The first thing that a dialysis patient should not do is to drink too much water especially when his/her urine output is low or very low because this could cause edema (swelling) of the legs and other body parts. The worst that a dialysis patient can get from drinking too much water is pulmonary edema wherein water could enter the lung cavity resulting to difficulty in breathing and high blood pressure. If the situation becomes serious the lung could not anymore function properly and the last resort for the doctor is intubation (putting a tube in the trachea of the patient to facilitate breathing with the help of a manual/mechanical pump). Too much water volume of the blood strain the heart as it tries to pump the excess water and it could result to enlargement of the heart or heart failure. The question is how much water is too much? For dialysis patients with low or very low urine output they should drink not more than one liter per day or preferably less.
To avoid drinking too much water, the dialysis patient should try licking small ice stick to quench his/her thirst. Water molecules in ice have already expanded and less water is contained in a certain volume compared to its liquid state. The dialysis patients should also avoid eating watery fruits like water melon, mango, banana, avocado, pineapple, oranges and papaya. The water content in these fruits is high and could contribute to the increase in the water intake of the patient. Eating too much cooked rice also contain high amount of water. The dialysis patient should sip small amount of water from the glass or mug and he/she should avoid frequent drinking of coffee or soft drinks. The patient should avoid salty foods as salt could cause water retention and will aggravate edema. The patient should avoid sipping too much soup as this may contain too much salt and water. The dialysis patient should eat fruit with less water content like apple. The patient should regularly monitor his/her blood pressure as well as his/her blood sodium. Low blood sodium value result to low blood pressure and prone to painful cramps. High blood sodium value result to high blood pressure because of constriction of the blood vessels that could strain the heart resulting to either stroke, coma and death.
High Phosphorous Toxicity:
The second thing that a dialysis patient should watch for is Phosphorous. This mineral is found in almost all the foods that we eat and too much phosphorous in the body of the patient is dangerous because it is very toxic and could cause weakening of the bones or osteoporosis. Phosphorous may also deplete the amount of Calcium in the blood. Phosphorous binds with Calcium in the body that forms abrasive calcium phosphate crystals which finds its way in the skin causing it to itch and rupture with constant scratching. Cracks in the skin could be infected causing Cellulitis (painful infection of the skin and if left untreated it becomes life threatening as it may reach the bloodstream) which is treated with strong anti-biotics that could harm the liver. Always remember that it is the liver that replaces the function of the kidneys in breaking down and excreting harmful chemicals. Calcium phosphate crystals are also deposited between soft tissues and joints causing pain and weakness. Calcification of organs such as the heart leads to heart disease and eventual death of the patient. To control Phosphorous, the dialysis patient should take at most 1,500 mg of calcium carbonate per day depending on how high is your phosphorous level. These can be taken either before, during and after eating. Calcium binds with Phosphorous in eaten foods in the digestive tract and excreted together with the stool. The other effective Phosphate binder is Sevelamer which is expensive (P80-P100 per tablet). This acts as a sponge and absorb the phosphorous in food in the stomach and also excreted with the stool. This tablet can be taken either before, during and after meals; but not more than 30 minutes after eating. The patient should monitor his/her serum or blood Calcium and Phosphorous level. Too much Calcium in the blood causes kidney stones or harmful deposits in the heart and artery. The patient should also avoid foods rich in Phosphorous like dairy product, chocolate, beans and nuts. Red meats are also rich in Phosphorous.
Hyper - Kalemia or High Serum Potassium:
The third important element that a dialysis patient should watch for is Potassium. Too much Potassium in the blood is also dangerous because it could stop the beating of the heart causing heart attack and possible death of the patient. Potassium Chloride is used in jail inmates with death sentence to execute and kill them. Overdose of Potassium is less painful compared to electric execution. Foods rich in Potassium are: banana, avocado, papaya, mango, pineapple, oranges, potato, tomato, squash and other green leafy vegetables. The dialysis patient could eat small amounts of these foods only but not on a regular basis as Potassium could accumulate in the blood before dialysis. Patients who suffered Myocardial Infarction or heart attack (injury of heart muscle due to lack of oxygen) have high Potassium level in the blood and should undergo regular dialysis. Foods rich in Potassium supplements such as catsup should also be avoided.
The dialysis patient should properly choose the fat he/she eats. Foods rich in cholesterol and uric acid should be avoided such as: fatty meats like pork, beef and chicken skin. Processed coconut oil and other vegetable oil are also rich in cholesterol. Cholesterol is deposited in the arteries and veins causing blockage which result to high blood pressure, stroke and heart attack. Fats that are allowed are corn oil, canola oil, and olive oil. They are rich in omega fatty acid which is good for the heart. As the usual practice, patients should consume only small amount of the cholesterol rich oils found in foods such as fried vegetables and fish but should avoid eating, potato fries, milk shakes and ice cream for they contain more harmful fats per serving. The patient should monitor on a regular basis his/her cholesterol level or triglycerides so he/she can take the proper medicine if the level is high.
