How dialysis saves lives of patients with renal failure

How dialysis saves lives of patients with renal failure
Photo: The Straits Times

You have been feeling more tired than usual, and find it difficult to concentrate at work despite having enough sleep.

Even walking up a flight of stairs feels like running a marathon.

You decide to pay a visit to your doctor, only to find out that you are suffering from kidney disease.

This is the case for many end-stage renal disease (ESRD) patients as they do not experience symptoms until the very late stages when the kidneys have started to fail.

By then, the only treatment option for patients is to undergo dialysis for the rest of their lives until a kidney donor becomes available, as ESRD is an irreversible condition.

But what happens when the treatment that provides a lifeline to ESRD patients becomes the cause of their death?

Dialysis landscape in Malaysia

In Malaysia, the number of dialysis patients has increased rapidly.

There were a total of 34,767 dialysis patients in Malaysia in 2014, which represented a two-and-a-half fold increase from 13,356 patients in 2005.

Of all the dialysis patients in the country, 90% of them are on haemodialysis (HD) treatment, while the remaining 10% are on peritoneal dialysis (PD) treatment.

Among these patients, the annual death rate in 2014 is 11.6% and 16.1% for those who undergo HD and PD treatment respectively.

The main cause of death among dialysis patients is cardiovascular disease, which accounted for 37% of all deaths.

However, over the last six years, death from sepsis - a potentially life-threatening condition caused by an infection - has increased, becaming the second most common cause of death in 2014 among dialysis patients, accounting for 24% of all deaths that year.

While dialysis patients who already have cardiovascular disease prior to commencing treatment can only manage and control their underlying conditions, it is possible to reduce the risk of contracting infections during treatment to reduce the number of deaths among dialysis patients.

Risk of infection in dialysis

The annual mortality rate caused by sepsis is 100 to 300 times higher in patients with ESRD than in the general population.

Although both HD and PD patients face the risk of infection, the former are at higher risk because the process of HD requires frequent use of catheters or insertion of needles to access the bloodstream.

HD patients also run the risk of contracting nosocomial infections, which are infections that are acquired in hospitals and healthcare facilities such as HD centres.

For example, they are at risk of getting hepatitis B and C infections, as these viruses can live on surfaces like dialysis chairs and machines, and they can be spread even with no visible blood.

As HD patients already have weakened immune systems, they are more vulnerable to infections, especially when they are exposed to other patients in HD facilities three times a week, and if they require frequent hospitalisations and surgery.

However, some types of infections can be prevented, such as hepatitis B and C, and bloodstream infections that are spread from patient to patient, most commonly by the hands of healthcare workers.

The role of dialysis nurses and assistant medical officers

To lower the risk of infection in dialysis patients and prevent the spread of infections, dialysis nurses and assistant medical officers should understand and follow the basics of infection control as a routine part of their practice.

Healthcare workers would have been trained on the best practices in patient care and infection control prior to becoming a certified dialysis nurse or assistant medical officer.

Nonetheless, it is still necessary for them to attend continuing medical education (CME) programmes over time, which serve both as a refresher course and an update on the latest infection control protocols.

It is important for dialysis nurses and assistant medical officers to participate in CME to update themselves on the types of infections patients can contract from dialysis, as well as infection control recommendations in dialysis settings.

As they are often the main contact for HD patients, it is also imperative for them to learn how to talk to patients about good vascular access care.

This is because signs of infection may only show when patients are at home, and they would not have their nurse or assistant medical officer by their side to help them clean the wound.

One of the CME programmes available for dialysis nurses and assistant medical officers in Malaysia is the Dialysis Education Work-shop (DEW) organised by the Association of Dialysis Medical Assistants and Nurses Malaysia, in partnership with Roche Malay-sia, which is held five to six times a year.

Placing emphasis on potential complications associated with patient care and other treatment-related procedures, the DEW aims to increase dialysis healthcare workers' competency in managing patients, which greatly translates into total patient care in the entire dialysis landscape.

Self-care to prevent infection

Although a large part of HD patients' care is handled by the nurses and assistant medical officers at HD facilities, patients can also take a few preventive measures of their own to protect themselves from contracting infections.

HD patients get vaccinated, and also, watch and report any signs of an infection as soon as possible, as the key to fighting an infection is to identify and treat it early.

It is also important for patients to comply to the treatment or medication that has been prescribed by their doctors.

Some of the signs of infection include fever, persistent cough, as well as redness and tenderness at the vascular access site, which is where a surgically-created vein is inserted to remove and return blood during the HD process.

Patients are advised to seek medical care or inform their nurse or assistant medical officer if these symptoms persist.

The prevalence of infections like hepatitis B and C has reduced gradually over the years, largely due to constant surveillance and strict implementation of infection control protocols within HD facilities throughout the country.

However, it is still vital for dialysis nurses and assistant medical officers to continue to pay full attention to infection control measures to ensure that no nosocomial transmission occurs within HD centres.

Even though ESRD patients are not able to be cured from their disease, healthcare workers can still play a part in their treatment process by providing them with quality patient care.

By participating in CME to learn about the latest medical information and best practices in dialysis, nurses and assistant medical officers are able to help lower the risk of infection among dialysis patients, and in turn, reduce the number of deaths caused by infection.

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