Steps to a normal life on dialysis

When someone is diagnosed with Kidney Failure and is told they need dialysis or a kidney transplant, it can come as a huge shock. While most people these days would have heard about kidney failure and dialysis (I had not, when I was diagnosed in 1997!), they are not ready to accept that they could have got it. It always seemed very distant; not something they would get.

The good part about kidney failure is you can lead a normal life. There are several people who lead completely normal lives despite being on dialysis. I do, too.

What constitutes a normal life, though?

In the context of dialysis, I would say doing most things you would do if you were not on dialysis. Fair definition?

We can't do anything about doing dialysis itself (apart from a kidney transplant - which I strongly recommend to every person who is clinically eligible). But this post is for those who need to continue being on dialysis for the foreseeable future. There are several things you can do to lead a completely normal life.

Here are some of them.

Get optimal dialysis. This is the most important. Recognise that dialysis is replacing your kidney function. While dialysis itself cannot completely replace the efficiency of normal kidneys, there are things that can help you come close. If you are on Peritoneal Dialysis, you should get the number of exchanges and the duration of each dwell as per your doctor's prescription. Don't skimp. Don't take liberties. If you are on Hemodialysis, you should get the number of sessions and duration of each session as per the doctor's recommendation. Never miss a session or shorten the duration. In dialysis, more is better. Always.

Maximise the efficiency of your dialysis. Ensure you are getting the correct PD fluid bag strength or the correct HD machine parameters. These play a huge role in determining the amount of cleaning and fluid removal that happen. This post has some details on the HD machine parameters while this post has some details on PD therapy parameters.

Eat a nutritious diet. Maximise your protein intake. We lose a lot of protein during dialysis. So, make sure you are eating food rich in protein and having a variety of nutrients. Have a protein supplement if you are unable to meet your 1 gram protein per kg body weight per day. Eat plenty of vegetables (if high potassium, leach them, but don't miss out on veggies). Eat low potassium fruits. You can eat pretty much anything you want in moderation (apart from a very small number of high potassium foods) if you are on thrice weekly dialysis. Make use of this. If you are not feeling hungry, ask your doctor to help with this. Without eating well, the the rest of the steps will not help.

Exercise regularly. Start small if you are not doing anything at the moment. Do whatever exercise you can do comfortably without going out of breath. Increase the duration and intensity gradually. Keep your nephrologist in the loop always. Walking, swimming, jogging, games like Badminton or Table Tennis. Anything you like and look forward to. The important thing here is consistency. Keep to a routine without pushing yourself too hard. Never stretch beyond what your body is comfortable with.

Keep busy. Start working. Take up a hobby. The mind is a strange beast. It loves to feel depressed and tries to get sympathy from everyone around. Don't let it control you. Control it by getting it to work and stay busy with work, housework or a hobby. Don't give it time to think 'why me', 'what harm did I do to anyone', 'look at my friends' and so on. Keep it busy. Again, start small and don't do anything the body is not comfortable with. Gradually increase the number of hours. 

Don't doomscroll.  Doomscrolling is spending time on social media and news sites scrolling indefinitely and spending time idling on the phone, tablet or computer. This makes you feel wasted and saturates your mind. Don't do that.

For the above steps to work, the precondition is you should want to lead a normal life. If that is not there, don't even bother with any of them. If you truly want to live a life close to what you would if you were not on dialysis, the above steps should be a great start. 

Remember, people are doing it. It is not a new concept. People are running marathons, going on treks, working full time, traveling. All this despite being on dialysis. Don't let dialysis restrain you from doing what you want to do. Just do it!