Tag: setup (Page 21 of 43)

Yesterday my dialysis nurse Cindy conducted a PET again. In a couple of days, we should have a readout on my Transport “Function” and go from there on whether or not my prescription should be altered. To uninitiated reading about a PET concerning dialysis involves manually loading 2000 mL of 2.5% fluid the night before the test, at home, and several loads and drains at the dialysis center the following day along with lab draws. The whole PET takes several hours. I started at 0900 and got back home about 1500.

We dialysis patients often get caught up in our little worlds. Friday night our son, a robust 61-year-old hard-working man, was admitted to the hospital with chest pains. He has been experiencing high blood pressure for some time and also experiences white coat anxiety. He was scheduled to go to the CathLab early Monday but was postponed to Tuesday because of continued hypertension. Stay tuned.

Introduction:
Palliative care and hospice are essential components of comprehensive healthcare that aim to improve the quality of life for patients with serious illnesses. While peritoneal dialysis is an effective treatment option for end-stage renal disease (ESRD), some patients may eventually require palliative care or transition to hospice as their condition progresses. In this blog entry, we will explore what palliative care and hospice entail and provide definitive examples of how they can benefit a patient on peritoneal dialysis.

Understanding Palliative Care:
Palliative care is a specialized medical approach that focuses on relieving symptoms and improving the overall well-being of patients facing serious illnesses. It is not limited to end-of-life care but can be initiated at any stage of a chronic illness. The primary goal of palliative care is to enhance the patient’s quality of life by managing pain, addressing emotional and psychological needs, and providing support for the patient’s family.

For a patient on peritoneal dialysis, palliative care can play a crucial role in managing symptoms and complications associated with the treatment. For instance, a patient may experience chronic pain, fatigue, or anxiety due to the dialysis process. Palliative care specialists can work collaboratively with the patient’s healthcare team to develop a comprehensive care plan that addresses these issues. They may prescribe medications to alleviate pain, provide counseling to manage emotional distress, and offer guidance on lifestyle modifications to enhance the patient’s overall well-being.

Exploring Hospice Care:
Hospice care is a form of specialized care provided to individuals who have a limited life expectancy, usually estimated to be six months or less. It is primarily focused on providing comfort and support to patients and their families during the end stages of a terminal illness. Hospice care can be delivered in various settings, including the patient’s home, a specialized hospice facility, or a hospital.

In the context of peritoneal dialysis, a patient may reach a stage where the treatment is no longer effective or desired. In such cases, the patient may choose to transition to hospice care to receive comprehensive support during their end-of-life journey. Hospice professionals can assist in managing symptoms such as pain, nausea, and breathing difficulties, while also providing emotional and spiritual support to both the patient and their loved ones. Additionally, they can help with organizing and coordinating necessary caregiving services, ensuring the patient’s comfort and dignity.

Definitive Examples of Palliative Care and Hospice for a Peritoneal Dialysis Patient:
Let’s consider the case of a patient on peritoneal dialysis who has advanced kidney disease and experiences significant fatigue, anxiety, and depression. Palliative care specialists can intervene by prescribing medications to alleviate the patient’s fatigue, offering counseling sessions to address anxiety and depression, and collaborating with the patient’s healthcare team to optimize the dialysis regimen. This holistic approach can enhance the patient’s quality of life, allowing them to engage in activities they enjoy and maintain emotional well-being.

In another scenario, imagine a patient on peritoneal dialysis who has progressed to the end stages of kidney disease and decides to discontinue treatment due to personal preferences or worsening health conditions. Hospice care professionals can step in to provide support during the patient’s remaining time. They can focus on pain management, ensure symptom control, and offer emotional support to the patient and their family members. This compassionate care allows the patient to spend their final days in comfort and dignity, surrounded by loved ones.

Conclusion:
Palliative care and hospice play vital roles in enhancing the quality of life for patients on peritoneal dialysis, both during active treatment and at the end stages of their illness. From managing symptoms to providing emotional support, these specialized care approaches ensure that patients receive holistic, patient-centered support. By integrating palliative care and hospice into the treatment plan, patients and their families can navigate the challenges of renal disease with dignity, compassion, and improved well-being.

