Peritoneal Dialysis as an effective treatment of kidney failure

Hopefully you have found out about your chronic kidney disease at an early stage. If so, there are treatments to help protect your kidneys and prevent, or slow down, further damage. These treatments include:Good control of high blood pressure, usually with medication, is very important in protecting the kidneys.If you have diabetes your kidneys will be helped by excellent blood sugar and blood pressure control.Avoiding dehydration;avoiding medications that could damage your kidneys such as Brufen, Nurofen, and Voltaren.Over time, if chronic kidney disease gets worse it makes you feel very unwell and if the damage becomesreally bad and the kidneys can’t get better. This is called “kidney failure”. Treatments for kidney failure People with kidney failure have three treatment choices Dialysis  Kidney transplant Conservative treatment.

Dialysis

You cannot live without having your blood cleaned properly. So, when the kidneys have failed completely, a treatment called dialysis can take over the job of filtering and cleaning the blood. While dialysis is not as easy or as good as having healthy kidneys – dialysis takes time and effort – it still does a pretty good job to help people live a normal life. There are two types of dialysis: haemodialysis and peritoneal dialysis. Most people can choose the type of dialysis that best suits them, but others may have a particular type recommended to them by their doctor because of their other medical problems.

Haemodialysis
One type of dialysis is called Haemodialysis (haemo means blood). With this treatment the filtering happens outside the body using a dialysis machine (also called a kidney machine). When you “go on the machine” needles connected to tubes are put into a special vein in your arm called a fistula (which is made by a small surgical operation). The blood flow though these tubes out of your body into a filter (called a dialyzer) attached to the dialysis machine and back into your body. Your blood goes round and round through the flter, just as it does with a normal kidney. The flter cleans the blood and removes the excess water and wastes the damaged kidneys can no longer manage.

The fluid made by the flter goes directly down the drain, just like urine. Most people go on the machine three times a week. You sit in a chair and are connected to the machine for four or five hours each time. Some people have dialysis more often and for a longer time. There are three places where you can have your dialysis treatment – at home (after being taught by hospital staff), at a satellite clinic or at the hospital. Going on the machine at home makes it easier to continue normal life, so it is best if you who can manage it. But if you cannot manage your own treatment, going three times a week to the satellite or hospital are the other choices. The kidney team will discuss with you which place is best for you.

Peritoneal Dialysis

The other type of dialysis is called Peritoneal Dialysis. This is where the cleaning of the blood is done inside the body instead of by a machine. The lining of the tummy is called the peritoneal membrane. This membrane covers some of the body’s organs like the bowel, liver and stomach. Special dialysis fluid is put into your abdomen (tummy) from a plastic bag through a soft rubber tube (called a catheter, put in by a small surgical operation). The fluid sits in your tummy for a few hours. While it is in there wastes and excess water pass from the blood vessels in the peritoneal membrane into the dialysis fluid.

After a few hours the fluid is changed by draining it out into another plastic bag and replacing it with fresh fluid as before. This is called an “exchange”. The used fluid is emptied down the toilet. This dialysis is done every day of the week, usually four times a day. During the exchange you are connected to a set of tubes and bags for 20 to 40 minutes. Because Peritoneal Dialysis does not need a machine, fluid exchanges can be done almost anywhere. People can take care of their own Peritoneal Dialysis at home. The catheter is left on the outside of the body in between exchanges. This tube can be hidden under your clothing and between exchanges you can go about your daily life as usual. There is a machine that can be used for peritoneal dialysis. The kidney team will discuss with each person if they need to use this instead.

Is dialysis forever? When kidneys have failed, dialysis must go on for the rest of the person’s life, unless the person can get a new kidney.

Kidney Transplant

Unfortunately dialysis cannot make the kidneys work again. For some people with complete kidney failure a kidney transplant may be an option. A kidney transplant is an operation to have someone else’s healthy kidney put inside your body. If the transplant works well the person will no longer need dialysis. For most people with kidney failure having a kidney transplant is the best treatment. If you are not sure whether a transplant would be right for you, ask your kidney team.

Making a choice of the best treatment for you

You can expect to be looked after by a team of people who are all specially trained to look after people with kidney problems. They will help you come to a decision about the best treatment option for you. If you are not sure what would be best for you, ask your doctor.

Understanding the Peritoneal Dialysis Diet

Diet and nutrition are important components to healthy living; it helps the body stay strong and has also been proven to help manage many chronic illnesses such as diabetes, high blood pressure and kidney disease. When an individual reaches the late stages of kidney disease, transplantation is not always the answer or an option that’s immediately available. At times, dialysis is a patient’s only choice, however there are many forms of dialysis that a patient must consider when selecting the one that’s right for them. Home dialysis therapies are popular choices among patients who feel comfortable taking a more active role in their care and prefer the freedom it allows them.

