Being Thankful Even in Challenging Times

Tips to Survive and Thrive on Dialysis

Preventing and Treating Catheter Infections

Making your Holidays Stress Free

Important Information You Should Know About Supplements

Being Thankful Even in Challenging Times
Anastasia Koribz, Editor and Dialysis Patients as Contributors

We’ve all done it. We have a challenge that comes our way and our response is, “Well, it could be worse.”

Sometimes it can be difficult to be thankful when you are facing a great challenge. But stepping back and looking at your challenge and then finding ways to be thankful in spite of it can be healing.

Take having kidney disease and the need to be on dialysis. It could be quite difficult to find anything to be thankful for in this scenario. But, when I asked patients to reflect upon what they are thankful for when it comes to dialysis, many patients had no difficulty putting their thoughts into words.

Here are all or part of their responses:

• Geraldine: I am an 88 years old lady and if it wasn’t for dialysis I would be very sick or dead. Dialysis has given me a new lease on life. I love to travel and dialysis doesn’t keep me from traveling. I evacuated from New Orleans because of hurricane Katrina and came to live in Wisconsin. My daughter found a good doctor and a very good dialysis clinic. I am in good health because I watch my diet and liquid intake and exercise and ride my bike every day. I also have two knee implants and they get a work out everytime. I get a chance because I love to dance, If you are on dialysis, take my work for it, you will have a fruitful life.
• Lloyd: The nurse and tech and administration group keep us strong and health. They are all a blessing. I look forward to my Tuesday, Thursday and Saturday treatment. Life is important to me and this dialysis team are all live savers. Lets all thank them for what they do!! We are all in the together. Praise them, talk to them and let them know they are all a God send.
• Dionne: The staff is very caring and helpful. I have been on dialysis 14 years and it is because staff that I have stayed healthy and kept coming. Thanks a lot for everything.
• Elva: I want to celebrate another birthday – because today is my birthday!
• Wendy: To tuck my baby in at night,
  To live another day to fight.
  To be with Lloyd and all my friends,
  To keep me going til’ this ends.
  (I want a transplant!)
• Olivia: I am very thankful for dialysis because they help me when I was down and out. The great dialysis team was here to help me to have my last child. Without the dialysis I would have no chance and was very sick. So on June 2, 2009 I had a little girl thanks to the WDI team. Dialysis gave me a very special gift. They gave me my life back and a wat to stay here for my family. Thank God that I came to Wisconsin when I did. May God bless WDI. They do care for us very much.
• Art: It keeps me alive! Fortunately because I do every session to completion, I feel good all of the time. I am also grateful for the caring medical staff at the dialysis unit.

Tips to Survive and Thrive on Dialysis
Philip J. Tuso. MD, FACP
EasyLink Access #: 519

Hemodialysis is the use of an artificial kidney to remove waste products, toxins, salt, and excess water from the blood. People with kidney failure require hemodialysis to maintain life. In general, the more you cooperate with the treatment you and your health team have agreed upon, the better you will feel, the better quality of life you will have, and the longer you will live.

Patients who follow a few simple tips can prevent serious complications.