I had the gut feeling that there’s more to the potential deleterious effect of Hypotension, that is low blood pressure, on Peritoneal Dialysis. So with the help of Poe, I dug deeper and questioned it along the lines of the impact on an 85-year-old male with hypotension and diabetes. The results bear out my suspicions. Read on. (To me, the most important finding is that of Impaired clearance of waste products which it is conjectored directly impacts Kt/V, the effectiveness of the peritoneal dialysis process itself. I hypothesize there is a direct correlation link between hypotension and Kt/V: decreased blood pressure results in decreased Kt/V.)

Low blood pressure, also known as hypotension, can potentially present challenges for an 85-year-old diabetic individual on peritoneal dialysis. Here are some issues that low blood pressure may pose in such a circumstance:

1. Decreased tissue perfusion: Low blood pressure results in reduced blood flow to the organs and tissues. This may compromise overall tissue perfusion, limiting the delivery of oxygen and nutrients to vital organs.
2. Hemodynamic instability: Low blood pressure can lead to hemodynamic instability, causing symptoms like dizziness, lightheadedness, fainting or syncopal episodes. For those on peritoneal dialysis, maintaining hemodynamic stability is important during the treatment process.
3. Dialysis impacting blood pressure: Peritoneal dialysis itself can have the potential to affect blood pressure. In some cases, dialysis may reduce blood volume or cause fluid shifts, potentially contributing to low blood pressure.
4. Diabetic complications: Diabetes may already predispose individuals to various cardiovascular complications such as autonomic neuropathy or arterial damage. These complications can further amplify the effects of low blood pressure.

Certainly! In the context of peritoneal dialysis, low blood pressure can have several implications:

1. Reduced ultrafiltration: One primary goal of peritoneal dialysis is to remove excess fluid from the body. Inadequate blood pressure may lead to decreased ultrafiltration, whereby less fluid is effectively removed from the peritoneal cavity during a dialysis session. This can result in fluid retention and worsen edema or other fluid-related complications.
2. Impaired clearance of waste products: Peritoneal dialysis relies on a pressure gradient to facilitate the exchange of toxins and waste products across the peritoneal membrane. Low blood pressure can compromise this pressure gradient, reducing the effectiveness of waste clearance during dialysis.
3. Altered drug removal: Peritoneal dialysis can limit the removal of certain medications and drugs from the body. Changes in blood pressure can affect drug removal rates, potentially leading to inadequate clearing of medication or increased drug levels in the bloodstream.
4. Increased risk of complications: Low blood pressure can increase the risk of resulting complications during peritoneal dialysis, including clotting or obstruction of the peritoneal catheter, infection, inadequate dialysis, or issues with maintaining adequate waste elimination.

Tissue perfusion refers to the blood flow and distribution of oxygen, nutrients, and other vital substances throughout the body’s tissues and organs. It is essential for maintaining the normal functioning of organs and sustaining cellular activities.

Adequate tissue perfusion ensures that every cell in the body receives sufficient oxygen and nutrients while facilitating the removal of waste products. The circulatory system with its network of blood vessels, such as arteries, arterioles, capillaries, venules, and veins, plays a vital role in maintaining tissue perfusion.

When blood pressure and blood flow are within a normal range, tissue perfusion remains optimal. However, factors such as decreased blood pressure, impaired circulation, or narrowed blood vessels can negatively affect tissue perfusion. Reduced tissue perfusion may result in inadequate oxygenation, diminished nutrient supply, impaired waste removal, and cellular dysfunction.

Most vulnerable to the effects of inadequate tissue perfusion are vital organs like the heart, brain, kidneys, liver, and lungs. Insufficient perfusion in these organs can lead to severe consequences such as organ dysfunction, tissue damage, or organ failure.

