre3 CGMs. I was assured that they either have them or will provide them when presented with a valid prescription by my doctor. I call my GP who sent them a script yesterday. My ExpressScripts app notified me they had received a script to fill. Today I received notification from ExpressScripts that a “Prior Authorization Required” has to be in place before they can ship my CGM order. My benefits plan must be approved through prior authorization to ensure my plan covers this medicine.
It looks like governmental red tape is taking over. Meanwhile, I’m paying $204.xx out-of-pocket for the Libre 3. I’ll keep you posted.
This updates a previous post about Fresenius, the company that provides Dialysis Support for me and thousands of others.
Fresenius Medical Care is a German company specializing in providing dialysis products and services. The company was founded in 1996 as a result of the merger of Fresenius AG and the American company National Medical Care. However, the roots of the company’s involvement in the dialysis business can be traced back to the 1960s.
In 1966, Fresenius AG was founded in Germany as a pharmaceutical company. In the early 1970s, the company began manufacturing dialysis machines and equipment, and by the mid-1970s, Fresenius had become one of the leading suppliers of dialysis equipment in Europe.
In 1987, Fresenius acquired a controlling stake in National Medical Care (NMC), a US-based dialysis company. NMC was founded in 1971 by Dr. Stanley Shaldon and was one of the largest dialysis providers in the United States at the time of its acquisition. Fresenius gained a significant presence in the US dialysis market through the acquisition.
In 1996, Fresenius AG merged with NMC to form Fresenius Medical Care. The merger created one of the largest dialysis companies in the world, with operations in over 100 countries. Fresenius Medical Care continued to expand its business through acquisitions and partnerships, including the acquisition of Gambro AB in 2013, a Swedish company that specialized in dialysis products and services.
Today, Fresenius Medical Care is one of the leading providers of dialysis products and services globally, with over 3,900 dialysis clinics and a workforce of approximately 120,000 employees. The company’s products and services include dialysis machines, dialyzers, renal pharmaceuticals, and related laboratory and diagnostic services.
In conclusion, Fresenius Medical Care’s involvement in the dialysis business began in the 1960s with the manufacturing of dialysis machines and equipment by Fresenius AG. The acquisition of NMC in 1987 and the subsequent merger with Fresenius AG in 1996 further expanded the company’s presence in the dialysis market, leading to its current position as a leading provider of dialysis products and services worldwide.
In general, employee reviews on websites such as Glassdoor and Indeed suggest that Fresenius Medical Care is a good place to work, with many employees citing good benefits, supportive colleagues, and opportunities for career growth. However, some reviews also mention a high workload and demanding job responsibilities, which may be expected given the nature of the healthcare industry.
In terms of industry recognition, Fresenius Medical Care has received several awards and accolades as an employer. In 2020, the company was named one of the “World’s Most Admired Companies” by Fortune magazine and was recognized as a “Best Place to Work for LGBTQ Equality” by the Human Rights Campaign Foundation.
Fresenius Medical Care has also received recognition for its commitment to diversity and inclusion in the workplace. In 2020, the company was named a “Top 50 Employer” by the National Association of Female Executives and was recognized as a “Best Employer for Diversity” by Forbes magazine.
Overall, while individual experiences may vary, Fresenius Medical Care appears to be a company that values its employees and strives to create a supportive and inclusive workplace culture.
Fresenius Medical Care is publicly traded on several stock exchanges, including the Frankfurt Stock Exchange in Germany and the New York Stock Exchange in the United States. The company’s stock symbol is FME in Germany and FMS in the United States.
Historically, Fresenius Medical Care has performed well in the stock market, with steady growth in share price over the years. For example, between 2016 and 2020, the company’s share price in Germany increased from around €70 to over €80 per share. In the United States, the company’s share price increased from around $43 to over $50 per share during the same period.
This week my weight has been steadily going up, like M-F 152.2, 151.2, 152.2, 153.0, and 155.2. this morning the cycler indicated a -599 mico which indicates fluid left in me. My wife noticed my face looked bloated. I going to have to call Fresenius Tech Support and spend an inordinate amount of time with them hoping to receive a replacement Cycler.
Meanwhile, out of the last seven days, I have only experienced ONE NIGHT without drain alarms. That for the record provided the potential for one night of interrupted sleep out of seven. Per my Neurologist and Fresenius team support personnel, I have been taking MiraLAX daily to no avail which leads me to suspect the Cycler even more.
