Lymphedema in Dialysis Patients: Causes and Treatment Options

Lymphedema caused by dialysis?

Hello Doctor: My father has a long history of dialysis due to a family history of hereditary diseases.
As a result of the dialysis, he frequently experiences various side effects (such as weight loss, dizziness, low blood pressure, nausea, diarrhea, etc.).
About six months ago, he began to develop lower limb lymphedema.
Initially, after consulting with a physician, he was informed that "this is one of the complications of dialysis patients." Although the doctor provided injections to alleviate the symptoms, my father had a significant reaction to steroids, so this treatment method was discontinued.
However, now he is experiencing discomfort from the lower limb swelling that has extended to severe pain in his lower back, leading to a loss of appetite and poor sleep at night.
He has to get up every hour to sit and relieve the discomfort, unable to sleep through the night like a normal person.
Additionally, my father used to have a habit of exercising for an hour daily to maintain muscle mass, but due to the swelling, he is gradually becoming less mobile and now finds it difficult to climb stairs.
He has now turned to acupuncture with traditional Chinese medicine, but I feel there hasn't been a significant improvement.
Therefore, I would like to ask the doctor a few questions: 1.
What is the cause of lymphedema due to dialysis? 2.
Does it always occur in the lower limbs? 3.
Since my father has a significant reaction to steroids, are there other more proactive and effective treatment options if steroids are not used? 4.
If the swelling continues without improvement, will it lead to other symptoms later on? 5.
If he continues to only see traditional Chinese medicine or acupuncture, will it delay the golden treatment period? Thank you.

Kakyo, 30~39 year old female. Ask Date: 2020/11/19

Dr. Wu Jiyu reply Internal Medicine

Due to the lack of direct examination of the patient, it is difficult to distinguish what you refer to as "lymphedema" from the "general edema" seen in dialysis patients.
If it is general edema in dialysis patients, enhancing dehydration should resolve the issue effectively.
Dialysis itself does not lead to lower limb lymphedema unless there is a fistula established in the leg, which could potentially cause lymphedema.
There is also a rare congenital hereditary condition known as lymphangiectasia associated with lymphedema, which can affect kidney function and ultimately lead to the need for dialysis.
Your inquiry did not mention whether your father has undergone any surgeries on his lower limbs, such as coronary bypass surgery, pelvic surgery, or knee surgery.
Typically, lymphedema occurs after these types of surgeries due to prolonged bed rest or inability to walk, but this is not caused by dialysis.
Another possibility is lymphatic cancer, but this would require further investigation for confirmation.
Since the symptoms you described are not commonly seen in typical dialysis patients, I recommend visiting a large hospital for further examination to clarify the condition.
Thank you for your inquiry.
The Nephrology Department at Changhua Hospital is concerned about your situation.

Reply Date: 2020/11/19

More Info

Lymphedema is a condition characterized by swelling due to the accumulation of lymphatic fluid, often occurring in the limbs. In dialysis patients, lymphedema can be particularly challenging due to the underlying health issues associated with chronic kidney disease (CKD) and the effects of dialysis treatment. Let's address your questions in detail.

1. Causes of Lymphedema in Dialysis Patients: The primary cause of lymphedema in dialysis patients is related to the fluid imbalance that occurs due to kidney dysfunction. The kidneys are responsible for filtering excess fluid and waste from the blood. When they are not functioning properly, as in the case of CKD, fluid can accumulate in the tissues, leading to swelling. Additionally, dialysis itself can contribute to lymphedema. The process of dialysis removes waste products and excess fluid from the blood, but it can also lead to fluctuations in fluid levels, which may exacerbate swelling in the lower extremities.

2. Location of Lymphedema: While lymphedema commonly occurs in the lower limbs, it is not limited to them. It can affect any part of the body, including the arms, abdomen, and even the face. However, in dialysis patients, the lower extremities are often more affected due to gravity and the position of the body during treatment.

3. Treatment Options Beyond Steroids: If your father has had adverse reactions to steroids, there are several other treatment options available for managing lymphedema. These include:
- Compression Therapy: Wearing compression garments can help reduce swelling by applying pressure to the affected area, promoting lymphatic drainage.

- Physical Therapy: A physical therapist specialized in lymphedema management can provide manual lymphatic drainage (MLD) techniques, which can help reduce swelling.

- Exercise: Gentle exercises can promote circulation and lymphatic flow. It's essential to tailor the exercise program to your father's current capabilities, especially considering his recent difficulties with mobility.

- Dietary Management: Reducing salt intake can help manage fluid retention, which may alleviate some symptoms of lymphedema.

- Medications: In some cases, diuretics may be prescribed to help manage fluid retention, although their use should be carefully monitored in dialysis patients.

4. Potential Complications of Persistent Lymphedema: If lymphedema is left untreated, it can lead to several complications, including:
- Infection: Swelling can increase the risk of skin infections, such as cellulitis, due to impaired lymphatic drainage.

- Skin Changes: Chronic swelling can lead to skin thickening and changes in texture, making the skin more susceptible to injury.

- Decreased Mobility: As swelling persists, it can further limit mobility, leading to a decline in overall physical health and increased risk of falls.

5. Impact of Solely Relying on Traditional Chinese Medicine (TCM): While acupuncture and other TCM practices can be beneficial for some conditions, relying solely on these treatments without addressing the underlying issues of lymphedema may delay effective management. It's crucial to have a comprehensive treatment plan that includes both conventional and alternative therapies. Consulting with healthcare providers who specialize in lymphedema management can ensure that your father receives the most appropriate care.

In conclusion, managing lymphedema in dialysis patients requires a multifaceted approach. It is essential to work closely with healthcare professionals, including nephrologists, physical therapists, and possibly lymphedema specialists, to develop a tailored treatment plan that addresses your father's specific needs. Regular monitoring and adjustments to the treatment strategy will be key to improving his quality of life and managing symptoms effectively.

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