Treatment Options for Kidney Disease Management

kidney dialysis

Written by: Dr Francisco Salcido-Ochoa

Dr. Francisco Salcido-Ochoa is a kidney specialist doctor [MD (Mex) & MRCP (UK)], an immunologist [MSc (UK), Ph.D. (UK)], and an international health coach. In his 23 years of medical practice, he has helped thousands of people to live their best health and achieve their peak form with his medical expertise, scientist background, and holistic deep health coaching approach.

 

His private medical practice is Francisco Kidney & Medical Centre, located at Mount Elizabeth Novena Hospital #07-32, 38 Irrawaddy Road, Singapore 329563. Dr Francisco also offers telemedicine consultations worldwide, both in English & Spanish, via Francisco Kidney & Medical Centre and also via WhatsDoc, a professional online platform specialising in Telemedicine Worldwide.

What are the treatment options for patients with kidney failure?

Patients being diagnosed with total kidney failure have 5 main broad treatment options. Kidney transplantation, haemodialysis, peritoneal dialysis, entering a disease retardation programme and palliative care. 

treatment options for kidney failure

Overall, kidney transplantation is the best treatment to replace kidney function. 

But not every patient is suitable medically for it; might not have a suitable or willing donor, or might not welcome it as an option (although occasionally this latter is due to some misconceptions or not having given the right or sufficient information to make an informed decision). Then, haemodialysis or peritoneal dialysis is the second-best options.

Haemodialysis and peritoneal dialysis, are overall, equally effective to clean the blood of patients with kidney failure; but not as good as kidney transplant nor the original kidneys.

However, some patients might not be suitable for one or the other therapy, according to their own medical conditions and their overall strength or frailty. 

For different people, haemodialysis and peritoneal dialysis provide different advantages but also come with distinct inconveniences, so the decision and choice must be individualised, and an important consideration is to choose the therapy more permissive of their own lifestyles, and which tally better their priorities and personality.

Irrespective of the kidney function deteriorating and the preparation for dialysis or the initiation of dialysis might be imminent, some patients opt not to have dialysis (or a kidney transplant). 

On occasions, this is out of fear, which is natural due to the gravity of the diagnosis, and they might need a little more support and coaching. But on occasions is a firm and respectable decision, or they might be too weak and debilitated to start dialysis or to undergo a major surgery like kidney transplantation. Then all the efforts are to prolong the life of the kidneys, including modifications of risk factors, therapies for renal protection and implementation of a more frugal lifestyle.

This latter is very important. In my years of experience, most of my patients that come to good terms with their disease and live a more frugal and healthier lifestyle tend to protect their kidneys better and do better and even live longer even after developing kidney failure and starting dialysis.

Finally, for some patients who are very ill or extremely weak and too frail because of their underlying condition, or the kidney failure is too advanced, or there are very elderly and weak, dialysis might be too taxing and risky for them (as dialysis is a very strong therapy), then dialysis is not an option anymore. Likewise, they will not be able to take a major surgery like kidney transplantation.

Therefore, the focus of medical care is to continue with medications and to ensure the patient is as comfortable as possible, especially at the end of life.

And this is where palliative care comes in. Palliative care doctors aim to make the last days of the patients as bearable and comfortable as possible, for them and for their families…as this can be an overwhelming situation, both physically and emotionally for caregivers, seeing their loved ones’ vitality going down.

In Francisco Kidney & Medical Centre, we understand how difficult the decision of choosing a therapy can be. 

We cannot decide for our patients, but we provide detailed information on the rationale, pros and cons of each type of therapy, their overall comparison, but we do weigh those options for them, according to their condition; for them, than to have all the necessary elements to make the best possible decision taking into account their condition, life priorities and personality. 

 

How to choose between haemodialysis and peritoneal dialysis?

Choosing between haemodialysis and peritoneal dialysis can be a difficult decision. There are many factors to consider, ranging from medical aspects to personal preference and particular lifestyles.

kidney dialysis

But do not forget that if you are eligible for kidney transplantation, probably you should consider it over haemodialysis or peritoneal dialysis.

There are patients who might have medical contraindications for any of these therapies and doctors might recommend one therapy over the other one. But most patients do have a choice.