With my weight gain, I noticed my glucose readings inching upward also. Not drastically, but three out of the five last morning fasting readings from my Libre 3 CGM have been over 106. It all points back to the Cycler IMHO.
Spring is really coming on strong here in North Texas. Our mowers have mowed our yard once, and last night’s rain really greened things up. Our tomato and pepper plants are doing well, as are our early flowers – hyacinths daffodils, and tulips. The female goose is still on her nest on our roof. In a couple of weeks, we should see some youngins. I read that the parents encourage their young to jump out of the next from a ground position but don’t force them out.
I changed the oil, oil filter, and air filter on our 2014 BMW 328D yesterday and accomplished the same on our 2019 BMW X5 today, along with topping off all the fluids and tire pressures. We are ready for summer.
Fresenius called me earlier today and informed me that our catch-up deliveries of supplies would take place between 7-11 AM Monday. Some things in the world of Dialysis do work. Hank
This blog is a fundamental introduction to the Peritoneal Dialysis treatment and will be useful for those who are new to peritoneal dialysis. It will include how it works, who it’s suitable for, and what patients can expect from treatment.
Graphic of Peritoneal Dialysis Simplified
A Fundamental Introduction to Peritoneal Dialysis
Introduction
Peritoneal dialysis (PD) is a lifesaving treatment for patients with kidney failure, myself included. As an alternative to hemodialysis, PD allows for more flexibility, as it can be done at home, and it is a gentler option for patients who cannot tolerate traditional hemodialysis so I am told. It can also be a pain in the ass – cycler drain problems that just won’t go away. Having said that, this blog post aims to provide a fundamental introduction to PD, its mechanisms, suitability for patients, and what to expect during treatment. It is so included because it has been my experience to date the TC Mits (The Common Man in the Streets) really doesn’t have a handle on what PD is all about – nor should they understandably. This blog is for TCMits.
What is Peritoneal Dialysis?
Kidneys are essential organs that filter waste products and excess water from the blood, maintaining a proper balance of minerals and electrolytes (1). When kidneys fail, waste products accumulate in the blood, leading to a dangerous condition known as uremia. Dialysis is a treatment that replicates the kidney’s filtering function and removes these waste products from the blood (2).
Peritoneal dialysis is a type of dialysis that uses the peritoneal membrane, the thin lining of the abdominal cavity, as a natural filter (3). The peritoneal membrane is rich in blood vessels, making it an effective filtration system. During PD, a sterile solution called dialysate is introduced into the peritoneal cavity through a catheter. The dialysate absorbs waste products and excess water from the blood, and is then drained from the body (4).
How Does Peritoneal Dialysis Work?
There are two primary types of peritoneal dialysis: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD) (5).
Continuous Ambulatory Peritoneal Dialysis (CAPD): CAPD is a manual process where the patient drains and refills the dialysate solution multiple times a day, usually four to five times, with each exchange taking about 30 minutes (6). This process is typically done during waking hours, and the dialysate remains in the abdomen for four to six hours before being exchanged (7).
Automated Peritoneal Dialysis (APD): APD uses a machine called a cycler to perform the dialysate exchanges (8). The cycler automatically fills and drains the peritoneal cavity with dialysate, usually overnight while the patient sleeps. The number of exchanges and the time spent on the cycler vary depending on individual needs (9).
Who is Suitable for Peritoneal Dialysis?
PD is suitable for a wide range of patients with end-stage renal disease (ESRD). It is particularly appropriate for those who:
Have difficulty accessing a hemodialysis center due to geographical or transportation limitations (10)
Are medically stable and can manage the treatment at home (11)
Prefer a more flexible schedule, as PD can be done at home and does not require strict adherence to a center’s schedule (12)
Are not suitable candidates for hemodialysis due to medical reasons or personal preference (13)
However, PD may not be suitable for patients with:
Severe peritoneal scarring or adhesions from previous surgeries or infections (14)
Limited manual dexterity or visual impairment, as these patients may have difficulty performing the exchanges (15)
Uncontrolled psychiatric or cognitive disorders that could affect their ability to manage treatment (16)
What to Expect from Peritoneal Dialysis Treatment
Preparing for PD: Before starting PD, patients undergo a minor surgical procedure to insert a catheter into the abdomen (17). This procedure is typically done under local anesthesia, and the catheter is left in place for several weeks to heal before PD begins (18).
