The main causes of winter itching include skin aging, excessive bathing, dry skin constitution, and low skin secretion in winter.

Notes :

(a) In winter, it is best to shower 2 to 3 times a week, and reduce the use of soap and bathing in sulfur hot springs.

(ii) Avoid taking hot baths as they can cause dry skin.

(iii) After bathing, you can use oily substances to moisturize your skin, such as olive oil, lanolin, and nourishing cream.

(iv) Clothing should be made primarily of cotton, avoiding wool and nylon, which may cause itchy skin.

(v) Do not scratch when your skin is itchy. Instead, pat it gently or apply ice to relieve the itching.

Winter is a high-risk season for gastrointestinal bleeding, which is commonly seen in gastric and duodenal ulcers.

Notes:

(a) Symptoms of bleeding: mainly vomiting blood and bloody stools, which may cause blurred vision, palpitations, and even dizziness, pale complexion, and decreased blood pressure.

(ii) Avoid eating irritating and hard-to-digest foods such as alcoholic beverages, coffee, chili peppers, curry, and pepper.

(iii) Those with a history of gastrointestinal bleeding should avoid lifting heavy objects, experiencing excessive emotional fluctuations, and overexertion.

★Prevention and health care methods:

Get plenty of rest, maintain a regular lifestyle, and avoid staying up late and overworking. Eat small, frequent meals and avoid foods that are too cold, too hot, or spicy. Use easily digestible cooking methods such as steaming, boiling, and stewing. Keep a cheerful mood and reduce unnecessary worries.

In winter, when wearing heavy clothing, any weight not removed during weighing should be deducted. Try to maintain the same clothing as much as possible.

1. Learn to monitor and record your blood sugar and blood pressure at home.

2. When going out or traveling, carry candy or food with you in case of hypoglycemia. Symptoms of hypoglycemia include hunger, palpitations, dizziness, sweating, and weakness. In this case, you should immediately eat sugary foods (such as 3-5 candies or sugar cubes). If the symptoms of hypoglycemia do not improve, please seek medical attention immediately.

3. It is advisable to quit smoking and drinking.

4. Daily foot care to prevent wounds or infection. Check and clean your feet and between your toes daily, keeping them clean. Use a suitable lotion to prevent dry skin. Choose appropriate shoes and socks to protect your feet from walking barefoot and avoid wounds. Trim your nails, following their shape, and do not cut them too short. If redness, swelling, heat, and pain occur at the wound site, seek medical attention immediately; do not apply unknown medications or herbal powders to the wound.

5. Diabetic patients should have an eye and foot examination at least once a year and a dental examination every six months.

6. Follow up with outpatient visits and treatment on time.

Non-pharmacological treatment:

Adjust your post-dialysis weight to the optimal dry weight to avoid excessive water retention. Hemodialysis patients should limit weight gain during dialysis sessions to no more than 5% of their dry weight. Adequate dialysis – please adhere to your doctor's prescribed dialysis schedule and do not skip sessions or reduce the time on your own.

Drug treatment:

Commonly used medications include beta-blockers (such as Dapoxetine and Concord), calcium ion blockers (such as Pulex and Cortex Elimin), serum tensor kinase inhibitors/serum tensor receptor blockers (such as Diclofenac and Pulsedox), and mineral corticosteroid receptor blockers (such as Idexcur). The first two are excellent medications for hypertension, while the latter two have additional benefits for patients with diabetes, heart failure, or coronary artery disease. Please take medication as directed by your doctor. The prescription may be adjusted according to your physical condition; do not increase or decrease the dosage on your own, and never take medications prescribed by someone else.

1. Dopamine-like preparations – In the past, levodopa had an efficacy rate of less than 50%, and in patients with familial restless legs, it had caused the side effect of “augmentation”, such as worsening of symptoms or metastasis to other locations. It has now been replaced by non-ergot preparations such as Ropinirole and Pramipexole, which have an efficacy rate of up to 70% and no serious side effects.

2. Sodium ion channel antiepileptic drugs – currently only gabapentin has been studied, and the efficacy rate can reach 80% when 200-300mg is given after each dialysis session, but it is prone to side effects such as fatigue, drowsiness and dizziness.

3. Iron supplements – Iron supplements can be given to people with iron deficiency anemia to improve their condition.

   Treatment for restless legs - non-pharmacological treatment

   Adequate dialysis – In theory, adequate dialysis treatment can reduce risk factors such as uremic toxins and calcium-phosphorus imbalance, but prolonged dialysis leading to increased bed rest/sitting time can actually worsen symptoms.

   Exercise – 30-45 minutes of cycling 2-3 hours after starting dialysis can significantly improve restless legs symptoms, and also has the additional effects of increasing lower limb muscle strength, improving quality of life, and increasing dialysis dose (Kt/V). It is very suitable for restless legs patients whose symptoms are aggravated by insufficient dialysis dose or calcium-phosphorus imbalance.

   Kidney transplantation – After receiving a transplant, the patient's symptoms will improve significantly or even disappear, but if rejection occurs and kidney function deteriorates, there is a possibility of relapse.