Overall, in Francisco Kidney & Medical Centre we advise our patients to choose the therapy for which they feel more comfortable, and which blends better or affects less of their lifestyle; and the one that suits their personality.

This might not be a very simple decision without experiencing any of them, but many decisions in life are like that. You need to use all the available elements and weigh them, but then take a leap of faith.

Just try to visualise how your personal, family, social, student, leisure, sports and work life will look like or be affected after one or the other therapy.

Then, we as doctors can help you give you more information and weigh it up, so you can tune up your decision, reaffirm it or dismiss it.

But in short, both therapies are equally good to clean the blood. That does not mean that they are as good as a kidney transplant or the normal kidneys, but their efficiency in cleaning the blood, in the long run, is comparable.

Some doctors claim that peritoneal dialysis gives you more independence, but that is relative.

If independence for you means do it by yourself and at home. The answer is then yes. But for some patients that is a big chore, doing it every day without rest days; in particular, if done manually several times a day. 

And for these patients, that is not independence. 

The same for haemodialysis. For some patients haemodialysis gives them independence as they do the therapy three times a week, then can rest from the therapy on the days free.

For others, haemodialysis is seen as taking their independence, as they need to go through it 3 days of their week and need to plan and modify their lives around it.

Like everything in life, this is relative; and as I mentioned, it depends on every individual’s particular preferences, priorities in life and personality.

Some people feel better choosing haemodialysis as it is performed by professionals and they do not need to worry about doing it by themselves.

While others feel better choosing peritoneal dialysis as they feel empowered by doing it by themselves and do not need to blame anyone else if something goes wrong, rather than being too dependent on someone else taking all the necessary precautions.

Some people believe haemodialysis permits more interactions with fellow patients suffering the same condition and living with similar challenges, and feel the haemodialysis centres provide peer support.

While others believe that peritoneal dialysis is more permissive of family life as it is performed at home: some patients might be performing peritoneal dialysis and still enjoying a good book at home or have the opportunity of watching their grandchildren, or to take care of chores at home.

But peritoneal dialysis will require some home rearrangements, being sure there is enough space to store the solution or to park the peritoneal dialysis machine. Something not necessary for haemodialysis, especially if having limited space or not wanting to disturb the aesthetics of your home.

Regarding diet, there are also differences in haemodialysis and peritoneal dialysis. Fluid and salt restriction and a more frugal diet are pivotal for both.

The first one to prevent all the negative consequences of fluid overload including breathlessness and higher heart risks. The second is to prevent a faster build-up of some toxins and toxic electrolytes (if they become too high in the blood) like potassium.

But it is the general belief and consensus that these restrictions are higher in haemodialysis because of their intermittent nature. Haemodialysis is performed only 3 times a week over a period of 4 hours per session, and that is the only time that the blood is cleaned and the excess of the fluid is removed.

In between dialysis sessions, the toxins and fluid just start building up once the dialysis stops until the next dialysis. 

To put this into perspective. You can dialyse, in a standard conventional prescription, 12 hours a week; when the week actually has 168 hours. The rest of the hours, 156, toxins build up continuously and fluid accumulates…both issues not ideal.

But with certain diet restrictions…fluid and toxins accumulation and importantly their negative effects on your health can be minimised.

For instance, chronic or acute fluid retention impacts not only the quality of life of patients but contributes to heart complications and others, including a higher risk of dying of an acute episode of fluid overload with acute heart failure, or shortened lifespan with chronic heart failure.

I do feel for my patients on these restrictions, I even carry a bottle of water myself wherever I go, so it must be hard, but the fluid restriction is one of the ways to ensure a less complicated and longer life. So, I encourage you to put that in a balance.

Seeing it from that perspective, it might motivate you to attach as best as you can to the recommended restrictions.

On the contrary, most patients on peritoneal dialysis can have a less stringent fluid restriction because the therapy is done continuously with constant fluid removal, but still being frugal on water and salt intake is ideal.

Some patients take this statement as they can eat and drink anything in whatever way and amount.

Even healthy people need to have a balanced, nutritious and moderate diet. Even more, people who are unfortunately ill. So, even if you are undergoing peritoneal dialysis, you still need to control your diet and fluid. If in doubt, consult your own doctor or consult me. 