Training: Patients receive training from a specialized PD nurse to learn the proper techniques for managing their treatment, including how to connect and disconnect from the dialysis system, maintaining sterility, and recognizing potential complications (19). The training period usually lasts one to two weeks and may take place in a hospital, clinic, or at home (20).
Managing PD at Home: Once trained, patients can perform PD in the comfort of their own homes. It is crucial to maintain a clean environment and follow the prescribed schedule for dialysate exchanges (21). Regular check-ups with the healthcare team are essential to monitor the patient’s health, make necessary adjustments to the treatment plan, and address any issues or concerns (22).
Diet and Fluid Intake: As with other dialysis treatments, patients on PD need to follow specific dietary guidelines to ensure their bodies receive the necessary nutrients without overloading on waste products (23). A dietitian will provide personalized advice on dietary restrictions, including limitations on sodium, potassium, and phosphorus intake (24). Fluid intake should also be monitored, as the body’s ability to remove excess fluids is limited (25).
Physical Activity: Most patients on PD can engage in regular physical activity, which helps maintain overall health and well-being (26). However, it is essential to consult with the healthcare team before starting any new exercise regimen (27).
Potential Complications: While PD is generally safe, complications can arise, including peritonitis (an infection of the peritoneal membrane) and hernias due to increased abdominal pressure (28). Prompt recognition and treatment of these complications are essential to prevent serious health issues (29).
Conclusion
Peritoneal dialysis is a valuable treatment option for patients with kidney failure, offering flexibility and a gentler alternative to traditional hemodialysis. Understanding the mechanics, suitability, and expectations of PD can help patients make informed decisions about their treatment options and better manage their condition. With the proper guidance and support from their healthcare team, patients on PD can maintain their health and enjoy an improved quality of life.
Couchoud, C., et al. (2009). Geographical variations in the epidemiology of end-stage renal disease: a French national study. Nephrology Dialysis Transplantation, 24(2), 715-722.
Jain, A. K., & Blake, P. (2020). Peritoneal Dialysis. In StatPearls. StatPearls Publishing.
National Kidney Foundation. (2017). Dialysis.
Ibid.
Jain, A. K., & Blake, P. (2020). Peritoneal Dialysis. In StatPearls. StatPearls Publishing.
Ibid.
Ibid.
U.S. National Library of Medicine. (2021). Peritoneal Dialysis. MedlinePlus.
Ibid.
Figueiredo, A., et al. (2016). Teaching peritoneal dialysis at home: evaluation of a new strategy. Peritoneal Dialysis International, 36(2), 159-166.
Ibid.
U.S. National Library of Medicine. (2021). Peritoneal Dialysis. MedlinePlus.
Heiwe, S., & Jacobson, S. H. (2014). Exercise training in adults with CKD: a systematic review and meta-analysis. American Journal of Kidney Diseases, 64(3), 383-393.
Ibid.
Jain, A. K., & Blake, P. (2020). Peritoneal Dialysis. In StatPearls. StatPearls Publishing.
Since I am a Peritoneal Dialysis user/patient, I must have a rudimentary understanding of the history behind this life-saving procedure. Thus, the following blog entry: Please note the many links included in this blog entry to explain the terms and concepts introduced.
From Stable Diffusion with prompt “Original dialysis machine”
Introduction:
Peritoneal dialysis (PD) is a life-saving treatment for patients with end-stage renal disease (ESRD). The history of PD dates back to ancient times when physicians used peritoneal lavage as a therapeutic tool to treat patients with abdominal infections. However, the modern use of peritoneal dialysis for the treatment of renal failure started in the 20th century. This blog will discuss the history of peritoneal dialysis, from its inception to the present day.
Ancient Times:
Peritoneal lavage was first described in ancient Greek medical texts as a treatment for abdominal infections. In the 1st century AD, the Roman physician Asclepiades used peritoneal lavage to treat a patient with peritonitis. This involved injecting warm water into the peritoneal cavity and then draining it out. The use of peritoneal lavage continued through the Middle Ages and the Renaissance, but it was not until the 19th century that peritoneal dialysis began to take shape as a medical procedure.
