Data from last night’s Cycler performance – screenshot
Recall from yesterday’s blog that Fresenius Tech Support recommended turning off alarms to solve my cycler throwing alarms consistently during most night’s cycler use. With alarms off, last night on drain one I received another alarm, this one with the Stop Button flashing and a warning not to stop the patient’s drain or something like that. I was 3/4 asleep on my feet. After pressing the OK button, and staying on my feet upright, the drain proceeded until about 1700 mL had been drained, at which point I got back in bed.
Referring to the screenshot at the blog top, fill times are pretty much right on the 10-minute spec. Dwell times, except the last one, are NOT on the 120-minute spec. Drain volumes are all over the place – disregard the Cycle 0 327 drain, that was left over from yesterday’s cycle. So we have drains of 1944, 1516, 1965, and 2217. Drain time of 36, 17, 25, and 20 where only the last meets spec of 20. Disregarding the 327 Cycle 0, we had UF (fluid left in gut) of -57, -485, -37, and + 292, for a net of -287mL. This is over a cup (236.6 mL) of fluid left. I expect when I hook up to the cycler tonight that drain 0, that is upon startup, there will be a drain of at least this amount.
Add to the above that my weight was up another pound to 154 this morning leads me to the conclusion that all is not right in my Fresenius-lead treatment at this point. I have passed this data on to my Team Nurse and we’ll have to see what falls out. The alarm panel is at the blog’s end.
CGM: Had a call this morning from my pharmacy ExpressScripts about another matter, and at the conversation close asked about the status of my Freestyle Libre 3 order. I was told that it had been approved and should ship somewhere around April 4, 2023. Until such time as I have firm shipping info, I’m not going to cancel my out-of-pocket order which is prudent given we ARE dealing with government resources!
VA: I happened to check the status of my request to the VA to up my kidney failure to 100% from 80% due to the fact that I am now on Dialysis. I saw that it had been approved and that the rating package with info on how they arrived at their decision was in the mail. I received the package and was informed that the monthly disability payment had been increased which I did not ask for or anticipate. Turns out that since with the new rating of 100% for being on Dialysis, and the fact that I have another non-related rating of at least 60% (actually have a triple-bypass at 60% plus a host of others), I now fall under Special Monthly Compensation tables which resulted in the unanticipated increase. Blind squirrels etc.
As stated in my blog entry last Friday, yesterday (Monday), I called Fresenius Tech Support concerning the seemingly continuous throwing of drain alarms by my Liberty Cycler. We spent over 20 minutes with the tech rep requesting data from various cycler screens. As of the phone call, the cycler was throwing drain alarms for exactly 50% of the evening dialysis treatments. Let me explain this so those not acquainted with the cycler have a little more insight into what I’m talking about.
The Cycler is a computer-controlled pumping device that controls the three phases of my evening dialysis treatment. After turning on and plugging my catheter into the cycler, it first checks to see if any fluid is left in my stomach cavity and if so pumps it out. It defaults to 50mL or more of such fluid. If there previously had been a “good” drain, the machine can’t remove at least 50mL of fluid so guess what, yes, it throws an alarm. You have to manually bypass this phase to move on.
From here on what takes place depends on what your nephrologist has ordered. From me, I am on 8000 mL total fluids, pumped in and out of my stomach lining 2000mL at a time, for four cycles total. So initially 2000mL is pumped in – called “fill,” which is left in my lining for two hours – called dwell, then pumped out – called a drain. Each fill is supposed to take 10 minutes, and each drain is 20 minutes. If you add up the total fill times 4×10=40 minutes and drain 4×20 = 80 minutes, you have 120 minutes or two hours ideally spent on fill and drain, plus 4×2 hrs = 8 hrs total dwell. So altogether, 10 hours in an ideal world. My best time is 10 hrs 11 minutes, and the worst is right at 11 hours. The problem is with the drain. For me, as previously stated, 50% or more of the time my system has problems with drains. Is it me, the cycler, or God knows?
On the me vector, I have been doing EVERYTHING my team has suggested. We tested my plumbing, and everything is working properly. I am on my second cycler; I have read that some patients have gone through more than 10 with drain problems. The internet is full of complaints by patients concerning drain problems with the Fresenius Cycler. The PR fluff Fresenius has released on their new cycler touts improvement in this area which is moot acknowledgment on their part of the cycler’s intrinsic problems with the current cycler. I guess other than the cycler, it’s in God’s bailiwick.
This morning I received a call from my Dialysis Team Nurse who had been contacted by Fresenius Tech Support. The bottom line is this: Tech Support’s solution to grossly excessive alarms is to turn them off. I was directed to a section in the Cycler manual called “Flow Alerts” wherein it states that if both flow alert and flow alert sound are set to “NO” the sound will not occur, but the cycler will display an alarm when you are draining or filling slowly. So I fired up my Cycler, went to the proper panel, and turned off the flow alert, defaulting the sound to N/A. Note the differences between what the manual stated needed to be accomplished and what took place on my Cycler.
