Practicing mindfulness and gratitude can contribute to happiness while on dialysis. Mindfulness involves being present and aware of one’s thoughts and feelings without judgment. Dialysis treatments can be stressful, and it is easy to become overwhelmed by negative thoughts and emotions. However, practicing mindfulness can help to reduce stress and anxiety levels. Additionally, focusing on things to be grateful for can help to shift one’s perspective and create a more positive outlook. It can be as simple as being grateful for the healthcare team, supportive loved ones, or even the ability to receive life-sustaining treatments.
Mindfulness is the act of being fully present, aware of where you are and what you’re doing, and not being overwhelmed by what’s going on around you. It’s a simple yet powerful practice that can help you to manage your stress, increase your focus, and improve your overall well-being. All of us on Dialysis need mindfulness to the nth degree.
Benefits of Mindfulness
Reduces Stress: Mindfulness has been shown to reduce stress levels by allowing individuals to focus on the present moment instead of worrying about the future or dwelling on the past. This can lead to a decrease in cortisol levels, which is a hormone that is released in response to stress.
Improves Focus: Practicing mindfulness regularly can improve your ability to focus and pay attention. By staying present in the moment, you can improve your productivity and reduce distractions.
Boosts Overall Well-being: Mindfulness has been linked to several physical and mental health benefits, including improved sleep, reduced anxiety, and lower levels of depression. It can also help individuals to develop a greater sense of self-awareness and compassion toward others.
How to Practice Mindfulness
There are many ways to practice mindfulness, and what works best for one person may not work for another. Here are a few common techniques to try:
Meditation: Meditation is a popular mindfulness technique that involves sitting quietly and focusing on your breathing or a specific object. It can be practiced for just a few minutes each day and can have a significant impact on your overall well-being.
Body Scan: A body scan involves lying down and focusing on each part of your body, starting with your toes and working your way up to your head. This can help you to become more aware of your physical sensations and can be a useful tool for relaxation.
Mindful Eating: Mindful eating involves paying close attention to the experience of eating, including the taste, smell, and texture of the food. By doing so, you can develop a greater appreciation for your food and become more aware of your body’s hunger and fullness cues.
Conclusion
Mindfulness is a simple yet powerful practice that can help you to manage stress, improve focus, and boost overall well-being. By incorporating mindfulness techniques into your daily dialysis routine, you can develop a greater sense of self-awareness and compassion towards others, and lead a more fulfilling life. So why not give it a try today? And be happy! See Ted-Talk below for more on Mindfulness please.
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.
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:
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.
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.
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:
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.
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
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
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:
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.
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.
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.
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.”
Concept of Social Portfolio and eating ice cream with friends
On 22 Feb 2023, WSJ ran a special section titled “Guide To Wealth.” In this section on page S3, there is an article titled “Why Your Retirement Plan Should Include Ice Cream” by Andrew Welsch. After reading his article and pondering about it – he tied in the concept of “Social Portfolio,” I began to picture his musing directly applying to those of us who are tied to a regime of dialysis, and for me, Peritoneal Dialysis.
To paraphrase him to some extent, he suggests the little things in life are what make us smile, like going out for an ice cream cone. Going out for an ice cream cone is a proxy for quality of life. You need mobility, freedom, and some cash in your pocket to get an ice cream cone. Being able to do so implies the maintenance of a higher quality of life, herein while on dialysis. Welsch extended this concept to not just getting to an ice cream cone, but who will you have one with? This is where he introduced the concept of the social portfolio. Do you have friends to share an ice cream cone with? Will you be able to find new friends while on dialysis? It takes time, which directly is a function of the quality of life you are experiencing.