19th Century:
In the 19th century, the Italian physiologist Carlo Matteucci conducted experiments in which he injected saline solution into the peritoneal cavity of dogs and observed the osmotic transfer of fluid across the peritoneal membrane. In 1856, the German physiologist Carl Ludwig described the transfer of fluids and solutes across the peritoneal membrane in his book “Physiology of the Circulation.” However, it was not until the early 20th century that peritoneal dialysis became a practical treatment option.
Early 20th Century:
In the early 1900s, Russian surgeon Dimitri Ivanovich Abrikossoff used peritoneal lavage as a treatment for uremia. He injected saline solution into the peritoneal cavity of patients with renal failure and then drained it out. Although Abrikossoff’s technique was not very effective, it laid the foundation for using peritoneal dialysis to treat renal failure.
In 1923, the American surgeon Leonard Rowntree and his colleagues at the University of Minnesota performed the first successful peritoneal dialysis in a dog. They injected saline solution into the peritoneal cavity of a dog with uremia and then drained it out. The dog’s condition improved, and it lived for several months after the procedure. Rowntree and his colleagues then performed peritoneal dialysis on a patient with renal failure, but the patient did not survive the procedure.
Mid-20th Century:
In the mid-20th century, several advances in peritoneal dialysis technology were made. In 1959, the Dutch physician Willem Kolff and his colleagues developed the first commercial peritoneal dialysis machine, the Kolff-Brigham dialysis machine. See the picture below. This machine used gravity to circulate the dialysis solution through the peritoneal cavity. In 1965, the American nephrologist Henry Tenckhoff developed the Tenckhoff catheter, which is still used today for peritoneal dialysis.
Artificial kidney. MG*291118, catalog number M-13845.
Late 20th Century:
In the late 20th century, peritoneal dialysis became a widely accepted treatment for ESRD. In 1976, the National Cooperative Dialysis Study showed that peritoneal dialysis was as effective as hemodialysis in the treatment of ESRD. In 1980, the International Society for Peritoneal Dialysis was founded to promote the development of peritoneal dialysis as a treatment for renal failure.
Current Era:
In the current era, peritoneal dialysis remains an important treatment option for patients with ESRD. In 2016, there were approximately 240,000 patients worldwide receiving peritoneal dialysis, with the majority of patients living in developing countries.
Advancements in technology have improved the safety and effectiveness of peritoneal dialysis. Newer machines use automated cycling to circulate the dialysis solution through the peritoneal cavity, reducing the risk of infection and improving patient outcomes. Additionally, the development of newer dialysis solutions has improved the removal of waste products from the blood.
Conclusion:
Peritoneal dialysis has a long and storied history, dating back to ancient times. The modern use of peritoneal dialysis for the treatment of renal failure started in the 20th century, with the development of peritoneal lavage techniques and the first successful peritoneal dialysis procedures. Advancements in technology and the widespread acceptance of peritoneal dialysis as a treatment for ESRD have improved patient outcomes and made peritoneal dialysis an important treatment option for patients around the world.
References:
Golper, T. A., & Piraino, B. (2015). Peritoneal dialysis: Its history and current status. American Journal of Kidney Diseases, 66(5), 932-936. doi: 10.1053/j.ajkd.2015.07.008
Bleyer, A. J., & Diaz-Buxo, J. A. (2002). The history of peritoneal dialysis. Journal of the American Society of Nephrology, 13(Supplement 1), S23-S28. doi: 10.1097/01.asn.0000031473.60357.2b
Oreopoulos, D. G. (1996). Peritoneal dialysis: A personal history. Peritoneal Dialysis International, 16(Supplement 1), S12-S18.
Krediet, R. T. (2008). Peritoneal dialysis: From its origins to the twenty-first century. Kidney International, 73(Supplement 108), S3-S12. doi: 10.1038/sj.ki.5002713
Li, P. K., Szeto, C. C., & Piraino, B. (2016). Peritoneal dialysis in the modern era: How did we get here and where are we going? American Journal of Kidney Diseases, 68(4), 692-699. doi: 10.1053/j.ajkd.2016.05.020
Dialysis treatment is a vital medical procedure that allows individuals with kidney failure to live healthier and longer lives. Since the first dialysis machine was invented in the 1940s, advancements in technology have revolutionized the way in which dialysis treatment is administered. These advancements have improved patient outcomes and quality of life. In this blog, we will explore the latest technologies and innovations in dialysis treatment and their impact on societal acceptance.