Restless legs not only affects the patient's life and sleep quality, but also damages interpersonal and family relationships, and may even increase the risk of cardiovascular disease. Although the cause is unknown, medication and exercise can improve symptoms, and kidney transplantation offers a better chance of curing restless legs.

The so-called "kidney dialysis" is clinically known as "hemodialysis," and "effective dialysis" refers to a uremic toxin clearance rate of over 75% per session. Commonly used dialysis catheters include:

1. Direct anastomosis of arteries and veins in the patient's limbs.

2. Artificial blood vessel connection surgery between arteries and veins.

3. Dialysis fuser units are used in procedures such as dialysis catheterization and large vein implantation. An ideal dialysis fuser unit includes:

(i) It can provide sufficient blood flow (more than 300cc per minute).

(ii) Long service life

(iii) Fewer complications

◎ The key points of care for patients with dialysis fistulas are:

1. Keep the wound clean after surgery and wipe the wound and skin tube outlet with iodine.

2. Do not lift excessively heavy objects or wear overly tight clothing.

3. Do not use the arm that has undergone fistula surgery as a pillow.

4. You must quit smoking.

5. Do not consume excessive amounts of potassium-containing foods to avoid fatal potassium ion overdose (such as bananas, cherries, and sports drinks).

The most important reason why end-stage renal disease requires long-term dialysis is that the kidneys have permanently lost their ability to eliminate toxins. Currently, according to the National Health Insurance Administration's regulations, when the kidney function's "glomerular filtration rate (eGFR)" drops to below 15 (for diabetic patients) or 10 (for non-diabetic patients), and uremia symptoms are present, a nephrologist will assess whether long-term dialysis is necessary.

The most important reason why end-stage renal disease requires long-term dialysis is that the kidneys have permanently lost their ability to eliminate toxins. Currently, according to the National Health Insurance Administration's regulations, when the kidney function's "glomerular filtration rate (eGFR)" drops to below 15 (for diabetic patients) or 10 (for non-diabetic patients), and uremia symptoms are present, a nephrologist will assess whether long-term dialysis is necessary.

The Health Promotion Administration (HPA) stated that Taiwan is known as the "Kingdom of Dialysis," with over 90,000 people undergoing dialysis. Chronic kidney disease incurs over NT$53 billion in annual health insurance expenditures, making it the most expensive medical condition. Therefore, prevention is better than cure. The HPA currently provides free preventative healthcare services to adults aged 40 to 64 every three years and to those aged 65 and above annually. Early screening and treatment can prevent kidney function from deteriorating to the point of requiring dialysis.

Hemodialysis, also known as kidney dialysis, mainly uses a semi-permeable membrane made of tiny hollow fibers (commonly called artificial kidneys). When blood flows through the membrane, dialysate (mostly acetate dialysate) flows through the outside of the hollow fibers. Toxins or waste products in the blood diffuse into the dialysate due to differences in concentration through the semi-permeable membrane and are then excreted from the body with the dialysate. This process is called dialysis.

On the other hand, by pressurizing blood within an artificial kidney, excess water in the blood is expelled from the body through a semipermeable membrane; this phenomenon is called ultrafiltration. When dialysis and ultrafiltration occur simultaneously, excess water and toxins can be eliminated from the body.

▶ When is hemodialysis necessary?

1. Acute renal failure can occur when there are high levels of potassium ions in the blood, severe edema, or uremia symptoms (such as BUN levels exceeding 100 mg%, oliguria, etc.).

2. Chronic kidney failure.

3. Stubborn edema.

4. Acute drug poisoning.

5. Abnormal metabolism in the body (such as high uric acid or high calcium levels in the blood).

▶ Hemodialysis involves four procedures for patients.

1. Remove products of protein metabolism, such as blood urea nitrogen (BUN), creatine, and uric acid.

2. Maintain blood electrolyte levels within a safe range.

3. Remove acids produced during metabolism.

4. Remove excess water that has accumulated in the body.

What symptoms might occur during hemodialysis?

1. Blood pressure drops or rises.

2. Nausea, vomiting, dizziness, or headache.

3. cramp.

4. Chest tightness, chest pain, and cold sweats.

5. Itchy skin, abdominal pain, back pain.

6. Other: Imbalance syndrome.

▶ What coordination work should be done?

Follow your doctor's instructions and receive dialysis on time. Do not skip dialysis sessions, as this may worsen your condition.

The weight gain between dialysis sessions should ideally not exceed 5% of your body weight (e.g., 5% of 60 kg is 3 kg) to avoid or reduce potential discomfort during dialysis. Dialysis is intended to alleviate physical discomfort and prolong life. Some patients have been on dialysis for over 10 years and are still able to contribute their talents to society. Therefore, have faith and patience; you can still live a normal and healthy life.

1. Regular check-ups: Check the fistula wound daily and feel it with your hands to see if you can feel any bleeding, abnormal swelling, or changes in limb color, etc.

