Dialysis is a life-saving treatment for people with end-stage renal disease (ESRD), but it also comes with some challenges and risks. One of them is poor wound healing, which can lead to serious complications such as infections, gangrene, amputation and even death. In this article, we will explain why dialysis patients are more prone to poor wound healing, what factors affect wound healing, and how to prevent and treat wounds effectively.
Contents
How Dialysis Affects Wound Healing
Wound healing is a complex process that involves inflammation, tissue formation, and remodeling. It requires adequate blood flow, oxygen, nutrients, and immune cells to the wound site. However, dialysis patients often have conditions that impair these factors, such as:
- Peripheral artery disease (PAD): This is a narrowing or blockage of the arteries that supply blood to the legs and feet. PAD reduces blood flow and oxygen delivery to the tissues, making them more vulnerable to injury and infection. PAD is more common in dialysis patients than in the general population, especially those with diabetes.
- Diabetes: Diabetes is the leading cause of ESRD and also a major risk factor for poor wound healing. High blood glucose levels damage the blood vessels and nerves, impair the immune system, and increase inflammation. Diabetic foot ulcers are a common complication of diabetes that can be difficult to heal and may lead to amputation.
- Malnutrition: Dialysis patients may have inadequate intake or absorption of protein, calories, vitamins, and minerals due to dietary restrictions, loss of appetite, gastrointestinal symptoms, or dialysis-related losses. Protein is essential for tissue repair and growth, while vitamins and minerals such as zinc, arginine, vitamin A, and vitamin C play important roles in wound healing. Malnutrition can delay wound healing and increase the risk of infection.
- Calciphylaxis: This is a rare but serious condition that causes calcification of the blood vessels in the skin and subcutaneous tissues. Calciphylaxis causes painful skin ulcers that are often infected and resistant to treatment. It is more common in dialysis patients with high levels of calcium, phosphorus, or parathyroid hormone. Calciphylaxis has a poor prognosis and requires aggressive management 3.
How to Prevent and Treat Wounds in Dialysis Patients
The best way to prevent poor wound healing is to avoid wounds in the first place. Dialysis patients should take good care of their skin and feet by:
- Keeping them clean and dry
- Moisturizing them regularly
- Wearing comfortable shoes and socks
- Checking them daily for any signs of injury or infection
- Seeking medical attention promptly if any problems arise
If a wound does occur, it should be treated as soon as possible to prevent further complications. The treatment of wounds in dialysis patients depends on the type, location, size, depth, and severity of the wound, as well as the presence of infection or ischemia. Some general principles of wound care include:
- Cleaning the wound with saline or water
- Applying an appropriate dressing that keeps the wound moist but not wet
- Changing the dressing regularly or as instructed by the health care provider
- Taking antibiotics if prescribed
- Controlling blood glucose levels
- Eating a balanced diet that meets the protein and micronutrient needs for wound healing
- Consulting a wound care specialist if needed
Some wounds may require additional interventions such as:
- Debridement: This is the removal of dead or infected tissue from the wound to promote healing and prevent infection.
- Revascularization: This is a procedure that restores blood flow to the ischemic limb by bypassing or opening up the blocked artery. Revascularization can improve wound healing and prevent amputation in some cases of PAD or CLI.
- Skin grafting: This is a surgery that transfers healthy skin from another part of the body to cover the wound. Skin grafting can speed up wound healing and improve cosmetic outcomes in some cases of large or deep wounds.
- Amputation: This is a surgery that removes part or all of a limb that is severely damaged or infected. Amputation may be necessary when other treatments fail or when the limb poses a threat to the patient’s life.
Conclusion
Poor wound healing is directly related to dialysis and can have serious consequences for dialysis patients. However, with proper prevention and treatment strategies, wounds can heal faster and better. Dialysis patients should work closely with their health care team to optimize their wound care and improve their quality of life.
Feeding the Patient on Dialysis With Wounds to Heal – Redorbit Promoting Wound Healing in Dialysis Patients through Nutrition – DaVita® Medical Insights Poor survival of dialysis patients with unhealed wounds due to critical limb ischemia: Limb salvage and survival requires wound healing – International Wound Journal
