Sunday, August 19, 2018

What you can do to live a full life on dialysis

Dialysis is often made out to be the worst thing ever. People think dialysis is pretty much the end of life. In India especially, not dialysis, it is your friends and neighbours and their half-knowledge and hearsay that will kill you. There are so many misconceptions about dialysis floating around among the population that it is dangerous.

The internet these days and more so, social media (Whatsapp included) has become the biggest source of misinformation. There are of course, several reliable sources of good information but it is equally easy to find completely wrong, baseless articles as well.

Despite what your neighbour and helpful aunty say, you can live a complete life on dialysis. Here are a few things you can do:

1. Get as much dialysis as you practically can: Most people feel that if you can manage with two sessions per week, why do the third. While there is some evidence that suggests that less dialysis can be good in the early days of kidney failure, once your kidneys have failed completely, the more dialysis you do, the better it is for you. Some people may attribute this advice to me being the co-founder of a dialysis company. If dialysis patients do more dialysis then I make more money. Right?

Wrong. I personally do five nights a week, seven and half hours every time. I practise what I preach. Think of it this way. Dialysis is replacing kidney function. Kidneys work 24X7. So logically, you should aim to get as close to that as practically possible. If you’re looking for scientific evidence, check this article out  Most of the other points mentioned below pale in significance compared to this one. Most of the points below and deeply linked to this one.

2. Correct anemia: Anemia means low blood counts - Hemoglobin, RBCs, WBC, Platelets etc. Make sure these are in the recommended range. Having low Hemoglobin can cause breathlessness, weakness, increased chances of infections and so on. Your overall quality of life will be much better if your anemia is corrected. So, don’t skimp on that EPO and Iron.

3. Keep a check on your heart: Most dialysis patients die of cardiac and not kidney problems. Since there is an increased build up of fluid in the body when the kidneys don’t function, the heart needs to pump all the extra fluid which it is not designed for. This can cause the heart to fail over a period of time. Make sure you’re getting your Heart Function checked from time to time. There is a simple test called a 2D Echo Cardiogram that can do this.

4. Food: If you eat meat, keep a check on your Phosphorus and Potassium. If you are vegetarian, keep tabs on your Potassium. Read up on foods that are high in Phosphorus and Potassium. You need to make intelligent food choices. I would say there’s nothing you cannot eat if you’re on dialysis. You need to eat in moderation and you need to balance things out. If you’ve had something high in Potassium, make sure what you eat for the rest of the day is very low in Potassium.

Make sure you get good protein. It is very important to get enough protein during the day. Serum Albumin is a good marker of nutrition. Get it tested regularly.

5. Exercise and Strength Training: Do some exercise every day. Even if it as simple as a walk. Talk to your nephrologist about the different types of exercise you can do. Pick something that you enjoy and do it regularly. You need to exercise your muscles. Long term kidney disease can cause wasting of the muscles. So some kind of strength training for your muscles is important in the long run. More details here.

6. Work: Like your body, you need to exercise your mind as well. This is very important, probably more important than exercising the body. A lot about kidney disease plays out in the mind. Several dialysis patients have depression, trouble with cognition and so on. So, keep your mind active. If you are unable to work full time, work part time. Do something to keep that mind busy.
It is not very difficult to lead a complete, productive and happy life on dialysis. The first step you need to take is to want to be able to do this. You have a choice - you can choose to feel like your life has come to an end - in which case it soon will; or you can choose to lead a normal, slightly different life - in this case too, you soon will. It all really is up to you.

Tuesday, August 14, 2018

Doing conventional dialysis at home is like going to Agra and seeing this

There are many patients in India who get Home Hemodialysis. However, almost all of them get the conventional twice or thrice weekly sessions for four to five hours. They are doing Home Hemodialysis simply for the convenience of dialysing at home and because they can afford it.

Have you seen the Taj Mahal at Agra? Well, if you haven’t seen it in person, there’s a good chance that you’ve seen it in a picture at least. What if you went to Agra to see the Taj and when you went in, you saw only this?

You would be disappointed, right? No majestic domes, no ornate pillars at the four corners of the platform. Well, the smallish facade looks good. But nothing compared to what could have been, right?

Doing conventional twice or thrice weekly hemodialysis at home is good. You have the flexibility of doing dialysis at home. You don’t need to go to a centre. You can enjoy the comfort of home. However, the true beauty of Home Hemodialysis is realised only when you do more frequent dialysis or longer duration dialysis or even better, both.

That’s when you feel the equivalent of seeing the full Taj Mahal. Like this:

The beauty of Home Hemodialysis is the ability it offers you to get more frequent, longer duration dialysis. You are freed from practically all diet and fluid restrictions. Your blood pressures come back to normal. You don’t need any phosphate binders any more. You don’t even need expensive Erythropoietin injections because your anemia disappears. Your restless legs settle. Your cardiac function improves. You don’t feel washed out after a dialysis session.

It is sad that almost everyone in India who does home hemo does it for all the wrong reasons. they are losing out on so much.