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Dialysis & wellbeing

When you are on dialysis it’s important to pay attention to your general wellbeing.

Emotional health
A very important aspect of wellbeing is your emotional health. It’s not unusual for people on dialysis to need additional support in difficult times. Find out more about this here.

Sexuality
One of the areas related to dialysis that is often overlooked is sexuality. It’s about more than just sex and can influence who you are, how you see yourself, how you express yourself, your sense of self-worth and your sexual feelings for others. Dialysis brings many physical changes that can affect how you feel about your body and your sexuality.

More useful information is provided in our fact sheet ‘Sexuality, intimacy and kidney disease’ and a booklet ‘Maintaining a healthy sex life’.

You can download the fact sheet here.

You can download the booklet here.

Community belonging
It’s been proven that people who are involved in community activities are generally healthier. There are many community activities you can become involved with, be it a hobby, sport or volunteering. There are groups who can help you get involved, like Act-Belong-Commit in Western Australia.

You can see more about Act-Belong-Commit here.

Health monitoring
Your kidney specialist and home dialysis healthcare team will continue to monitor everything related to your kidneys and other aspects of your health. However, you should still see your doctor for regular check-ups covering:

  • cancer screening – such as breast checks, prostate checks, pap-smears
  • diabetes (see below)
  • dental health – decaying teeth can cause infections throughout the body
  • eye health – good eyesight is important for safe home dialysis and to prevent falls.

Your doctor will also check other chronic conditions you may have.

Control of diabetes
Insulin, prescribed tablets or just maintaining a healthy diet may control diabetes. 

If you are an insulin-dependent diabetic, when you are on peritoneal dialysis you will usually require more insulin. It’s important to monitor your blood sugar closely every day, as advised by your dialysis healthcare team or diabetes specialist.

Some diabetics on insulin may get low blood sugar levels on haemodialysis so it’s also important to monitor your blood sugar closely during treatment, at least until you have a stable pattern.

More information about diabetes is provided by Diabetes Australia here.

Falls risk
Falls can have major consequences. Every year, many people are hospitalised with broken bones and concussion because of falls. There are numerous factors that can increase the risk of you falling at home, such as advancing years, injuries, chronic disease, diabetes and poor vision.

You can take steps to decrease the risk and improve the safety of your home environment. Useful information is provided by organisations such as Independent Living Centres Australia and Stay On Your Feet.

You can access the Independent Living Centres website here.

You can access the Stay On Your Feet website here.

Flu vaccine
The flu can make people with chronic diseases far sicker than the general population. Ask your doctor or dialysis healthcare team if you can, and should, have the flu vaccine.

Your Kidney Forum
You may also wish to visit our onsite forum to read about the experience of others on dialysis, ask a question or to post about your experience on dialysis. You need to register to post in Your Kidney Forum.

Diet & nutrition

When you are on dialysis, managing what you eat and drink can be a challenge; however, doing it well can positively influence how you feel.

An accredited practising dietitian experienced in kidney disease, called a renal dietitian, is the best person to consult about a personalised meal plan. The first step will be a dietary assessment to review your intake of energy and important nutrients.

You will learn about different things in your diet that may need to change because you are on dialysis, such as:

  • protein
  • sodium/salt
  • potassium
  • phosphate
  • fluid

Dietary advice is given on a personal basis, taking into account what you like to eat, how you are feeling, your age, lifestyle, weight, muscle size, health status and dialysis type. Most importantly, you will have regular blood tests that will help to guide your diet.

Everyone on dialysis should limit their salt and fat intake as part of healthy living.

Haemodialysis and diet
For most people on haemodialysis, protein intake rarely has to be changed; however, they will need to restrict their potassium and fluid. Avoiding foods extremely high in phosphate may be necessary, although many people use special tablets called phosphate binders instead.

If you are on home haemodialysis and can do extra dialysis the restrictions are reduced.

