As renal failure progresses and subjective symptoms appear, dialysis therapy is required. There are two types of dialysis therapy, hemodialysis, and peritoneal dialysis. Each treatment has its characteristics, so you can choose the treatment that suits your lifestyle.
Hemodialysis moves water and substances through a semi-permeable membrane between the blood and dialysate, removing toxins and replenishing deficiencies. The principles of Hemodialysis are based on “extreme filtration” and “diffusion.”
- Extreme filtration is to remove excess body fluid (mainly salt and water) in the blood by applying pressure to narrow the outlet of the dialyzer.
- Diffusion is the principle in which waste products in the blood and electrolytes such as potassium and phosphorus are removed. On the contrary, calcium and bicarbonate ions are replenished.
A needle is pierced into a blood vessel (puncture) and connected to a blood circuit (tube). The blood is purified with a dialyzer and returned to the body through another blood vessel that has been punctured. The dialyzer has a semi-permeable membrane bundled in a straw shape, with dialysate flowing on the outside and blood flowing on the inside. The blood flow rate there requires about 200 ml per minute. Therefore, it creates blood vessels (vascular access) to supply enough blood. Generally, an operation called “inner shunt” (meaning shunt = short circuit) that connects arteries and veins is performed on the blood vessels of the wrist.
After surgery, blood flows from the arteries into the veins, dilating the veins that flow to the skin’s surface and making it easier to puncture. Next, two needles are stabbed on the side that takes blood (blood removal) and the side that returns blood (returning blood).
The mental health of Dialysis patients
In the dialysis process, patients may be mentally depressed due to shock. It’s normal to feel anxious and stressed by an illness, and you don’t have to be ashamed of your weakness. However, for a fulfilling life, always look at your physical health and your mental health.
Is it easy for Dialysis patients to feel Depressed?
When a diagnosis of chronic renal failure is made, about 30 to 40% of people will be “depressed” due to fluctuations in their mental health. When you’re “depressed,” you can’t do what you’ve been able to do, and you’re no longer interested in what you’ve liked before, and you can’t enjoy your life. Behind this is the feeling of not accepting the illness, asking, “Why am I?”, The anxiety of “I don’t know what to do next,”.
Depression tends to appear as the stage of renal failure at diagnosis is higher. Besides, those in the prime of work are more worried about the future than those who have been diagnosed at an older age, such as “I may not be able to continue childcare or work.”
How does a patient feel before and after the introduction of Dialysis?
Many people are worried about their future lives when their doctor tells them to start dialysis. Unfortunately, you may lose sight of your fundamental value, as you may not be able to continue what you have been trying to do, such as your work or hobbies.
In addition, after the introduction of dialysis, it is easy to get upset when complications appear, when the treatment method changes, such as the transition from peritoneal dialysis to hemodialysis or the transition from kidney transplantation to dialysis. It is said that mental and physical conditions are related and that if the physical condition is stable, the mind will be stable. Conversely, if the mind is stable, the physical condition will be stable.
However, the state of mind changes, and the depressed state does not last forever. In general, when a person suffers from a chronic disease that is difficult to cure, such as renal failure, the person’s mind changes significantly in five stages:
“depression,” “avoidance,” “fight,” “combination,” and “acceptance.” However, some people have severe depressive symptoms and require a psychiatrist, psychotherapy, and counseling. Therefore, “depression” can be one of the important complications associated with dialysis treatment.
How should the family treat the dialysis patient when he/she is depressed?
Patients with mental problems have complex emotions and are very sensitive to words that deny them. Family members are also at difficulty because they are closest to the patient. Having a third-party medical professional intervene is often successful, so it’s a good idea to ask for advice.
Who should you talk to, and how should you talk about mental problems?
Among medical professionals, nurses have a good understanding of the patient’s life and mental condition. Some people may find it difficult to discuss mental problems, but frankly, say that patients and their families are in trouble. Dialysis treatment is a treatment for patients to lead a fulfilling life and enjoy life positively.
How should you choose the treatment method that suits you?
The patient understands the illness and active participation in his / her treatment will greatly affect the quality of life thereafter. The treatment options are the use of hemodialysis (HD) and the peritoneal dialysis (PD) and kidney transplantation. Choose a treatment that suits your life and values by actively listening to your doctor and receiving a second opinion if necessary.
Message to the patient
It’s only natural that your feelings change depending on your situation, so think that you’re not the only one who’s depressed. Also, when you have a problem in your mind, if you think too much about the present and the future, you will be more depressed. Take a break from your heart by looking back on what you have done and what you have cherished. It is also the role of medical professionals to support the new life of dialysis patients.