Regardless, the alarm is now off, and we’ll soon know what effect this “fix” has. I’m going to watch what happens to the overall time I’m on the cycler. I suspect it will increase, perhaps drastically, because I’m not getting up to increase the drain flow as I have in the past. We’ll see, and I’ll report back.
CGM: Last week I had a conversation with my online pharmacy, ExpressScripts about an unrelated matter. Upon conclusion of this call, I inquired about their provision of Libre3 CGMs. I was assured that they either have them or will provide them when presented with a valid prescription by my doctor. I call my GP who sent them a script yesterday. My ExpressScripts app notified me they had received a script to fill. Today I received notification from ExpressScripts that a “Prior Authorization Required” has to be in place before they can ship my CGM order. My benefits plan must be approved through prior authorization to ensure my plan covers this medicine.
It looks like governmental red tape is taking over. Meanwhile, I’m paying $204.xx out-of-pocket for the Libre 3. I’ll keep you posted.
This updates a previous post about Fresenius, the company that provides Dialysis Support for me and thousands of others.
Fresenius Medical Care is a German company specializing in providing dialysis products and services. The company was founded in 1996 as a result of the merger of Fresenius AG and the American company National Medical Care. However, the roots of the company’s involvement in the dialysis business can be traced back to the 1960s.
In 1966, Fresenius AG was founded in Germany as a pharmaceutical company. In the early 1970s, the company began manufacturing dialysis machines and equipment, and by the mid-1970s, Fresenius had become one of the leading suppliers of dialysis equipment in Europe.
In 1987, Fresenius acquired a controlling stake in National Medical Care (NMC), a US-based dialysis company. NMC was founded in 1971 by Dr. Stanley Shaldon and was one of the largest dialysis providers in the United States at the time of its acquisition. Fresenius gained a significant presence in the US dialysis market through the acquisition.
In 1996, Fresenius AG merged with NMC to form Fresenius Medical Care. The merger created one of the largest dialysis companies in the world, with operations in over 100 countries. Fresenius Medical Care continued to expand its business through acquisitions and partnerships, including the acquisition of Gambro AB in 2013, a Swedish company that specialized in dialysis products and services.
Today, Fresenius Medical Care is one of the leading providers of dialysis products and services globally, with over 3,900 dialysis clinics and a workforce of approximately 120,000 employees. The company’s products and services include dialysis machines, dialyzers, renal pharmaceuticals, and related laboratory and diagnostic services.
In conclusion, Fresenius Medical Care’s involvement in the dialysis business began in the 1960s with the manufacturing of dialysis machines and equipment by Fresenius AG. The acquisition of NMC in 1987 and the subsequent merger with Fresenius AG in 1996 further expanded the company’s presence in the dialysis market, leading to its current position as a leading provider of dialysis products and services worldwide.
In general, employee reviews on websites such as Glassdoor and Indeed suggest that Fresenius Medical Care is a good place to work, with many employees citing good benefits, supportive colleagues, and opportunities for career growth. However, some reviews also mention a high workload and demanding job responsibilities, which may be expected given the nature of the healthcare industry.
In terms of industry recognition, Fresenius Medical Care has received several awards and accolades as an employer. In 2020, the company was named one of the “World’s Most Admired Companies” by Fortune magazine and was recognized as a “Best Place to Work for LGBTQ Equality” by the Human Rights Campaign Foundation.
Fresenius Medical Care has also received recognition for its commitment to diversity and inclusion in the workplace. In 2020, the company was named a “Top 50 Employer” by the National Association of Female Executives and was recognized as a “Best Employer for Diversity” by Forbes magazine.
Overall, while individual experiences may vary, Fresenius Medical Care appears to be a company that values its employees and strives to create a supportive and inclusive workplace culture.
Fresenius Medical Care is publicly traded on several stock exchanges, including the Frankfurt Stock Exchange in Germany and the New York Stock Exchange in the United States. The company’s stock symbol is FME in Germany and FMS in the United States.
Historically, Fresenius Medical Care has performed well in the stock market, with steady growth in share price over the years. For example, between 2016 and 2020, the company’s share price in Germany increased from around €70 to over €80 per share. In the United States, the company’s share price increased from around $43 to over $50 per share during the same period.
Since I am a Peritoneal Dialysis user/patient, I must have a rudimentary understanding of the history behind this life-saving procedure. Thus, the following blog entry: Please note the many links included in this blog entry to explain the terms and concepts introduced.