Wearable Dialysis Devices: Wearable dialysis devices such as wearable artificial kidneys (WAK) are a promising innovation in dialysis treatment. The development of these devices began in the early 2000s, and they are still in the testing phase. However, early results have shown that WAKs have the potential to improve patients’ quality of life by allowing them to receive dialysis treatment while going about their daily activities. This technology has the potential to reduce the burden on patients and caregivers by eliminating the need for frequent visits to a dialysis center.
High-Flux Dialyzers: High-flux dialyzers are a newer type of dialyzer that removes more toxins from the blood than traditional dialyzers. These devices were introduced in the 1990s and have become increasingly common in dialysis centers. High-flux dialyzers work by allowing more water to flow through the membrane, which improves the removal of toxins from the blood. This technology has been shown to improve patient outcomes, reduce treatment times, and lower the risk of complications.
Online Hemodiafiltration: Online hemodiafiltration (HDF) is a type of dialysis that combines the processes of hemodialysis and hemofiltration. This technology was introduced in the early 2000s and has been shown to improve patient outcomes. Online HDF removes more toxins from the blood than traditional dialysis and has been associated with reduced cardiovascular mortality rates.
Remote Monitoring: Remote monitoring technology has been developed to allow healthcare providers to monitor patients’ vital signs and dialysis treatment remotely. This technology has the potential to improve patient outcomes by detecting potential complications before they become severe. Remote monitoring technology has been introduced in the past decade and is becoming increasingly common in dialysis centers.
Personalized Dialysis: Personalized dialysis is an emerging field that uses a patient’s individual characteristics to develop a personalized dialysis treatment plan. This technology has the potential to improve patient outcomes and reduce the risk of complications. Personalized dialysis is still in the early stages of development, but early results have shown promising results.
Overall, these technological advancements have the potential to improve dialysis treatment outcomes and increase societal acceptance. However, issues of accessibility and affordability must be addressed to ensure that all individuals with kidney failure have access to the latest dialysis treatments.
The Monday 3/13/2023 WSJ page A17 had an article by Allysia Finley titled “President Biden and the Science of Aging.” It was not so much about the President, as it was about the science of aging. The following is excerpted from this article: “ Alzheimer’s has also been linked to shorter telomeres. but puzzlingly, some people have all the pathological hallmarks of the disease in their brains but don’t suffer symptoms. Scientists suspect these people have a higher cognitive reserve—that is, resilience to brain damage—which is associated with higher education mentally demanding occupations, and healthy lifestyles.” Emphasis on cognitive reserve added.
Here we go again with more unrecognized terminology, specifically Cognitive Reserve. Just what is this thing? Is it good? Should I go out and buy some? Is it like Canadian Reserve, the whiskey? So let’s get into this concept and ascertain how if at all, it applies to dialysis patients such as myself. But first, we are going to define just what the term Cognitive means, before talking about any Reserve.
The Definition of Cognitive
Cognitive refers to the mental processes involved in the acquisition, processing, and utilization of knowledge. These processes include perception, attention, memory, language, problem-solving, and decision-making. The cognitive perspective emphasizes how people think, perceive, remember, and learn. It is a multidisciplinary field that draws on psychology, neuroscience, linguistics, philosophy, and computer science to understand the complex workings of the mind.
Perception
Perception is the process of interpreting and organizing sensory information from the environment. It involves the detection of stimuli through the senses and the interpretation of those stimuli in the brain. Perception can be influenced by factors such as attention and expectations. For example, if you are looking for your friend in a crowded room, you are more likely to notice people who match your friend’s description.
Attention
Attention is the ability to focus on a particular stimulus while ignoring other stimuli. It is an essential component of cognitive processing because it allows us to filter out irrelevant information and concentrate on what is relevant. Attention can be influenced by factors such as motivation and emotion. For example, if you are highly motivated to complete a task, you are more likely to be able to focus your attention on that task.
Memory
Memory is the process of encoding, storing, and retrieving information. It is critical for learning and is involved in all aspects of cognition. Memory can be influenced by factors such as attention and rehearsal. For example, if you pay close attention to a lecture and review your notes afterward, you are more likely to remember the information.
