Exercises for Dialysis Patients

By Siti Noor Huda

A healthy body makes for a healthier mind. For patients with advanced kidney disease who require dialysis, exercising is especially vital to not only help circumvent the fatigue they would feel while undergoing dialysis treatments but to also help them regain a better semblance of normalcy in their daily lives when carrying out everyday activities.

At the outset, many patients with kidney disease – especially those at advanced stages – believe that their condition prevents them from doing any real exercises. This is because limited information is provided to them on this aspect and kidney patients are often excluded from exercise programs as part of their treatment,  more so when compared to patients with other chronic diseases.

Physical fitness is crucial to helping kidney disease patients manage their condition in the long-term and is highly recommended.

However, it is very important for patients to first speak with their doctor, who can recommend which exercise routines suit them best, depending on how advanced their condition is.

A better lease of life through exercising

For dialysis patients, exercising can represent another form of medicine.

On one hand, regular exercise is one of the most direct ways to improve energy levels in the body. This is especially crucial as dialysis patients undergoing treatment will often feel fatigued due to muscle wastage and – in more extreme cases – experience muscle atrophy.

Exercising helps patients utilise their muscles, which then makes it easier for them to move around and gain better flexibility to carry out daily tasks, whether it is for work or household activities. Those who are fitter may even be able to carry out activities that they were able to do before they started their dialysis treatment – giving them more agency in managing their condition. However, it is crucial that patients who exercise keep themselves hydrated, as experts have noted that heavy perspiration may signal the kidneys to save water and keep toxins within the body.

Another key benefit of exercising is to prevent the occurrence of other chronic conditions. A particular risk for dialysis patients who are inactive is developing heart disease, especially if they intake food or substances that could raise cholesterol and blood pressure levels. Regular exercising also helps to reduce or control the risk of diabetes, as muscles are important for regulating insulin resistance and glucose levels.

While the rigorousness of an exercise routine for kidney patients depends on how advanced their affliction is, in general, it is always advisable to start things slowly and measuredly.

Stretching out

The one thing that nearly all dialysis patients can do – no matter how serious their condition is – to stretch. Stretching is important to get the blood flowing to different parts of the body and reduce instances of cramping which would help in exercising more comfortably and could further motivate the patients to exercise more. It also helps to unwind and mentally relax and could even be beneficial to help them sleep better at night.

Starting slowly with warm-ups

Patients should not dive straight into heavier exercises.

It is advisable that they first gently warm up via light cardiovascular activities, such as walking, for several minutes. Near the end of the exercise session, it is also crucial that they slow things down, followed by doing stretches and then relaxing.

Getting more active with interdialytic anaerobic exercises

For patients who have remained inactive for long periods, it can be difficult to accustom themselves to regular exercise routines. Hence, interdialytic exercises – which mostly comprise anaerobic exercise – are now being adopted more regularly as part of the patient’s overall treatment at clinics, especially for patients undergoing haemodialysis. However, there are limitations to interdialytic exercising as it is often stationary; oftentimes being done in beds or while sitting (i.e. using a stationary fitness bicycle). As such, it is recommended that interdialytic exercise be done even outside the confines of clinics, and to be supplemented with personal exercise routines so that patients can incorporate a greater variety of activities into their routines.

Improving resistance

Once patients can do more, the next step is to move towards resistance training, such as exercising using weights or dumbbells, to strengthen their muscles. As mentioned earlier, inactive kidney patients run the risk of suffering from muscle weakness so resistance training helps to address this and by extension, helps them do other exercises more easily and make the conduct of everyday activities easier.

However, it is important that resistance exercises must be hard enough so that patients can only do it for a few times. These exercises can be done using equipment at gyms, but it is advisable to consult with the trainers there on how to use them properly. Resistance training can also be done at home, even with everyday items like tin cans or water-filled buckets. Whether at the gym or at home, these exercises should be done using very controlled movements and they must be done until the muscles tire. Throughout the entire session, it is vital that they breathe normally and do not hold their breath.