From Stable Diffusion with prompt “Original dialysis machine”
Introduction:
Peritoneal dialysis (PD) is a life-saving treatment for patients with end-stage renal disease (ESRD). The history of PD dates back to ancient times when physicians used peritoneal lavage as a therapeutic tool to treat patients with abdominal infections. However, the modern use of peritoneal dialysis for the treatment of renal failure started in the 20th century. This blog will discuss the history of peritoneal dialysis, from its inception to the present day.
Ancient Times:
Peritoneal lavage was first described in ancient Greek medical texts as a treatment for abdominal infections. In the 1st century AD, the Roman physician Asclepiades used peritoneal lavage to treat a patient with peritonitis. This involved injecting warm water into the peritoneal cavity and then draining it out. The use of peritoneal lavage continued through the Middle Ages and the Renaissance, but it was not until the 19th century that peritoneal dialysis began to take shape as a medical procedure.
19th Century:
In the 19th century, the Italian physiologist Carlo Matteucci conducted experiments in which he injected saline solution into the peritoneal cavity of dogs and observed the osmotic transfer of fluid across the peritoneal membrane. In 1856, the German physiologist Carl Ludwig described the transfer of fluids and solutes across the peritoneal membrane in his book “Physiology of the Circulation.” However, it was not until the early 20th century that peritoneal dialysis became a practical treatment option.
Early 20th Century:
In the early 1900s, Russian surgeon Dimitri Ivanovich Abrikossoff used peritoneal lavage as a treatment for uremia. He injected saline solution into the peritoneal cavity of patients with renal failure and then drained it out. Although Abrikossoff’s technique was not very effective, it laid the foundation for using peritoneal dialysis to treat renal failure.
In 1923, the American surgeon Leonard Rowntree and his colleagues at the University of Minnesota performed the first successful peritoneal dialysis in a dog. They injected saline solution into the peritoneal cavity of a dog with uremia and then drained it out. The dog’s condition improved, and it lived for several months after the procedure. Rowntree and his colleagues then performed peritoneal dialysis on a patient with renal failure, but the patient did not survive the procedure.
Mid-20th Century:
In the mid-20th century, several advances in peritoneal dialysis technology were made. In 1959, the Dutch physician Willem Kolff and his colleagues developed the first commercial peritoneal dialysis machine, the Kolff-Brigham dialysis machine. See the picture below. This machine used gravity to circulate the dialysis solution through the peritoneal cavity. In 1965, the American nephrologist Henry Tenckhoff developed the Tenckhoff catheter, which is still used today for peritoneal dialysis.
Artificial kidney. MG*291118, catalog number M-13845.
Late 20th Century:
In the late 20th century, peritoneal dialysis became a widely accepted treatment for ESRD. In 1976, the National Cooperative Dialysis Study showed that peritoneal dialysis was as effective as hemodialysis in the treatment of ESRD. In 1980, the International Society for Peritoneal Dialysis was founded to promote the development of peritoneal dialysis as a treatment for renal failure.
Current Era:
In the current era, peritoneal dialysis remains an important treatment option for patients with ESRD. In 2016, there were approximately 240,000 patients worldwide receiving peritoneal dialysis, with the majority of patients living in developing countries.
Advancements in technology have improved the safety and effectiveness of peritoneal dialysis. Newer machines use automated cycling to circulate the dialysis solution through the peritoneal cavity, reducing the risk of infection and improving patient outcomes. Additionally, the development of newer dialysis solutions has improved the removal of waste products from the blood.
Conclusion:
Peritoneal dialysis has a long and storied history, dating back to ancient times. The modern use of peritoneal dialysis for the treatment of renal failure started in the 20th century, with the development of peritoneal lavage techniques and the first successful peritoneal dialysis procedures. Advancements in technology and the widespread acceptance of peritoneal dialysis as a treatment for ESRD have improved patient outcomes and made peritoneal dialysis an important treatment option for patients around the world.
References:
Golper, T. A., & Piraino, B. (2015). Peritoneal dialysis: Its history and current status. American Journal of Kidney Diseases, 66(5), 932-936. doi: 10.1053/j.ajkd.2015.07.008
Bleyer, A. J., & Diaz-Buxo, J. A. (2002). The history of peritoneal dialysis. Journal of the American Society of Nephrology, 13(Supplement 1), S23-S28. doi: 10.1097/01.asn.0000031473.60357.2b
Oreopoulos, D. G. (1996). Peritoneal dialysis: A personal history. Peritoneal Dialysis International, 16(Supplement 1), S12-S18.
