Live with Kidney Disease

Kidney Failure

Kidney disease can get worse over time, and may lead to kidney failure. Kidney failure means very advanced kidney damage with less than 15% normal function. Most people with kidney failure have symptoms from the build up of waste products and extra water in their body. End-stage renal disease (ESRD) is kidney failure treated by dialysis or kidney transplant.
If the kidneys fail, treatment options such as dialysis or a kidney transplant can help people live longer and healthier lives. If your kidneys fail, talk with your health care provider about choosing a treatment that is right for you. Learn about what you can do to prepare for kidney failure and treatment.

What are the Causes of kidney failure.

In Acute Kidney Failure, kidney function is lost over a period of hours, days, or in some cases, weeks. The causes are categorized based on where the injury is set. We mainly talk about the causes of Chronic Kidney Failure.

1. Pre-renal causes
Pre-renal kidney failure occurs due to decreased blood supply to the kidneys. Pre-renal causes mainly include the follows:

• Low blood volume due to blood loss
• Dehydration from loss body fluid, examples of which include: vomiting, diarrhea, severe sweating, high fever, etc.
• Insufficient fluid intake. Such medicines as diuretics may result in severe water loss
• Abnormal blood flow to and from the kidney due to obstructions in renal arteries or veins

 

2. Renal Causes
Renal causes of kidney failure (factors that damage kidney itself) mainly include:
Sepsis: the body's immune system is overwhelmed from infection and causes inflammation and shutdown of the kidneys. This usually doesn't occur with urinary tract infections.
Nephrotoxic medicines: nonsteroidal anti-inflammatory analgesic medicines like idomethacin, ibuprofen, aspirin, etc. Other potentially toxic medicines also include antibiotics such as gentamicin, Nafcillin, and anesthetic medicines like diethyl ether.

 

3. Multiple myeloma
Acute glomerulonephritis or inflammation of glomeruli the filtering system of the kidneys. Diseases that could cause the inflammation mainly include Systemic Lupus Erythematosus, Goodpasture Syndrome, Wengener's granlomatosis, etc.

 

4. Post-renal causes of kidney failure
Common causes mainly include

• urinary tract stones
• bilateral pelvic effusion
• prostatic hyperplasia
• tumors in the abdomen that surround and obstruct the ureters.

 

5. Chronic Kidney Failure.
Chronic diseases, such as Diabetes and Hypertension.

 

6. Diseases and factors.

• Recurring pyelonephritis
• Polycystic kidney disease
• Autoimmune disorders such as Systemic Lupus Erythematosus and Purpura
• Hardening of the arteries, which can damage blood vessels in the kidney
• Urinary tract blockages and reflux, due to frequent infections, stones, or an anatomical abnormality that happened at birth
• Excessive use of medications that are metabolized through the kidneys

 

What are the Symptoms of Kidney Failure

• Itching (pruritus) and dry skin
• Headaches
• Weight loss without trying
• Loss of appetite
• Nausea
• Other symptoms may include:
• Abnormally dark or light skin
• Nail changes
• Bone pain
• Drowsiness and confusion
• Problems concentrating or thinking
• Numbness in the hands, feet, or other areas
• Muscle twitching or cramps
• Breath odor
• Easy bruising, nosebleeds, or blood in the stool
• Excessive thirst
• Frequent hiccups
• Low level of sexual interest and impotence
• Menstrual periods stop (amenorrhea)
• Sleep problems, such as insomnia, restless leg syndrome, or obstructive sleep apnea
• Swelling of the feet and hands (edema)
• Vomiting, especially in the morning
• Metallic taste in mouth
• Abdominal pains

 

Treatment

The first step in the treatment of chronic kidney disease is to determine the underlying cause. Some causes are reversible, including use of medications that impair kidney function, blockage in the urinary tract, or decreased blood flow to the kidneys. Treatment of reversible causes may prevent CKD from worsening.
Research has shown that management of chronic kidney disease is best done with the assistance of a nephrologist, a doctor who specializes in kidney diseases. Early referral to a nephrologist decreases the chance of developing complications associated with chronic kidney disease.