Healthcare providers closely monitor tissue perfusion in various medical and clinical settings to ensure efficient body functioning. Adequate perfusion is a key consideration in managing and treating conditions such as cardiovascular disease, sepsis, shock, and other critical illnesses.

In medical settings, tissue perfusion can be assessed through various methods. Some common approaches include:

1. Vital signs monitoring: Essential signs such as blood pressure, heart rate, and oxygen saturation levels can provide insights into tissue perfusion. Significant changes in these parameters may indicate potential perfusion issues.
2. Capillary refill: Capillary refill time, which measures the time taken for color to return to the blanched fingertip after pressure is applied, can offer a rough indication of peripheral tissue perfusion. Longer refill times might suggest compromised perfusion.
3. Pulses: Palpating peripheral pulses (e.g., radial, femoral, etc.) can indicate the strength and regularity of blood flow to peripheral tissues. Absent or diminished pulses may imply diminished tissue perfusion.
4. Skin condition and temperature: The appearance and temperature of the skin can indicate tissue perfusion. Pallor, cyanosis, coolness, or mottling might suggest poor perfusion in the affected areas.
5. Ankle-brachial index (ABI): ABI is a non-invasive test that assesses peripheral arterial perfusion. It compares the blood pressure in the ankle to that in the upper arm, estimating the degree of peripheral arterial disease.
6. Blood tests: Various laboratory tests can indirectly reflect tissue perfusion status, such as measuring levels of lactate or analyzing blood gases.
7. Diagnostic imaging: When assessing tissue perfusion in the context of specific organs or regions, imaging techniques like Doppler ultrasound, CT scans, or magnetic resonance angiography (MRA) can provide information about blood flow and potentially identify vascular abnormalities or blockages.

So what’s the bottom line here? It should be clear that the ramifications of hypotension on peritoneal dialysis patients can be indeed very serious to the point of death and should not be shrugged off.

My wife Linda and I are on separate ends of the blood pressure spectrum. She is struggling with high blood pressure while I am at the other end with chronically low. While she has received specific guidelines from her GP on what her upper normal target should be, 135 over 85, nothing is ever mentioned about hypotension, that is, low blood pressure. We don’t even see the term, hypotension, to any extent when blood pressure is discussed. As a society, we seem to be fixated on hypertension. My first approved disability with the US Veteran’s Association was for “Diabetes with Hypertension.”

There seem to be philosophical differences between medical professionals as to what constitutes hypertension. For instance, my current dentist takes my blood pressure before opening my mouth for any dental procedure. By current guidelines, in the past, I have been hypertensive but nothing was ever said or done about it. Compounding this are definitional concepts like who are the “elderly” that have different parameters than the “normal” population. To illustrate this point, I queried Poe as to what the definition of “elderly” is in the USA with the following results:

“In the USA, the term “elderly” generally refers to individuals who are considered to be advanced in age or the later stages of life. However, it’s important to note that there isn’t a universally agreed-upon definition of when someone is considered elderly. The perception of old age can vary depending on cultural, social, and individual factors. In many contexts, the term “elderly” is often used to describe individuals who are around 65 years of age or older, which is the age at which many people become eligible for certain government benefits and programs such as Medicare. However, it’s worth mentioning that this age threshold is not fixed or definitive, and some organizations or researchers may utilize different age ranges or criteria when discussing the elderly population. Additionally, it’s important to recognize that the term “elderly” can be subjective and may carry different connotations for different people. Some individuals may consider themselves elderly at a younger age, while others may not identify as elderly even at an older age. It’s always best to consider individual preferences and perspectives when discussing age-related topics.” (Emphasis provided.)

Since I am interested in specific guidelines for my particular case, an 85-year-old male on peritoneal dialysis, I went back to Perplexity to ascertain what current research indicates for my particular case with the following Prompt and results:

What are the most recent guidelines for both high and low limits on blood pressure for an 85-year-old male on peritoneal dialysis?