With all of these strange concepts floating around in my brain, and now I’ve added something called a social portfolio, it became starkly apparent I needed to know more about this squishy thing. (It’s squishy because as an engineer if I can’t attach numbers to an entity and put it into a formula to predict the future with an acceptable degree of accuracy, it’s squishy.) I turned to my trusty companion AI bot, Notion, and with editing, produced the following for our common edification:
Introduction
Dialysis patients face numerous challenges that can negatively affect their quality of life. One of these challenges is social isolation, which is common in this population due to the need for frequent medical appointments and treatment sessions. A social portfolio is a valuable tool that can help dialysis patients manage their social lives and maintain a sense of normalcy. This blog will explore the role of the social portfolio in dialysis patients, with a focus on peritoneal dialysis.
The Social Portfolio
The social portfolio is a document that contains important information about a patient’s social life. It includes contact information for family, friends, and healthcare providers, as well as details about support groups, hobbies, and other activities. The social portfolio is designed to help patients stay connected with their social network and maintain a healthy balance between their medical treatments and their personal lives.
Social Isolation in Dialysis Patients
Social isolation is a common problem among dialysis patients, as they often have to spend several hours a week receiving treatment. This can make it difficult for them to maintain normal relationships with family and friends and can lead to feelings of loneliness and depression. Social isolation can also impact a patient’s physical health, as it has been linked to an increased risk of cardiovascular disease, cognitive decline, and premature death.
The Role of the Social Portfolio in Dialysis Patients
The social portfolio can be an effective tool for combating social isolation in dialysis patients. By providing patients with a comprehensive list of contacts and activities, the social portfolio can help them stay connected with their social network and maintain a sense of normalcy. It can also help patients identify support groups and other resources that can provide them with emotional and practical support.
Peritoneal Dialysis and the Social Portfolio
Peritoneal dialysis (PD) is a type of dialysis that uses the lining of the abdomen to filter waste products from the blood. PD is often done at home, which can make it easier for patients to maintain their social lives. However, even patients with PD can still experience social isolation, especially if they have limited mobility or live in remote areas.
The social portfolio can be particularly valuable for PD patients, as it can help them stay connected with their social network and maintain a sense of normalcy while receiving treatment at home. PD patients can use their social portfolio to identify local support groups, connect with other patients online, and find activities that they can participate in from home.
Conclusion
In conclusion, a social portfolio is a valuable tool that can help dialysis patients manage their social lives and combat social isolation. PD patients, in particular, can benefit from the social portfolio, as it can help them maintain their social lives while receiving treatment at home. It is important for healthcare providers to encourage patients to create a social portfolio and to provide them with the resources they need to stay connected with their social network.
References:
Marquez-Herrera EC, et al. Social isolation and health-related quality of life in chronic kidney disease. J Ren Care. 2017 Mar;43(1):10-18.
Bossola M, et al. Social support and chronic kidney disease: an update. J Nephrol. 2018 Feb;31(1):15-22.
Chan R, et al. Social isolation and loneliness among patients receiving dialysis: a cross-sectional survey. Hemodial Int. 2019 Apr;23(2):274-282.
Lopes AA, et al. Social support and mortality in patients undergoing long-term hemodialysis. Am J Kidney Dis. 2004 Sep;44(3):471-9.
Brown EA, et al. Peritoneal Dialysis—Today and Tomorrow: State of the Art and Future Directions. J Am Soc Nephrol. 2020 Mar;31(3):406-422.
Crabtree JH, et al. Quality of life among patients receiving different renal replacement therapies: a systematic review and meta-analysis. Am J Kidney Dis. 2017 Oct;70(4):548-558.
Gilmartin H. Peritoneal Dialysis: A Review of the Evidence. Clin J Am Soc Nephrol. 2019 Mar;14(3):425-433.
Purnell TS, et al. Social Support, Quality of Life, and Clinical Outcomes in Hemodialysis Patients. Am J Kidney Dis. 2005 Oct;46(4):661-9.
Wong CKH, et al. Social support and health-related quality of life in patients undergoing hemodialysis in Hong Kong. Int J Environ Res Public Health. 2019 Jul;16(13):2396.
