Gut Feeling of a Patient on Dialysis

Cora Lee was sitting in wheelchair by the window. Her eyes were closed. Lunch time in the nursing home is a very busy part of  the day. Residents are being wheeled in and out of the dinning room, some were walking slowly, pushing their walkers on worn out  maroon carpet with large tan flowers. Clicking sounds of cutlery were interwoven with the background music from 1980s. From the first day she came to live in the nursing home, Cora Lee was so delighted by the music they played during lunch.

1980s seem so far gone. Different era. It was her favorite. The music, the fashion, her zest for life.

She spent endless hours in front of the mirror trying new hair and make up styles, while the music, oh, that music, filled the room and her soul with magic and joy. It had electrifying effect on her. Like struck by a jolt of high voltage energy, she would dance in the kitchen,bathroom , bedroom, virtually anywhere.Saturday nights were the highlight of the week. Dolled up ,she would meet her sister downtown and after a feast of banana split in heavy cream, the two would walk to the disco club and dance the night away.

Good old 80s.

” Cora”, the nurse called her as she was grabbing handles of her wheelchair to push her toward the table where her girlfriends have already started enjoying chicken parmigiana.

Cora Lee lifted her head and opened her eyes.

“Cora, my girl, what’s wrong?”, the nurse asked noticing that Cora was crying. Cora Lee wiped wet smears with the back of her hand and gazed at her red chipped nail polish.

“Just memories”, she replied.

“What did you remember?”, the nurse asked.

“My sister”, Cora Lee whispered.

“What about her?”, the nurse was curious.

“Today is her anniversary”, Cora Lee responded.

“Anniversary?”, nurse went on .

“My sister died on this day five years ago. This was her favorite song”, Cora Lee said , as she joined her girlfriends for lunch.

After her parents have died, Cora Lee had only her sister. She never got married, she did not have children. When her kidneys failed two years ago and the doctor started her on dialysis, she was no longer able to take care of herself. They put her in the nursing home.

It seemed to her that all her life she had problems with her gut. Not only that ‘gut feeling’ that she would often not obey, but also that constant rollercoaster of bloating, nausea, irregular movement. Cora Lee never expected her kidneys to fail her. it was her tummy that would never let her be, new skirt feeling too tight from the bloat or nausea after a large Chinese meal enjoyed in front of TV on a Sunday night.

Suddenly,she lost appetite and asked the nurse to wheel her back to her room.

Gut-kidney axis is coming to focus of attention of researchers. Patients with chronic kidney disease are noted to have altered gut microbiota. Bacteria produce toxins, some of which are uremic toxins and can influence toxic burden and chronic inflammation in patient with chronic kidney disease.I

n one study composition of fecal microbiota was compared between patients with end stage kidney disease and healthy controls and demonstrated reduced bacterial variety in patients on dialysis.

In a different study, authors looked at the patients with diabetes mellitus and chronic kidney disease, both of which are associated with chronic inflammation. Altered Intestinal microbiota and dysbiosis via increased intestinal permeability and circulating lipopolysaccharides from the bacterial waste products are part of the process known as endotoxemia and play a role in chronic inflammation.

In a another study authors have evaluated the prevalence of constipation in patients with chronic kidney disease and potential  association with altered microbiome.

 

1) Gut hormones and gut microbiota: implications for kidney function and hypertension

Afshar Bet al J Am Soc Hypertens 2016 Dec;10(12): 954-961

2) Constipation and Incident CKD

Sumida K et al J Am soc Nephrol 2017 Aprl;28 (4): 1248-1258

3 )Intestinal Microbiota in Type 2 Diabetes and Chronic Kidney Disease

Sabatino A et al Cura Diab rep 2017 Mar;17 (3):16

4) Alteration of the gut microbiota in Chinese population with chronic kidney disease

Jiang S et al Sci Rep 2017 jun 6;7(1)

5) Advanced glycation end products dietary restriction effects on bacterial gut microbiota in peritoneal dialysis patients: a randomized open label trial

Jacob R et al Pos One 2017 Sep 12(9)

 

 

2 thoughts on “Gut Feeling of a Patient on Dialysis”

  1. This post is an excellent example of the importance of keeping yourself well hydrated throughout the day as well as the need to cut down on foods with high levels of sodium. Not to mention how fascinating the link you established between chronic kidney failure and altered gut microbiota. People need to be understand how important the connection between your whole body is and that daily care is necessary in order to prosper physically into your old age.

    Great Post!

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