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Introduction

If you have a catheter, wear a mask while the nurse is hooking you up to the dialysis machine to prevent germs from your mouth from falling or spraying onto the catheter. Get the flu vaccine every year. Get the hepatitis B vaccine. If you will receive intravenous fluids, request that they do not use the bag for other patients or set up the intravenous tubing until they are ready to administer fluid to you. Notify a nurse or doctor if the area around the central line is painful or inflamed, secreting pus , or if the bandage becomes wet or unclean.

Sometimes patients on dialysis do not develop a fever when they have an infection, so all symptoms are important. What patients can ask: Ask for a hepatitis C blood test before starting dialysis treatment, and then on a routine basis. Before receiving an injection, ask if the needle and syringe have been newly opened for you since syringes and needles must be used one time only.

Ask doctors and nurses to explain why a central line is required, how long you will need to have it in, and if you can use a fistula or graft for dialysis treatment. One interview with a PD informant is also based on the notes alone because the tape recording failed. In these cases the interviewers listened through the recordings once again during the analysis process. Only two of our informants had CAPD as their primary and only modality.

The other informants had experience with various forms of dialysis, and many had changed modality several times. The interviewees with HHD were two women and one man, aged years, all working. They spent four to five days, 16 to 20 hours a week, on dialysis. All had received three previous transplants. One had previously practiced APD for two years; this was stopped for medical reasons. Two informants had performed HHD for more than two decades, the last for about three years. One managed the dialysis without any assistance; the two others relied on friends or family for practical support and security.

One, who had a definite need for back-up, had designed together with the hospital staff a telemedicine connection to the local hospital's emergency department, which was able to react to machine alarms. The interviewees with PD were two women and six men, aged years; five were over 60 years old. Two were working and the rest were retired or had disability pensions. All lived in their own home. One informant with APD had assistance from a visiting nurse service; the others performed the dialysis procedures alone. Only two had previously received transplants; three were waiting for transplants.

Empower Yourself with Kidney Knowledge

The project was submitted for the Regional Ethics Committee who found that their approval was not necessary. The study was approved by the Chief security officer at the University Hospital of North Norway, who ensures that personal information is treated lawfully and safely. All participants gave their voluntary, informed and written consent to participate in the project, including consent to publication of the results in a scientific journal. Analysis is mainly based on an inductive research strategy, searching the actor's point of view through interview data and observations [ 20 ].

Our focus was the informants' experiences, and our theoretical frame of reference was patient empowerment and self-management through ICT solutions [ 21 ]. Analysis of the material was performed in the following stages: i the interviewers read or listened to all the collected material to obtain an overall impression; ii units of meaning were identified and coded in a matrix according to the questions in the interview guide; iii this material was further structured and condensed into more general patterns, and iv findings were summarized into major themes [ 22 ].

Visiting informants in their home, we could observe how dialysis influenced their everyday activities. One informant had just come home from moose hunting. Another had installed himself for the CAPD procedures by the kitchen table, which offered the best view in the house; and one had arranged a home hospital in the basement living room, where helpers and friends regularly paid visits. Major themes that emerged from the interviews were: i choice of modality; ii training and coping; iii communication with health services; iv quality-of-life and sick role; v potential for telemedicine.

All of our interviewees expressed satisfaction with the choice of home dialysis. Many pointed out that they could have wanted information about the possibility of home dialysis, as well as information about different modalities, at an earlier stage. Observation of and listening to other patients' experiences were often more influential on their choice than information from health professionals:. I talked to several people who were in hospital just for controls of that PD-dialysis. One, an old man of 80 years, told that he took the equipment along when he was in the forest chopping wood PD patient.

Oh, it was really good to talk with others who have experienced the same thing. I think this could be a lot of the reason that you make a choice, really The interviewees had individual reactions to the different modalities, according to their personal preferences and life situation:. But there is a slight catch to it, to get these catheters to work I was just pissed off with the machine; honestly, it was puffing and blowing; I was lying there, and felt maybe I was caught by it.

No, I just couldn't manage that The HHD users had all discovered this modality by chance, and they had to make quite hard efforts and actively request the hospital to acquire the competence to deliver this alternative to them:. If I had continued with hospital dialysis, I had been dead I realized that I had to take control of the situation, otherwise I would not bear to live. In part, I would die from physical diseases, in part I would die of depression The doctors were willing, but the method was almost forgotten. They were a little shaky, the procedure had to be invented all over again HHD patient.

Nearly all the respondents felt they had received sufficient training in the hospital. They found the treatment easy to learn and manage, and after a while they mostly felt safe in the home setting. Yes, then it all worked automatically.