Most haemodialysis is performed in a dialysis centre and not at home, so people need to commute to dialysis centres.

Occasionally, dialysis centres might not be very accessible or access-friendly, which is important as many patients are elderly or have mobility issues.

So, this is important to consider, because special transport might need to be arranged, and peritoneal dialysis is performed at home with no need to commute. In addition, for busy patients, commuting becomes a chore.

If choosing peritoneal dialysis, the quality of the vision and the degree of dexterity of the patient needs to be considered as it involves the precise connection of tubes, avoiding the need for accidental contamination by touching with the fingers or other objects the sterile ends of the tubes, to prevent infection.

These can be circumvented with the help of a caregiver, which can be a relative or someone paid for that service, but this imposes on the caregiver, with such responsibility.

But as mentioned before, some people would prefer to do it themselves for their loved ones instead of a third party, but still can be imposing irrespective of how much love and care.

Caregiver stress and burnout is a reality in the care of many patients with kidney failure and undergoing dialysis. I will not discuss that in detail in this article, but for you to consider it too.

Again, everything is relative. Haemodialysis, on the contrary, is typically performed by a nurse on behalf of the patient.

Haemodialysis, overall, it is more expensive than peritoneal dialysis for both the patient and the healthcare system, but this greatly depends on insurance policies, benefits, etc.

Regarding work-life, haemodialysis seems to be more disturbing for working schedules as a break of half a day or more needs to be taken to perform the therapy: Commuting to the centre, preparation and connection to the machine, therapy for 4 hours, unwind, then go back home. Three times a week.

Some people find this challenging, especially if having a full-time job and one that requires strength or concentration, as many people feel drained after dialysis.

Besides, this brings important worries to patients that are employed; fearing they cannot perform their job at their best or feared to be sacked.

This is a reality, many employers are not flexible or kind enough to facilitate the patient still working for their company with modified duties or schedules. 

But many are and hopefully, the ones dragged behind catch up on their level of support to people who want to live a productive life as close as normal. Self-employed patients might not have this problem.

Patients with peritoneal dialysis might not have these issues, especially if they chose automated therapy to be performed at night. But again, some patients said cannot get a good sleep while connected, especially if the machine requires attention.

Patients performing manual peritoneal dialysis during the daytime might have some challenges. Indeed, many patients don’t work, either being retired or too weak, so this does not make a difference.

But I have observed many patients do not work, either because they are retrenched (which is sad), but many times because they self-defeat and decide not to work after developing kidney failure.

Indeed, knowing that is devastating for the morale of patients, but this can be overcome with empathetic and kind support, and on the contrary, going back to work will boost their morale and might give them some sense of fulfilment and contribution, which is important. I always encourage my patients to try to remain professionally active.

What is more, dialysis is too expensive, so working is a way to balance their expenses better.

Practising sports might be more permissive in haemodialysis, but this has to be assessed on a case to case basis, both considering the stamina and overall health of the patients and the physical effort required for that particular sport. They might need to adjust to playing the sports in a less demanding way.

On the other hand, because on peritoneal dialysis you have a plastic catheter piercing your tummy all the time, contact sports are not recommended to avoid accidental pulling and dislodgement of the catheter. Similarly, swimming is not recommended either to prevent water from entering the exit site of the catheter, causing infection risks.

Travel might be more cumbersome for some people if undergoing haemodialysis, not so much because they cannot find a haemodialysis centre overseas to dialyse, but they will be worried if they will be at higher risk of catching hepatitis or HIV overseas. The quality of dialysis centres is increasing around the World, you just need to do your search for a trustable one.

One significant problem when travelling is that sometimes patients miss some dialysis sessions when on holiday to prevent that infection risk and to save money as it is more expensive overseas. I will advise against this: It is risky missing sessions and certainly you will not like to become ill in an unfamiliar environment.

On the other hand, vendors of peritoneal dialysis solutions can deliver their solutions to foreign address, so they can perform the dialysis while on holiday. This indeed permits you to continue your dialysis, but still, you would need to take breaks every day to perform the therapy many times a day. Some patients find that cumbersome, especially if they have busy business schedules or want to enjoy the entire day out.

Aesthetics are important for many patients. A fistula created for haemodialysis as vascular access can become lumpy. Patients can cover it with long sleeves. 