Conclusion
In conclusion, cognitive processes are essential for understanding how the mind works. Perception, attention, and memory are just a few of the many cognitive processes involved in our daily lives. By studying cognitive processes, we can gain a deeper understanding of how we learn, think, and behave.
With this background into the many facets of “Cognitive,” let’s delve into Cognitive Reserve.
Abstract: The concept of cognitive reserve has gained attention in recent years as a way to understand why some individuals may have better cognitive function despite brain damage or aging. Cognitive reserve refers to the brain’s ability to maintain cognitive function despite damage, injury, or aging. This blog explores the concept of cognitive reserve and its application to individuals on dialysis. Dialysis patients are at a higher risk of cognitive impairment due to several factors, including comorbidities and the effects of dialysis. See several previous blogs on this subject. The blog will also examine the potential cognitive benefits of interventions that can increase cognitive reserve in dialysis patients, such as cognitive training and physical exercise.
Introduction: Cognitive reserve refers to the brain’s ability to maintain cognitive function despite damage, injury, or aging. This concept has been studied extensively in the field of neurology to understand why some individuals may have better cognitive function despite brain damage or aging. The concept of cognitive reserve suggests that individuals who engage in mentally stimulating activities, such as reading, playing games, or learning new skills, can build up a cognitive reserve that can help them maintain cognitive function even in the face of damage or aging. Dialysis is a treatment for individuals with end-stage kidney disease. While dialysis can extend the lives of these patients, it is associated with several adverse effects, including cognitive impairment. Dialysis patients are at a higher risk of cognitive impairment due to several factors, including comorbidities and the effects of dialysis. Studies have shown that up to 70% of dialysis patients have some form of cognitive impairment, ranging from mild cognitive impairment to dementia.
The concept of cognitive reserve may have important implications for dialysis patients. Interventions that can increase cognitive reserve may help dialysis patients maintain cognitive function and improve their quality of life. The purpose of this blog is to explore the concept of cognitive reserve and its application to individuals on dialysis.
Cognitive Reserve: The concept of cognitive reserve suggests that individuals who engage in mentally stimulating activities can build up a cognitive reserve that can help them maintain cognitive function even in the face of damage or aging. This cognitive reserve is thought to be the result of the brain’s ability to adapt and reorganize itself in response to new experiences and challenges. Individuals who engage in mentally stimulating activities, such as reading, playing games, or learning new skills, are thought to build up a cognitive reserve that can help them maintain cognitive function even in the face of damage or aging.
Several factors have been identified as potential contributors to cognitive reserve, including education, occupational complexity, social engagement, and physical exercise. Education has been identified as a significant contributor to cognitive reserve, with higher levels of education associated with better cognitive function in later life. Occupational complexity, or the complexity of an individual’s job, has also been identified as a potential contributor to cognitive reserve. Individuals with more complex jobs, such as lawyers or doctors, may have a greater cognitive reserve due to the mental challenges of their work. Social engagement, or the extent to which an individual interacts with others, has also been identified as a potential contributor to cognitive reserve. Individuals who engage in social activities, such as volunteering or participating in clubs, may have a greater cognitive reserve due to the mental challenges of social interaction. Finally, physical exercise has also been identified as a potential contributor to cognitive reserve. Studies have shown that regular exercise can improve cognitive function in older adults and may help to build cognitive reserve.
Cognitive Reserve and Dialysis:
Dialysis patients are at a higher risk of cognitive impairment due to several factors, including comorbidities and the effects of dialysis. Comorbidities, or other medical conditions, are common in dialysis patients and can contribute to cognitive impairment. The effects of dialysis, including changes in blood pressure and the accumulation of toxins, can also contribute to cognitive impairment in these patients. As a result, up to 70% of dialysis patients have some form of cognitive impairment, ranging from mild cognitive impairment to dementia. However, interventions that can increase cognitive reserve may help dialysis patients maintain cognitive function and improve their quality of life. Cognitive training, for example, has been shown to improve cognitive function in dialysis patients. Cognitive training involves engaging in mentally stimulating activities, such as memory exercises or problem-solving tasks, to improve cognitive function. One study found that dialysis patients who participated in cognitive training had significant improvements in cognitive function compared to those who did not participate in the training. Physical exercise has also been identified as a potential contributor to cognitive reserve in dialysis patients. Regular exercise can help to improve cognitive function in older adults and may help to build a cognitive reserve in dialysis patients. One study found that dialysis patients who engaged in regular physical exercise had better cognitive function than those who did not exercise regularly.