Peritoneal dialysis and diet
Most people on haemodialysis will have to avoid foods very high in potassium, phosphate and fluid, but the restrictions are far less than on haemodialysis at a unit.

Useful diet information
Back on the Menu recipe book
Nutrition and Kidney Disease fact sheet
Calcium and Phosphate fact sheet
Taking Care of Phosphate Levels brochure

Fluids
Fluids are any foods that are liquid at room temperature, including ice cream, yoghurt and ice cubes. Fluid is also contained in foods like cooked pasta and rice, salad ingredients, soup and watermelon.

When on dialysis, some people may need to limit fluid intake while others may have free intake. Those on peritoneal dialysis and more frequent home haemodialysis should have better control and improved freedom with their fluids.

It will also depend on your urine output; more dialysis again being the option for more frequent and better fluid removal. You will be told what your weight should be when on dialysis.

If your body has extra fluid on board then your weight may be up. If there’s not enough fluid in your system then your weight may be down. This change in fluid weight is different to your general body weight (muscles and fat), which changes depending on what you eat and how much you exercise.

A renal dietitian or your nursing team can help you to manage your fluid intake. Ask their advice to help you decide what to drink each day.

Exercise & sport

There is a growing body of evidence that exercise and sport have beneficial effects for people on dialysis, and may help to prevent the negative side effects of treatment. It’s also a great way to pass the time.

While there are a few special considerations, you can do any sport or exercise you can tolerate.

Haemodialysis and exercise
It’s important to protect your fistula or dialysis catheter if there is a risk of contact. Talk to your dialysis healthcare team or occupational therapist about how you can protect your fistula.

If you have a catheter for haemodialysis it’s recommended that you do not swim. If swimming is important to you, ask your dialysis healthcare team about your options.

Also check if there are opportunities for exercise available in your dialysis unit.

Some options include:

  • cycling on a portable pedal machine
  • Zumba on dialysis
  • resistance exercises.

Resistance band exercises
A new exercise program has been designed for people on haemodialysis, using a resistance band to improve muscle strength. The resistance bands can be purchased from health and fitness stores or online.

The simple but effective program was developed by a team of exercise physiologists and staff, led by Professor Paul Bennett at Deakin University.

It’s recommended that you discuss the program with your dialysis healthcare team before trying any of the exercises.

An A4 prompt card and an instruction manual have been prepared to support the program, details of which have been sent to most dialysis units in Australia.

You can download the A4 prompt card here.

You can download the instruction manual here.

This video also shows you the exercises.

 

Peritoneal dialysis and exercise
Swimming may cause an infection around the peritoneal dialysis tube. If swimming is important to you, ask your dialysis healthcare team about your options.

You should be able to play other sports but if your stomach is full of peritoneal dialysis fluid this could be uncomfortable or cause a leak. Talk to your dialysis healthcare team to see how you can most safely play sports or exercise.

General benefits of exercise
Physical exercise benefits many organs in the body, more than you might think. With regular exercise, the heart muscle gets stronger, the amount of blood pumped out with each heart beat increases, and the pulse slows down.

The blood flow to the heart and to the muscles being exercised improves with activity. This makes them stronger and more efficient. The blood volume increases and more red blood cells are made to carry oxygen around the body. Blood cholesterol can also improve.

Breathing also improves with exercise. If you exercise regularly you will be able to breathe easier at the same level of exertion, thanks to more effective heart and lung function. Exercise also improves muscle strength and endurance, which enables you to do more for longer.

With regular exercise, muscle cells are better able to take up sugar from the blood, helping to control blood sugar levels and manage diabetes. The hormonal system also undergoes changes. Even with moderate physical exercise the immune system improves and you may become less vulnerable to infection. The skeleton becomes stronger when the body is allowed to work and is exposed to mechanical loads.

Cartilage and connective tissues in the joints benefit from reasonable load as well. Finally, the brain and nervous system also benefit from regular physical activity. For instance, coordination, balance and reaction time all improve. More physical movement reduces the symptoms of depression and boosts self-esteem.