• Hypertension — Hypertension, or high blood pressure, is present in 80 to 85 percent of people with chronic kidney disease. Maintaining good blood pressure control is the most important goal for trying to slow progression of CKD. Taking a medication called an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) reduces blood pressure and levels of protein in the urine, and is thought to slow the progression of chronic kidney disease to a greater extent than some of the other medicines used to treat high blood pressure. Sometimes, a diuretic (water pill) or other medication is also added. You may be asked to monitor your blood pressure at home to be sure that your blood pressure is well controlled.
• Control of blood glucose: Maintaining good control of diabetes is critical. People with diabetes who do not control their blood glucose have a much higher risk of all complications of diabetes, including chronic kidney disease.
• Anemia — People with chronic kidney disease are at risk for anemia. This occurs because improperly functioning kidneys produce reduced amounts of a substance called erythropoietin. Anemia can lead to fatigue and other complications.
• Selected patients can be treated with drugs that stimulate production of red blood cells. You or a family member can inject these drugs at home. In some cases, iron supplements are also prescribed
• Dietary changes — Changes in your diet may be recommended to control or prevent some of the complications of chronic kidney disease; most important is salt restriction to help control the blood pressure.
• Protein restriction — Restricting protein in the diet may slow the progression of chronic kidney disease, although it is not clear if the benefits of protein restriction are worth the difficulty of sticking to a low protein diet. Although a reduced protein diet may delay dialysis for several years, the unappetizing nature of the diet is difficult for most people to tolerate. Speak to your healthcare provider about the advantages and disadvantages of a low protein diet.
• Salt restriction: Limit to 2 to 4grams a day to avoid fluid retention and help control high blood pressure
• High potassium — Some people with chronic kidney disease develop a high blood potassium level, which can interfere with normal cell function. This is frequently treated with a diuretic. Measures to prevent high potassium might also be recommended, including a low potassium diet and avoiding medicines that raise potassium levels.
• High phosphate — Phosphate is a mineral that helps to keep the bones healthy. Early in the course of chronic kidney disease, the body begins to retain phosphate. As the disease progresses, high blood phosphate levels can develop. This is usually treated with medicines that prevent phosphate (found in foods) from being absorbed in the digestive tract. Dietary phosphate restrictions are also recommended
• High cholesterol and triglycerides — High cholesterol and triglyceride levels are common in people with kidney disease. High triglycerides have been associated with an increased risk of coronary artery disease, which can lead to heart attack.Treatments to reduce the risk of coronary artery disease are usually recommended, including dietary changes, medications for high triglyceride and cholesterol levels, stopping smoking, and tight blood sugar control in people with diabetes.
• Sexual function — Men and women with advanced chronic kidney disease often have difficulties with sexual function and infertility. Over 50 percent of men with end-stage kidney disease have difficulties with erection and decreased sex drive. Women often have disturbances in the menstrual cycle and fertility, usually leading to a stop in menstrual periods. Decreased sex drive may also occur in women. You should discuss any changes in your sexual function with your healthcare provider because medications or other treatments may be effective
• Pregnancy — The risk that pregnancy will worsen kidney function, or that decreased kidney function will interfere with pregnancy depends upon a number of factors. A woman with mild to moderate chronic kidney disease who is considering becoming pregnant should discuss the possible risks with her nephrologist and obstetrical provider before trying to conceive. Women with end-stage kidney disease who are on dialysis and who become pregnant are at very high risk for miscarriage, premature delivery, severe hypertension, and preeclampsia. A woman who undergoes successful renal transplantation has a lower risk of these complications. It may be advantageous for a woman to delay becoming pregnant while on hemodialysis if renal transplantation in the near future is likely.