View 2 more

Answer

The most recent guidelines for blood pressure management in elderly patients with chronic kidney disease (CKD) on peritoneal dialysis are not explicitly detailed in the search results provided. However, the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines suggest a target blood pressure of less than or equal to 140/90 mmHg if albuminuria is present

2. Additionally, the 2015 International Society of Peritoneal Dialysis (ISPD) guidelines recommend that persistently high blood pressure in peritoneal dialysis patients should be corrected to levels below 140/90 mmHg5.For patients with CKD not receiving dialysis, the KDIGO 2021 Clinical Practice Guideline suggests a target systolic blood pressure (SBP) of less than 120 mm Hg3. However, this target may not be directly applicable to patients on peritoneal dialysis, such as the 85-year-old male in question. It is important to note that individual patient factors, such as the presence of other comorbidities, should be considered when determining the appropriate blood pressure targets. Therefore, the patient should consult with their healthcare provider to determine the most appropriate blood pressure goals based on their specific health status and the latest clinical guidelines.

So although I specifically requested a lower limit, Perplexity aka a smart Google did not provide any, just the 140 number for an upper limit. I went one step further and quizzed Perplexity about my potential problems related to blood pressure while on PD with the following Prompt and results:

Prompt:

What are the most recent guidelines for both high and low limits on blood pressure for a 85 year old male on peritoneal dialysis?

Answer

The most recent guidelines for blood pressure management in elderly patients with chronic kidney disease (CKD) on peritoneal dialysis are not explicitly detailed in the search results provided. However, the 2013 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines suggest a target blood pressure of less than or equal to 140/90 mmHg if albuminuria is present

2. Additionally, the 2015 International Society of Peritoneal Dialysis (ISPD) guidelines recommend that persistently high blood pressure in peritoneal dialysis patients should be corrected to levels below 140/90 mmHg5.For patients with CKD not receiving dialysis, the KDIGO 2021 Clinical Practice Guideline suggests a target systolic blood pressure (SBP) of less than 120 mm Hg3. However, this target may not be directly applicable to patients on peritoneal dialysis, such as the 85-year-old male in question.It is important to note that individual patient factors, such as the presence of other comorbidities, should be considered when determining the appropriate blood pressure targets. Therefore, it is advisable for the patient to consult with their healthcare provider to determine the most appropriate blood pressure goals based on their specific health status and the latest clinical guidelines.

what are the risks of low blood pressure for elderly patients on peritoneal dialysis?

Low blood pressure in elderly patients on peritoneal dialysis can pose several risks, including an increased risk of clots during dialysis. A study led by researchers at Stanford University School of Medicine reported an elevated risk of clots associated with a fall in blood pressure during dialysis, emphasizing the importance of blood pressure management in this patient population

1. Additionally, low blood pressure during dialysis can lead to various short-term symptoms such as nausea, dizziness, and gastrointestinal, muscular, and neurologic symptoms13. Furthermore, the 2015 International Society of Peritoneal Dialysis (ISPD) guidelines recommend that persistently high blood pressure in peritoneal dialysis patients should be corrected to levels below 140/90 mmHg, highlighting the significance of blood pressure control in this population4. Therefore, it is essential to monitor and manage blood pressure carefully in elderly patients on peritoneal dialysis to mitigate these potential risks.

Last Thursday I attended my monthly Dialysis Team meeting. We went over my lab results and my doctor did her normal checking me over for obvious things.

Most of the conversation was about my Kt/V reading, and how it had not drastically responded to the last dialysis prescription. Recall, that it increased by 0.1 points to 1.8 from 1.7. We discussed increasing dwells to 6 from the current 5, with the last dwell occurring while I’m awake. A manual drain at some point would follow it during the day. Since there is doubt about the complete accuracy of my last PET and the resulting Transport Function, it was decided to conduct another PET before changing anything. I wrote an in-depth blog about PET that is at this link. Alternatively, you can use the blogs search function and enter either “Transport” or “Pet” to refer to blogs about these subjects.

The second subject that was discussed was my low blood pressure. One of the drugs I take for high blood pressure, Amlodipine Besylate had previously been reduced to a 5 mg cap from 10 mg. This time, we reduced my Irbesartan tab to 150 mg from 300.