Lopes GB, et al. Social support and chronic kidney disease: A scoping review. Braz J Med Biol Res. 2018 Jul;51(10):e7446.
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
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.
Williams, D. R. (2012). African American renal disease: recent progress and future directions. Current Opinion in Nephrology and Hypertension, 21(3), 289-294.
Kuczewski, M. G. (2015). Jehovah’s Witnesses and the meaning of the transfusion taboo. Theoretical Medicine and Bioethics, 36(1), 45-62.
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.
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.
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.
Hedayat, K. M., & Pirzadeh, R. (2014). Cultural and religious considerations in palliative care. International Journal of Preventive Medicine, 5(Suppl 2), S179-S182.
From Craiyon.com AI using prompt “act as a patient, draw a picture of a typical lab visit”
Wednesday morning I attended my monthly meeting with my Dialysis Nurse at the Granbury, TX Fresenius facility. There is lots of attention to detail and exchange of advice and information that can take place at these meetings, so herein I intend to share what may typically transpire.
Upon arrival, my temperature was checked via an ear thermometer as an antiCovid check. 98.4 and good to go. We then proceeded to the nurses’ office area. I provided the USB Thumb drive from my Cycler for their records, and also a 3×5 card with morning vitals – weight, glucose, blood pressure, pulse, and temperature – and supplies I needed to cover the following month.
After morning greetings and entering a private room in the facility, I removed my sweatshirt in preparation for the monthly blood draw. I signed some paperwork that had not been signed as required during my training back in September 2022, received a card with my Nephrologist meeting time and date in April, confirmed my March meeting date with the same, and was informed that for my April labs, I need to bring a 24-hour urine sample plus Cycler drain bags using all 2.5% dialysate.
My dialysis nurse then went through a litany of questions which in general addressed my overall health and wellness often pinpointing changes, such as weight, appetite, soreness vomiting, etc. She then used her stethoscope to listen to my ticker front and back, had me take off my shoes and socks, and thoroughly went over my feet and ankles and between my toes – said I had +pretty feet.+ She then had me uncover my catheter area where she first replaced the bitter end of the tubing that connects to the line that actually enters the stomach – this is done every four months and involves adherence to strict sterile procedures while being accomplished. Lastly, she inspected the area around where the catheter enters my abdomen for any signs of abnormalities – nada so I’m good to go.
Upon departure I was provided the Fresenius monthly education packet, this month module 9 involved Emergency Procedures and Preparedness along with my supplies and a urine sample jug – as if I could even at my best come close to needing a jug as big as the one provided.
My actual lab results should be, based on past performance, ready for my perusal online tomorrow.
An additional topic of discussion involves the life cycle of PD. Seem that it is unlikely that a PD-treated patient can count on being on this regimen forever. The Peritoneal interface becomes less viable over time and the patient may have to revert back to Hemo as a fallback. That’s why some PD patients go ahead and have a fistula installed prior to “needing it.” An alternative is getting on a/the kidney transplant list somewhere. Seems since Covid took many lives, the kidney transplant list is less lengthy and I am opting to put my name on a/the list. I asked to start the paperwork to finalize the same at my Neurologist meeting next week.
Hopefully, in Friday’s blog I will be able to bring you up-to-date on my lab results et al. I also have a meeting with my GP tomorrow wherein I am going to request a referral to a Podiatrist to start taking care of my feet, and toenails. What bell?
Craiyon.com using AI Prompt “picture of a female nurse treating a patient with extreme anxiety’
A central figure in the management and treatment of CKF/Dialysis is the assigned Dialysis Team Nurse. She/he is the central point of contact for everything and anything having to do with a patient’s Dialysis. This includes being the eyes and ears for the rest of the team should the patient display signs of anxiety, depression, or other cognitive expressions of degrading health and well-being.
