Friday, April 12, 2019

Problems that are not serious but can hamper quality of life on Dialysis

The kidneys are wonder-organs. They do so many different things. They impact so many life-processes. It is impossible for us personally, to realise what all they do unless they stop doing these things. That is why when the kidneys do not function, so many routine aspects of daily life are affected that dealing with these issues (co-morbidities as they are called) becomes as big a challenge as the main kidney failure itself.

Some of these co-morbidities are serious. Problems with the heart, for example, are probably the most serious of them all. There are several smaller problems that may not pose a risk to life itself. These problems however severely impact the quality of life of dialysis patients if left untreated. Sometimes, doctors don’t take them as seriously because they are not clinically significant - they don’t do any harm to the body itself. However, for the person who is suffering, often these problems can dramatically increase the burden of the disease.

The good thing is these problems often have simple solutions. It is just about talking to your doctor, insisting on finding a solution and then sometimes, by trial and error figuring out what works for you. Like everything in medicine, these problems may not have a one-size-fits-all solution. However, it is possible to find a solution to most such problems. 

Here are a few commonly encountered problems which are not life-threatening but can seriously hamper quality of life and some effort should be made to treat them. Remember, never, ever start any medication suggested here without talking to your treating nephrologist. Start any medication only if he or she prescribes it for you. Each individual is different and every medication has side effects that can sometimes be worse than the condition it is treating.



1. Restless Legs Syndrome: Restless Legs Syndrome (RLS) describes the urge to shake or move the legs and extreme restlessness of the legs in the absence of motion. This is a common side effect of those with Kidney Failure. Patients typically have to walk about to get relief from the symptoms. Shaking the legs vigorously also helps. The symptoms usually worsen at night and many patients find it very difficult to sleep. There are some very effective treatments for this syndrome such as Gabapentin, Pregabalin. It is important to talk to your doctor before starting any of these drugs. You can find more information about RLS here.


2. Peripheral Neuropathy: Numbness of the feet and hands. Long term kidney failure affects the nerves. This results in numbness and a feeling of tingling in the hands and feet. Over a period of time, the symptoms can worsen and become painful. While longer, more frequent duration dialysis can help with this, the symptoms are not always completely reversible. However some amount of relief can be achieved by drugs such as Gabapentin and Pregabalin. Read more about Peripheral Neuropathy here.


3. Constipation: Difficulty in passing stools is a very common side effect of kidney failure. A lot of this is due to the change in fluid status of the body. Dialysis patients are sometimes fluid overloaded and then during the dialysis sessions, there is rapid removal of fluid. This results in several problems with the gut and the way it works. This problem is further compounded by the diet restrictions that are a standard part of the dialysis diet. It is difficult to get adequate quantities of fibre in the diet and this can worsen the problem. There are several possible solutions to constipation and you should talk to your doctor about what you can try. Some of the solutions worth discussing are the use of Lactulose Syrup (Duphalac), Psyllium Husk (Isab Gol) and Stool Softeners such as Cremafin. Read this excellent article for more information about Constipation on dialysis.


4. Itching: Also called Uremic Pruritis, many patients have a big problem with itching. There could be multiple causes of itching. The most common is excess Posphate in the body. Since the kidneys do not remove the excess phosphorus in the blood, this can build up and cause itching. There are multiple types of Phosphate binders that you could be prescribed to help with this problem. More efficient and regular dialysis can also help. Another cause for itching is related to the nerves. If your Serum Phosphorus levels are normal, then your nephrologist might recommend a drug that treats disorders of the nerves.


5. Sleep Problems: Called Insomnia in medical parlance, sleep disturbances are very common among dialysis patients. There could be several reasons for this. It is quite difficult to nail down the cause of sleeplessness. Some people find it difficult to sleep because of Restless Legs Syndrome described above. In that case, addressing that could give almost immediate relief from insomnia as well. In several patients, sleeping during the day or not engaging in any physical activity during the day can result in sleeplessness at night. Try doing something to get you tired during the day and see if this improves your sleep at night. Avoid sleeping in the afternoons. In other cases, if it is diffficult to identify the cause, discuss with your doctor about taking a mild sedative. While it is not always the best solution, sometimes the harm to the quality of life due to poor sleep might be worse than the side effects of a sedative. These days there are drugs that are relatively harmless and you should have a conversation with your doctor about this option.



6. Sexual Dysfunction: This is is a common side effect of kidney failure. Most patients on dialysis report some form of sexual dysfunction over a period of time. Typically the symptoms worsen with age with kidney disease. Lack of arousal, erectile dysfunction, fertility problems are typically reported by patients. For some of these problem, there are effective drugs that can be prescribed. For some, there are other solutions. For Sexual Dysfunction, remember the rule: if you don’t use it, you’ll lose it. See this excellent article for more information about Sexual Dysfunction with Kidney Disease.

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