All posts by В. Пенчев

Nutrition for optimal health

Your nephrologist and medical team will work with you to create a nutrition plan. If you are on dialysis and you have developed diabetes, you will need to control your blood sugar and test your levels at least twice a day. If you have high blood pressure you should avoid salt. Your medical team will explain to you how the food and drinks you consume affects your health condition and your treatment. Your nephrologist could will also recommend if needed vitamins and health supplements.

Diabetes
In our country, diabetes is factor number one in 38% of cases of chronic kidney disease (CKD) leading to dialysis. This is also the main cause of kidney failure worldwide. If you are living with diabetes and kidney disease, it is important to keep control of both conditions by eating properly, following the medication prescribed by your doctor.

High blood pressure (hypertension) – High blood pressure is the second factor of chronic kidney disease, responsible for 28% of CKD cases. If you have high blood pressure, it is important to live a healthy lifestyle and take medicines as prescribed by your doctor. High blood pressure weakens the blood vessels, which can lead to kidney disfunction.

Anemia
 – Having CKD reflects your body’s ability to produce red blood cells that transport oxygen to your organs. Condition of having low level of red blood cells is called anemia and makes you feel tired and weak. Taking medication – erythropoietin and iron – will help your body to generates more red blood cells.

High cholesterol
– If the levels of cholesterol in your blood are too high, it can clog your arteries. It becomes a hard plaque that restricts or blocks blood circulation to your heart. Your doctor may recommend dietary changes, exercises, and most probably special medications to help lower your cholesterol levels.

Bone and mineral diseases
– When your kidneys are not working properly, your body is not able to keep the levels of calcium and phosphate at healthy levels – your kidneys cannot filter out the excess amount of phosphorus in your blood and they are not helping your body of retaining Vitamin D. Your kidneys activate (switch on) vitamin D which is important for calcium balance. When these minerals are not in balance that makes your bones weaker and more fragile. Your doctor will probably prescribe you to take phosphorus binders (medicines that bind phosphorus and lower its levels in your blood and are commonly prescribed class of drug for patients on dialysis) and vitamin D.

Smoking

– If you smoke you should consider giving it up. When you have CKD, tobacco increases the stress on your heart and other organs, which is extremely dangerous. Some versions of smokeless tobacco also contain molasses, which has high levels of potassium and should be avoided.

KIDNEY DISEASE

When living with chronic kidney disease, managing what you eat and drink can be a challenge.

Some of the waste in your blood comes from foods you consume, so following a proper diet can help avoid a buildup. This can reduce stress on your kidneys, which can slow the progress of kidney disease.

There is a group of products that is recommended to be included in our diet plan.

Skim milk, cantaloupe and brown rice may be the keys to prevent kidney disfunction. According to research, junk food, smoking and obesity can cause kidney disease in otherwise healthy people.

A group of scientists led by Alexander Chang, MD of Loyola University Medical Center found that people with normal kidney function and no hypertension or diabetes whose diet was high in red meat, sugar-sweetened beverages and low in fruit and whole grains were 97% more likely to develop kidney disease. Additionally, obese people or those with BMI over 30 were nearly three times more likely to develop kidney disfunction. Those who smoked were 53% more likely to develop it.

Researchers also pointed a connection between sugary sweet beverages and the development of chronic kidney disease. Those who drink more than 4 sugary sweet beverages each week had a 150% increased chance of developing kidney disease. “Consumption of these beverages has recently been linked to the presence of protein in the urine, one of the earliest signs of kidney disease, ” said Dr. Chang. “It’s possible that the fructose in these drinks is uniquely metabolized, promoting production of uric acid which has been shown to cause hypertension and reduced blood flow to the kidney in rat models.”

When you’re on dialysis, it’s important to avoid infections of any kind. Infections occur when bacteria, viruses or fungi enter the body by touch or inhalation through the nose or mouth. Some people on dialysis may be likely to get an infection due to the vulnerability of their access site or other health conditions like diabetes. People living with kidney disease are also at greater risk for complications related to illnesses like the flu and pneumonia

It’s important to be your own advocate. Remember that you are the person who can have the most direct impact on looking after your health. Staying healthy and avoiding infection can help keep you out of the hospital.

How can I avoid infection?

There are simple steps you can take to help you stay your healthiest:

Practice good hygiene—washing your hands often or using an alcohol based hand sanitizer can help prevent infection.

Care for your access properly—it’s important to follow your nurse’s exact instructions on how to care for your hemodialysis access site or care for your peritoneal access site.

Check for infection—learn the signs and symptoms of access site infection elsewhere in your body. Alert your nurse immediately if you think you may have an infection, so you can receive proper treatment.