In my research for the previous three blog posts where we discussed the potential reduction of cognitive strength caused by dialysis itself, the use of laxatives, and B12 deficiencies, I found a thread running through research on dialysis and cognitive decline suggesting that anxiety in elders, particularly those on dialysis, is a confounding variable. The specific trigger was an article in Feb 26, 2023, New York Times titled “Why Aren’t Doctors Screening Older Americans for Anxiety?” by Paula Span.
Furthermore, I thought it would be interesting to view this aspect of Dialysis from the team’s point person, the Dialysis Nurse. I prompt-engineered my faithful go-to AI engine, Notion, and the following resulted from the perspective of my D-Nurse. Hello Cindy.
As a dialysis nurse, one of the most challenging aspects of the job is managing the cognitive decline and anxiety that many patients experience. Cognitive decline is a common condition that affects many individuals who require dialysis treatment, and it can have a significant impact on their quality of life. Anxiety is also a common issue faced by dialysis patients, and it can exacerbate cognitive decline and other health problems. In this article, we will explore the role of a dialysis nurse in managing cognitive decline and anxiety in patients undergoing dialysis treatment.
Cognitive Decay in Dialysis Patients
Cognitive decay, also known as cognitive impairment or cognitive dysfunction, is a condition that affects an individual’s ability to think, reason, and remember. It is a common problem among dialysis patients, with studies reporting that up to 70% of patients experience some form of cognitive decline. The causes of cognitive decay in dialysis patients are not fully understood, but several factors are believed to contribute to its development, including:
Chronic kidney disease
Diabetes
Cardiovascular disease
Anemia
Hypertension
Chronic kidney disease (CKD) is a significant risk factor for cognitive decline in dialysis patients. CKD can lead to neurochemical and structural changes in the brain, which can affect cognitive function. Diabetes and cardiovascular disease are also common comorbidities in dialysis patients that can contribute to cognitive decline. Anemia and hypertension are also potential causes of cognitive impairment in dialysis patients. Anemia can lead to reduced oxygen delivery to the brain, while hypertension can lead to cerebral ischemia and impaired cognitive function.
As a dialysis nurse, it is essential to recognize the signs and symptoms of cognitive decline in patients. Common symptoms include forgetfulness, difficulty concentrating, problems with language, and confusion. It is also important to note that cognitive decline can worsen with age and disease progression, leading to more severe symptoms and a decline in the patient’s overall quality of life.
Managing Cognitive Decline
Managing cognitive decline in dialysis patients can be challenging, but several strategies can help slow its progression and improve patients’ quality of life. These include:
Regular cognitive assessments to monitor changes in cognitive function
Medications to manage underlying conditions, such as hypertension and anemia
Brain exercises and cognitive training
Diet and lifestyle modifications, such as a low-sodium diet and regular physical activity
Regular cognitive assessments are essential for monitoring changes in cognitive function over time. Medications, such as antihypertensive drugs and erythropoietin-stimulating agents, can help manage underlying conditions that contribute to cognitive decline. Brain exercises and cognitive training have also been shown to improve cognitive function in dialysis patients. Diet and lifestyle modifications, such as a low-sodium diet and regular physical activity, can also help reduce the risk of cognitive decline in dialysis patients.
As a dialysis nurse, it is essential to work closely with other healthcare professionals, such as physicians, dietitians, and social workers, to develop a comprehensive treatment plan for patients with cognitive decline.
Anxiety in Dialysis Patients
Anxiety is another common issue faced by dialysis patients. It is estimated that up to 40% of dialysis patients experience some form of anxiety, which can exacerbate cognitive decline and other health problems. Anxiety can also lead to depression, which is another common mental health issue among dialysis patients.