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It was just to take the bag and hang it on the wall In contrast to this, one of the older informants with APD felt insecure and did not like being alone at night. This feeling was strengthened when, in the beginning, neither the informant nor the community nurses were able to manage the machine alarms:. I'm safer now, but jump when the alarm goes After a time at home the interviewees developed a considerable ability to manage their own illness, and were often so independent that they could react to complications and even suggest adjustments in the treatment:.

Eventually you get to understand how much fluid to remove, the correlations With more frequent dialysis one does not need to remove as much fluid. The chance of blood pressure fall is almost gone; it's almost like a jog The blood pressure may vary by the amount of fluid removal, but [I] have not had blood pressure fall at home. Must be stable to take HHD, [can get] cramps in my legs, [be] dizzy and ill.

Must be familiar with the symptoms, but have not had any of this at home, I stop the ultrafiltration before it comes that far The feelings of security and coping when coming home were closely related to satisfactory access to professionals in the dialysis unit. The informants required very close contact with the hospital staff for issues concerning machine alarms, complications and related diseases, but also routinely for practical things like ordering materials. This was a very personal relationship, where the patient had his own nephrologist over time and had a direct number to the hospital department.

The dialysis nurses knew practically everyone by their voice; it was enough to call and say, "Hey, it's me. Important that the kidney doctor is involved in everything that happens. It is a clear precondition for optimal treatment of chronic dialysis patients to have an open door to the hospital. They have been very supportive Most had little contact with primary health services and with their general practitioner GP , so that it was the nephrologist who functioned as their GP also in cases of minor intercurrent diseases.

This was partly because many had developed knowledge about their disease that exceeded the competence of the GP. The alternative to home dialysis was CHD, which would occupy four hours, three days a week in addition to the travel time needed. Informants felt that having to be dependent on the hospitals' opening hours would be a significant obstacle to living a normal life with regard to work and leisure time. Have worked, taken care of myself, controlled my own time.

Those who had received CHD earlier, told that home treatment provided a considerably improved quality of life. Many felt in better shape and had less medical complications:. When I changed to this type of dialysis, it was quite a different everyday life for me. Especially after I got the night machine it was much easier, you can utilize the day better; not a problem to be fully employed Despite having a very serious illness and the fact that they spent a lot of their time on dialysis, many perceived themselves only to a limited extent as ill.

It seems that being able to take control of their lives also helped them not feel like patients:. The time outside the dialysis was too valuable to be wasted on long journeys to and stay in the hospital. In addition, in the hospital, they experienced how sick many of the other patients were; which was an uncomfortable reminder that this might be their fate also:. Informants felt that routine admissions to the hospital were a strain, and they suggested that follow-up could be conducted by telecommunication. The six persons on dialysis machines APD and HHD were most responsive to telemedicine guidance and follow-up in their home, believing that this could enable more patients to have dialysis at home:.

It gives a feeling of safety [when] somebody observes that everything is going as it should. Those with HHD were especially positive to the potential of ICT solutions, like transmission of data and remote monitoring and problem-solving over VC:. Then even the most nervous and insecure persons can handle this. I would also think that it could be less scary to start up, when you are not alone.

Those without machines did not see advantages of telemedicine. For instance, most of the respondents with CAPD, generally the older men, were satisfied to use their mobile phone when needing to call the hospital department:. I write it down in a form, and eventually read it loud for them on the phone. Our preconception was that telemedicine may be useful in supporting patients doing dialysis in their homes, thus making it easier for more patients to choose and live with home dialysis. This could, as a result, lead to enhanced quality of life and better treatment for more patients.

Many of our interviewees had no previous experience with telemedicine. We therefore had to explain what this concept implied.

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They, in turn, responded to their experiences with home dialysis without telemedicine, and their imagination of what telemedicine could add. Several informants, especially those without machines, did not see any added value of telemedicine, which suggests that they did not feel obliged to please us. Others, mainly respondents using dialysis machines, saw benefits in telemedicine and ICT.

This may indicate that they were more familiar with the use of technology. This study represents comprehensive in-depth interviews of a purposeful sample of PD-patients in the catchment area of the University Hospital of North Norway, and all known HHD users in Norway at the time the study was conducted. The small sample size reflects the limited population of inhabitants in this area.

During the number of patients receiving PD fluctuated from sixteen patients in January to eight patients in December 4. There is no reason to believe that our results and conclusions would be different if we had interviewed more of the excluded patients. Although data saturation was not a question, since we interviewed all the feasible patients, we found our material robust and diverse, appropriate to answer the research questions of this study. The observations of the patients in their homes gave additional insight into informants' everyday life. The fact that all PD users came from the same catchment area, may imply that the pre-dialysis information may not be the same as for other areas where this is organized differently.

