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HEMODIALYSIS – WATER BALANCE AND PROTEINS

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.

POTASSIUM, SODIUM AND PHOSPHORUS BALANCE – HEMODIALYSIS

How important is the balance of potassium, sodium, and phosphorus in the diet of the hemodialysis patients?

The lоw intake of potassium, sodium, and phosphorus is crucial when the case involves feeding patients on hemodialysis.

Potassium

Potassium is involved in the water balance maintaining and in the transmission of nerve impulses and muscles contractions and regulates the blood pressure.

High plasma potassium is a life-threating case of emergency and is an indicator that the patient has made a mistake with his/her diet. Such a state of health is called hyperkalemia and is distinguished by muscle weakness, paralytic symptoms and irregular heart beat, In patients with anuria (complete absence of diuresis) the potassium intake is limited up to 1.5 – 2.0 gr. per day.

Dietary recommendations: the intake of rich in K food is limited – stone fruits, beans, lentils, olives, nuts, vegetable juices, dietary salt, dried fruits. Potatoes and the other vegetables lose most of the potassium when they are pre-cut and soaked in water for 3 hours as well as when they are cooked for 30 minutes. When using canned fruits and vegetables the liquid must be removed beforehand. Fruit juices, dried fruits, and nuts must be avoided.

Sodium

It is crucial to minimize sodium intake and to avoid food additives and fast foods. The use of salt causes fluid retention in the body and is a reason for high blood pressure, cardiac hypertrophy and eventually increases cardio-vascular mortality. Water and potassium control for patients on dialysis is important for the quality of the dialysis treatment and for their survival.

Dietary recommendations: to avoid rich in salt food – canned, marinated, salty and smoked products.

Phosphorus

Since phosphorus can not be fully extracted through dialysis, it is accumulated, thus damaging the bone structure and making bones fragile. The product of potassium and phosphorus values is called the potassium-phosphorus product and its levels should not overcome 4. Otherwise, it is subcutaneously accumulated and causes unpleasant itching.

Dietary recommendation: Foods high in phosphorus must be limited. Limiting the intake of phosphorus may also be done by decreasing the intake of proteins in food. However, this may cause malnutrition of the patient, which is highly undesirable. An efficient way of decreasing the serum phosphorus is the intake of calcium tablets while eating, since at that time the potassium intake is highest and its binding is most efficient.

This mineral may reach high levels in the blood and cause complications such as weak bones, heart problems, joint pain, and skin ulcers.

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

A question, commonly asked by our patients is: Why doesn’t our blood pressure drop and we feel better?

The answer lies in the following:

The quality of the dialysis water depends on well-functioning equipment for reverse osmosis and on the use of dry bicarbonate as an important prerequisite for avoiding series of complications. While achieving this quality is somehow associated with a certain increase in the cost of the dialysis, it may lead to some notable savings, far more exceeding the funding. The good water quality contributes to anemia improvement and reduces the patients’ needs of erythropoietin. The use of an ultrapure dialysate helps overcoming the chronic inflammatory response that is associated with the erythropoietin in the dialysis solution in blood and the erythropoietin dose is reduced with almost 30% as meanwhile the hemoglobin values are preserved.

During the last years quite weighty arguments were gathered evidencing that chronic inflammatory reaction plays important role in the genesis of the accelerated atherosclerosis in the dialysis patients and it is one the reasons for the higher morbidity and mortality among them. It has been found that by using dialysis with ultrapure dialysate the progress of the dialysis amyloidosis is notably delayed. Therefore, the use of ultrapure dialysate may lead to saving money from the hospital treatment of the complications as well as to provide better prognosis for the dialysis patients and their quality of life.

The most certain way of getting microorganisms- and endotoxins-free dialysis solution is to use dry bicarbonate and regularly to change the ultrafiltration of the dialysis path.

This is the dialysis that Nephrolife offers to its patients.

INFORMATION FOR THE PATIENT

Arriving at the center

After arriving at the center the patients may change their casual clothes in the dressing room and to leave their clothes in personal lockers. The clothes during the procedure must be light and comfortable thus providing an opportunity for an easy access for accomplishing the dialysis. There is a weighing scale in the waiting room for easy weighing even for patients in wheelchairs.

Wash the hand where the fistula will be carefully with soup before the dialysis in order to minimize the risk of infections. Use the sink that is in the WC for patients.

Please, keep in mind that the dialysis center does not bear responsibility for any loss of valuables and personal belongings.

During the treatment

A personal TV is available for each patient. You can also use individual headphones that we provide free of charge. There is free Wi-Fi access in the Dialisys Centre.

We will offer you a light refreshment during the procedure and a cup of hot coffee or tea. You may receive consultations by a nurse or the doctor on duty about everything that may concerns you at any time.

At the end of the treatment

Before removing the needles the nurse will give you a glove to put on your hand when pressing the spot of the puncture. After removing the needles, you must be patient and wait the bleeding from the fistula to stop. The nurse will give you protective patches or a bandage.

With view to your safety, it is required not to leave the room without informing the nurse for that. Be sure that you feel well and you can move without any help.

Before leaving the dialysis room, please put slippers on and weigh yourself by using the weighing scale.

If you need help, do not hesitate to turn to someone of the staff.

THE MOST ADVANCED DIALYSIS CENTER IN THE COUNTRY STARTED WORKING IN BURGAS

A month after the Medical Faculty in Burgas received a work license, a new super technological dialysis center opened doors in the town. It is a result of an Israeli investment and currently is the most advanced one in the whole country.

„We are working with leading Israeli professors to be able to be of help to the people from Burgas and the region. Our main goal is patients to feel well because they believe us.

With the high-quality equipment that we offer they will have a better quality of life” explained to the journalists Alberto Behar, the administrative director of the company – investor.

The Specialized Medical Center NephroLife is located in “Izgrev” housing estate behind Plaza Mall. Prof. Doron Schwartz is the consultant of the center. He is the director of the Department of Nephrology and Dialysis in Ilchilov Suras, one of the biggest hospitals in Israel.

Prof. Schwartz is a professor at the University in Tel Aviv and is on Forbes list of {Best Israeli Doctors}. Dr. Nikolay Tordorov will be the Director of the Clinics. He has more than 40 years experience and is twice included in the list of “The Best Doctors in Sofia”. The clinics disposes of with 18 pieces of apparatus and more than 1000 patients can take advantage of the treatment.

„It is a well-known fact that extremely skillful and competent doctors work in Israel. This is a certain opportunity to use good practices and ideas through them. Some of these lecturers may also educate our students at the Medical University.

In this way, we will have the opportunity to establish education in the English language. Thus we can welcome students form all over Europe, who will be educated in a foreign language” said the mayor Dimitar Nikolov during the official opening of the clinic.

Among the guests, there was the Israeli ambassador N. Pr. Irit Lilian, who was also satisfied with the investment, the Israeli Honorary Consulate in Burgas Orlin Mandov, the Director of the Regional Health Inspectorate Dr. Georgi Pazderov, doctors and specialists.

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