The causes of anxiety in dialysis patients are not fully understood, but several factors are believed to contribute to its development, including:
Fear of needles and medical procedures
Changes in body image
Loss of independence
Fear of death
Fear of needles and medical procedures is a common cause of anxiety in dialysis patients. Many patients require frequent blood draws and vascular access procedures, which can be painful and uncomfortable. Changes in body image, such as weight gain and fluid retention, can also contribute to anxiety in dialysis patients. Loss of independence is another significant stressor for patients undergoing dialysis, as they may require assistance with daily activities and have limited mobility. Fear of death is also a common concern among dialysis patients, as they may feel that their health is out of their control.
As a dialysis nurse, it is essential to recognize the signs and symptoms of anxiety in patients. Common symptoms include restlessness, irritability, difficulty sleeping, and panic attacks.
Managing Anxiety
Managing anxiety in dialysis patients is essential to improve their overall quality of life and prevent the exacerbation of other health problems. Several strategies can help manage anxiety, including:
Medications, such as anti-anxiety medications and antidepressants
Cognitive-behavioral therapy
Relaxation techniques, such as deep breathing and meditation
Support groups and counseling
Medications, such as benzodiazepines and selective serotonin reuptake inhibitors, can help manage anxiety symptoms in dialysis patients. Cognitive-behavioral therapy (CBT) is a type of talk therapy that can help patients identify and change negative patterns of thinking that contribute to anxiety. Relaxation techniques, such as deep breathing and meditation, can also help reduce anxiety symptoms. Support groups and counseling can provide patients with social support and help them cope with the emotional challenges of living with a chronic illness.
Since not all anxiety is created equal, I have included a short video (1-min 35 sec) below to explain how anxiety can manifest itself.
As a dialysis nurse, it is essential to work closely with patients and their families to develop a comprehensive treatment plan for anxiety. This may include referrals to mental health professionals, as well as education about the various treatment options available.
Conclusion
In conclusion, cognitive decay and anxiety are common issues faced by dialysis patients, and they can have a significant impact on their quality of life. As a dialysis nurse, it is essential to recognize the signs and symptoms of these conditions and work closely with other healthcare professionals to develop a comprehensive treatment plan for patients. By implementing strategies to manage cognitive decline and anxiety, dialysis nurses can improve their patient’s overall quality of life and help them live a more fulfilling life.
References:
Kurella Tamura M, Yaffe K. Dementia and Cognitive Impairment in ESRD: Diagnostic and Therapeutic Strategies. Kidney Int. 2011;79(1):14-22.
Murray AM, Tupper DE, Knopman DS, et al. Cognitive impairment in hemodialysis patients is common. Neurology. 2006;67(2):216-223.
Cukor D, Coplan J, Brown C, et al. Anxiety disorders in adults treated by hemodialysis: a single-center study. Am J Kidney Dis. 2008;52(1):128-136.
Palmer S, Vecchio M, Craig JC, et al. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int. 2013;84(1):179-191.
Kimmel PL, Peterson RA, Weihs KL, et al. Psychologic functioning, quality of life, and behavioral compliance in patients beginning hemodialysis. J Am Soc Nephrol. 1996;7(2):215-224.
Kimmel PL, Peterson RA, Weihs KL, et al. Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney Int. 2000;57(5):2093-2098.
Kutner NG, Zhang R, Huang Y, et al. Patient-reported quality of life early after kidney transplant: effects of pairing by donor type and recipient age. Clin Transplant. 2013;27(3):E264-E272.
Slickers J, DuBay DA, Finkelstein FO, et al. Quality of life in patients with chronic kidney disease and comorbidities. Adv Chronic Kidney Dis. 2009;16(1):11-19.
Weisbord SD, Fried LF, Arnold RM, et al. Development of a symptom assessment instrument for chronic hemodialysis patients: the Dialysis Symptom Index. J Pain Symptom Manage. 2004;27(3):226-240.
Weisbord SD, Fried LF, Mor MK, et al. Renal provider recognition of symptoms in patients on maintenance hemodialysis. Clin J Am Soc Nephrol. 2007;2(5):960-967.
