Goals
● Reduce risk of cardiovascular disease (relatively common coexisting condition)
● Reduce risk of infection (considered the second greatest risk for those on dialysis)
● Manage diabetes, blood pressure, and cholesterol
● Prevent cachexia (severe weight loss that occurs in up to 75% of patients)
● Address other risk factors that can affect health (see below)
● Reduce common complications of dialysis (eg. intra-dialysis hypotension, cardiac dysfunction)
● Correct common nutritional deficiencies
Approach
Kidney Function
Many people do not realize that kidney function still plays a role even after dialysis is initiated. Research suggests that those who have some remaining kidney function tend to live longer and healthier.[1]
Nutrition
Dr. Baker (ND) creates a dialysis dietary protocol for each person, tailored to their blood work. This includes addressing nutrients such as protein, potassium, phosphorus, and calcium. For those with kidney disease, each of these nutrients is related to a person’s health and long term outlook. A 2007 study found that individuals that can meet at least six nutritional and metabolic goals were 89% more likely to survive over a six year time period, compared to those who did not reach those goals.[2]
Other Risk Factors
There are many other underlying risk factors that can be addressed to help improve prognosis and longevity. These include blood pressure, cholesterol, hormone health, muscle mass, sleep, exercise, oral health, and many more.[3]
Side Effects of Dialysis
● Low blood pressure and dizziness
● Muscle cramps
● Infection
● Fatigue
● Bone and joint pain
● Dry mouth
There are certain deficiencies that can exacerbate these side effects. Research on patients undergoing dialysis has found that those who maintain healthy levels of certain nutrients have lower risk of infections[4], increased longevity[5], and reduced inflammatory markers.[6] Low blood pressure and muscle cramping can also be related to specific nutrient deficiencies that are commonly depleted in those undergoing dialysis.
Blood Testing For Patients on Dialysis
As part of the dialysis protocol, each person is tested for over 20 items, each of which have been shown in research to affect risk of complications, longevity, and/or overall health of those with kidney disease. For example, anemia is a common condition that can occur and some research suggests that those who maintain normal blood counts have improved longevity and outlook.[7] If a person has anemia and low hemoglobin, testing can be done to check for any other underlying factors.
Inflammation
There tends to be high levels of inflammation in the body when cellular waste products build up. While dialysis can help to remove wastes and reduce inflammation, levels still tend to be higher in those with chronic kidney disease. Research suggests that inflammation is linked to longevity of those undergoing dialysis.[8] If inflammatory markers are high, these can sometimes be addressed with natural therapies.
Natural Therapies for Patients on Dialysis
Natural therapies can be used to help improve health and reduce risks of complications during dialysis. Therapies can be used to address other underlying risk factors, such as blood pressure, cholesterol, and diabetes. Some research suggests that those who can control blood sugar levels have improved overall outlook and longevity.[9] A 2009 study on patients undergoing dialysis found that nearly all of the differences in survival from patient to patient are related to the other underlying risk factors a person has.[10] In conclusion, natural therapies offer a holistic approach to improving the health and well-being of patients on dialysis. They have been shown in research to help reduce complications, side effects of dialysis, and improve longevity. By addressing various goals such as reducing the risk of cardiovascular disease, infections, and complications associated with dialysis, managing diabetes, blood pressure, and cholesterol, preventing cachexia, and correcting nutritional deficiencies, these therapies offer a holistic approach to improving the health and well-being of dialysis patients.
[1] Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study. Shafi T, Jaar BG, Plantinga LC, Fink NE, Sadler JH, Parekh RS, Powe NR, Coresh J. Am J Kidney Dis. 2010;56(2):348. Epub 2010 Jun 3. [2] Tentori F, Hunt WC, Rohrscheib M, Zhu M, Stidley CA, Servilla K, Miskulin D, Meyer KB, Bedrick EJ, Johnson HK, Zager PG. Which targets in clinical practice guidelines are associated with improved survival in a large dialysis organization? J Am Soc Nephrol. 2007 Aug;18(8):2377-84. doi: 10.1681/ASN.2006111250. Epub 2007 Jul 18. PMID: 17634440. [3] Matsuzawa R, Matsunaga A, Wang G, Kutsuna T, Ishii A, Abe Y, Takagi Y, Yoshida A, Takahira N. Habitual physical activity measured by accelerometer and survival in maintenance hemodialysis patients. Clin J Am Soc Nephrol. 2012 Dec;7(12):2010-6. doi: 10.2215/CJN.03660412. Epub 2012 Sep 13. PMID: 22977216; PMCID: PMC3513746. [4] Su G, Liu Z, Qin X, Hong X, Liu X, Wen Z, Lindholm B, Carrero JJ, Johnson DW, Brusselaers N, Stålsby Lundborg C. Vitamin D deficiency and treatment versus risk of infection in end-stage renal disease patients under dialysis: a systematic review and meta-analysis. Nephrol Dial Transplant. 2019 Jan 1;34(1):146-156. doi: 10.1093/ndt/gfy216. PMID: 30060084. [5] Zhang Y, Darssan D, Pascoe EM, Johnson DW, Pi H, Dong J. Vitamin D status and mortality risk among patients on dialysis: a systematic review and meta-analysis of observational studies. Nephrol Dial Transplant. 2018 Oct 1;33(10):1742-1751. doi: 10.1093/ndt/gfy016. PMID: 29481620. [6] Meireles MS, Kamimura MA, Dalboni MA, Giffoni de Carvalho JT, Aoike DT, Cuppari L. Effect of cholecalciferol on vitamin D-regulatory proteins in monocytes and on inflammatory markers in dialysis patients: A randomized controlled trial. Clin Nutr. 2016 Dec;35(6):1251-1258. doi: 10.1016/j.clnu.2016.04.014. Epub 2016 Apr 26. PMID: 27161894. [7] Anemia and Hypoalbuminemia at Initiation of Hemodialysis as Risk Factor for Survival of Dialysis Patients Muhammad Anees1 and Muhammad Ibrahim2. Link. [8] Bazeley J, Bieber B, Li Y, Morgenstern H, de Sequera P, Combe C, Yamamoto H, Gallagher M, Port FK, Robinson BM. C-reactive protein and prediction of 1-year mortality in prevalent hemodialysis patients. Clin J Am Soc Nephrol. 2011 Oct;6(10):2452-61. doi: 10.2215/CJN.00710111. Epub 2011 Aug 25. PMID: 21868617; PMCID: PMC3186454. [9] Best Practice for Diabetic Patients on Hemodialysis 2012 Toshiyuki Nakao, Masaaki Inaba, Masanori Abe, Kazo Kaizu, Kenji Shima, Tetsuya Babazono, Tadashi Tomo, Hideki Hirakata, Tadao Akizawa, Japanese Society for Dialysis Therapy. First published: 29 March 2015 https://doi.org/10.1111/1744-9987.12299 Citations: 57. https://onlinelibrary.wiley.com/doi/10.1111/1744-9987.12299#tap12299-bib-0022 [10]Miskulin D, Bragg-Gresham J, Gillespie BW, Tentori F, Pisoni RL, Tighiouart H, Levey AS, Port FK. Key comorbid conditions that are predictive of survival among hemodialysis patients. Clin J Am Soc Nephrol. 2009 Nov;4(11):1818-26. doi: 10.2215/CJN.00640109. Epub 2009 Sep 24. PMID: 19808231; PMCID: PMC2774950.