Knowing when to stop

While exercising regularly can transform a dialysis patient’s life for the better, they must not be overtly gung-ho about it and remain conscious of their own physical limitations. It is hence vital that they stop immediately if they feel very tired, light-headed and/or start feeling irregular heartbeats.

There are also instances where dialysis patients should avoid exercising at all costs. This includes instances where they have altered either their dialysis or medication schedule. When this happens, it is doubly important for the patients to speak to their doctor before beginning their exercise again.

The importance of taking it easy

No matter at which stage a chronic kidney disease patient is at, exercising will always be beneficial even if different patients need to plan their routines according to their specific condition. The general rule, however, is to take things slowly; it is best to start doing 15-20 minutes of exercise for a few days within a week to better ascertain if they can gradually push themselves further.

Above all, being slow and steady wins a patient’s race of regaining more normalcy and independence in their lives.


Disclaimer:

The author and/or AWAK Technologies Pte Ltd shall not be held liable for any inaccurate information or any financial or non-financial damages caused by using such information.

AWAK TALENT: Zhi Hao Low!

Meet Zhi Hao Low, straight out of university and on the path to enriching lives of many already!

The AWAK team comprises of individuals across all career timelines; Zhi Hao joined our team this year as a fresh graduate from NUS Bachelors of Engineering (Mechanical). In addition to excelling in academics, Zhi Hao also followed his passion for sports and helping others as a NUS lifesaving varsity athlete.

Zhi Hao Low is excited to be part of AWAK for the opportunity to apply his university learnings to practically create tangible change in the healthcare industry.

Through his role in product development, Zhi Hao continues to learn and enhance his career and personal development whilst growing together with the AWAK team!

DID YOU KNOW?

#DidYouKnow that 96% of people with mild CKD and 48% with severe CKD are completely unaware of having Chronic Kidney Disease?

The disease slowly progresses to significant kidney damage, often without showing signs or symptoms until it is too late for damage control.

What we know for sure though is that the two main causes of CKD are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Hence, it is essential for these patients to recognize the risk of impending kidney failure and proactively take measures to reduce the kidney disease progression.

Here is some information from NIDDK to aid you in your kidney health management:


Diabetes and CKD:

https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-kidney-disease#:~:text=The%20best%20way%20to%20slow,and%20improve%20your%20health%20overall.

Hypertension and CKD:

https://www.niddk.nih.gov/health-information/kidney-disease/high-blood-pressure#:~:text=blood%20pressure%20checked.-,Medicines,the%20progression%20of%20kidney%20disease

Maintaining good personal relationships with dialysis patients

By Priyanka Arya

Starting dialysis treatment significantly affects a person, both physically and psychologically. It involves large lifestyle changes that may initially be difficult to accept and adapt to. However, with the right support from their loved ones, dialysis patients can overcome these challenges faster, maintain a positive frame of mind and continue living their lives to the fullest.

Being supportive of a dialysis patient requires achieving a delicate balance that varies according to the patients’ personality. Some find it helpful to be open about their condition. Others may still be in the process of acceptance and prefer to downplay it. Regardless, staying well-informed, keeping lines of communication open and being accommodating without being overbearing form a good basis to sustain and strengthen any relationship, and that applies equally here.

Communication is

When first diagnosed, it is common for sufferers of chronic illnesses – such as kidney disease – to undergo the five stages of grief: denial, anger, bargaining, depression and acceptance.

Dialysis patients tend to grieve the loss of their physical strength, freedom, social life and more, due to dialysis-related restrictions. This grief response can continue for years, which can be hard for the loved ones of these patients to accept and cope with. It’s human nature to want to alleviate their pain, but people worry about unintentionally making the problem worse.

Clear communication between both sides is the first and most important step to ensure the patient receives the support they need. To help build this, it is important to keep patience during the early stages of interaction and give them space. However, make sure they know that you are there for them and calmly let them sort through their emotions at their pace. Recognizing your presence in the process, they will talk when they feel ready. Being a good listener takes some practice, but they will appreciate your effort and it will get easier as you work towards acceptance together.