If you’re on peritoneal dialysis (PD): infection can cause peritonitis, a serious infection of your peritoneum. Treating peritontis early with antibiotics is important. Tell your nurse immediately if you think you have contaminated yourself during PD treatment or if you suspect you may have an infection.

Talk to your nurse or doctor about infection

If you suspect you have an access infection or any other infection in your body, alert your care team immediately. A severe access infection can prevent you from getting dialysis, so it’s important to treat any infection as early as possible. Inspect your access site regularly and look out for redness, draining, tenderness or swelling. Also tell your doctor right away if you have a fever—a sign your body is fighting infection.

Take all antibiotics exactly as directed

Your doctor or nurse practitioner will prescribe the exact dose and duration of antibiotics for your particular infection. It’s important to take your medication exactly as prescribed to clear the infection completely and help prevent recurrence.

No matter if you are working full or part-time job, or you live active life, you can find ways to balance your social life and treatment. As you know dialysis can take a major time of your life so, if you are working at that time and you would like to continue doing that, ask your doctor for advice on how to balance your work with dialysis treatment.

A lot of working hours or a busy schedule may also influence your decision on which treatment method you would prefer – hemodialysis or peritoneal dialysis. You could always ask your doctor for an advice about best way of balancing your health condition and living satisfying life.

For example, if you work during the day, you may prefer to do dialysis treatment in the late hours, in the comfortable environment of your dialysis center.
You can talk to your employer and find a solution so that dialysis does not interfere with your income and family care. Those of you, who work in an office and use computer most of the time, might consider working for a few hours from the dialysis center, combining work with health.

Most of the time friends are like family. Friends in our life always help us with advice and moral support but also can offer us practical advice and tips.

Show them that despite the illness, you are still “the same person” and you are able to do most of the things you used to do before getting the disease. It’s also a good idea to remind them that you still want to remain close friends and still want to be involved in the social events, reunions, and other fun things you’ve done so far.
If you choose to share news about your health condition on social media, be selective in how your health is disseminated and announced. You can create different “groups” on Facebook – one group for close friends and relatives who support you – and another group for a larger circle of friends.
Whatever you decide, beware of unreliable people who can offer you “miracle” cures or questionable treatments and services. To protect yourself from this, you can make your posts private or visible only to your friends.

Regardless of your decision, be prepared for many different answers. Remember, everyone has his own problems and vision of life. Expected support or lack of it, does not necessarily shows their feelings about you.

The importance of examining our kidney function

Each of us can get kidney disease at any time. However, if kidney disease is found and treated early, you can help slow or even stop it from getting worse. Most people with early kidney disease have no symptoms. That is why it is important to do preventive examinations.

If you suffer from one or more of the following, ask your doctor to check your kidney function:

diabetes and hypertension
• Acute kidney disease
• cardiovascular disease (ischemic heart disease, chronic heart failure, peripheral vascular disease)
• structural disorders of the urinary tract
• multisystemic diseases with potential renal impairment – eg systemic lupus erythematosus
• family history of end-stage kidney disease or hereditary kidney disease
• accidental detection of hematuria.
• Taking multiple medications

It is a fact that chronic kidney disease is asymptomatic, however in a further phase of it is accompanied by notable symptoms. Prompt diagnosis is important for several reasons.

First, because of the increased cardiovascular risk.
Second, because of the significant therapeutic interventions that can be made in the early stages of the disease, aiming to cure (rarely), or to delay the progression of renal damage.
And third, because of the “quiet” complications of the disease, which begin to appear during the third stage of chronic kidney disease. These complications include, among other things, anemia and bone diseases that, if diagnosed relatively early, can be treated with appropriate medication.

WHY DOESN’T OUR BLOOD PRESSURE DROP AND WE FEEL BETTER?

Intimacy is the deep human need involving a mental and emotional sense of well-being. We all have an inherent need to be loved and appreciated- no matter the age or our chronic kidney disease. The desire for sexual activity, on the other hand, could vary for a lot of reasons – medication, general fatigue or depression. All of them might be some of the reasons for not being in the mood for having sex as often as before.

Sex and dialysis can go together
Dialysis can be really challenging when it comes to sexuality and intimacy. Communication between partners is the right way to overcome these barriers , improve your sex life and feel more comfortable in intimacy.

Intimacy and vascular access
Talk to your doctor or nurse, if you have any concerns about that being intimate with someone will harm your dialysis access. You could also ask how to protect it when having sex. Generally, you should avoid direct pressure on the fistula or prosthesis.

Lack of motivation
There can be many reasons for not being in a mood for having sex. The cause might be a physical condition – such as anemia, medication, diabetes or fatigue. On the other hand, it can be also psychological. It is a good idea to ask your doctor about finding out the root cause – even if your lack of motivation at this stage, is not a problem for you. Intimate moments are important for both mental and physical health of you and your partner.

