1. Which type of dialysis modality is better?
Neither method can be said to be ‘better’ or ‘worse’ as each has its advantages and disadvantages. Regardless of whether you are on haemodialysis (HD) or peritoneal dialysis (PD), you will need to adjust your daily routine. Planning ahead for dialysis will give you more time to consider your options and how each would affect your daily routine.
When it comes to comparing HD or PD, both modalities result in the same overall patient survival. PD patients have the opportunity to customize PD prescriptions and also report high levels of satisfaction and personal well-being. They also have a lower rate of certain infections, for example, septicaemia, pneumonia, and hepatitis B and C.
As everyone’s situation is different, you should talk to your doctor about planning for dialysis as early as possible.
2. How much does dialysis cost? Can my insurance pay for it?
There are a number of factors that affect the cost of dialysis. Haemodialysis and peritoneal dialysis incur different costs and there is provision for dialysis payments under the Medisave Scheme. Speak to your medical social worker (MSW) if you require assistance with the cost of dialysis.
3. How do I know that it is time for me to start dialysis? Can I avoid going on dialysis altogether? What are the consequences of not undergoing dialysis at all?
Generally, if you are in CKD Stage 3 or 4, then it is time to prepare for dialysis, which becomes necessary at CKD Stage 5 (when your GFR falls to below 15 ml/min). To begin planning, a nephrologist (kidney specialist) will assess your condition and advise you on expected lifestyle changes as well as dialysis treatment options. It is important to have a full understanding of PD – HD and kidney transplantation, so you and your family are well informed, prior to making your decision for one treatment over another. An increased understanding of your options will allow you to make the best choice for yourself.
If CKD is diagnosed in the early stages (1 or 2), your doctor may advise you to try and control further kidney decline through diet and lifestyle changes. If you adhere to these recommendations, you may be able to avoid dialysis. Making an informed choice, such as eating a balanced diet that is low in fat and salt, exercising regularly, and curbing habits like smoking and drinking will also help keep your kidneys from further deterioration. Be sure to also have your doctor monitor the disease closely along with other potential problems such as blood pressure or diabetes.
At CKD stage 5, not undergoing dialysis will impact your body and how you feel. At this point, you may begin experiencing certain symptoms of kidney failure, such as weakness, fatigue, shortness of breath, nausea and vomiting. Consult your doctor about planning for dialysis before you need emergency dialysis at which point you will no longer be able to choose the type of dialysis that best suits your lifestyle.
An alternative solution to dialysis is having a kidney transplant, if you have been certified medically suitable by your nephrologist.
4. Do I still need to continue medication after I start on dialysis?
You will most likely need medications as dialysis cannot take the place of all kidney function. Also, it will be necessary to maintain vitamins and hormones, such as erythropoietin, calcium and vitamin D. The doctor will advise you on the best course of action and will take into consideration all the medications you may be taking.
5. Do I need to control my diet and fluid intake after I start dialysis?
Yes, a balanced and kidney-conscious diet and fluidsare essential to maintaining health and keeping energy levels up while on dialysis. Your intake of certain nutrients, particularly sodium, potassium (for patients on haemodialysis), phosphate and fluids need to be controlled to avoid waste products from building up in your body.
Also, depending on your dialysis modality and frequency, further dietary and fluid restrictions may apply. Your dietician will provide you with both education and information guides about the right diet for you. They will tailor your diet to meet your clinical and personal preferences.
6. Can I continue to work or find a job if I am on dialysis?
Continuing to work is actually encouraged for dialysis patients who have the physical stamina to do so. Working will help keep you active, since you will be carrying out a regular day-to-day routine, and will continue to support yourself and your family. If you are already working at the time dialysis begins, you may want to consider discussing your healthcare needs with your employer, particularly about potential changes in performance or special needs (especially with jobs involving physical exertion).
By planning ahead for dialysis, you allow yourself enough time to have these discussions as well as consult your physician on any questions your employer may have.
Read more under My Life for more information on working with kidney disease.
7. While on dialysis, can I still take part in outdoor activities such as swimming, jogging, or going to exercise classes?
Yes. Along with diet, exercise is a great way to maintain your health and wellbeing. However, it is important to ease back into vigorous activities because your body needs time to adjust to the treatment, whether you are on HD or PD. Depending on the sport or activity you want to do, there could be extra precautions to take, so do be aware. For example, if you are a PD patient and you want to go swimming, avoid applying lotion directly onto your exit site or swimming in places where the cleanliness of the water is questionable. Your exit site is particularly prone to infection, so you need to be careful not to expose it to chemicals and bacteria as much as possible. Your healthcare professional will be able to provide you with an action plan to take into account your desired activities.
8. How will I feel on dialysis?
It will take a few months to settle into your dialysis routine and you notice your symptoms improve. It is important to share with your doctor how you feel during and after haemodialysis or peritoneal dialysis so that they can monitor your progress. Dialysis should help you regain your energy and your appetite so that you can go about your day and get things done.
9. I’m a caregiver. How can I help the CKD patient I’m caring for? Is there anything that I should be looking out for?
If you are a caregiver, just remember that the person you’re caring for has CKD, so you must:
C – Commit to the dialysis schedule and help the patient be on time for every treatment, and be prepared for anything that might be required during treatment so you can assist and help him/her be more comfortable.
K – Keep track of the patient’s health status, including fluctuations in their blood pressure, infections in exit sites, their general disposition, symptoms like weakness and nausea, etc.
D – Diet is just as crucial as treatment when it comes to maintaining the CKD patient’s health, so keep track of ingredients being used and methods of preparation, to ensure that your patient is consuming kidney-conscious meals.
Last but not least, the moral support you give is invaluable. As with most diseases, a positive outlook and mindset can greatly impact their physical well-being as well as empower them to live life to the full, despite their disease.