Henry Feeser's Peritoneal Dialysis (PD) journey

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

March 13, 2023 / / 0 Comments

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

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

Introduction

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

Stigma Associated with Dialysis

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

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

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

Impact of Stigma on Patients’ Lives

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

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

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

Addressing Stigma Associated with Dialysis

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

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

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

Conclusion

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

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

References

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

Cognitive Burden and Dialysis: What research relates?

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

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

Introduction:

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

Literature Review:

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

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

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

Discussion:

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

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

Conclusion:

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

References:

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

Results Meeting with Dialysis Team Friday 3-10-2023

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

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

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

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

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

March 9, 2023 / / 0 Comments

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

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

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

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

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

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

Culture and Dialysis Treatment

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

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

Religion and Dialysis Treatment

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

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

Positive Impact of Culture and Religion on Dialysis Treatment

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

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

Negative Impact of Culture and Religion on Dialysis Treatment

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

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

Conclusion

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

References

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

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

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

Background

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

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

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

List of the best free mental health apps<-Link

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

Introduction

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

Benefits of Smart Phone Delivery of CBT

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

Evidence of Effectiveness

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

Challenges and Limitations

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

Conclusion

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

References:

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

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

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

VR Use in Peritoneal Dialysis Training by Fresenius and Others

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

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

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

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

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

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

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

Fresenius VR PD Training

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

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

Other VR PD Training Programs

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

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

Successes and Failures

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

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

Conclusion

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

References:

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

Breaking News Regarding CGMs + Lab Results

March 3, 2023 / / 0 Comments

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

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

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

Trending Down – talk to the team about

t

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

What a Typical PD Lab Visit Involves

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

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

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

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

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

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

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

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

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


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The Role of Dialysis Nurses in Managing Cognitive Decline and Anxiety

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

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

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

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

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

Cognitive Decay in Dialysis Patients

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

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

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

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

Managing Cognitive Decline

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

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

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

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

Anxiety in Dialysis Patients

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

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

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

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

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

Managing Anxiety

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

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

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

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

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

Conclusion

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

References:

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