 

Other important measures that a patient can take include:

Carefully follow prescribed regimens to control blood pressure and/or diabetes;
stop smoking; and  lose excess weight.
In chronic kidney disease, several medications can be toxic to the kidneys and may need to be avoided or given in adjusted doses. Among over-the-counter medications, the following need to be avoided or used with caution:

• Certain analgesics: Aspirin; nonsteroidal antiinflammatory drugs (NSAIDs, such as ibuprofen [Motrin, for example])
• Fleets or Phospho-Soda enemas because of their high content of phosphorus
• Laxatives and antacids containing magnesium and aluminum such as magnesium hydroxide (Milk of Magnesia) and magnesium and aluminum hydroxide (Mylanta)
• Ulcer medication H2-receptor antagonists: cimetidine (Tagamet) and ranitidine (Zantac) (decreased dosage with kidney disease)
• Decongestants such as pseudoephedrine (Sudafed) and phenylpropanolamine (Rhindecon) especially if the patient has high blood pressure
• Alka Seltzer, since this contains large amounts of sodium
• Herbal medications

If a patient has a condition such as diabetes, high blood pressure, or high cholesterol underlying chronic kidney disease, they should take all medications as directed and see their health care practitioner as recommended for follow-up and monitoring.

 

Diet and Lifestyle Changes

People with kidney disease can continue to live productive lives: working, enjoying friends and family, and staying physically active. You may need to make some changes to your diet and lifestyle to help you live a healthier and longer life. Because heart attack and stroke are more common among people with kidney disease, these changes are good for your heart and for your kidneys.

Lifestyle Changes

Following a healthy lifestyle is good for people with kidney disease, especially if you have diabetes, high blood pressure, or both. Talk with your dietitian, diabetes educator, or other health care professional about which actions are most important for you to take. As you will see, many of these actions are related.

• Keep your blood pressure at the target set by your health care provider. Aim for less than 1,500 milligrams (mg) of sodium each day.
• If you have diabetes, control your blood glucose level. Good blood glucose control may help prevent or delay diabetes complications, including kidney disease.
• Keep your blood cholesterol in your target range. Diet, being active, maintaining a healthy weight, and medicines can all help control your blood cholesterol level.
• Take medicines the way your provider tells you to.
• If you smoke, take steps to quit. Cigarette smoking can make kidney damage worse.
• Get or become more active. Physical activity is good for your blood pressure, as well as your blood glucose and blood cholesterol levels.
• Lose weight if you are overweight. Being overweight makes your kidneys work harder. Losing weight helps your kidneys last longer.

 

Dialysis

Dialysis is a treatment to filter wastes and water from your blood, allowing people with kidney failure to feel better and continue doing the things they enjoy. However, when many people think of dialysis, their fears can keep them from learning about this treatment. In fact, most people are surprised to find how well dialysis works and how much better they feel with treatment.
If you have advanced kidney disease, it is important to take an active role in your care by talking with your health care provider about your options ahead of time. It takes time to understand dialysis and get used to the idea that you will be receiving this treatment. Although dialysis does not cure kidney failure, it can help you feel better and live longer.

 

Some people with chronic kidney disease progressively worsen over time and will eventually need dialysis. Dialysis is a treatment to filter wastes and water from your blood, allowing people with kidney failure to feel better and continue doing the things they enjoy. However, when many people think of dialysis, their fears can keep them from learning about this treatment. In fact, most people are surprised to find how well dialysis works and how much better they feel with treatment.
If you have advanced kidney disease, it is important to take an active role in your care by talking with your health care provider about your options ahead of time. It takes time to understand dialysis and get used to the idea that you will be receiving this treatment. Although dialysis does not cure kidney failure, it can help you feel better and live longer.
hemodialysis and peritoneal dialysis. Kidney transplantation is also an option for some people with chronic kidney disease. Although kidney transplantation is the treatment of choice in most cases, many people must wait months or years for a kidney to become available. Dialysis will likely be needed, often for an extended period.
Dialysis and kidney transplants are treatments—not cure—for kidney failure.