Arm yourself with knowledge

Many people do not understand the condition and the experience that dialysis patients are going through, so they might feel at a loss of words. Some may ignore the situation entirely to hide their uncertainty. Others may default to generic platitudes and unsolicited advice that despite being well-intentioned, might come off as being condescending and unhelpful. All these situations can be upsetting and stressful to dialysis patients and may strain your relationship as a result.

Therefore, it is essential that you acquaint yourself with basic knowledge on the disease and its effects on patients. This would help you understand them even if their attitudes may be harsh sometimes.

It is well documented that patients with chronic kidney disease (CKD) suffer psychologically, with depression, anxiety and in some cases, even post-traumatic stress disorder (PTSD). Some patients may feel especially aggrieved with their condition, and so, having empathy and consideration for their condition can help prevent patients from going down a psychological downward spiral.

Ignorance is common, but investing the extra effort will help you be more involved, which in turn would significantly transform the lives of your loved ones for the better. It is natural to turn to the Internet as the first source of knowledge, but it is very important to consume information critically. Make sure that the sources are verified, such as peer-reviewed medical journals or government health websites, as misinformation can be dangerous and frustrating for both parties. Qualified doctors or other health professionals can also be good sources of credible information on dialysis.

Dialysis should not be a taboo subject. When in doubt, it is always best to ask the dialysis patients themselves what they need. They can share their perspectives, what their condition means for them and how you can help. Asking may seem very personal, but most patients will understand that your questions spring from a genuine desire to support them. Speaking to other people who have gone through the same situation with other dialysis patients can also help you navigate this new dynamic.

Keeping regular routines

The biggest struggle for dialysis patients is the disruption that dialysis causes in their lives, which can lead to loss of confidence and a pessimistic outlook. To maintain good mental wellbeing, dialysis patients are encouraged to maintain their regular routines as much as possible. This helps provide a sense of normality and enables them to accept their condition with ease.

While dialysis treatments can cause patients to tire more easily and have a more restricted schedule, they can otherwise still work, travel, exercise and engage in most other activities. Most patients will appreciate not being treated like fragile glass as that reinforces a negative self-image. Their new limitations however, may make them feel guilty or uncomfortable for affecting others.

It is hence important to reassure them and find ways to accommodate their needs together.

Extra consideration does not necessarily mean making drastic changes. Suggest brisk walks instead of long runs. Invite them for two-hour high teas instead of all-day shopping sprees. If possible, accompany them to the medical centre for their appointments. Planning activities together helps them regain a sense of control over their lives and shows them that it is possible to continue engaging in what they love – it simply requires a new approach.

Embracing the joint effort

Dialysis patients must undergo numerous life changes, but this does not have to include affecting or losing close relationships. Every relationship takes effort. The presence of a chronic illness does not change that – it simply requires a little more give and take from both sides.

Many dialysis patients will continue to live long and happy lives even after starting dialysis. As a friend or loved one of a patient, the best thing you can do is to accept their condition and then help them do the same for themselves. Knowing that they have your support is a huge reassurance, can have a big impact in their journey and may make your relationship even stronger.


Disclaimer:

The author and/or AWAK Technologies Pte Ltd shall not be held liable for any inaccurate information or any financial or non-financial damages caused by using such information.

AWAK TALENT: Ricardo Aguilar!

Let us introduce you to Ricardo, our in-house R&D Engineer and Technologist.

Ricardo has an avid interest in wearable tech which has taken him all around the world

After graduating from Mexico as a biomedical engineer, he developed sedentary behavior tech with Loughborough university in the UK, was an international exchange student at Calgary University in Canada and moved to Singapore to pursue his Ph.D. in physical activities monitoring and wearable technologies at NTU.

In addition to sharing his tech expertise, he is often found telling stories of his 6-month solo travel around South East Asia.

