WHEN my late mother suffered end-stage renal failure, she had trouble breathing, and swollen ankles and feet that made walking difficult and painful. She was very tired, too tired to even get out of bed. We feared losing her.
She didn’t like the idea of being committed to haemodialysis treatment that required her to stay put in the clinic for three to four hours thrice a week. She was also terrified of having a tube called the AV fistula surgically placed in her arm, something necessary for her haemodialysis treatment.
This fistula was necessary when doing dialysis because our blood vessels are not well suited to provide sufficient and constant flow for dialysis. We rallied around her and learnt as much as we could about kidney disease and tried to comfort her with the knowledge that we gathered.
Haemodialysis is a life-saving treatment. It works like external kidneys, cleaning the blood and removing toxins and excess fluids, among other things. We had to gently tell mum that this was the best thing for her since kidney transplant wasn’t an option for her. The benefits of this treatment far outweighed the risks.
Some of the risks and side effects of dialysis include itching, bone disease like osteoporosis, sleeping problems, anaemia and fluid overload. To manage these problems, we had to adhere to the guidelines prescribed by the doctor.
CHANGES APLENTY
The first thing we had to do was change her diet. Everything she ate and drank, and how much was consumed mattered because this would determine the load on her damaged kidneys and how well the haemodialysis treatment would work for her.
She had to watch her water intake. Dialysis patients’ fluid intake varies from 500ml to 1,000ml a day. Drinking too much could overtax the body’s system because the kidneys can’t function as they should, which means that the toxins can’t be flushed out along with excess water. This would cause a build-up of fluids in her lungs, making it hard for her to breathe. Her heart would also have to work harder, which can lead to serious heart trouble.
She had to watch out for food that had high water content like melons, grapes, lettuce, celery, soups and even jelly. So if she ate these, her total water intake for that day had to be less than what the dietitian recommended.
Her nephrologists, dietitian and other support staff emphasised the importance of diet for haemodialysis patients. One should really observe and do’s and don’ts. The kidneys of people with this disease can’t adequately remove excess sodium, potassium and phosphorous.
Eating food with excess sodium like crisps and processed food would make you thirsty. If you drank more than you should, you’d get into trouble. You would over-burden your kidneys.
BE ALERT
Sodium is a form of salt and can be found in nearly everything from seasonings, canned goods, frozen food and especially fast food. While you should try to eat “healthy” and avoid sodium, do be careful when buying salt substitutes because they contain potassium – another no-no for dialysis patients. Instead, use lime or lemon juice, as well as spices and herbs to give flavour to your food.
Potassium is a vital mineral for all of us to keep the heart beating at a steady pace. However, for people undergoing dialysis, eating food containing too much potassium can be dangerous and may even be fatal. Potassium-rich food include avocado, banana, kiwi and dried fruits. You have to be cautious and limit your intake.
Too much phosphorus in your blood pulls calcium from your bones, making them weak and more likely to break. Having too much phosphorus in your body would also make your skin itch. Some dietitians advise to keep the amount to a minimum and totally avoid processed and packaged food like sausages and cured meats as they contain very high levels of phosphorus.
Limiting an intake of food containing phosphorus can be difficult because these are found in most proteins we consume, like meat, poultry, fish, nuts, peanut butter, beans, sodas, tea and dairy products. To manage this, dietitians recommend eating good quality meat, poultry, fish and eggs because these produce less waste for removal during haemodialysis.
When you’re on haemodialysis, you’d hear the word “dry weight” mentioned often. This is basically your weight taken after your haemodialysis session has finished and excess water removed. You’re weighed before and after the session to ensure that your fluid amount is at its optimum level.
Due to this, many dialysis patients hardly urinate anymore. Even if they did, it would be small amounts, perhaps just once or twice a day, which isn’t dangerous for them. This, however, doesn’t prevent them from urinating normally.
If you have any doubts or concerns, always discuss with your health providers.
Putri Juneita Johari volunteers for the Special Children Society of Ampang. She can be reached at juneitajohari@yahoo.com.