Essential Health Tips for Dialysis Patients: Supplements and Care Guidance

Which department should I consult for diseases related to dialysis patients regarding dietary supplements?

1.
Is it appropriate for dialysis patients to supplement with free lutein and sphingolipids? My mother is currently 67 years old.
Last week, she was discharged from National Taiwan University Hospital after experiencing severe edema and undergoing five dialysis sessions.
The edema has now disappeared, but she continues to have some issues.
For example, during her hospitalization at NTU, she was given antibiotics, and her toenails turned black and purple, with several nails easily breaking.
The nurses referred her to the dermatology department, where she was diagnosed with onychomycosis and paronychia.
They provided us with a spray and an ointment, advising us to continue applying it.
We have been doing so since her discharge.
During this time, we have observed that her nails continue to break and bleed.
We consulted a nearby dermatologist who suspected subungual hematoma and prescribed a general topical ointment.
After using it for two days, my mother's nail breaking worsened, and the bleeding increased, so we have reverted to using the ointment prescribed by NTU.
2.
However, we are unsure where to seek medical attention and which specialty to consult.
I found various possibilities online regarding nail breakage, but I am confused about what information is accurate and what is not.

3.
I am very worried; some sources even suggest it could be related to liver function.
However, at discharge, my mother's liver function indices were low, and the nurse advised us to monitor them.
I am unsure how to do this.
The dialysis center mentioned that low liver indices are normal for kidney disease patients.
My mother's white blood cell function was normal during her blood tests, which suggests that her internal organs are functioning normally without inflammation.
Does this mean I may not need to worry too much about this aspect?
4.
Recently, my mother has had a significant increase in appetite.
Is this a good sign or a bad sign?

Yu Yu, 30~39 year old female. Ask Date: 2023/12/12

Dr. Lin Wuxuan reply Internal Medicine

It is recommended that you take your elder to the outpatient clinic of the Department of Nephrology at National Taiwan University to discuss your concerns and any issues encountered with the original attending physician.
Thank you.

Reply Date: 2023/12/12

More Info

When it comes to managing the health of dialysis patients, particularly in the context of nutritional supplementation and overall care, there are several important considerations to keep in mind. Your mother's situation, involving recent hospitalization and ongoing issues with her nails and swelling, highlights the complexities of care for individuals undergoing dialysis.

Nutritional Supplements
1. Lutein and Phosphatidylserine: These supplements can have potential benefits, but their use should be approached with caution. Lutein is known for its antioxidant properties and is often associated with eye health. Phosphatidylserine is a phospholipid that plays a role in cell membrane integrity and may support cognitive function. However, the specific needs of dialysis patients can vary significantly based on their overall health, dietary restrictions, and the presence of other medical conditions. It is crucial to consult with a healthcare provider or a registered dietitian who specializes in renal nutrition before introducing any new supplements.

2. Dietary Considerations: Dialysis patients often have specific dietary restrictions, including limitations on potassium, phosphorus, and sodium intake. A dietitian can help tailor a meal plan that meets your mother's nutritional needs while considering her dialysis schedule. Adequate protein intake is also essential, as dialysis can lead to protein loss.

Nail Health Issues
1. Nail Changes: The changes in your mother's nails, including discoloration and brittleness, can be attributed to several factors, including the effects of medications, underlying health conditions, or even nutritional deficiencies. The fact that she experienced black and purple discoloration could indicate subungual hematomas (bleeding under the nail) or fungal infections, such as onychomycosis.
2. Medical Attention: Given the ongoing issues with her nails, it is advisable to seek care from a dermatologist who has experience with nail disorders, especially in patients with underlying health conditions like kidney disease. They can provide a more accurate diagnosis and appropriate treatment options.
3. Follow-Up Care: Monitoring liver function is also important, especially since some medications can affect liver health. Regular follow-ups with her nephrologist and primary care physician can help ensure that her liver and kidney functions are being appropriately managed. If her liver function tests are low, it may be a normal finding in dialysis patients, but it should still be monitored closely.

Appetite Changes
1. Increased Appetite: An increase in appetite can be a positive sign, indicating that your mother is recovering and her body is seeking nutrients. However, it is essential to ensure that her food choices align with her dietary restrictions. Overeating or consuming foods high in potassium or phosphorus can lead to complications.

2. Monitoring and Adjustments: Keep track of her dietary intake and any symptoms she may experience after eating. If her appetite continues to increase, it may be beneficial to discuss this with her healthcare team to ensure that her nutritional needs are being met without compromising her health.

Conclusion
In summary, managing the health of a dialysis patient involves a multifaceted approach that includes careful monitoring of nutritional needs, addressing any medical issues such as nail health, and ensuring regular follow-up with healthcare providers. It is essential to work closely with a healthcare team to tailor a care plan that meets your mother's specific needs while considering her overall health status. If you have any concerns about her condition or treatment, do not hesitate to reach out to her healthcare providers for guidance.

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