Constantly working towards making a difference in the lives of patients by developing innovative and accessible technologies to enhance healthcare delivery, Ricardo is an integral part of AWAK!

DID YOU KNOW?

#DidYouKnow that your kidneys filter 200 litres of blood each day?

When the kidney function reduces significantly, it is unable to clear toxins and excess water from the body. The electrolyte (sodium, potassium, calcium) balances as well as production of hormones for blood pressure control are also adversely affected.

Diseases like diabetes, high blood pressure, polycystic kidney and kidney infections are the common culprits of kidney failure. In addition to causing reduced kidney function, these conditions might also lead to diminished blood flow to the kidneys.


Here is an article on how you can keep your kidneys healthy through simple diet management : https://awak.com/2020/09/24/how-to-eat-well-for-a-kidney-patient/

AWAK TALENT: BA SAI!

With a passion for biochemistry and the urgency for putting her talents to make a difference, Ba Sai came to Singapore to complete her PhD in Biological Chemistry at NTU. In her pursuit of R&D for healthcare industry applications, she chanced upon the opportunity to work at AWAK Technologies, a place en route to revolutionize kidney dialysis.

Being at AWAK allows her to put her 11 years of hands-on laboratory experience to productive use while working along side a talented bunch of colleagues.

Ba Sai feels encouraged working at AWAK!

How to eat well for a Kidney Patient

By Sheena Gow

Our kidneys are amongst the human body’s core organs, facilitating the crucial function of removing waste and excess fluids from our bodies as well as regulating hormones that regulate our blood pressure. For renal patients suffering from chronic kidney disease (CKD), their ability to perform these core functions is adversely impacted, as more waste accumulates in their blood – including waste products from food.

It is therefore crucial for those living with damaged kidneys to follow a renal diet that is friendly to the kidneys; one that would help prevent further kidney damage and boost kidney function, which could then help the patients live healthier and longer. Such a diet requires them to limit certain foods and fluids to prevent certain minerals from building up in the body, while also obtaining optimum levels of protein, vitamins, minerals and calories.

Keeping nutrient intake in check

Dietary restrictions vary depending on the stage of a person’s kidney failure. For instance, end stage renal disease (ESRD) patients will need to keep a watchful eye on their nutrient intake to manage the limits of their severely impacted kidneys. However, no matter what level a kidney sufferer may be at, it is important to limit the intake of the following nutrients to prevent them from building up:

Sodium

This is a mineral found naturally in most of the foods we consume and is important for blood pressure and maintaining the body’s water balance. Yet, while healthy kidneys can help balance sodium levels, those with impaired kidneys (especially CKD patients) cannot properly regulate it, which could lead to high blood pressure, shortness of breath, swollen ankles and fluid build-up around other vital organs such as the heart and lungs. For those with kidney disease, it is recommended that they take no more than 2,300 milligrams of sodium daily.

Potassium

For most people, potassium helps with the nervous systems and the proper functioning of muscles. However, kidney disease patients will find this harder to do so while CKD patients cannot filter excess potassium at all. Having too much potassium in the blood could then lead to serious heart issues.

However, potassium is largely found in a lot of fresh fruits and vegetables we eat every day, such as bananas, potatoes, melons and even avocados. Those at advanced stages of kidney disease should then curtail the intake of such foods, on top of switching to low-potassium substitutes such as apples, cranberries, strawberries and pineapples. For most kidney patients, it is recommended that they limit their potassium intake to under 2,000 milligrams each day.

Phosphorus and calcium

Both of these minerals work together to keep our bones strong and healthy, and excess levels of them can be filtered out by healthy kidneys. Kidney patients – especially those at advanced stages – will find it hard to regulate phosphorus and calcium levels. Having too much phosphorus raises the risk of heart disease, while having low calcium levels (as many CKD patients find it hard to absorb calcium) could see the body obtaining that mineral from the bones, which could make them weaker and more brittle – meaning they would be easier to break.