Conclusion: The concept of cognitive reserve suggests that individuals who engage in mentally stimulating activities can build up a cognitive reserve that can help them maintain cognitive function even in the face of damage or aging. Dialysis patients are at a higher risk of cognitive impairment due to several factors, including comorbidities and the effects of dialysis. However, interventions that can increase cognitive reserves, such as cognitive training and physical exercise, may help dialysis patients maintain cognitive function and improve their quality of life. Further research is needed to determine the most effective interventions for increasing cognitive reserve in dialysis patients and understanding the underlying mechanisms of cognitive reserve in this population.
References:
Stern Y. Cognitive reserve in aging and Alzheimer’s disease. The Lancet Neurology. 2012;11(11):1006-1012. doi:10.1016/S1474-4422(12)70191-6
Kurella Tamura M, Yaffe K. Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies. Kidney international. 2011;79(1):14-22.
Drew DA, Tighiouart H, Scott TM, Lou KV, Shaffi K, Weiner DE, Sarnak MJ. Cognitive function and all-cause mortality in maintenance hemodialysis patients. American Journal of Kidney Diseases. 2015;65(2):303-311.
Wu YH, Huang JW, Chen CY, et al. Cognitive training on hemodialysis patients: a randomized controlled trial. American Journal of Kidney Diseases. 2012;60(2):252- 259.
Johansen KL, Painter PL, Sakkas GK, Gordon P, Doyle J, Shubert T. Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: a randomized, controlled trial. Journal of the American Society of Nephrology. 2006;17(8):2307- 2314.
Kitzman DW, Brubaker PH, Herrington DM, et al. Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. Journal of the American College of Cardiology. 2013;62(7):584-592.
Cheng YH, Tsai YC, Tung CW, Chen YC, Chang HH, Lee YC. The effects of exercise on cognitive function in older adults with cognitive impairment: a systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Medicine. 2019;8(2):217. Untitled 5
Schmidt R, Hofer E, Bouwman FH, Buerger K, Cordonnier C, Fladby T, Galimberti D, Georges J, Heneka MT, Hort J, et al. EFNS-ENS/EAN Guideline on concomitant use of cholinesterase inhibitors and memantine in moderate to severe Alzheimer’s disease. European Journal of Neurology. 2015;22(6):889-898.
Valenzuela M, Sachdev P. Brain reserve and dementia: a systematic review. Psychological Medicine. 2006;36(4):441-454.
Andrade LP, Gualano B, Delfino LD, Rodrigues RN, Santos PC, Lima FR, Roschel H, Benatti FB, Bonfa E, Artioli GG. Effects of exercise training on neurovascular function and cognition in hemodialysis patients. American Journal of PhysiologyRenal Physiology. 2018;315(6):F1659-F1668
In the March 18-19, 2023, issue of WSJ, page C3 of the REVIEW section ran an article titled “For Long-Term Health And Happiness, Marriage Still Matters.” In this article by Brendan Case and Ying Chen, a new Harvard study shows that getting married is linked to significantly better physical and mental health for women. They also studied staying married versus getting divorced and found divorce was associated with consistently worse subsequent health and well-being, including greater loneliness and depression and lower levels of social integration. The research article published in the journal Global Epidemiology is linked here.
This got me musing about the correlation, if any, between dialysis and being married and/or getting divorced because of dialysis. I searched Google using terms like “marriage, divorce, and dialysis” and combinations without any real results – some feel-good articles, but nothing research worthy. I’m signed up for Chatbot 4.0 and asked it. With some editing on my part, this is what AI had to say.
Dialysis can significantly impact marriages due to the physical, emotional, and financial strain it puts on patients and their families. However, it’s important to note that while there may be a correlation between dialysis and divorce, correlation does not necessarily imply causation.
Physical impact: Dialysis patients often experience fatigue, reduced energy levels, and restricted diets. This may limit their ability to participate in activities they used to enjoy with their spouse, which could potentially strain the relationship.