The tube on the tummy of patients with peritoneal dialysis will prevent people from wearing bikinis while sunbathing. If that troubles you, just buy a full swimsuit and enjoy the sun. This is not a trivial consideration that must be discussed, not only with female patients.

Neither haemodialysis nor peritoneal dialysis is devoid of complications. I will not be exhaustive, not detailed but overall both are associated with bacterial infections, haemodialysis more with viral infections because of the manipulation of patient’s blood outside the body by the dialysis machine.

In both types of dialysis, the access for the dialysis can be blocked (that is the fistula or the graft for haemodialysis or the peritoneal dialysis tube for peritoneal dialysis), requiring intervention or even surgery.

Haemodialysis is more bound to hypotensive episodes and messier blood pressure than peritoneal dialysis, but there can be more weight gain and worse diabetic control in peritoneal dialysis because of the amount of sugar instilled into the body during the peritoneal dialysis process, as well as the risk for hernias. Among many others.

Haemodialysis tends to be a more long-lasting therapy than peritoneal dialysis, as progressive thickening of the peritoneal membrane, the one that works as a filter of the blood, can occur through time. It does not happen to all patients but the length of use and complications like infections are highly associated with this thickening. If that happens, they need to be switched to haemodialysis.

In most cases, there is no strong medical contraindication for any of these therapies, so, in most cases, the patient can choose one or the other.

As a professional, I cannot decide on behalf of my patients, but I can explain the rationale, the pros and the cons of all therapies, so they have more elements for their decision. I, maximum, can weigh the options for them, based on their medical condition and the ‘intel’ gained after a detailed conversation with me, aiming to understand their preferences and priorities.

In Francisco Kidney & Medical Centre, we provide empathetic, approachable and flexible renal care, taking into account all these factors, helping our patients to choose the therapy that is more permissive of their lifestyle and attaches better to their personality and priorities in life. Please contact us if you need our help.

 

If you start dialysis, do you need to do it for life? If you start dialysis, will you become dependent on dialysis?

These are very common and important questions that I have been asked many times.

The facts are that progressive and severe injury to the kidneys can cause permanent and irreparable damage to them; which can end up in total kidney failure.

worried

If total kidney failure is confirmed by your doctor, dialysis will be needed for life. Obviously, unless you have the option of a kidney transplant.

Dialysis will be then for life, because, unfortunately, permanent and severe damage cannot be repaired and the kidney function will not recover on its own- not because you become or have become dependent on dialysis – like becoming dependent on a drug.

It is simply that your kidney problem is too advanced or severe enough that the kidneys cannot clean the blood adequately anymore to sustain your life or to keep you well, and then, as a consequence, dialysis is necessary; or otherwise, you will become very ill and your life could be in imminent danger.

All that I just mentioned applies when chronic kidney failure progresses to total kidney failure.

But it is important to discuss acute kidney failure, too.

Some patients develop acute kidney failure, which can be potentially reversible and they might need to be supported with some sort of dialysis for a certain period of time, while their kidneys or their general condition improves. Then, dialysis can be stopped. So, in these cases, dialysis will not be forever.

Similarly, some other patients develop an acute deterioration of a chronic kidney problem. For instance, they might have chronic kidney disease, let’s say due to diabetes, and they suddenly become acutely ill due to an infection or a heart attack, causing their general condition to deteriorate fast and making their kidney function to drop to the point of needing dialysis, but later the general condition of the patient improves and the kidney has sufficient recovery to be off dialysis.

So, in these scenarios, dialysis will not be forever.

However, many patients present with kidney function seemingly in the levels of kidney failure, without other previous tests or clues suggesting if indeed the disorder is chronic or acute problems. What I mean is, patients just discovered out of the blue in a health screen with poor kidney function or after seeing a doctor for some unexplained symptoms. 

Then we, nephrologists, need to use our clinical experience and extra tests to help us differentiate these two situations, for example, the size of the kidneys on ultrasound and many more. But occasionally, only time passing by gives us the answer. If through time there is no observable recovery, it is most likely that the damage is permanent.