For those living with kidney disease, it is recommended that they limit their phosphorus intake to 800-1,000 milligrams per day, while daily calcium intake should not exceed 2,000 milligrams. Foods that are high in calcium tend to be high in phosphorus too, so patients may need to cut back heavily on calcium-rich foods such as dairy products, dark green leafy vegetables and fish with bones.

Protein

Protein is one of our body’s crucial building blocks, playing an important role in generating bones, muscles, cartilage, skin and blood as well as repairing tissues and producing bodily chemicals such as enzymes and hormones. But, when the body uses protein, the kidneys work harder – meaning that kidney patients will need to stress their kidneys out further if they take too much protein.

Protein is a mineral that needs to be controlled according to the stage of kidney disease.

For those at the early stages, it is best to limit their protein intake (especially by substituting animal sources of protein with plant-based ones). For advanced stage of CKD – where dialysis is required – patients need to instead increase the amount of protein in their diet. This is because once they have started dialysis, having higher protein levels is important for them to balance blood protein levels and improve their overall health. Also, dialysis removes protein waste from the patient’s blood, eliminating the need for a low protein diet.

Creating a renal diet plan that works for you

While these recommendations can serve as an early guideline for new kidney patients and those helping to take care of them, it should be stressed that no one kidney patient is the same. It is therefore crucial to consult with their doctor and a nutritionist to determine the proper renal diet plan that is best suited to their stage of affliction.

That being said, kidney patients may be able to take some matters in their own hands to maintain the right balance of nutrients in their body. This can be done by eating and cooking fresh as often as possible, especially as many nutrients (such as sodium) are added to foods at levels we cannot control if we get them from restaurants or from packaged foods at supermarkets. Essentially, when you prepare your own food, you have complete control as to what goes into it.

At the onset, a renal diet can feel daunting and restrictive. However, there are still plenty of nutritious foods that can be incorporated into a well-balanced diet plan that makes it delicious as well as kidney friendly.

To learn more tips on creating and maintaining a kidney-friendly diet, visit AWAK’s Facebook page.


Disclaimer:

The author and/or AWAK Technologies Pte Ltd shall not be held liable for any inaccurate information or any financial or non-financial damages caused by using such information.

Living with dialysis: Maintaining mental and physical wellness while undergoing dialysis

By Mandar Gori

Dialysis saves lives, but there is no denying the fact that it also changes a patient’s life forever. It becomes an important part of their daily routine and takes a significant toll on mental and physical health – especially when they are adjusting to the initial stages of receiving dialysis treatment.

While living with dialysis is not easy, being able to acknowledge the challenges and taking a proactive, holistic approach to managing their personal wellbeing can help dialysis patients regain a sense of agency. This goes a long way towards restoring their confidence and enthusiasm for life.

Overcoming the mental impact of dialysis

Dialysis can be traumatizing to even the most well-prepared patients. Having to plan their lives around dialysis is a big change and it takes time to accept and adapt to it. It is absolutely normal for them to have negative emotions; dialysis patients most commonly report experiencing anxiety, depression and frustration.

Many of these symptoms stem from a fear of the unknown and a sense of losing control over their lives. Acceptance is the first step to recovery and gathering knowledge is the logical next move. However, patients should ensure that their information comes from credible sources, such as accredited healthcare professionals.

Patients should not feel ashamed to seek help to understand dialysis. Doctors, nurses and other caregivers exist to help them manage the lifestyle changes that they need to make. Once they know what they need to do, the scales of control tip back towards balance as they can plan their next steps with more confidence.

Dialysis may be part of a patient’s life, but that does not mean it has to be their whole world.

People who try to maintain their regular routines as much as possible report experiencing more satisfaction and have fewer emotional issues.

There are multiple ways to preserve existing routines for working and socializing, even if they may need some adaptation to the new dialysis schedule and requirements. For instance, patients can take up new hobbies to replace any that are no longer feasible or meet their friends at new places closer to home.

