Caregiving for haemodialysis patients

LAST week, I wrote about the dietary needs and restrictions for people undergoing haemodialysis. There are quite a few dos and don’ts, and the restrictions mostly encompass the need to watch your intake of fluids and nutrients like sodium, potassium and phosphorus.

Kidney disease, especially end stage renal failure, causes a build-up of waste products and excess fluids in the body that may cause breathlessness, swelling of ankles and feet (that make walking painful), lethargy and abnormal heart rhythms.

While some kidney failures are reversible, others are not. The kidneys may work again if the cause of the failure is identified and treated.

You wouldn’t likely need to continue with dialysis either if you have undergone a successful kidney transplant. However, some chronic or long-lasting kidney problems may cause kidney failure. In such cases, long-term dialysis may be necessary.

What happens if someone with end stage renal failure does not go for dialysis? They may live for about a week to several weeks, depending on the amount of kidney function left. The average life expectancy on dialysis is five to 10 years, although many patients have lived well on dialysis for 20-30 years. It depends very much on the patient’s medical condition and how well he or she follows the treatment plan.

For the most part, people on dialysis can lead a relatively normal life. You can even drive and travel on days that you don’t need to do the dialysis. Just be mindful of your condition and plan properly.

My late mother under went ha e mo dialysis for many years. Initially, she was reluctant to do it because it meant she had to have a fistula surgically installed in her left arm to facilitate dialysis. Haemodialysis totally altered her lifestyle, what she ate and what she could do.

However, she felt better after the first week of dialysis and that gave her hope. After a few months, she felt so well that she returned to her old self again. She started

to plan and looked forward to doing things and meeting people. She confided that she felt as though she’d been given a second chance at life.

When her condition was well controlled, we took short trips abroad over the weekend, planning the treatment and medications with the nephrologist. We even identified and contacted hospitals at our destinations in case mum needed to have emergency dialysis. For the most part, we kept our trips short so that she would not have to miss any session.

A NEW NORMAL

Not all haemodialysis patients are elderly. I’ve met men and women in their 30s and 40s at the clinic where mum received treatment. Looking at them, you’d never guess they were dialysis patients.

We used to chat about how dialysis had changed people’s lives — mostly for the better. But they also told me that people just need to be sensible about many things, especially what they do and what they eat. They shared that they still drove when they could but not on days when they had dialysis as they would usually be exhausted after each session.

Driving immediately after dialysis can pose a risk. Low blood pressure and cramps are the common side-effects of haemodialysis. This happens when too much fluid has been removed from the blood during dialysis, causing the pressure to drop. You’d feel dizzy and nauseous.

This happened to my late mother in the early days of haemodialysis when she had to be stabilised — too much water and toxins in the system but her blood pressure remained high. The nephrologist didn’t seem to be concerned about that. He was more concerned if her blood pressure dropped.

ASK YOUR DOCTOR

I remember him telling us that this is the one and only time when you need the blood pressure to be on the high side of normal. If the blood pressure drops or is “normal” for the ordinary person, the patient cannot undergo dialysis.

Lack of minerals and nutrients may cause this. When you’re on dialysis, you may not get enough vitamins and minerals because you have to avoid so many types of food. Haemodialysis also removes mineral and vitamins from your body.

Discuss what you need with your doctor because he can prescribe vitamin and mineral supplements designed specifically for patients with kidney failure.

Be careful about buying vitamin supplements and pain relief medications over the counter or from well-meaning people. Under the circumstances, it’s always best to ask your doctor.

Haemodialysis treatments typically take about three to four hours per session and is done thrice a week. The caregiver doesn’t need to sit by the patient’s side during that time as the nurses will be around all the time to ensure that all’s well. This is a good time for caregivers to take a break, run errands or just have some time for themselves.