In fact, some patients might need to start dialysis first. Although it is not an exact rule: if by three months the kidneys do not show signs of recovery, it is more likely that the kidney dysfunction is permanent and dialysis will be needed for the rest of the patient’s life. Or that they need to be transplanted.

On occasions, some patients start showing some signs of recovery; for instance, more urine volume or the creatinine levels are too good for a patient on dialysis, then maybe the kidneys have improved through the time to the point of not needing dialysis.

Every patient and every situation is different, so it is sometimes difficult to predict the chances of recovery for specific patients.

In Francisco Kidney & Medical Centre, we do thorough assessments of our patients’ situations to be able to advise them as best as possible regarding this difficult situation. We know many patients have big hopes, hoping their kidneys will improve. We are empathetic but also frank to them, but we walk the path with them and guide them to understand their disease better and manage it better.

 

Does age matter for dialysis?

Age is one of the main factors determining the suitability for being able to undergo dialysis safely, and influence the type of dialysis your doctor might suggest; but more important than age, in my experience, it is the comorbidities, fitness, fragility, frailty, and nutritional status of the patient what influence these decisions overage. Malnutrition and poor mobility, especially if being wheelchair-bound or bedridden, are important factors too.

does age matter for dialysis

It is true, they can come together with age and they are more common in older people than younger people, but not necessarily.

Many patients maintaining an active and healthy lifestyle throughout the years and decades reach older age in a fitter state than others doing the opposite. And if they were to need dialysis, they can do fairly well despite their age, in comparison to other patients with many illnesses, complications and who chose a different lifestyle.

With ageing, new medical conditions, problems or disabilities can appear, including heart problems, arthritis, amputations, lung disease, blindness. We cannot deny that. But patients with a stronger build, better nutrition, taking better care of their health or with the certain fortune of not developing certain diseases in life can do better than patients with the opposite characteristics.

For instance, I have met patients over 80 years all which are fitter than many 40 or 50 years old ones, because disease and unhealthy lifestyle habits took a huge toll on people’s health, lifespan, quality of life and suitability or fitness for certain therapies like dialysis. 

As patients grow older, their heart can become weaker or develop circulation problems. In haemodialysis, it is important to consider the degree of heart dysfunction, which must be assessed by your doctor, as haemodialysis imposes more workload on the heart than peritoneal dialysis, and doctors tend to advise patients with severe heart problems to consider peritoneal dialysis which is softer for the heart.  

However, peritoneal dialysis also brings along other issues. Overall, there is no perfect therapy. Everything needs to be individualised. 

You also need to consider many factors when choosing a modality of dialysis, including medical, personal, social and economic factors. 

A proper and thorough assessment by a nephrologist and a cardiologist is typically recommended, and on occasions by many other specialists, depending on particular patient characteristics.

In Francisco Kidney & Medical Centre, we give advice to our patients regarding these and more factors depending on their particular situation, so they can take the best possible decisions in regards to their disease care or when needing to choose a dialytic therapy.

 

How much dialysis affects or disrupts lifestyles?

Reaching total kidney failure and needing dialysis is a huge event in the life of patients and their families. Not only in the physical but the emotional, social, professional or school-related and financial components.

We cannot deny all these consequences. But we cannot forget that without dialysis, once developing total kidney failure, the general well-being of the patient and his or her life will be in jeopardy. So, it is necessary to go through it, make the necessary arrangements and adjustments… to get on top of the disease (rather than the other way round) and embrace dialysis, despite how difficult it might seem, as a new stage of your life.

But true, most of the time, it requires huge modifications in the lifestyle of patients and their caregivers, affecting many aspects related to family, social, work or school life. But, with the right support most patients can adapt well; especially if following general recommendations and taking charge of their own care.

All these modifications, new advice and some restrictions are necessary to ensure you take good care of your disease, your health; but not necessarily should forbid you to enjoy life and do the things you like. Indeed, you might need to modify things a bit; but you should not defeat yourself thinking dialysis has taken your freedom, choice and life.

Many patients are concerned about how dialysis will affect their work-life and they are worried about losing their job and all that implies, and this brings lots of unnecessary stress.

Haemodialysis is more likely to impose in your work-life, than peritoneal dialysis as we discussed in another article; especially if you have a corporate or full-time job because each session can take at least half of your day.