You want more intimacy
If you want to have more sex – or better sex – talk to your doctor, nurse or psychologist. These specialists can advise you on both medical and psychological issues. It is important to know that erectile dysfunction (ED) is very common in men as well as sexual dysfunction (arousal or orgasm) in women during dialysis treatment. Remember that members of your healthcare team are used to consult these sexual and intimacy problems, so don’t worry.

Talk to your partner
You might be surprised about how many people don’t want to talk about sex with their partners. Most couples think that, it is not an important and necessary issue. On the other hand, discussing and listening about both of your needs can make your relationship stronger and happier.

Prof. Dr. Talia Weinstein will consult patients for free

Israel’s nephrologists will visit Burgas. Prof. Dr. Talia Weinstein arrives on December 12^th at the invitation of the NephroLife Dialysis Center. On December 14^th she will give free consultations to patients from Burgas with hemodialysis and in the pre-dialysis stage.

At the invitation of Burgas Mayor Dimitar Nikolov, Prof. Weinstein will visit the Municipality, where future Bulgarian-Israeli health-related initiatives will be discussed. The meeting will also be attended by representatives of the management of the University “Prof. Dr. Asen Zlatarov” and the newly opened Faculty of Medicine at the University.

Prof. Talia Weinstein is a nephrology specialist. For more than 35 years of practice, she has gained clinical experience in the diagnosis and treatment of various kidney diseases. She is the Past-President of the Israeli Society of Nephrology and Hypertension and a member of the European Union of Medical Specialists (UEMS) – Kidney Section.

Prof. Weinstein studied at medical schools in Israel. Her specialization includes acute and chronic kidney disease, diabetic nephropathy, and autoimmune glomerulonephritis. She also treats patients on hemodialysis.

Visiting a specialist of similar rank in Burgas enables not only the residents of the region but also all Bulgarian citizens in need to be examined and consulted in the best possible way. A similar opportunity is possible thanks to the policy of the NephroLife Dialysis Center, which was created and opened in the seaside town in the middle of this year. The super-modern healthcare facility is built and fully equipped with Israeli investments, the latest in medical hemodialysis technology. The emergence of the dialysis center in Burgas greatly facilitates the needs of thousands of seriously ill patients, as well as giving them the most competent and good prospect for health and life-saving care and insurance.

On December 14, 2019, the Dialysis Center invites the citizens of Burgas to visit the health facility to get acquainted with the opportunities offered by NephroLife .

Prof. Dr. Talia Weinstein will consult patients on dialysis and predialysis stage on 14^th of December in Burgas for free. This is a gesture to all those who suffer from kidney problems in Bulgaria. Consultations do not require referrals from GPs. Patients should make an appointment by calling: 056/555 – 588, 0800 11 881.

REGISTRATION FOR PATIENTS

Water balance during hemodialysis

Water balance is closely related with the optimal body weight maintenance. Since the amount of urine (diuresis) is reduced up to a complete lack in patients on hemodialysis, a strict self-control of fluid intake is required. Super hydrogenation may provoke intensification of the peripheral edema, ascites (leakage of fluid in the abdominal cavity), hypertension, pulmonary congestion and life-threatening complications such as brain and pulmonary edema.

The basic rule for calculating the quantity of the fluid intake is: fluids (for 24 hors) = diuresis /ml/24 hours + 500 up to 800 ml. The increase in weigh must not overcome 1kg per day. All soups, any yoghurt, sauces, stewed and bottled fruits, fruits, vegetables, etc. that are included in the daily menu must be calculated as liquids.

Dietary recommendations: Table salt consumption to be reduced and other seasonings to be used instead; any food with high content of water to be avoided [soups, sauces, water-melon, ice-creams], any dry air spaces to be avoided, when one feels thirsty, not to drink water but to suck a lemon or a cube of ice.

The role of proteins  in hemodialysis

Goal: To maintain all vital metabolic processes in normal levels, to ensure muscle growth and recovery.

Proteins are essential for the diet since the need of them is higher for dialysis patients. Proteins are divided in two basic groups: such with high biological value and such with low biological value. 1.2 gr./kg./24hs is considered to be the optimal protein intake. Half of this quantity should be the so called complete proteins (of higher biological value), that may be found in meat, eggs and milk. That is why appropriate meats, poultry, fish, egg protein or cottage cheese must be consumed at least once a day. It is recommended 100-200 gr. meat to be involved at least once per day during eating. The way of cooking meat may vary depending on the taste preferences of the patient, however for those who have a limited diuresis a dry cooking of meal (excluding sauces) is recommended. Low-value proteins include bread, pasta, fruit and vegetables.

Nausea, vomiting, confusion, itching, bad breath are observed upon excessive protein import. The symptoms of insufficient import are muscle mass decrease, lack of strength, weight loss, difficult wound healing.