I don't want to wait till I have symptoms, because by that point I could feel really sick.

Kidney Failure: When Should I Start Dialysis?

So I'm going to start dialysis while I'm still feeling okay. I have a couple of family members who are interested in donating a kidney for me. They are having tests to see if one of them is a good match. The rest of my health is pretty good. So I'm not going to have dialysis yet. Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements. Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

How sure do you feel right now about your decision? Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

The Diet for Chronic Kidney Disease

I'm not ready to make lifestyle changes and commit time to dialysis. I don't want to wait until I feel bad and maybe have complications. My lab results aren't great, but I'm not worried about it right now. Many kidney specialists recommend starting dialysis earlier rather than later to improve nutrition, reduce fluid in the body, and reduce the chance of going into the hospital for complications from kidney failure.

Are you clear about which benefits and side effects matter most to you? Do you have enough support and advice from others to make a choice? Medical Review: Anne C.

Skip Navigation. Get the facts. Your options Start kidney dialysis before you have symptoms of kidney failure or before your lab results show very poor kidney function. Start dialysis after you have symptoms or after your lab results get worse. Key points to remember At a certain point in chronic kidney disease, you may need to have dialysis or a kidney transplant to live.

This stage is called kidney failure. You reach it if you have constant fluid buildup and symptoms of too much urea and other wastes in your blood. You also have it if a measure of your kidney function glomerular filtration rate, or GFR falls too low. If you don't have symptoms yet, you may choose to start dialysis or wait until your lab results show very poor kidney function.

Your doctor may recommend starting dialysis while your kidney function is better. Starting dialysis may improve nutrition, reduce fluid in the body, and reduce your chance of going into the hospital for complications from kidney failure. You might decide to wait if you may be able to have a kidney transplant. Dialysis may help you feel better and live longer. Dialysis is time-consuming and can have serious side effects such as low blood pressure, muscle cramps, and infection. Experts aren't sure that starting dialysis before you have symptoms helps you live longer than if you wait until your kidneys are working very poorly.

How well you do on dialysis depends a lot on your age and on other health problems you may have. Thinking about starting dialysis may feel unsettling or even scary. If you decide to have it, dialysis will become a big part of your life. But you can take good care of yourself with a healthy diet and not smoking to help you get the most benefit from dialysis. What is kidney failure? As your kidney function gets worse, you may: Feel very tired. Feel nauseated or vomit.

Have swelling from fluid building up in your body. Not feel hungry.

Chronic Kidney Disease and Dialysis Treatment | Fresenius Kidney Care

You may lose weight. Have trouble thinking. Have a metallic taste in your mouth. Have severe itching. Kidney failure can cause serious heart, bone, and brain problems. What is the treatment for kidney failure? You can choose from two types of dialysis : hemodialysis say "HEE-moh-dy-AL-uh-sus" and peritoneal dialysis say "pair-uh-tuh-NEE-uhl dy-AL-uh-sus" : A kidney transplant may be the best choice if you are otherwise healthy. When do experts recommend starting dialysis?

Many things to consider Your GFR isn't the only thing you and your doctor will look at in deciding when you should start dialysis.

REFERENCES

You will also consider: Whether you have swelling, nausea, or other symptoms of kidney failure. Your age. Your health aside from your kidney failure. How you feel—if you have the energy to do your daily activities. Your ability to make lifestyle changes and to commit time to dialysis.

What are the benefits of starting before symptoms are bad? What are the benefits of waiting? What would you need to do to get the most benefit from dialysis?


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Be careful about what you eat and drink when you're on dialysis. Your doctor will tell you how much fluid, protein, and salt sodium you can have. A dietitian can work with you to help you plan your meals. Exercise to help improve your energy. Work with your doctor to make sure that you are getting the right amount of exercise. Avoid substances that can harm your kidneys, such as alcohol, any kind of tobacco, or illegal drugs. Tell your doctor about all prescription medicines, over-the-counter medicines, and herbs that you are taking.

Introduction

Compare your options. Compare Option 1 Start dialysis Wait to have dialysis. Compare Option 2 Start dialysis Wait to have dialysis. Start dialysis Start dialysis You have surgery to place an access in your blood vessels usually in your lower arm for hemodialysis. For peritoneal dialysis, you will have a catheter placed in your belly.

It takes a lot of time—from several times a week to every day, depending on the type of dialysis.