And even your life can be affected more if all the time consumed for your dialysis treatment gives you worries or difficulties to maintain your job.

Your family and social life will likely be affected, too; but you can arrange meetings and events around your dialysis sessions or even request your dialysis centre to change one-off the time or date of your haemodialysis session to permit an important celebration or a holiday, for example. So, you can play around with it. It is possible, but in practice, it can be not that simple as many dialysis centres have all the dialysis slots taken.

Discovering having kidney failure and going through the process of accepting it or already undergoing dialysis can also affect your personal life. It can certainly affect your mood and overall mental wellbeing, which through stress can also affect your physical wellbeing. This is indeed a challenge but not necessarily has to be a huge or impossible task. 

You can set your mindset and actions into positive ones, believing that there is a life beyond and despite dialysis, a life that you can still enjoy; believing that you can still perform in life and enjoy life despite dialysis, and with a supportive network and care providers, like me, it is definitively much simpler than it could seem.

I can tell you. Try to do your activities as normal as possible when you are not undergoing dialysis. If you like to go to the movies or to a museum, still go. If you like to walk in the park or on the beach, still do it. If you like sports, still do them…you might need to bring down the level, but you might still be able to do them…just double-check with your doctor what level of activity can be appropriate for you, as your overall health might change around the time your kidneys have failed; and can continuously change as time passes by. Many patients can continue practising sports, just take some precautions.

Diet is a huge aspect of the lives of patients that get affected. You need to improve your diet and try to follow the ‘kidney diet’. It is indeed not as varied and palatable as your previous diet, but your efforts will pay out well. 

You need to see it from the perspective that is an important channel for your health goals. Your efforts and your frugality will increase your chances of living a longer and better life than if not taking the right precautions and modifying accordingly your diet and lifestyle. 

In my experience, most of my patients that live a more frugal life with diet control and fluid restriction, tend to live a healthier, happier and longer life while on dialysis.

In short, get your treatment done, and after done, try to set your mindset into “back to normal life mode”, and then aim to do the things you used to do for yourself. It is not simple, but I trust you can do it. I have seen many patients doing it, especially if getting good family, social and support from their healthcare providers.

Try to do your activities as normal as possible when you are not undergoing dialysis. If you like to go to the movies, still go. If you like to walk in the park, still do it. If you like sports, still do them, but double-check with your doctor what level of activity can be appropriate for you, as your overall health might change around the time your kidneys have failed. Many patients can continue practising sports, just take some precautions.

But remember something very important. Even if you have developed kidney failure and are already on dialysis, the kidney disease and how your body gets affected by kidney disease or affected by undergoing dialysis is not static. On the contrary, your overall health can go down faster and you sort of age faster after developing kidney failure. So, you need to do your best efforts to remain as healthy as possible.

You need to improve your diet and try to follow the ‘kidney diet’. It is indeed not as varied and palatable as your previous diet, but your efforts will pay out well. You need to see it from this perspective. Your efforts and your frugality will increase your chances of living a longer and better life than if not taking the right precautions and modifying accordingly your diet and lifestyle. 

Knowing that kidney failure and dialysis already impinge on your quality and quantity of life, you certainly do not want to hasten that, right? 

In my experience, most of my patients that live a more frugal life with diet control and fluid restriction, tend to live a healthier, happier and longer life while on dialysis.

In short, get your treatment done while chatting and interacting with your peers having haemodialysis together with you (it helps in your mood and makes it more bearable), and after done, try to set your mindset into “back to normal life mode”, and then try to do the things you used to do you.

It is not simple, but I trust you can do it. I have seen many patients doing it, especially if getting good social and medical support. We can help you.

 

Is Haemodialysis painful?

First of all, I need to say, once more that every patient is different, and everyone experiences pain differently.

is dialysis painfulMany patients indeed can experience pain in the needling process if they have an arteriovenous fistula or a vascular graft as vascular dialysis access.

But some topical creams containing an analgesic (that is a painkiller) to numb the surface area to needles are used before needling to minimise pain while inserting the dialysis needles.

On the other hand, there are patients who say they have no pain while needling.

Pain is thus very individualised.