 

Renal Replacement Therapies

Hemodialysis

Hemodialysis involves circulation of blood through a filter or dialyzer on a dialysis machine.
The dialyzer has two fluid compartments and is configured with bundles of hollow fiber capillary tubes.
Blood in the first compartment is pumped along one side of a semipermeable membrane, while dialysate (the fluid that is used to cleanse the blood) is pumped along the other side, in a separate compartment, in the opposite direction.
Concentration gradients of substances between blood and dialysate lead to desired changes in the blood composition, such as a reduction in waste products (urea nitrogen and creatinine); a correction of acid levels; and equilibration of various mineral levels.
Excess water is also removed.
The blood is then returned to the body.
Hemodialysis may be done in a dialysis center or at home. In-center hemodialysis typically takes 3 to 5 hours and is performed three times a week. The patient will need to travel to a dialysis center for in-center hemodialysis.
Some centers may offer the option of nocturnal (night-time) hemodialysis wherein the therapy is delivered while the patient sleeps. Long nocturnal dialysis offers patients a better survival and an improvement in their quality of life.
Home hemodialysis is possible in some situations. A care partner is needed to assist the patient with the dialysis treatments. A family member or close friends are the usual options, though occasionally people may hire a professional to assist with dialysis. Home hemodialysis may be performed as traditional three times a week treatments, long nocturnal (overnight) hemodialysis, or short daily hemodialysis. Daily hemodialysis and long nocturnal hemodialysis offer advantages in quality of life and better control of high blood pressure, anemia, and bone disease.

Dialysis access
A vascular access is required for hemodialysis so that blood can be moved through the dialysis filter at rapid speeds to allow clearing of the wastes, toxins, and excess fluid. There are three different types of vascular accesses: arteriovenous fistula (AVF), arteriovenous graft, and central venous catheters.

1. Arteriovenous fistula (AVF): The preferred access for hemodialysis is an AVF, wherein an artery is directly joined to a vein. The vein takes 2 to 4 months to enlarge and mature before it can be used for dialysis. Once matured, two needles are placed into the vein for dialysis. One needle is used to draw blood and run through the dialysis machine. The second needle is to return the cleansed blood. AVFs are less likely to get infected or develop clots than any other types of dialysis access.
2. Arteriovenous graft: An arteriovenous graft is placed in those who have small veins or in whom a fistula has failed to develop. The graft is made of artificial material and the dialysis needles are inserted into the graft directly. An arteriovenous graft can be used for dialysis within 2 to 3 weeks of placement. Compared with fistulas, grafts tend to have more problems with clotting and infection.
3. Central venous catheter: A catheter may be either temporary or permanent. These catheters are either placed in the neck or the groin into a large blood vessel. While these catheters provide an immediate access for dialysis, they are prone to infection and may also cause blood vessels to clot or narrow.

Peritoneal Dialysis

Peritoneal dialysis utilizes the lining membrane (peritoneum) of the abdomen as a filter to clean blood and remove excess fluid. Peritoneal dialysis may be performed manually (continuous ambulatory peritoneal dialysis) or by using a machine to perform the dialysis at night (automated peritoneal dialysis).

About 2 to 3 liters of dialysis fluid are infused into the abdominal cavity through the access catheter. This fluid contains substances that pull wastes and excess water out of neighboring tissues.
The fluid is allowed to dwell for 2 to several hours before being drained, taking the unwanted wastes and water with it.

The fluid typically needs to be exchanged four to five times a day.
Peritoneal dialysis offers much more freedom compared to hemodialysis since patients do not need to come to a dialysis center for their treatment. The patient can carry out many of their usual activities while undergoing this treatment. This may be the preferable therapy for children.
Most patients are candidates for both hemodialysis and peritoneal dialysis. There are little differences in outcomes between the two procedures. The physician may recommend one kind of dialysis over the other based on the patient's medical and surgical history. It is best to choose one's modality of dialysis after understanding both procedures and matching them to one's lifestyle, daily activities, schedule, distance from the dialysis unit, support system, and personal preference.

Peritoneal access (for peritoneal dialysis): A catheter is implanted into the abdominal cavity (lined by the peritoneum) by a minor surgical procedure. This catheter is a thin tube made of a soft flexible material, usually silicone or polyurethane. The catheter usually has one or two cuffs that help hold it in place. The tip of the catheter may be straight or coiled and has multiple holes to allow egress and return of fluid. Though the catheter can be used immediately after implantation, it is usually recommended to delay peritoneal dialysis for at least 2 weeks so as to allow healing and decrease the risk of developing leaks.