1. Get optimal dialysis. Good dialysis means that the dialysis treatments you are receiving at the dialysis unit are sufficient to maintain your life and quality of life. Inadequate dialysis means that the dialysis treatments you are receiving at the dialysis unit are insufficient to maintain life. Good dialysis is partly determined by taking samples of kidney waste products in your blood before and after your dialysis treatment. By calculating the reductions in kidney toxins removed during dialysis your heath care provider can determine if the time you are on dialysis is adequate to keep you healthy. Complications from inadequate dialysis include higher than normal death rate, increased number of days per year spent in the hospital and loss of appetite.
2. Minimize weight gain between dialysis treatments. When kidney function decreases, water consumed in your diet may not be removed by the kidneys and may remain in the body. Excess fluid and salt in the body may cause swelling and shortness of breath. The amount of fluid gained can be determined by subtracting your weight before dialysis from your weight at the end of dialysis. For most patients on dialysis, your weight at the end of dialysis is considered your dry weight because it represents the weight in which excess fluid has been completely removed from your body. Your weight gain could be considered excessive if you gain more than three kilograms of water weight between dialysis treatments. So if you are gaining more than three kilograms of weight between dialysis treatments you may be at risk for fluid overload.
3. Maintain potassium in normal range. Potassium is an element that is involved in both electrical and cellular functions in the body. Potassium is found in human cells and most foods. Potassium plays a role in keeping your heartbeat regular and your muscles working properly. It is the job of the kidneys to keep the right amount of potassium in your body. When kidneys fail, the body has difficulty eliminating potassium. High levels of potassium in your blood can cause your heart to beat irregularly or to stop beating which could result in sudden death. Patients are vulnerable to high potassium levels if they consume large amounts of potassium containing foods (bananas, oranges, tomatoes). If your potassium levels are elevated ask your dietitian how you can adjust your diet so that the potassium you eat is equal to the potassium removed by dialysis.
4. Maintain a normal phosphorus level. Phosphorus is another element involved in normal cell function. Like potassium, phosphorus is removed by our kidneys and accumulates in our body when kidneys fail. Excess phosphorus in our blood combines with calcium in our blood to form a calcium phosphorus complex that precipitates into skin and muscle forming microscopic bone like lesions. As a result, calcium levels in your blood are lowered and can result in irregularities of your heart. In addition, our bones release calcium to replace the calcium lost in our blood and that can result in weak bones. To prevent this cascade of events, keep your blood phosphorus and calcium levels normal by eating a diet low in phosphorus and by taking phosphate binders with your food.
5. Use a fistula for dialysis access. Central venous catheters are used for dialysis access when arterio-venous fistulas or grafts fail or when a fistula is not feasible for medical reasons. Catheters can lead to scarring of veins and serious infections. If you are using a catheter for dialysis, discuss with your health care provider options for vascular access and how to care for your catheter to prevent infection.
6. Avoid Infections: Each year, thousands of patients on dialysis are hospitalized for treatment of life threatening infections. The most serious infections are related to vascular access. Besides central venous catheter type infections, as mentioned above, patients on dialysis can have infections related to their fistula or graft. Most of the time these infections can be treated with intravenous antibiotics but sometimes serious infections will require removal of the fistula or graft and placement of a central venous catheter. To prevent infections of your fistula or graft, keep the skin over your vascular access clean by washing with soap and water before and after dialysis. In addition, alert your health care provider if you have fever or chills or notice any changes in color of the skin around your vascular access. Patients on dialysis are also susceptible to community acquired infections such as pneumonia and influenza. These types of infections can be prevented by immunization. Ask you your health care provider about putting you on a schedule for pneumonia and influenza vaccinations. Finally, patients on dialysis can help prevent and fight infections by preventing protein malnutrition. Protein is used for growth and building of muscles, maintenance and repair of all body tissues, and maintenance and repair of your immune system. Ask your dietitian if you are at risk for protein malnutrition. If your at risk for protein malnutrition, discuss with you dietitian how you can adjust your diet with foods high in protein or taking protein supplements designed for patients on dialysis.

About the Author
Philip Tuso, MD, is a nephrologist in Lancaster, CA. He is also founder of a non-profit organization called the Foundation to Improve Renal Nutrition (FIRN), whose mission is to eliminate malnutrition in dialysis. He has recently published two books, Save Your Kidneys, and How Do I Survive on Hemodialysis?

Last Updated October 2010
The information on KidneyTimes.com is provided for general information purposes only. Always consult with your healthcare team before making any changes to your healthcare or nutrition regime. KidneyTimes.com is a program of Renal Support Network.

This article was reprinted with the permission of Renal Support Network, www.rsnhope.org.

Preventing and Treating Catheter Infections
Kim Holdener, PharmD

The best access for hemodialysis is one that can deliver an adequate flow rate, have a long use-life and a low rate of complications. A fistula is the type of access that best fills these criteria. However, some people are not able to have a fistula or have a fistula that is not ready for use yet. In these patients, a catheter is the alternative. Catheters have a much higher rate of infection compared to fistulas. In fact, infections are a major cause of hospitalization and the second leading cause of death in dialysis patients. That is why it is important to change from catheters to fistulas whenever possible.

When hemodialysis patients with catheters get infections it is important to treat those infections appropriately to avoid serious complications. Treating infections due to catheters usually is done with intravenous (IV) antibiotics. These antibiotics are given during your dialysis sessions in most cases. If your infection is severe you may be required to go to the emergency room or be admitted to the hospital for treatment and observation. Blood samples are often taken to see if we can determine exactly what type of bacteria is causing the infection. The antibiotic therapy you receive can then be adjusted to make sure the infection is treated appropriately.

Often when a catheter is infected it will need to be changed. This is a fairly quick procedure done at the hospital by one of the nephrologists. In some cases for hard to treat infections, or when a new catheter is not possible, an antibiotic lock can be used. An antibiotic lock is a small amount of antibiotics that is inserted into the catheter and allowed to dwell between dialysis treatments.
Taking good care of the catheter is important and can help prevent infections. The dialysis center staff always use proper hand-hygiene when handling your catheter. This includes hand washing and wearing gloves. WDI staff will change catheter dressing weekly or when wet or dirty when you come in for your treatments to make sure it stays clean.