Do tell your dialysis nurse or doctor if you are having so much pain while needling. They could use such a cream. Occasionally, it can be the technique used by the nurse. I have heard patients that say they feel less pain when another nurse needles them. Do not feel afraid to try that; they will understand. Nurses always do the best to minimise your discomfort and will be accommodative if manpower allows. You do not need to just bear pain unassisted. Sometimes, something can be done, sometimes not so much. Using a smaller needle can help but usually this is difficult to change as certain sizes of needles are required for your type of vascular access and your prescription.

Once the needle is in place, it typically is not painful. But if you have pain, ask your nurse to check the position of the needle or be sure something like a bruise or so has not occurred.

The process of haemodialysis, specifically cleaning the blood by the haemodialysis machines, is not painful by itself. But certain degrees of pain and discomfort can be experienced by some patients.

Some patients can feel some aches, for instance at the back, especially in the first dialysis sessions after starting dialysis, while their body is adjusting to the new therapy.

Sometimes it is caused by sitting for long hours on the dialysis chairs. Sometimes by drastic shifts of fluids and electrolytes. Because some patients can develop painful cramps. This might sound simple, but can be very disturbing and requires a thorough assessment of the patient general condition and fluid status and the adequacy of the dialysis prescription.

Furthermore, some patients can feel a little weak or drained during the dialysis session or after, which resolves by itself and after some rest and the fluid and salt levels in the body get back to certain equilibrium post-dialysis.

Occasionally, patients with heart circulation problems and weak heart can experience chest discomfort, palpitations or fainting symptoms during haemodialysis. This situation must be addressed immediately by your dialysis team. This is very individualised, so it requires a specific medical assessment.

In Francisco Kidney & Medical Centre, we provide empathetic, approachable and flexible specialist renal and medical care; because we can imagine the struggles our patients and their relatives could face, and we care about the physical and mental wellbeing of our patients and their families. Please contact us if you need our help.

 

Can I travel while undergoing haemodialysis?

The simple answer is yes.

People on haemodialysis can travel overseas because of pleasure, business or an emergency.

If you are a haemodialysis patient and want or need to travel, first of all, you need to assess the  COVID19 situation worldwide, in particular in your country and in the country you want or need to travel to… because COVID19 is still spreading in many countries and second phases cannot be excluded in others, so, to assess the risk you could be exposing yourself to plus to check if there are any travelling restrictions from your country and in the country you are travelling to; including the requirement for quarantine. That can vary a lot; so your local dialysis centre (and your health authorities) can advise you more on that. And do contact beforehand a dialysis centre overseas.

In general, yes, you can travel while undergoing haemodialysis; but your travelling plans and itineraries might need to be modified, but not necessarily avoided.

In fact, many centres overseas offer the so-called ‘holiday haemodialysis’. Many centres in Singapore also. As I am a private specialist, I have helped foreign patients (before the times of COVID19) arranging haemodialysis sessions in Singapore while travelling in Singapore for leisure or business; trying my best to make the process stress-free for them. Obviously, as a medical doctor, not a travel agent.

In addition, it is important to check what are the requirements the other country or dialysis centre has for you to be able to dialyse in their facilities; for example, blood tests for your hepatitis or HIV status, etc. 

Do double check with them. Every country and centre has their own requirements. 

This is to avoid disappointments and getting stuck in limbo when arriving at a foreign country where the dialysis centre cannot dialyse you, causing you to skip your dialysis (which is dangerous), needing to book yourself in a hospital through emergency services so you can be dialysed there, or wasting a lot of time finding a new centre… when you have better things to do when you are overseas.

It is not just dropping by and get your dialysis done, as many might think.

A very important piece of advice is to look for a trustable (first) and then affordable dialysis centre (there are published lists of international centres on the web), and ask whether your dialysis coordinator, your nurses or your doctor can help you with the preparation, selection of a centre and planning, including helping you getting hold of all the necessary documentation as requested by your holiday dialysis centre. 

This typically includes a letter written by the doctor with your medical conditions and current health status, a list of medications, haemodialysis prescription, dialysis charts, latest laboratory tests or occasionally some other investigations like echocardiogram, etc. 

Do check what are the requirements of the foreign dialysis centre or the welcoming country.

Also, remember that on and off haemodialysis therapies performed in a foreign country can be much more expensive than in your country.

