Long-term Effects of Dialysis

There are four long-term dialysis problems:

  1. Heart disease
  2. Bone disease
  3. Amyloidosis
  4. Nerve damage

Heart disease

Heart disease is the number one cause of death for people on dialysis.

When your kidneys fail, fluid builds up in your body in these ‘spaces’:

  • Inside your cells
  • Between your cells
  • In your bloodstream

Dialysis can only remove fluid that is in your bloodstream. Only about 15% of the fluid in your body is in your bloodstream. Dialysis takes fluid out of your blood. At the same time, some of the fluid in and between your cells slowly moves into your blood to replace the fluid taken off by dialysis. Dialysis can take fluid out of your blood faster than fluid in and between your cells can move into your blood. Even after a treatment, you may still have extra fluid in and between your cells.

Taking off a lot of fluid in a short time can make your blood pressure drop. This can harm your access and give you painful cramps and headache. You may even feel sick to your stomach or throw up.  It may take more hours to feel better after a standard in-centre haemodialysis when a lot of fluid is taken off quickly. On peritoneal dialysis, taking off a lot of fluid can make you feel sick and washed out.

Over time, if your body holds too much fluid, your heart has to work much harder. And if you have high blood pressure, your blood vessels become stiff, which makes more work for your heart, too. These problems can force your heart to work so hard that the left ventricle becomes tick and enlarged, which is called left ventricular hypertrophy, or LVH. With LVH, flabby heart muscle takes up space that should be used for pumping blood. When the heart can’t pump out all the blood, blood backs up into the lungs.

The best way to avoid it is to keep blood pressure in control by keeping fluid levels in your body as close to normal as possible all the time.

Bone Disease:

Calcification & Calciphylaxis occurs when high calcium-phosphorus products in your blood form crystals. This can happen in your eyes, blood vessels, heart, lungs, or other organs. It may show up as knobs or lumps on top of bones, in joints or on tendons. Worse, the crystals can harm blood vessels and even cut of blood flow to a finger or toe, a whole limb, or soft tissue. This problem is painful and can be fatal. It starts as red or purple skin marks. They may look like bruises. A skin biopsy shows calcium in the tissues. The marks turn black as the skin dies, and turns into ulcers that grows larger and won’t heal.

Renal osteodystrophy occurs when high phosphate lever in the body, to balance it – too much calcium is pulled from your bones over a long period of time. This can cause your bones to become weak and brittle. Common symptoms include:

  • Joint pain
  • Bone pain
  • Bone fractures

The best way to avoid bone disease are eating low-phosphorus foods, taking phosphate binders with each meal and snack, and getting more dialysis if possible.

Treatment for bone disease may include:

  • Phosphate binders
  • Active Vitamin D (Calcitriol) by oral or through vein.
  • Surgery to remove of the parathyroid glands.

Amyloidosis

Dialysis-related amyloidosis (DRA) is a common problem that can occur in dialysis when the protein beta-2-microglobulin (ß2m) builds up in joints, tendons, and around bones. DRA can lead to:

  • Arthritis-like pain
  • Joint damage
  • Bone cysts that can lead to fracture
  • Carpal tunnel syndrome (wrist pain, numbness, and tingling)

Two main ways to prevent DRA are:

1) Choose a treatment that removes more ß2m

  • High flux dialyser is remove more ß2m
  • Study shows daily and nocturnal haemodialysis remove much more ß2m.

2) Use ultrapure water for haemodialysis
Inflammation seems to make DRA occur faster. Ultrapure water has less endotoxin (toxic pieces of the cell walls of dead bacteria). It may cause less inflammation in your body. In RenalTeam, we use ultrapure water for dialysis.

Nerve Disease (Neuropathy)

Nerve damage (neuropathy) can change sensation, causing pain, numbness, burning, or tingling. From 60% to 100% of people on dialysis have some degree of nerve damage.

Research shows that neuropathy mainly happens when the GFR is less than 12ml/min. Another study found that it was more likely the longer someone was on standard in-centre HD- and the lower the dose of treatment. Men had more problems than women, perhaps because they are larger and need more blood cleaning.

Three steps may help you avoid neuropathy:

1) Getting your blood cleaner

2) Prevent vitamin deficiencies
Dialysis removes B vitamins. Specially, B6 helps relieve nerve pain in people on dialysis. Take a renal vitamin and take it after dialysis.

3) Prevent mineral deficiencies
Dialysis also removes zinc. Zinc helps nerve function – and sense of taste. Before you take zinc or any supplement, talk with your nephrologist. There is a risk that any drug or herb could build up to toxic levels.

Whether you are looking down the road and doing what you can to protect yourself, or you are dealing with long-term problems caused by dialysis, knowledge is power! Making informed choices about your health can improve your quality of life and help you live more fully.

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