Tjiang W, See KS Kris, Osel Diagnostics, Osel Group
Abstract: Chronic kidney disease, also called chronic renal failure, describes the gradual loss of kidney function. Several conditions can cause chronic kidney disease, but the two most common are diabetes and high blood pressure. Our kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in your body. Uremia is a dangerous medical condition that causes urea to accumulate in the blood. Urea is the waste that the kidneys usually help to filter away and is a symptom of kidney failure. Urea is the major nitrogen-containing metabolic product of protein catabolism in human, accounting for 75% of the nonprotein nitrogen eventually excreted. Most people with uremia will need dialysis. Dialysis uses a machine to act as an "artificial kidney" that filters the blood. However, we are investigating how “dermato-dialysis” – sweating can help to reduce
Symptoms of Chronic Kidney Disease
Chronic kidney disease can affect almost every part of your body. Potential complications may include:
Fluid retention, lead to swelling in arms and legs, high blood pressure, or fluid in your lungs
A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart's ability to function and may be life-threatening
Heart and blood vessel (cardiovascular) disease
Weak bones and an increased risk of bone fractures
Anemia
Decreased sex drive, erectile dysfunction or reduced fertility
Damage to your central nervous system, personality changes or seizures
Decreased immune response, which makes you more vulnerable to infection
Dermatodialysis is Beneficial
In the absence of renal replacement therapies such as hemodialysis and continuous peritoneal dialysis, there are high amounts of urea and other molecules transferred from the bloodstream into perspiration/sweat for them to crystalize out and deposit on the skin as ‘uremic frost’. Urea excretion via sweating is particularly important when the kidneys are damaged or their functions are impaired.
The use of sweating as the vehicle to remove body molecules normally removed in the urine was identified some decades ago, with successes such as reducing blood urea concentrations from 105 to 75 mg/dl over 7 days with little suggestion of a plateau having been reached at the end of the experiment then, eliminating uremic pruritis, and achieving compliance with fluid intake restrictions and the resultant optimization of blood pressure. However, the evolution of hemodialysis and peritoneal dialysis displaced interest in exploring sweating methods properly.
Urea concentration in the sweat fluid was found to be present at a much higher concentration than the serum level. Therefore, the possibility of using stimulated sweating as an alternative way to hemodialysis was considered. The presence of such a high level of urea in the sweat fluid suggested a selective transport mechanism across the eccrine sweat gland to clear the blood of urea.
Sweat fluid mainly contains sodium chloride, potassium, nitrogen metabolites such as urea, ammonia, uric acid, and creatinine. The concentrations of urea and potassium in sweat fluid were higher than that in serum. The mean sweat fluid urea concentration could reach 5.5 to 50 times the serum concentration; therefore, urea and potassium excretion via sweating is important when the renal function is impaired. The volume of fluid lost by sweating was also highly variable, depend on physical activity and environmental temperature.
Stimulated Dermatodialysis
The use of stimulated sweating or dermodialytic methodologies involving the use of personal environmental control of temperature and humidity in conjunction with low intensity moderate duration physical exercise, to stimulate sweating and remove that sweat, would clearly be substantially beneficial to not only the many chronic renal failure patients in the developing world who would otherwise have no treatment at all, but also to those in the developed world by way of delaying or reducing the need for hemodialysis or peritoneal dialysis.
Specific symptoms of chronic renal failure can be relieved by hot baths. Hot bath can reduce mean weight gain and improve blood pressure and potassium/urea balance in patients with end stage renal disease. Hot bath can increase the sufficiency of dialysis and reduce the fluctuation of blood pressure and cardiovascular events in peridialysis period. Other method to stimulate sweating is sauna baths which might increase the excretion of impurities, such as uremic toxicity, water, and heavy metals. After one to two hours’ sauna bath, the patient’s body weight decreased by 1.5–2 kg.
A 30-minute hot water bath daily was as effective as a two-hour sauna bath three times a week. Sweat rates in sauna and hot water baths were 21 and 33 mL/min, respectively. Urea clearance in hot (42 °C) water baths were higher than in sauna baths, which were 56 and 40 mL/min. Calculated losses of urea and potassium in sweat fluid were 43 and 12 mmol/h compared with 117 and 20 mmol/h by hemodialysis. These findings indicated that hot bath can be used as an adjunct to chronic intermittent hemodialysis. Recommendations suggested that persons with aortic stenosis, unstable angina, orthostatic hypotension, or recent myocardial infarction avoid hot bath therapy.
Conclusion: In patients with chronic renal failure, control of fluid balance, uraemia, and hyperkalaemia can be facilitated by this mode of treatment, which might obviate the need for strict dietary regulations and thereby improve quality of life in these patients.
References
Huang CT, Chen ML , Huang LL, Mao IF. Uric Acid and Urea in Human Sweat. Chinese Journal of Physiology. 2002;45(3): 109-115
Man in't Veld AJ,van Maanen JH,Schicht IM. Stimulated sweating in chronic renal failure. Br Med J. 1978; 2(6131): 172–173
Mayo Clinic. Chronic Kidney Disease. March 2018
Vance DJ. Dermodialysis – Could sweating treatments for chronic renal failure substantially and feasibly improve outcomes in developing and even developed world contexts?. Global Journal of Medicine and Public Health. 2016 ;5 (1)
Villines Z. All you need to know about uremia. Medical News Today. December 2017
Ye T, Tu W, Xu G. Hot bath for the treatment of chronic renal failure. Renal Failure. 2014; 36(1): 126–130
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