Does the patient on hemodialysis have to observe any dietary
Yes, he still has to observe certain dietary restrictions very strictly.
He is allowed to take normal amounts of meat and carbohydrates but
he must restrict potassium, salt and water in his diet. This is because he
can still retain lethal amounts of potassium, salt and water in between
dialysis. He must avoid all potassium-containing foodstuff, some of
these being fruits and vegetables. These include preserved fruits, jams
and other preserves. Citrus fruits, especially oranges and grapes are
worst. Our local specialty, the durian has claimed many lives on
dialysis, as it has a particularly high potassium content. Patients who
cannot resist the temptation and consume only a few seeds meet with
sudden death as the potassium causes sudden irregularity in the
heart-beat. The only fruits patients are allowed are apples and pears.
Even these have to be consumed sparingly as the potassium content is
Vegetables must be boiled and the water containing the extracted
potassium poured away before consumption.
Patients on hemodialysis hardly pass more than about 200 to 300 mls
of urine, some even less. Water accumulates sometimes very rapidly in
between dialysis. In most patients, the accumulation of excess water in
the body is due to failure to observe the rules regarding salt and water
restriction. Some recalcitrant ones who disregard the rules will die
suddenly from too much fluid retention in the lungs.
Excessive salt and water intake will cause a patient on dialysis to
develop very high blood pressure, resulting in death and brain haemorrhage due to sudden heart failure or the bursting of a blood
vessel in the brain.
What are the medical problems that are still present in a patient on hemodialysis?
Itch, anaemia and renal bone disease are still present in the patient
Hypertension can also be a problem. This is often due to the patient's non-adherence to the doctor's advice on salt and water
As dialysis patients are often anaemic and require blood transfusions
they are at a greater risk of being infected with Hepatitis B transmitted
easily by infected blood and syringes. Nowadays, an effective vaccine
has been developed against Hepatitis B and patients, helpers, nurses
and doctors are immunised against Hepatitis.
What are the psychological effects on the dialysis patient?
For some patients, the thought of being on dialysis for the rest of
their lives or until they can get a kidney transplant, may mean the end
of the world and some may become suicidal.
Some patients may refuse to accept the fact that they have kidney
failure. Given time, however, and with patience from the medical staff,
most of them finally learn to come to terms with their illness.
Most patients who overcome the initial trauma, fears and resentment
regarding their illness adapt very well and bear testimony to the belief
that the human spirit is indefatigable and cannot be conquered. On a
cheerful note, they can also plan to go on holidays abroad as many
overseas dialysis units, like Singapore, do accommodate visiting patients.
For the dialysis patient, it is of utmost importance that he dialyses and
maintains himself well in preparation for the day when he is called up to
receive a cadaver transplant.
What is peritoneal dialysis?
This is a form of dialysis where the dialysate fluid is run into the
abdomen via the catheter and out again after the exchange of waste
products have taken place. Each cycle takes about 1 hour. Usually after
2 to 3 days the patient feels much better with this treatment.
This form of dialysis can be used for the patient who is awaiting the
maturation of his AV fistula prior to hemodialysis. It can also be used
for the patient with acute renal failure due to septicemia or drugs as he
only requires a few dialysis before his kidneys return to normal
What is Continuous Ambulatory Peritoneal Dialysis (CAPD)?
CAPD is an alternative form of treatment to hemodialysis for end-stage renal failure. The procedure involves exchanging 2 litres of
dialysate 3 or 4 times a day, with each cycle lasting 5 to 8 hours. This is
done daily and each exchange takes about 30 minutes. After each
exchange the bag is rolled up and worn until the next exchange. The
patient walks about and does his work until the next exchange when the
bag is disconnected and a new one connected and run in.
It requires no capital expenditure as the patient does not require a
machine and the only disposables are the bags of dialysate. The
monthly recurrent expenditure is about $1000 if the patient does 4
exchanges a day. If he requires only 3 exchanges a day, it will cost him $750
What is the prognosis for patients on dialysis?
Mortality varies from 5% annually for those between 20 to 39 years
of age to 15% annually for those over 60 years. The cause of death is
usually due to heart attack, stroke or infection. Only about 15% of
patients are classified as unfit for full or part time work on medical
grounds. However, as the typical dialysis patient is anaemic, he cannot
sustain hard physical effort.