The only access option for a peritoneal dialysis patient is a catheter. That is why it is so important to practice good sterile technique when handling the catheter to prevent infection. Peritoneal dialysis catheters can become infected around the catheter site and/or they can cause an infection in the abdomen called peritonitis. Infections around the catheter site can sometimes be treated with antibiotic pills you take by mouth. Peritonitis must be treated by putting antibiotic solutions into the bags of fluid used for dialysis. Depending on what treatment is prescribed for you, you may need to put antibiotics in every dialysis bag you use or just one a day.

The best treatment for infection is prevention. It is important to make sure to keep your catheter dry and clean at all times. Hemodialysis catheters should not be manipulated or have dressings changed except by dialysis staff. Peritoneal dialysis catheters must be well cared for and kept clean at all times according to WDI staff instructions. If you have any questions about your catheter or about antibiotics used to treat infections related to catheters please talk to any of the WDI medical staff.

Making your Holidays Stress Free
Anastasia Korbitz, LCSW

Although the holidays can be an exciting time of year, it can also be stressful given all that needs to be done in a very short period of time. Remember when you were a kid and it took forever for the holidays to arrive? Now as adults it seems the time comes far too quickly! Regardless of how slow or quickly the holidays come for you, it’s important to take good care of yourself during this busy time of year.

Although your to-do list may be long, the very first thing on your to-do should be “taking care YOU.” This means taking good care of your physical and emotional health. Keep your body healthy by taking your medications, attending all your dialysis treatments and following your diet and fluid guidelines.

But don’t forget to take care of your emotional health too. Although the mind and body are linked and stress can have both mental and physical effects, being able to recognize when too much stress is present can be helpful in decreasing it. Here are some fun tips for relieving stress:

1. take a walk in the snow
2. sing
3. watch a sunrise or sunset
4. hang out with kids
5. share time with a friend
6. pray or meditate
7. go to a holiday market
8. volunteer
9. go to a movie
10. take a warm bath
11. craft
12. attend a support group
13. read
14. get a massage
15. take photographs
16. go for a drive
17. listen to favorite music
18. explore a small town
19. try a new restaurant
20. get good sleep
21. write in a journal
22. spend more time with family
23. enjoy holiday displays
24. watch wildlife
25. cozy up next to your fireplace
26. bake bread
27. laugh
28. browse a bookstore
29. play with a pet
30. volunteer
31. hold a baby
32. join a choir
33. puzzles
34. start a collection
35. write letters
36. play a computer game
37. have an indoor picnic
38. walk a dog
39. pet a cat
40. stretch
41. think positive thoughts
42. visit a neighbor
43. start a tradition
44. stargaze
45. take a few deep breaths

Remember, stress can creep up on you. Take the time to recognize it in yourself and then take steps in a positive direction to decrease your stress. Good stress management is better for your health and will ensure that you have an enjoyable holiday season.

Important Information You Should Know About  Supplements
Cassie Dufresne, BA
Dietetic Intern

What’s with all the hype about protein supplements? Typically we associate protein supplements with power lifters and body builders, so why would dialysis patients need to use these?

Every time you dialyze you lose protein, and so dialysis patients have higher protein needs than the average person. Research has shown that dialysis patients with better nutrition and protein status have improved health, quality of life and decreased risk of mortality.

The best sources of protein are lean meats, fish and eggs. It can be challenging for dialysis patients to meet these protein needs through foods alone. If it is too difficult, your Dietitian can help you choose a protein supplement.

If you’ve been down the “health food” aisle of your grocery store lately, you know there are many different brands and types of supplements. So how do you know which one is best for you?

Nepro is a supplement specially formulated for dialysis patients because it is low in phosphorus, potassium, and sodium, and it has a good amount of protein in it to help you reach your protein needs. Nepro is a fairly concentrated formula so that you can enjoy it without taking in a lot of fluid. The goal is to find a supplement that best fits into your diet and “supplements” your meals to improve your nutrition status. See Table 1 to compare of a few different supplements:

Depending upon a variety of factors, medical assistance or the manufacturer may be able to help cover the cost for you. Abbott has a program that may be able to supply these to you depending upon your nutrition needs.

Many different forms of supplements are available besides those mentioned above. Talk to your Registered Dietitian about how you can receive a supplement to help you meet your specific nutritional needs. And as always, continue working with your renal Dietitian to design a healthy and enjoyable meal plan that fits you!