However, one of the main concerns from patients and care providers is the chance of getting infected with blood viruses or other infections (forget about COVID19 for a moment); I am talking about viruses like hepatitis B or C or HIV. 

True, this can happen, nothing is ever risk-free, but it is just a matter of finding a reputable centre in which you can put your trust and feeling comfortable and safe, especially for common travellers. Some patients who travel a lot do this and rarely encounter problems.

Before concluding, I want to give you a couple more pieces of advice. Many patients when travelling put themselves into holiday mode and mood, and eat more food and drink more fluids than normal, as they try to enjoy their holiday. 

However, they can run into problems like high potassium or fluid overload. Some patients have required emergency dialysis overseas or coming back because of that -cutting their stay short (and also putting their lives at risk). 

So try your best to enjoy your holiday and local delicacies with moderation and understanding that you still have kidney disease to take care of.

Other patients stretch their luck when travelling overseas. They might skip a dialysis session or more, or arrange a lesser number of dialysis sessions overseas, as it is more expensive and can be troublesome and time-consuming. 

Many patients do it, some get lucky and no major thing happens, but many run into complications, needing emergency admission and putting their lives in danger, and worse spoiling their holiday. Please do not do this. Aim to follow your normal prescription as best as possible. Extra cost and hassle will incur… but it is part of the responsibilities and commitments when travelling, and your health is more important. No shortcuts on your health and wellbeing for some extra bugs that you need to pay that can come back later. But if you have a complication, sometimes that can be irreparable.

In Francisco Kidney & Medical Centre, we advise our patients and their relatives on travelling preparations, knowing how important travelling is for someone’s lifestyle. Please contact us if you need our help.

 

Is peritoneal dialysis permissive of travelling?

If you are undergoing peritoneal dialysis, this modality of renal therapy is also permissive of travelling life.

It can be done manually at the comfort of your holiday home or at a hotel. This is because peritoneal dialysis is a do-it-by-yourself therapy, a self-care therapy, obviously if being trained and being empowered in performing it with confidence.

can I travel while on peritoneal dialysisBeing a do-it-by-yourself therapy, peritoneal dialysis gives you a certain freedom and independence to decide the timing and place to perform the therapy, able to manipulate better your schedule while overseas. However, it needs to be performed daily, but if you are already practising it, this should not be a big issue. But the issue of converting from automated peritoneal dialysis to manual must require more adaptability of your plans while overseas. If you normally use the manual technique, this should not be a major issue.

But because it might be a foreign environment, you might be concerned about contamination of the peritoneal dialysis system, infections or other mishaps if performing your peritoneal dialysis in an unfamiliar environment. You just need to do the therapy as you were trained and take the necessary precautions that your care team told you.

For this reason, if you normally use the peritoneal dialysis machine, it is ideal that you get a refresher training session with your care team on the ‘manual technique’, to build your confidence when overseas and to be sure you follow the steps to minimise risk for bacterial contamination and infection.

You would need to take all the hygienic precautions explained to you by the nurses, ensure the room where you are performing is clean and comfortable and take good care of your exit site. Then, you can enjoy your trip or take care of your business matters with more confidence and fewer concerns or worries.

Many vendors of peritoneal dialysis fluid deliver the dialysis fluids (and sometimes other equipment) to your foreign address or hotel, so you do need to carry with the fluid bags which could be a big hassle and deterrent to travel. To arrange that, you need to contact your vendor.

Some patients undergoing peritoneal dialysis, sometimes want to shorten their treatment duration or the number of treatments per day or even missing one or two days of dialysis at all, so to minimise hassle, save money, gain time and avoid risks of infection as they are doing it in an unfamiliar environment.

I understand these reasons, but missing dialysis is always not that safe, especially in an unfamiliar environment and perhaps in the holiday mood, perhaps eating and drinking more than usual. 

So, please aim to continue with your therapy as best as you can. But true, if for whatever reason you miss one session (one bag), most likely nothing will happen, if it is just a one-off…but depending on your condition; you know yourself better at the end of the day.

For further information and queries do ask your dialysis nurse or your doctor.

In Francisco Kidney & Medical Centre, we advise our patients and their relatives on travelling preparations, knowing how important travelling is for someone’s lifestyle. Please contact us if you need our help.

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