The Fresenius Liberty Cycler has well-documented problems with its drain cycle. Just do a Google and find out for yourself. I am currently experiencing sleep-shattering alarms more than 50% of the time. Last night I had drain alarms on the second and third drains and had to get out of bed and stand upright until the drain was complete before I could go back to bed. Countless dialysis patients have experienced the klaxon-like blare of alarms going off during the drain cycle. This seemingly constant sleep deprivation is akin to the outlawed methodology used by our CIA in illegal intelligence-gathering efforts.
The go-to solution to the alarm situation advised by Fresenius personnel including my Team is to use laxatives such as Miralax. The concept on their part is that blockage in the colon leads to interruption of fluid flow which in turn leads to alarms. Clean intestines, no alarms.
I’m using ClearLAX by “equate” from Walmart as a cost-effective alternative to Miralax. ClearLAX has several Label Warnings including “Do not use if you have kidney disease, except under the advice and supervision of a doctor” and “use not more than 7 days.” I quizzed my team nurse about the latter warning and was informed to continue using the laxative, that “it was OK.”
Recently (February 22, 2023) I ran across an article in CNNHealth titled “Laxative use may be linked to dementia risk, study says.” The article is linked to CNNHealth. This produced yet another “itshay” moment on my behalf. Here I am, on Peritoneal Dialysis which is strongly associated with Cognitive Decline. Here I am on Peritoneal Dialysis while a stage two diabetic which is more strongly associated with Cognitive Decline. And here it goes yet again. I am on Peritoneal Dialysis and told to take laxatives so a company’s dialysis machine will operate. But emerging research suggests a strong and positive correlation between laxative use and Cognitive Decline. In football, this is called “piling on.” Just how many bullets can I take before I go down the primrose path with Cognitive Decline and end up in LaLa Land?
OK? So I felt a need (when younger I had a need for speed which is why I raced Porsches) to look into the subject of laxatives, dialysis, cognitive decline, etc. further. I perturbed my ever-present and all-knowing bot Notion, and the following with modest editing resulted. Be advised. Be aware. Be.
Notion has this to say:
Cognitive decline is a common concern among aging adults, and there is growing evidence that dialysis patients may be at even greater risk for cognitive impairment. I previously blogged about this. Additionally, many dialysis patients experience constipation, which often leads to the use of laxatives. (Such use has been prescribed for me by my Fresenius Dialysis Team.) However, recent research has suggested that the use of laxatives may contribute to cognitive decline in dialysis patients. In this blog post, we will explore the link between cognitive decline and laxative use in dialysis patients.
The Link Between Cognitive Decline and Dialysis
Dialysis patients are at an increased risk for cognitive decline due to a variety of factors. One of the most significant factors is the accumulation of toxins in the blood, which can occur when the kidneys are not functioning properly. These toxins can cross the blood-brain barrier and cause damage to brain cells, leading to cognitive impairment.
Other factors that may contribute to cognitive decline in dialysis patients include changes in blood pressure and blood sugar levels, as well as the use of medications that can affect brain function. These factors can all interact to create a perfect storm for cognitive impairment.
The Risk of Laxative Use in Dialysis Patients
Constipation is a common problem among dialysis patients, and laxatives are often used to alleviate symptoms. However, recent research has suggested that the use of laxatives may actually contribute to cognitive decline in these patients.
One study published in the Journal of Renal Nutrition analyzed data from 271 dialysis patients and found that those who used laxatives had a significantly higher risk of cognitive impairment than those who did not use laxatives. The researchers also found that the use of certain types of laxatives, such as stimulant laxatives, was associated with an increased risk of cognitive impairment.
Another study published in the Journal of the American Society of Nephrology followed 1,361 dialysis patients for two years and found that those who used laxatives had a 50% higher risk of developing dementia than those who did not use laxatives. The study also found that the use of laxatives was associated with a decline in cognitive function over time.