Peritoneal Dialysis (PD) is one of those daily at home dialysis options; however when you are on any form of dialysis, diet can play a big role in how your treatments go and how you feel. Since the process of peritoneal dialysis uses a fluid that contains carbohydrates to help filter out the toxins in your blood, dietary changes may be necessary to maintain body weight and prevent excess weight gain in patients choosing this therapy. Moreover, having ongoing dialysis daily changes your nutritional needs. Calories and Carbohydrates the fluid used (called dialysate) for peritoneal dialysis has carbohydrates in it which means it has calories. Calories are the fuel for your body. Different amounts of carbohydrates are used during peritoneal dialysis treatments, also called exchanges, to remove wastes and excess fluids from your blood.

Typically, peritoneal dialysis dialysate can add about 500 extra calories each day, depending on the dialysate used. The challenge begins when attempting to lose weight or control blood sugars adequately. Regardless, maintaining energy balance, meaning the calories (food) you put in equal to the activity (fun or what can technically be called exercise) you do each day, is necessary when on peritoneal dialysis to ensure appropriate energy levels for spending time with friends or family. Contact your dietitian if you have concerns about the amount of calories you are getting from dialysis and he or she will be able to provide you with individualized direction on how to account for this extra energy.

Protein

Protein is necessary for building and repairing your body as well as preventing infections. With peritoneal dialysis, protein is constantly drained from the body and this increases your protein needs. In addition, if you get peritonitis (infection of the area where your dialysis takes place in your body) your protein losses increase, causing you to need even more protein from your diet or supplements. So remember to follow your dietitian’s orders when he or she says to eat more protein; this is to ensure that your body can ward off infections and replenish all the lost protein from treatments. Generally you need about eight to 10 ounces or more of protein a day which is about 1.3 grams of protein per kilogram of body weight (there are 2.2 pounds per kilogram). Three ounces of meat/chicken looks like a deck of cards and the fish equivalent looks like a checkbook. You can also use the palm of your hand to estimate how much protein you are eating, with it representing approximately four ounces of protein for an average sized palm. Good sources of protein are lean beef or pork, tuna, tilapia, salmon, shrimp, eggs (or egg whites/substitute), and skinless chicken and turkey. Try to get at least one serving of these at each meal, every day.

Calcium and Phosphorus

Bone health is often compromised not only in the general public, but also for those on dialysis. Calcium and phosphorus help build and maintain bone, but too much of these minerals can be detrimental for peritoneal dialysis patients. Foods high in calcium are dairy products (milk, yogurt and cheese) and foods fortified in calcium (everything from juices and breads to crackers and margarine spreads). Foods lows in phosphorus are plentiful, below is a sample list which is not all-inclusive, but can be of some use when choosing foods to eat. For a more in-depth list of foods with lower phosphorus content seek direction from your dietitian. Remember that cheese-flavored snacks, chocolate, dairy products (especially cheese and ice cream), nuts and whole grain products are higher in phosphorus, but can possibly be incorporated into your diet with help from your dietitian.

Potassium

Potassium, an electrolyte important in heart function, is significantly removed with peritoneal dialysis treatments; thus, you may need to eat more potassium-rich foods. Signs and symptoms of low potassium are muscle cramps, difficulty breathing and irregular heart beat. Too low or high potassium can be dangerous, resulting in cardiac arrest. Be sure to speak with your dietitian about your potassium levels and which foods are best for you to have with your meals and snacks safely. The general potassium recommendation for those on peritoneal dialysis is 3,000-4,000mg a day and the amount in many foods is now listed on the nutrition facts label of many food items. Below is a chart that can help you understand what is considered very high, high, medium and low for potassium when looking at food labels: Typically fruits and vegetables are associated with potassium, but chocolate, dairy products like milk, cheese and yogurt all contain significant sources of potassium. The serving size for many fruits and vegetables are approximately one-half to one cup. Here are some examples of one serving of fruits and vegetables: one cup of salad greens, one cup cooked broccoli or other vegetable, 12 strawberries or 16 grapes.

Sodium

As with other treatment types, peritoneal dialysis require a need to be aware of sodium and fluid intake. Sodium is found in table salt and is plentiful in processed meats like bologna, sausage, hot dogs, bacon, corned beef, lunch meat, pickles, frozen meats, and canned soups and vegetables. Fluid is anything liquid at room temperature: coffee, soda, ice, juice, soup, popsicles, sherbet and gelatin. Sodium is connected to fluid intake and how much fluid your body holds on to; if you eat foods high in sodium you will get thirsty and drink more fluid.

Conclusion

Being on peritoneal dialysis brings many different factors into play and nutrition is just one participant. Remember the resources you have available to you, especially your dietitian. Because each patient is different, your dietitian can help create a meal plan just right for you and your health care needs. With proper support and planning as well as educating yourself, confidence will grow. Making food choices will not be a chore or a feat to conquer, but something to enjoy that becomes like second nature. Try to see your food choices not as a “diet,” but as making healthier choices to promote your well-being and enjoyment of life’s daily gifts.