Krediet, R. T. (2008). Peritoneal dialysis: From its origins to the twenty-first century. Kidney International, 73(Supplement 108), S3-S12. doi: 10.1038/sj.ki.5002713
Li, P. K., Szeto, C. C., & Piraino, B. (2016). Peritoneal dialysis in the modern era: How did we get here and where are we going? American Journal of Kidney Diseases, 68(4), 692-699. doi: 10.1053/j.ajkd.2016.05.020
Dialysis treatment is a vital medical procedure that allows individuals with kidney failure to live healthier and longer lives. Since the first dialysis machine was invented in the 1940s, advancements in technology have revolutionized the way in which dialysis treatment is administered. These advancements have improved patient outcomes and quality of life. In this blog, we will explore the latest technologies and innovations in dialysis treatment and their impact on societal acceptance.
Wearable Dialysis Devices: Wearable dialysis devices such as wearable artificial kidneys (WAK) are a promising innovation in dialysis treatment. The development of these devices began in the early 2000s, and they are still in the testing phase. However, early results have shown that WAKs have the potential to improve patients’ quality of life by allowing them to receive dialysis treatment while going about their daily activities. This technology has the potential to reduce the burden on patients and caregivers by eliminating the need for frequent visits to a dialysis center.
High-Flux Dialyzers: High-flux dialyzers are a newer type of dialyzer that removes more toxins from the blood than traditional dialyzers. These devices were introduced in the 1990s and have become increasingly common in dialysis centers. High-flux dialyzers work by allowing more water to flow through the membrane, which improves the removal of toxins from the blood. This technology has been shown to improve patient outcomes, reduce treatment times, and lower the risk of complications.
Online Hemodiafiltration: Online hemodiafiltration (HDF) is a type of dialysis that combines the processes of hemodialysis and hemofiltration. This technology was introduced in the early 2000s and has been shown to improve patient outcomes. Online HDF removes more toxins from the blood than traditional dialysis and has been associated with reduced cardiovascular mortality rates.
Remote Monitoring: Remote monitoring technology has been developed to allow healthcare providers to monitor patients’ vital signs and dialysis treatment remotely. This technology has the potential to improve patient outcomes by detecting potential complications before they become severe. Remote monitoring technology has been introduced in the past decade and is becoming increasingly common in dialysis centers.
Personalized Dialysis: Personalized dialysis is an emerging field that uses a patient’s individual characteristics to develop a personalized dialysis treatment plan. This technology has the potential to improve patient outcomes and reduce the risk of complications. Personalized dialysis is still in the early stages of development, but early results have shown promising results.
Overall, these technological advancements have the potential to improve dialysis treatment outcomes and increase societal acceptance. However, issues of accessibility and affordability must be addressed to ensure that all individuals with kidney failure have access to the latest dialysis treatments.
Look at this as an unstructured chat about whatever comes to mind that’s taking place in my universe as we speak.
Yesterday Fresenius made a delivery of Dialysate for the next thirty days. They started with the delivery of several boxes of manual Dialysate, which is not usable in the Liberty Cycle Dialysis Machine I am currently using. I had to refuse delivery, get on the line with Fresenius Custom Service, and reorder several boxes of Dialysate. What happened doesn’t matter. Perhaps I screwed up the order when I placed it using the PatientHub app, or Fresenius. Regardless, a corrected order is now scheduled for 3/27/23. My Dialysis Nurse through the backdoor got involved and called to make certain I have enough Dialysate to last until delivery which I think I do.
The bottom line here is that Fresenius is taking care of me. I have seen gripes that Fresenius is not responsive which I find NOT to be the case.
For the past five nights, I have not received ANY Drain Alarms!!!!! So what is different? After constant probing by my Dialysis Team, I finally started taking MiraLAX daily. I took the cover off the plastic line leading from the Cycler to my catheter, and I rerouted the line on my stomach that leads from the catheter outbound to the Cycler – three changes that appear to be working. I’ll keep you posted. Hope I haven’t jinxed my current success by reporting the same.
I’ve been thinking about Mindfulness, and how we can apply this concept to our daily lives. As a starting point, during my morning walk with our Golden Retriever Dickens, I have with malice of forethought paused several times, just to “smell a rose,” listen to morning sounds of birds chirping, mowers mowing, PickleBall balls going whack, and in general, being more observant and at peace with our surroundings. It is working. I seem to be less tense and more in tune with nature.
Speaking of Nature, we have an Egyptian Goose that has laid eggs on the roof dormer over our master bedroom. The pair paraded around our and our neighbor’s yards for several weeks. They went missing for several days, and a neighbor who faces our bedroom side of the house said he has been watching them come and go on the leaf and stick nest they mashed up on our roof. Looks like we will be blessed with little geese running around our yard in the near future. Worse things could certainly happen.
Lastly, before my kidney failure, my fighting weight was around 162 pounds, and stayed there for years and years. As my kidneys started failing and my eGFR became lower and lower, I started losing weight. Just before I started Dialysis, I was down to 137 pounds. Once I started on Dialysis, initially I did not gain any appreciable weight. In the last month or so, I have been able to start gaining weight again and am up to about 150 pounds. There is a God.
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.”
