Dialysis and renal transplant, and driving recommendations

The treatment of chronic renal failure by dialysis should be initiated prior to the onset of serious uremic complications

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The treatment of chronic renal failure by dialysis should be initiated prior to the onset of serious uremic complications.

The initiation of dialysis should be considered if decreased glomerular filtering is accompanied by nausea, vomiting, anorexia, cramps, insomnia, pruritis, paresthesia of the legs, pericarditis, uremic encephalopathy or bloating which proves resistant to diuretics.

Haemodialysis

Haemodialysis is carried out through an access point created by making a fistula or by means of AV subcutaneous derivation.

The majority of patients undergo dialysis for four hours, three times a week, and eat a low protein, salt and potassium diet.

Complications

  • There is a danger of local infection, thrombosis and aneurysm of the access point.
  • Accelerated atherosclerosis is common, and anaemia can be aggravated by haemorrhages.
  • Cardiovascular problems are associated with hypotension, cardiac arrhythmia, air embolism, pericardial tamponade, etc.
  • Aluminium poisoning can cause dementia in dialysis, verbal dyspraxia syndrome, convulsions and myoclonia.
  • Central nervous system symptoms include those classified as “unbalanced”, and vary from nausea to convulsions, and are always related to metabolic problems.
  • Renal osteodystrophy can be progressive or appear as osteomalacia with osseous pain and fractures.

Advice on Haemodialysis

  • A haemodialysis session precludes driving due to the possible and frequent side effects patients present after they have these have finished.
  • The ability to drive safety on days between dialysis sessions depends on the symptoms the patient is experiencing from the renal failure itself, as well as those resulting from the underlying cause of this.
  • These patients tend to be vulnerable because of their advanced renal failure, so they are recommended to avoid all but the slightest of risks, including those involved with driving.

Peritoneal dialysis

No vascular access is required, there is no blood loss, the cardiovascular load is not so great and the patient enjoys a greater degree of independence.

The catheter will require a post-implant recovery period, which will be specified by the specialist, to ensure this is correctly implanted.

Complications

  • The most commonly-observed mechanical complications related to implant of catheters are haematoma, haemorrhage of the abdominal cavity, perforated internal organs, obstructions of the catheter, etc.
  • The most frequently-seen complication is peritonitis. Patients can also suffer from malnutrition due to protein loss, hypertriglyceridaemia, hyperglycaemia and obesity.
  • It can lead to hypernatraemia and cardiopulmonary conditions, such as pulmonary oedema, hypotension and arrhythmia.
  • Other complications vary from convulsions to abdominal and inguinal hernias.

Advice on Peritoneal dialysis

  • Fitting a catheter will require a follow up and observational period to be defined by the specialist, during which the patient may not drive, until the device is correctly implanted without any complications.
  • A dialysis session precludes driving for a few hours, because of the possible side effects that can include headaches, nausea, vomiting, dizziness and heart failure.
  • Dialysis can affect prior cardiovascular conditions, especially in the case of anaemia, and can also cause arrhythmia, angor and hypotension.
  • While the patient is experiencing symptoms, he should be advised not to drive.

Renal transplant

When kidney failure is terminal, the technique used to treat it is renal transplant, the main risk of which is rejection by the immune system.

Most patients who receive kidney transplants recover a level of health and activity, which allows them to drive again, so long as a doctor has given permission for them to do so.

  • Post-operative medical complications: The problems that can lead to the rejection of the kidney transplant are varied, and can be medical, surgical, social or psychiatric in nature. The short-term complications leading to rejection are acute renal failure, thromboembolitic disease, infection and gastrointestinal conditions. Hypertension and hyperlipidaemia appear within the three months after the surgery and can persist during the entire post transplant period. Late onset complications of the procedure are chronic progressive decrease in the function of the transplanted organ, cardiovascular atherosclerotic disease, malign lesions, hepatic failure, treatment-resistant renal disease, diabetes, musculoskeletal problems and cutaneous lesions. The ocular diseases most frequently associated are cataracts, cytomegaloviral retinitis or toxoplama, glaucoma, diabetic retinopathy, viral keratoconjunctivitis and vitreous haemorrhage.
  • Immunosuppressant treatments: These can have toxic effects, including leucopoenia, thrombopaenia, icthericia and alopaecia, such as in the case of azatioprin. Glucocorticoids are used for maintenance treatment, and increase the likelihood of infections, diabetes mellitus, peptic ulcer, hypertension, osteoporosis, myopathy, and can produce euphoria and psychosis. Cyclosporin can be nephrotoxic with oliguria after the transplant, elevating creatinine in serum, hypertension, hyperpotassaemia and renal tubular acidosis. It can also cause hepatotoxicity and trembling.

Advice on Renal transplant

  • The transplant patient has to go through a period of convalescence due to the surgery itself, because of the risk of rejection and possible complications. The specialist will tell the patient when he has recovered to a sufficient degree to be able to drive again safely.
  • Those patients who suffer from chronic progressive functional impairment of the transplanted organ should not drive because of the progressive hypertension and gradual deterioration in renal function.
  • The late-onset complications, which include pharmacological toxicity, underlying treatment-resistant renal disease, prednisone side effects and infections, which seriously limit driving and of which the patient should be warned.
  • Associated ocular conditions which do not receive treatment or which progress unfavourably will preclude the patient from driving, a fact about which he must be informed.
  • In general, patients who have undergone transplants are very vulnerable and at risk of suffering multiple complications which will significantly disable them when it comes to driving.
  • They are patients who have to undergo multiple treatments with side effect that interfere with driving.
  • Patients taking anticoagulating drugs for prolonged periods of time after suffering from thrombosis or embolism must be warned that they run a greater risk of haemorrhaging when they suffer even the slightest knock, and they should be extremely careful to stay safe when driving.
  • Therefore, the specialist should systematically inform the patient of the situation during each check-up and mention his ability to drive.