Managing the effects of dialysis on the body

Maintaining good physical health is equally as important as maintaining a positive frame of mind to manage living with dialysis. Studies show that insomnia, fatigue and cramping are among the most common physical symptoms reported by dialysis patients. They also often report excessive interdialytic weight gain, which is caused by not properly following a suitable fluid intake regimen.

Patients cite fatigue, muscle weakness, nausea and the fear of getting hurt as main reasons for the lack of exercise. However, exercise – when coupled with a proper diet – has been shown to improve physical fitness, muscular strength and cardiovascular health along with mental wellbeing.

Exercise can be done during dialysis with intradialytic cycling and basic strength training with weights, but it is more important for patients to incorporate exercise more fully into their daily routine. This may include walking more and taking the stairs – anything that gets them moving more frequently.

Dialysis patients are usually advised to limit their fluid intake due to reduced kidney function. Recording their intake in a journal or carrying around a water bottle with a clearly marked storage capacity can be useful to keep track of their fluid consumption.

It is also very important for patients to limit sodium intake as salt makes you feel thirsty and your body retain water, which can lead to fluid overload. They may need to increase their intake of high-quality protein as some protein can be lost during the dialysis process. Reducing their consumption of phosphorus and potassium is also advisable as the kidneys are now less effective at filtering these.

Living with dialysis

Even with technological advancements patients must have access to adequate resources and support to properly manage dialysis on a daily basis. Social support along with medical care is an important aspect for most patients. Access to the right treatment and resources are crucial for their longevity, they can help extend the patients’ lifespan by up to 20-30 years.

By taking back control over the wellbeing of their mind, body and soul, dialysis patients can ultimately live a more rewarding life.


Disclaimer:

The author and/or AWAK Technologies Pte Ltd shall not be held liable for any inaccurate information or any financial or non-financial damages caused by using such information.

Impact of the COVID-19 pandemic on dialysis patients

by Victoria Wang Yue & Sheena Gow

COVID-19. This is on the forefront of many of our thoughts these days. While this virus is infecting the general population, the exacerbations of pneumonitis and secondary bacterial pneumonia are more pronounced in populations who already have pre-existing health conditions like hypertension, heart failure, diabetes, chronic kidney disease (CKD), asthma or chronic obstructive pulmonary disease (COPD). With ESKD patients on dialysis, they are at increased risk as they usually have co-morbidities.

With their kidneys ineffective, most dialysis patients endure a challenging regimen of having their blood cleansed three days a week, typically four hours each time (hemodialysis-HD). This is done mainly in dialysis centers where 8 to more than 30 chairs are placed in a large single room. Globally, a majority of patients undergo in-center dialysis, while relatively smaller percentage of patients receive their care at home (mostly peritoneal dialysis). The nature of their kidney disease makes dialysis patients highly vulnerable to complications of infection and other threats from co-morbidities. Even a single missed session can cause life-threatening results like fluid buildup in their lungs and hearts. In addition, during a severe infection, more medications are being used in the COVID treatment and these can be harmful to an already compromised kidney. It may result in an acute kidney injury which can be lethal for ESKD patients.

The challenges to the ongoing provision of maintenance out-patient hemodialysis are significant in the current pandemic situation. In addition to their medical conditions, they will be exposed to staff and other patients at the center who might have the same risk profiles as themselves. On the other hand, with PD patients, whilst they might also be impacted by delayed logistics of medical supplies reaching them/the dialysis centers due to major airline/transportation disruptions, having home dialysis is still advantageous as their exposure to the outside world is greatly reduced.

It is in dire times that health disparities are more pronounced and this is an opportune time for the dialysis world to rethink health processes and to innovate ways to bring health treatment to the unwell without potentially causing them more risk of serious morbidity and mortality during a pandemic.

This article was written based on the information from Naicker S, Yang CW, Hwang SJ, Liu BC, Chen JH, Jha V. The Novel Coronavirus 2019 epidemic and kidneys. Kidney Int. 2020;In press

Disclaimer:

The author and/or AWAK Technologies Pte Ltd shall not be held liable for any inaccurate information or any financial or non-financial damages caused by using such information.

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