Blood Uric Acid (BUA):
Dialysis patient should avoid eating too much of fish with no scales such as tuna and animal organs because it contains high amount of uric acid. Uric acid causes gout and arthritis and helps in the formation of hard kidney stones. The derivative of uric acid which is purine is rich in animal organs, some type of fish, bean and nuts, some green leafy vegetables and fruits.
Uremia or too much toxic wastes in the blood:
The dialysis patient should eat moderate amount of red meat such as pork and beef. Eating too much animal protein could lead to uremia (high level of nitrogenous waste in the blood) which if left untreated will lead to confusion, convulsion, excessive vomiting, coma and even death.
Monthly Laboratory Tests:
One of the most important routine or practice that a dialysis patient should do is to check his blood count especially the hemoglobin for it indicates if the patient should be transfused with blood or not. Almost all of dialysis patients are anemic and have below normal level of hemoglobin. This is because it is the normal kidney that produces erythropoietin (helps in the production of hemoglobin in the blood). Once the kidneys are damaged, production of erythropoietin is affected and the same is true for hemoglobin and the red blood cells, thus causing anemia. To maintain acceptable values of hemoglobin, the dialysis patient should inject synthetic erythropoietin alpha or beta two to three times per week at hemoglobin value of ten or below while only once or twice a week for hemoglobin value of more than 10 but not to exceed 12. If the hemoglobin is high, 13 and above, the patient is at risk of having a stroke because erythropoietin has a tendency to thicken the blood. The patient should stop injecting erythropoietin. Optimum hemoglobin value is at 11. For erythropoietin to be effective, the patient should take organic iron supplements. Iron and hemoglobin help in the distribution of oxygen in cells and tissues. Regular monthly or bi-weekly monitoring of the hemoglobin is very important to prevent the patient having blood transfusion which increases his/her risk of acquiring hepatitis infection. Patient infected with hepatitis is not anymore accepted in some dialysis centers/clinics with no isolated machine for hepatitis patients. Also, patients with very low hemoglobin cannot be dialyzed since he/she can strain his/her heart and may die while dialyzing. Patients should check their iron in their blood every three months.
The Dialysis Access:
The dialysis access (it is where the dialysis needles are inserted or connected) of the patient is very important since it is the connection of the patient and the dialysis machine. Without the access, there is no way for the patient to be dialyzed and he/she is in danger of becoming uremic and will die if his/her blood is not cleaned. New dialysis patients have their access either on the neck, wrist or thigh. Few patients have a functioning fistula (artery and vein joined together to make the vein large enough for needle insertion) before the onset of dialysis. Proper care of the dialysis access is very important to prevent infection which could lead to sepsis (severe infection of the blood). This is done by regular cleaning using povidine iodine (Betadine) solution and anti-biotic ointment. Symptoms of infected access are shivering (feeling very cold) and fever during dialysis. The fistula that is infected with cellulitis means it can not be used during dialysis such that a new emergency dialysis access should be inserted either in the neck or thigh.
Dialysis patients should also take care of their heart by having chest x_ray and 2D Echo- cardiogram once in a while or when you feel pain or something not ordinary in your chest or experiencing difficulty in breathing. In dialysis, it is the heart that always compensates when you have low hemoglobin and RBC, high blood pressure, too much fluid in the blood or lungs, fast flow rate of the dialysis machine and when too much fluid is taken from your body and you are already dehydrated. The patient should feel if his/her heart is already stressed and should tell the nurse to lower the blood flow rate of the dialysis machine or lower the set goal of fluid to be taken. The most important is for the patient to discipline himself/herself to avoid drinking too much fluid and eating the right foods in their allowed quantity.
Prevention of infection:
Dialysis patients usually have a compromised immune system or they are prone to infections like pneumonia. When the patient has a persistent cough with yellow phlegm for two to three weeks, this is a sign that he/she has a lung infection and should have an x-ray to confirm the diagnosis. Early detection and treatment is ideal to prevent complications such as sepsis (an infection of the blood). A monthly Complete Blood Count (CBC) or urinalysis will also help in the early diagnosis of infection(s). To prevent lung infection, the patient should wear a face mask while in the dialysis room especially if in-patients and out-patients have their dialysis at the same time (big hospitals have separate dialysis rooms for in-patients and out-patients). Wearing a face mask while in dialysis is important since some virus and bacteria is present in the air or they are lodged in air-con filters and dislodged into the air later. In-patients are also exposed to hospital acquired infections that are already immune to some anti-biotics and are difficult to treat. The patient should also wear a face mask if he/she is with many people like movie-houses, mall and other gatherings.
The dialysis patient should develop his/her discipline of the mind and body by proper and regular (but not strenuous) exercises such as stretching, bending and brisk walking. This enhances proper disposition and keep the body healthy (with sufficient dialysis of two or more dialysis sessions per week). The patient should also grow in spirit to enhance awareness and acceptance and make him/her always hopeful that there is still life during dialysis. He/she should firmly believe that with God nothing is impossible and he will be cured of his disease. Of course this should be done with less expectations. With proper discipline the dialysis patient should realize that following his/her diet is not difficult if he/she believes that one should eat to live and not live to eat.