2. Daily protection: Do not wear watches, tight clothing, lift heavy objects, apply pressure, use as a pillow, have blood drawn, receive injections, have your blood pressure measured, or be struck by sharp objects. If the blood vessels are too thick, use a wrist brace or elastic bandage for protection.

3. Infection prevention: Maintain good personal hygiene. Wash your hands before puncture, keep the fistula area clean and dry, and avoid picking or scratching to prevent skin breakage and infection. If subcutaneous hematoma occurs after dialysis, apply ice for 24 hours, followed by warm compresses after 24 hours.

4. Develop good hygiene habits: Do not smoke, keep your living environment clean to reduce the chance of infection; when bathing, do not use excessively hot water; it is recommended to use neutral soap or shower gel, and apply a neutral or oily lotion after washing to moisturize the skin and prevent itching. If symptoms do not improve, inform medical staff so that a doctor can evaluate the treatment method.

When a dialysis fistula is blocked or narrowed, endovascular thrombolysis and balloon dilation are usually the first-line treatments. If the blockage or narrowing of the dialysis fistula is too severe, open surgery to remove the thrombus in the vascular chamber will be considered to restore smooth blood flow. If the dialysis fistula continues to narrow after several balloon dilation procedures, a vascular stent, medicated balloon, or patch enlargement surgery can be considered to prolong the time before recurrence of narrowing or blockage.

(a) Developing correct medical concepts

a. Do not seek treatment from unqualified practitioners when you are sick. Find a regular family doctor for treatment. If you experience any discomfort, you should contact a specialist doctor immediately. Never believe in folk remedies and delay treatment.

b. Take medication on time and follow your doctor's instructions. Do not stop or increase medication on your own, as this may worsen your condition or cause side effects.

(ii) Regularly measure body weight and blood pressure to prevent swelling or high blood pressure.

(iii) Appropriate exercise and rest to avoid fatigue and tension.

(iv) Correct dietary intake: The diet of patients with kidney disease varies depending on the disease and must be followed in accordance with the guidance of doctors and nutritionists.

(v) Prevention of infection: Avoid bacterial infections, diseases that can easily worsen kidney disease, such as respiratory infections, fever, etc. In such cases, you should seek medical treatment and not neglect them.

(vi) Special medical treatment is determined by the doctor after diagnosis: such as special drugs, dialysis treatment or kidney transplant.

(vii) Women who wish to become pregnant should consult with a specialist and undergo regular check-ups during pregnancy in order to detect changes in kidney function early and avoid harming the mother and fetus.

(viii) Follow-up examinations for patients with kidney disease: Regular follow-up examinations can assess whether kidney function is stable or continues to deteriorate, so as to carry out further treatment in an early stage.

1. Consume enough calories to maintain an ideal weight.

   Patients undergoing dialysis face dietary restrictions, often having to avoid certain foods, leading to gradual weight loss, weakened immunity, and increased complications. Therefore, adequate calorie intake is crucial. The recommended daily intake is 35-45 kcal per kilogram of body weight, aiming to maintain an ideal weight.

2. Consume sufficient and high-quality protein

   Once kidney patients begin dialysis, they generally do not need to restrict their protein intake and should consume sufficient high-biological-value protein. During dialysis, the dialysate removes nitrogenous waste along with small protein molecules (approximately 6-8 grams, equivalent to one serving of protein food). Therefore, adequate protein intake is necessary, but excessive supplementation should be avoided to prevent hyperphosphatemia and high blood urea nitrogen. The recommended daily protein intake is 1.1-1.4 grams per kilogram of body weight. Sources of higher biological value protein include eggs, fish, meat, and soy products.

3. Phosphorus restriction

   Excessive phosphorus can lead to bone diseases and skin malnutrition, so limiting the phosphorus content in the diet can slow down the decline of kidney function.

4. Potassium limit

   Kidney failure reduces the body's ability to excrete potassium ions, but as long as kidney patients urinate at least 1000 ml, they usually do not develop hyperkalemia even if their diet is not restricted.

5. sodium restriction

   When kidney function is inadequate, the body cannot excrete excess sodium ions, which can cause high blood pressure, edema, pulmonary edema, and increased burden on the heart, eventually leading to heart failure.

6. Control water intake

   Your daily weight gain should not exceed 0.5 kg. Your fluid intake for the next day should be 500-750 ml more than your total urine output from the previous day. The interval between dialysis sessions should ideally not exceed 5% of your body weight (e.g., 5% of a 60 kg body weight is 3 kg).

   Moisture control techniques:

   a. Fill a fixed container with the amount of water needed for one day, and then drink it in equal portions.

   b. Mix lemon juice and freeze into ice cubes to quench thirst (lemon slices can stimulate saliva production).

   c. Chewing gum.

   d. When feeling thirsty, simply moisten your lips with a cotton swab, rinse your mouth, or apply lip balm.

7. Exercise and a regular lifestyle

   a. Develop regular lifestyle habits: do not stay up late, do not drink excessively, and do not smoke.

   b. Exercise three to five days a week, one to one and a half hours after meals, for at least 30 minutes each time. For example, take a walk.