Emotional impact: The stress of managing a chronic illness, attending frequent medical appointments, and facing an uncertain future can lead to anxiety and depression for both the patient and their spouse. Emotional support is crucial, but both partners may struggle to cope with the changes in their lives.
Financial impact: The cost of dialysis treatments, medications, and related healthcare expenses can significantly burden a family. This may lead to disagreements over finances and additional stress within the marriage.
Time commitment: Dialysis treatments can be time-consuming, especially for in-center hemodialysis patients. This may reduce the quality time couples spend together, negatively affecting their relationship.
Intimacy and sexual health: Dialysis can change body image, self-esteem, and sexual function. These factors may contribute to decreased sexual intimacy, which can strain a marriage.
Not all marriages experience these challenges to the same extent, and some couples may become even stronger and more resilient in the face of adversity. Support from family, friends, and healthcare professionals, as well as open communication and empathy, can help couples navigate the difficulties of living with dialysis.
While it’s difficult to pinpoint a specific correlation between dialysis and divorce, research has shown that chronic illness, in general, can increase the risk of marital dissatisfaction and divorce. Each marriage is unique, and various factors contribute to the success or failure of a relationship. Therefore, it’s important to consider the individual circumstances of each couple when examining the impact of dialysis on their relationship.
References
Kimmel, P. L., Cukor, D., Cohen, S. D., & Peterson, R. A. (2007). Depression in end-stage renal disease patients: A critical review. Advances in Chronic Kidney Disease, 14(4), 328-334.
Kimmel, P. L., Peterson, R. A., Weihs, K. L., Simmens, S. J., Alleyne, S., Cruz, I., & Veis, J. H. (2000). Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney International, 57(5), 2093-2098.
Song, M. K., Lin, F. C., Gilet, C. A., Arnold, R. M., Bridgman, J. C., & Ward, S. E. (2011). Patient perspectives on informed decision-making surrounding dialysis initiation. Nephrology Dialysis Transplantation, 26(11), 3739-3744.
Finkelstein, F. O., West, W., Gobin, J., Finkelstein, S. H., & Wuerth, D. (2010). End-of-life care for the end-stage renal disease patient: A nephrologist’s perspective. Clinical Nephrology, 74(Suppl 1), S61-S65.
Trief, P. M., Grant, W., Elbert, K., & Weinstock, R. S. (1998). Family environment, glycemic control, and the psychosocial adaptation of adults with diabetes. Diabetes Care, 21(2), 241-245.
Schmaling, K. B., & Sher, T. G. (2000). The psychology of couples and illness: Theory, research, and practice. American Psychological Association.
These references should provide some background information on the impact of chronic illness, including end-stage renal disease, on relationships. For the most recent and directly related research, I recommend searching academic databases like PubMed, Google Scholar, or similar platforms.
I did jinx myself. Last night my Liberty Cycler on the first drain blared its klaxon horn and I had to get out of bed for 5 minutes or so until the indicated drain volume was over 1700 mL. At this point, I got back into bed and it remained mute for the remainder of the night. Just as five nights in a row without alarms does not a whole story make, so does a single alarm on a given night not indicate a trend. I still maintain that Fresenius knows full well the problems with their Cycler (notice that I refer to the cycler/problem as “theirs”) and not the dialysis patient’s problem to correct with MiraLAX or other nonconventional workarounds.
The weather in North Texas tends to be sinusoidal in the Spring, with broad swings between cool/cold and warm weather. The last couple of days we had fronts coming through from the West, and now the temperature is in the forties. In a couple of days, it will be back in the 70s/80s. The trick is to time your planned outside activities accordingly. One thing I can plan but not around the weather is walking our Golden Retriever Dickens. Come rain, shine, heat, cold, he gets his due exercise, and by association, I get mine. I read yesterday in the WSJ not less than 20 minutes of brisk walking at my seniority is necessary and sufficient exercise. Thanks to Dickens, which is why I agree to raise yet another Golden, I am getting my exercise in.
My last follow-up concerns the Egyptian Goose/Geese that built a nest on a valley of our roof. Below are four pictures. The first shows the pair out in front of our home when they were casing the joint. The remaining three are in-session closeups of the nesting female. All of the shots were made with my new – to me Samsung S23-Ultra phone which has a 200-megapixel lens and great zoom capability. What does this have to do with Dialysis you ask? Part of smelling the coffee and Mindfulness, for don’t you see?