Bottom line: More tests and more trial and error in an attempt to increase the efficacy of my dialysis treatment as measured by Kt/V. Ditto blood pressure.

Over the more than a year that I have been on peritoneal dialysis, I have noticed that I am prone to an excessive amount of farting, AKA in nicer terms, “flatulence.” While this occurence is often grinned at by men and made almost a joke of, for me it is way beyond that. Since this blog is meant to share and inform others interested in PD, let it be known that, at least from my perspective, farting is an inherent byproduct of PD. And we’re not talking innocent toots here, but rips that would strike envy in the Paul Bunyans of the world.

With this background, I am more than interested in what research into this area has found. Recall that Perplexity is an AI-powered Google which I turned to with the following query and results in the posed question:

Query: Summarize research into the link between peritoneal dialysis and flatulence.

The link between peritoneal dialysis (PD) and flatulence has been studied, but the results are conflicting. A study on gastrointestinal symptoms in PD patients found that gastrointestinal symptom scores were not significantly different in PD patients, and gastrointestinal life quality was not correlated with the duration of PD treatment

1. Another article mentioned that gastrointestinal symptoms appear to be common in all dialysis patients, with reflux being more prevalent in PD patients compared with those on hemodialysis (HD)2. However, the specific link between PD and flatulence was not explicitly discussed in the available search results. Therefore, the existing research provides limited and conflicting evidence on the relationship between peritoneal dialysis and flatulence. Further investigation may be needed to establish a clear link between the two.

OK, so not any correlation to speak of as reported by Perplexity. I then turned to a straight AI engine that I use a lot, Poe,with the following prompt and results:

Prompt; Write a concise 250-word or so blog entry about the association between peritoneal dialysis and flatulence from a layman’s perspective.

Assistant Poe

Title: Peritoneal Dialysis and Flatulence: A Layman’s Guide

Introduction:
Peritoneal dialysis (PD) is a life-saving treatment for individuals with kidney failure. While it offers numerous benefits, patients may experience certain side effects, including flatulence. In this blog post, we’ll explore the association between peritoneal dialysis and flatulence from a layman’s perspective.

Understanding Peritoneal Dialysis:
A peritoneal dialysis is a form of renal replacement therapy that cleanses the blood by using the peritoneal membrane in the abdomen as a natural filter. During PD, a sterile solution (dialysate) is introduced into the abdominal cavity through a catheter, where it absorbs waste products and excess fluids from the bloodstream. The dialysate is then drained out, carrying the accumulated waste with it.

The Connection to Flatulence:
Flatulence, commonly known as gas or bloating, refers to the release of air from the digestive system through the rectum. In peritoneal dialysis, one potential cause of flatulence is the presence of air in the dialysate. When the dialysate fluid enters the abdomen, it can introduce small amounts of air, which may cause discomfort and lead to increased gas production.

Managing Flatulence:
Here are a few tips to manage flatulence during peritoneal dialysis:

1. Slow and Steady: Take your time during the exchange process to allow any trapped air to escape naturally.
2. Proper Technique: Ensure that the dialysate bags are properly warmed and primed to minimize the introduction of air.
3. Positioning: Changing positions during the exchange can help air bubbles rise to the top of the abdominal cavity, making it easier for them to be drained out.
4. Diet Modification: Some foods known to cause gas, such as beans, cabbage, and carbonated beverages, may exacerbate flatulence. Consider discussing dietary modifications with a healthcare professional.

Conclusion:
While flatulence can be an uncomfortable side effect of peritoneal dialysis, it is often manageable with the right techniques and adjustments. If you experience persistent or severe flatulence, it is important to consult your healthcare team for further evaluation and guidance. Remember, they are your best resource for personalized advice regarding peritoneal dialysis and its potential side effects.

We see that Poe suggests a stronger correlation between PD and flatulence and suggests ways to combat the same. My thesis hypothesis stands: there is a strong correlation between PD and farting. QED