The mechanisms underlying the association between laxative use and cognitive decline are not yet fully understood. However, it has been suggested that the dehydration caused by laxatives may lead to a decrease in blood flow to the brain, which can damage brain cells and contribute to cognitive impairment. Additionally, some types of laxatives, such as stimulant laxatives, may disrupt the balance of neurotransmitters in the brain, which can also contribute to cognitive decline.
Alternative Treatments for Constipation in Dialysis Patients
While laxatives may be effective in relieving constipation, there are alternative treatments that may be less harmful to cognitive function. One option is to increase dietary fiber intake, which can help regulate bowel movements. Another option is to use stool softeners, which can make bowel movements easier and more frequent without the risk of dehydration.
In some cases, laxatives may still be necessary to manage constipation in dialysis patients. In these cases, healthcare providers should be cautious when prescribing laxatives and consider alternative treatments whenever possible. It may also be helpful to monitor cognitive function in patients who use laxatives regularly to detect any signs of cognitive decline early on. (For me, this has not happened at all. Nada, Zip, Zero.)
Conclusion
Cognitive decline is a serious concern for dialysis patients, and the use of laxatives to alleviate constipation may exacerbate the problem. While it is important to manage constipation in dialysis patients, healthcare providers should be cautious when prescribing laxatives and consider alternative treatments whenever possible. By taking steps to prevent cognitive decline, healthcare providers can help dialysis patients maintain their quality of life and cognitive function.
Dialysis is a common treatment for patients with end-stage renal disease (ESRD). It is a life-saving treatment that helps remove waste products and excess fluid from the body when the kidneys are no longer able to do so. However, despite its benefits, dialysis is also associated with several complications, including cognitive impairment. Studies have shown that cognitive dysfunction affects up to 75% of patients on chronic dialysis. Researchers have been investigating the possible causes of cognitive impairment in dialysis patients, and one factor that has emerged as a significant contributor is vitamin B12 deficiency. In this blog post, we will review the literature on the link between cognitive loss in dialysis patients and vitamin B12.
Vitamin B12 Deficiency in Dialysis Patients
Vitamin B12 is an essential nutrient that plays a crucial role in the maintenance of the nervous system. It is involved in the synthesis of myelin, which coats nerve fibers and speeds up the transmission of nerve impulses. Vitamin B12 deficiency can lead to a range of neurological symptoms, including cognitive impairment, memory loss, and depression.
Dialysis patients are at increased risk of developing vitamin B12 deficiency due to several factors. First, they are often on a restricted diet, which may limit their intake of vitamin B12-rich foods. Second, dialysis can lead to the loss of vitamin B12 through the dialysis membrane. Third, patients with ESRD often have comorbid conditions that can affect vitamin B12 absorption, such as gastritis and pernicious anemia.
The Link Between Cognitive Loss and Vitamin B12 Deficiency
Several studies have investigated the link between cognitive loss in dialysis patients and vitamin B12 deficiency. A study published in the Journal of the American Society of Nephrology found that vitamin B12 deficiency was associated with cognitive impairment in patients on chronic dialysis. The study found that patients with vitamin B12 deficiency had significantly lower scores on tests of cognitive function compared to patients with normal vitamin B12 levels.
Another study published in the Journal of Renal Nutrition found that vitamin B12 supplementation improved cognitive function in dialysis patients with vitamin B12 deficiency. The study found that patients who received vitamin B12 supplementation had significant improvements in memory and executive function compared to patients who did not receive supplementation.
Conclusion
In conclusion, cognitive impairment is a common complication of dialysis, and vitamin B12 deficiency may be a significant contributing factor. Dialysis patients are at increased risk of developing vitamin B12 deficiency due to several factors, and studies have shown that vitamin B12 supplementation can improve cognitive function in dialysis patients with vitamin B12 deficiency. Therefore, regular monitoring of vitamin B12 levels and appropriate supplementation may be an important strategy to prevent cognitive decline in dialysis patients.