How much exercise do you need?
If you want to improve your heart health and blood pressure, 30 minutes of activity most days at low to moderate intensity can be enough for some of your exercise sessions.

There are many simple everyday opportunities for low to moderate physical activity, such as cleaning, gardening, playing with children or grandchildren, walking the dog, using stairs instead of the lift, and walking to the shops rather than driving or taking the bus.

If you want to lose weight, you may need to do some longer sessions (45 to 60 minutes) of higher intensity exercises (fast walking, swimming, slow jogging, weights).

It’s important to watch out for these signs to stop exercising:

  • chest pain or pressure
  • dizziness or feeling light-headed
  • irregular or very fast heart rate
  • excessive shortness of breath
  • nausea
  • severe leg cramps
  • pain or pressure in the neck or jaw
  • excessive tiredness
  • blurring vision.

If you experience any of these, stop, cool down and tell your doctor or a member of your healthcare team.

Medications

Managing your medication is very important when you are on dialysis. It’s very easy to get confused and wonder what each medication is doing, which medications are critical, and which are less important.

Detailed information should be sought from your doctor, who can organise a review of your medications in your home. Each medication is given for a particular reason and should be taken as directed. Below is a brief summary. 

Blood pressure tablets
There are many blood pressure tablets (anti-hypertensives) on the market, each with different advantages and disadvantages. Often the need for these tablets becomes less once dialysis is started. For many people, on haemodialysis days it’s better to take blood pressure tablets after dialysis.

If you control your fluids well you may not need blood pressure tablets at all, and this is often the case for those on peritoneal dialysis and frequent home haemodialysis.

Some tablets that affect blood pressure may be prescribed to strengthen the heart, usually for people with direct heart problems that are affecting their blood pressure. It’s important the tablets are taken every day.

Diuretics
Diuretics help the kidneys get rid of extra water in your urine. There are a number of types of diuretics. The cause of the fluid build-up can be from heart problems or kidney problems. If you are still passing urine when you start dialysis, your doctor will usually leave you on your diuretics. Over time, as kidney disease develops, they have less effect.

Artificial erythropoeitin
Artificial erythropoeitin (EPO) injections are required once the kidney is not producing enough erythropoeitin of its own. Various companies produce the medication. The injections might be needed once a month or more often.

EPO stimulates the bone marrow to produce red blood cells (erythropoeisis). This prevents anaemia, which is a low red cell blood count. Your dialysis healthcare team will monitor your red blood cell count every month and advise if you need to change your EPO dosage.

If you are on home haemodialysis you may inject the EPO into the lines on the machine. Ask your dialysis healthcare team for advice.

Artificial vitamin D
Vitamin D is necessary for the body to absorb calcium. It also helps to stop the parathyroid gland from over-functioning (hyperparathyroidism) and producing too much parathyroid hormone (PTH). 

This is a problem that often occurs with chronic kidney disease and can lead to bone disease, when the calcium leaches out of the bones. Your dialysis healthcare team will monitor your blood PTH level and advise the dose needed for your vitamin D.

Phosphate binders
When the kidneys cannot get rid of phosphate, the levels build up in the body. The phosphate joins with the calcium in the blood and causes deposits in the skin and joints. Phosphate also steals the calcium needed for healthy bones, and makes your bones weak.

Phosphate binders are usually some sort of calcium tablet. It’s very important to take them with meals that are high in phosphate.

Long sessions of haemodialysis remove phosphate very effectively and these medications may no longer be required. Your dialysis healthcare team will check your phosphate regularly and advise the dose needed.

Pharmacy review
Your pharmacist can be a great help if you are struggling to understand your medications or remember which ones to take and when. Ask your pharmacist for more information and about handy aids like dosette boxes.

Also enquire about an in-home pharmacy review of your medications.

You can read more about the benefits of a pharmacy review here.

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