Why your patient is not improving despite being on dialysis

Joan Mutesi has a mother with chronic kidney disease. The 54 year-old has been on regular dialysis but there has not been much improvement. Kidney failure is a condition in which the kidneys lose the ability to remove waste and balance fluids.

When one’s kidney’s fail, they require a transplant or being on dialysis. Dr Denis Kiguli, a nephrologist at UMC Victoria Hospital remarks that dialysis is the washing (rinsing) of blood from toxins which would have been filtered and excreted by the kidneys.

It is usually a lifetime intervention or a may be for a mean time while a patient waits for a kidney transplant. Dialysis is not a cure for kidney failure, but it can help you feel better and live longer. However, there are some factors that may hinder the dialysis process and greatly impacts on the patient.

Frequency of dialysis

The number of dialysis sessions matter. Most of the patients receive fewer sessions of dialysis in regard to what is prescribed. This is due to financial constrain to the families since dialysis very expensive and overwhelmed facilities. A session of dialysis costs between Shs 80,000 and Shs150,000 in public hospital and around Shs300,000 to Shs400000 in private hospital. 

“Most patients cannot keep up with the financial requirements so they do fewer sessions than the recommended sessions which is usually three times per week. Also as per the hospital protocol to meet all increasing numbers of patients, fewer sessions are scheduled for the patients and less ultra-filtration time sessions in order to serve all the people. This in return reduces the quality of life due to inadequate therapy,” Dr Kiguli says.

The quality of dialysis you receive may affect the quality of life of the patient. Poor quality of dialysis is brought by poor quality of dialysis water reversal osmosis, dialyser surface area with respect to patient’s needs all of which affect the patient. 

Dr Kiguli warns that, “The team that attends to you should be able to adjust these parameters in order to make the dialysis effective. This would in turn improve the quality of life of your patient. Ask to know how much ultrafiltration, water removed and the toxins being filtered. Poor removal and inappropriate removal of toxins could be the reason your patient is not improving.”

Quality of dialysis is also measured using routine laboratory investigation. If your patients is not improving, try to do some laboratory tests as advised and track down the quality of dialysis session received. The pre and post dialysis renal function tests are very essential and from these you can tell there is an improvement. 

Infections

Most of the dialysis patients do not get better due to repeated infections; especially the frequently infected access sites which are a big challenge in kidney failure treatment. 

He says, “There are standards of operations aimed at reducing infections because patients with infected catheters and septicemia often fall sick and have poor quality of life. We usually encourage patients to use the catheter vs arteriole venous fistula (AVF) since it has less chances of infection and good blood flow which later improves the quality of dialysis compared to catheters and a permanent catheter to a temporary catheter.”

You barely see a nephrologist

Kidney specialists should review the patient, discuss with the renal nurse and nutritionist how to improve the quality of life of your patient. Missing these reviews may at some point defoliate the quality of life.

Dr Kiguli says “The nephrologist assess the need for dialysis, its prescription, frequency, and need for other medication such as iron sucrose, a source of iron in patients with iron deficiency anemia with chronic kidney disease and undergoing dialysis. All these will improve the quality of life of your patient.”

Other medical conditions

Some patients do not get well even with dialysis because of other medical problems other than renal failure. Such medical problems as cardiovascular disease, cancers, diabetes, hypertension, HIV/Aids, hepatitis A, B, C, thyroid illness can affect the quality of life of a patient. 

These can come with complications such as diarrhoea, poor appetite, headache, fatigue, and fever. It is important that you seek medical help for the other issues as well.

Psychological issues

CKD is a long term illness and hemodialysis or renal replacement therapy is more of palliative care management condition, most of patients do not improve because of psychological issues like depression and anxiety. 

Many patients, as well as caretakers become depressed because of the cost involved and time spent in hospital. This negatively affects the patient and will not improve even when they have all the recommended sessions of dialysis.

Dr Kiguli recommends seeking professional help from counsellors or psychologists and spiritual uplifting.