Can dialysis cause disability in patients?

From the Guidelines

Yes, dialysis can cause disability in patients. The most recent and highest quality study, published in 2023 in the journal Kidney International 1, highlights the significant symptom burden associated with maintenance dialysis, including fatigue, pain, poor mood, dry skin, poor sleep, and muscle cramps. These symptoms can lead to physical and cognitive impairments that may qualify as disabilities.

Common Disabilities

• Fatigue, muscle weakness, and mobility issues resulting from the time-consuming nature of treatments and the physical toll of the procedure
• Vascular access complications like fistula problems or catheter infections can limit arm function
• Bone and mineral disorders leading to bone pain and fractures
• Neurological complications such as dialysis-related encephalopathy or neuropathy can impair cognitive function and cause nerve damage

Impact on Quality of Life

The strict dietary and fluid restrictions, medication regimens, and treatment schedules can significantly impact quality of life and ability to work. The cumulative effect of these issues often leads to disability status for many long-term dialysis patients. As noted in another recent study published in 2023 in the journal Critical Care 1, palliative care aspects in patients with terminal renal diseases, including those on dialysis, are becoming increasingly important due to the high physical symptom burden and reduced quality of life.

Key Considerations

• The frequency and burden of symptoms experienced by individuals undergoing dialysis
• The importance of incorporating symptom assessment into the patient’s medical records and facilitating integration into the overall clinical assessment
• The need for integrated palliative care for patients who are stopping or deciding not to undergo dialysis, as well as those with a severely limited life expectancy, low quality of life, refractory pain, or progressive deterioration due to an untreatable disease.

From the Research

Dialysis and Disability

• Dialysis can cause disability in patients, as it affects their physical and psychosocial well-being, leading to a decline in their daily living activities 2.
• The symptoms experienced by dialysis patients, such as tiredness, sadness, and muscle-joint pain, can negatively impact their ability to perform daily tasks, making them dependent on others 2.
• A study found that 26.2% of dialysis patients were semi-dependent, while 8.7% were totally dependent on others for their daily living activities 2.
• The impact of dialysis on daily life can be significant, especially for older adults, who may experience a decline in their physical function and ability to perform daily tasks, leading to a diminished quality of life 3.

Factors Contributing to Disability

• The duration of dialysis and the presence of other chronic diseases can contribute to the decline in daily living activities in dialysis patients 2.
• The symptoms experienced by dialysis patients can also contribute to their disability, as they can affect their physical and mental health, making it difficult for them to perform daily tasks 2.
• A study found that perceived difficulty in mobility tasks, such as basic activities of daily living, ambulation, and walking up or down stairs, was associated with all-cause mortality in patients receiving hemodialysis 4.

Interventions to Prevent Disability

• Exercise programs can help improve physical function and activity levels in dialysis patients, reducing their risk of disability 5.
• A study found that nurse-led and home-based exercise interventions can produce beneficial effects on physical function, activity levels, and health-related quality of life in patients undergoing hemodialysis 5.
• Early and continued support of meaningful activities may also help prevent disability in dialysis patients, by enabling them to maintain their physical and mental health, and perform daily tasks independently 3.