BTW I take a B12 shot every two weeks and have been doing so for several years. Hank
References:
Drew DA, Bhadelia R, Tighiouart H, Novak V, Scott TM, Lou KV, et al. Anatomic brain disease in hemodialysis patients: a cross-sectional study. Am J Kidney Dis. 2013;61(2):271–8.
Yaffe K, Ackerson L, Hoang TD, et al. Retinopathy and cognitive impairment in adults with CKD. Am J Kidney Dis. 2013;61(2):219–27.
Kurella Tamura M, Yaffe K. Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies. Kidney Int. 2011;79(1):14–22.
Boudville N, Li I, Geddes C, et al. Brain atrophy in hemodialysis patients: a prospective study. Am J Kidney Dis. 2015;65(2):167–75.
Kurella Tamura M, Wadley V, Yaffe K, et al. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2008;52(2):227–34.
Kurella Tamura M, Xie D, Yaffe K, et al. Vascular risk factors and cognitive impairment in chronic kidney disease: the Chronic Renal Insufficiency Cohort (CRIC) study. Clin J Am Soc Nephrol. 2011;6(11):248–56.
Kurella Tamura M, Xie D, Yaffe K, Cohen DL, Teal V, Kasner SE, et al. Regional vascular calcification and cognitive function in hemodialysis patients. Am J Kidney Dis. 2014;64(2):245–52.
Sheshadri S, Wolf PA, Beiser A, et al. Stroke risk profile, brain volume, and cognitive function: the Framingham Offspring Study. Neurology. 2004;63(9):1591–9.
Slinin Y, Guo H, Li S, et al. Association between serum creatinine and cognitive function in diabetic elders. Diabetes Care. 2011;34(12):2527–32.
Xia Z, Friedland J, Brayman K, et al. The association of malnutrition-inflammation score with cognitive functioning in hemodialysis patients. Nephrol Dial Transplant. 2013;28(8):1936–45.
Yamamoto R, Nagasawa Y, Shoji S, et al. Cognitive impairment in chronic kidney disease. Clin Exp Nephrol. 2012;16(1):7–14.
Yoon HE, Ha YC, Choi HJ, et al. Association between cognitive function and serum albumin adjusted for C-reactive protein levels in elderly Korean individuals with normal kidney function. PLoS One. 2015;10(7):e0132450.
Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136–41.
Kurella Tamura M, Wadley V, Yaffe K, et al. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis. 2008;52(2):227–34.
Kurella Tamura M, Xie D, Yaffe K, et al. Vascular risk factors and cognitive impairment in chronic kidney disease: the Chronic Renal Insufficiency Cohort (CRIC) study. Clin J Am Soc Nephrol. 2011;6(11):248–56.
Kurella Tamura M, Xie D, Yaffe K, Cohen DL, Teal V, Kasner SE, et al. Regional vascular calcification and cognitive function in hemodialysis patients. Am J Kidney Dis. 2014;64(2):245–52.
Sheshadri S, Wolf PA, Beiser A, et al. Stroke risk profile, brain volume, and cognitive function: the Framingham Offspring Study. Neurology. 2004;63(9):1591–9.
Slinin Y, Guo H, Li S, et al. Association between serum creatinine and cognitive function in diabetic elders. Diabetes Care. 2011;34(12):2527–32.
Xia Z, Friedland J, Brayman K, et al. The association of malnutrition-inflammation score with cognitive functioning in hemodialysis patients. Nephrol Dial Transplant. 2013;28(8):1936–45.
Yamamoto R, Nagasawa Y, Shoji S, et al. Cognitive impairment in chronic kidney disease. Clin Exp Nephrol. 2012;16(1):7–14.
Yoon HE, Ha YC, Choi HJ, et al. Association between cognitive function and serum albumin adjusted for C-reactive protein levels in elderly Korean individuals with normal kidney function. PLoS One. 2015;10(7):e0132450.
Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136–41.
