Managing Chronic Kidney Disease
Chronic Kidney Disease (CKD) is a condition where there is documented damage to the kidney which may compromise the kidneys’ abilities to clean up toxic metabolites and maintain normal levels of electrolytes in your blood. This encompasses many different medical conditions that can result in CKD, such as hypertension and diabetes. CKD can lead to many different complications such as anemia, weak bones, malnutrition, nerve damage, high blood pressure and chronic heart failure. These problems may happen slowly over a long period of time or rapidly depending on the medical cause of CKD. Early detection and treatment can often keep CKD from getting worse. When kidney disease progresses, it may eventually lead to kidney failure and require dialysis or kidney transplant in order to maintain life.
—Source: The National Kidney Foundation
High Blood Pressure and Kidney Disease
Blood pressure is the force of your blood against the walls of your blood vessels as your heart pumps blood around your body. If the force becomes too high, you are said to have high blood pressure or hypertension.
How are high blood pressure and kidney disease related? High blood pressure is a leading cause of CKD. Over time, high blood pressure can damage blood vessels throughout your body. This can reduce the blood supply to important organs like the kidneys. High blood pressure also damages the tiny filtering units in your kidneys. As a result, the kidneys may stop removing wastes and extra fluid from your blood. The extra fluid in the blood vessels may build up and raise blood pressure even more.
High blood pressure can also be a complication of CKD. Your kidneys play a key role in keeping your blood pressure in a healthy range. Diseased kidneys are less able to help regulate blood pressure increases.
If you have CKD, high blood pressure makes it more likely that your kidney disease will get worse and you will have heart problems. Following your treatment plan and keeping your blood pressure controlled can help keep your kidney disease from getting worse and prevent heart disease.
—Source: The National Kidney Foundation
Anemia and Chronic Kidney Disease
What is Anemia?
Anemia happens when your red blood cells are in short supply. Red blood cells carry oxygen from your lungs to all parts of your body, giving you the energy you need for your daily activities.
Anemia can cause you to:
- Look pale
- Feel tired
- Have little energy for your daily activities
- Have a poor appetite
- Have trouble sleeping
- Have trouble thinking clearly
- Feel dizzy or have headaches
- Have a rapid heartbeat
- Feel short of breath
- Feel depressed or “down in the dumps”
Causes of Anemia
Anemia can be caused by:
- Diseases like kidney disease, liver disease, HIV/AIDS, systemic lupus erythematosus or cancer
- Diseases that harm or destroy your blood cells, such as sickle cell anemia
- Blood loss from accidents, surgery, stomach ulcers, kidney or bladder tumors, cancer or polyps in the intestines or other causes
- An infection or inflammation in your body
- Too little iron, vitamin B12 or folic acid in your body – Iron is a mineral that you get from eating foods like liver and leafy, green vegetables. Both vitamin B12 and folic acid are important vitamins that you get from eating foods like eggs, fish and liver. Your body needs these important minerals and vitamins to help make red blood cells.
- A poor diet – You can become anemic if you do not eat healthy foods with enough vitamin B12 folic acid and iron. Your body needs these important vitamins and minerals to help make red blood cells.
Before starting anemia treatment, your doctor will order tests to find the exact cause of your anemia.
Anemia and CKD
Your kidneys make an important hormone called erythropoietin (EPO). Hormones are secretions that your body makes to help your body work and keep you healthy. EPO tells your body to make red blood cells. When you have kidney disease, your kidneys cannot make enough EPO. This causes your red blood cell count to drop and anemia to develop.
Are all people with kidney disease at risk for anemia?
Most people with kidney disease will develop anemia. Anemia can happen early in the course of kidney disease and grow worse as kidneys lose their ability to work well and make EPO. Anemia is especially common if you:
- Have diabetes
- Are African American
- Have moderate or severe loss of kidney function (stage 3 or 4)
- Have kidney failure (stage 5)
- Are female
FACT: If you are African American or have diabetes and chronic kidney disease, you are more likely to get anemia and at an earlier stage of kidney disease.
How do I know if I have anemia?
Not everyone with anemia has symptoms. If you have kidney disease, you should have a blood test to measure your hemoglobin level at least once per year to check for anemia. Hemoglobin is the part of red blood cells that carries oxygen throughout your body. Your doctor can tell if you have anemia by measuring your hemoglobin. If your hemoglobin level is lower than the normal range (12.0 for women and 13.5 for men), it is likely you have anemia. In that case, your doctor will check to find the exact cause of your anemia and develop a treatment plan that is right for you.
TIP: Speak to your doctor if you think you have anemia. Make a list of questions. Write down your symptoms, allergies, medications and previous medical and other health problems. Show the list of symptoms to your doctor. Discuss how you are feeling and ask questions.
For more information, go to www.kidney.org
—Source: The National Kidney Foundation
If your doctor wants you to have a kidney biopsy, here are some things you should know.
A kidney biopsy involves taking one or more tiny pieces of your kidney tissue to look at under a regular microscope and a highly specialized electron microscope.
The kidney tissue may be taken in one of two ways:
- Percutaneous (means through the skin) biopsy: This is done using a needle placed through the skin over the kidney and guided to the right place in the kidney, usually with the help of ultrasound.
- Open biopsy: The kidney tissue is taken directly from the kidney during surgery.
The kidney tissue is sent to a doctor (pathologist) who looks at it using special microscopes. He or she will check for any abnormal cells or signs of disease.
Reasons for doing a kidney biopsy
Some kidney problems can often be found by blood and urine tests, a sonogram (an image made by ultrasound) or other specialized X-rays, and a physical examination rather than a biopsy. But, in some patients with certain types of kidney disease, and those with a kidney transplant that is not working properly, a correct diagnosis can only be made with a kidney biopsy.
Specific reasons to do a kidney biopsy include:
- Blood in the urine (hematuria) or protein in the urine (proteinuria)
- Abnormal blood test results
- Acute or chronic kidney disease with no clear cause
- Nephrotic syndrome (which happens when the filtering units of the kidney are damaged)
A kidney biopsy may also help to find:
- A particular disease to see if it gets better with treatment or if it is getting worse. It may also show a problem that cannot be cured, but can be slowed down by other therapy.
- How much permanent damage has happened in the kidney.
- Why a transplanted kidney is not working well. It helps your doctor decide on further treatment.
- A kidney tumor.
- Other unusual or special conditions.
Your healthcare provider should explain about the kidney biopsy. You should know why it is necessary, the benefits and any risks. You will be asked to sign a consent (permission) form to make sure you are aware of any risks. Be sure you understand the risks before you sign the consent form. You may want to write down a list of questions about the biopsy.
How to get ready for the biopsy
For two weeks before the biopsy, you should not take aspirin, over-the-counter pain medicines such as ibuprofen, naproxen, Advil, Nuprin, or other medicines that may cause thinning of the blood. These medicines can change the way the blood clots and raise the risk of bleeding. Blood and urine samples are usually taken before the kidney biopsy to make sure you do not have an infection or other condition. Your doctor may also want you to change other medications before the biopsy.
You may be told to not eat or drink for eight hours before the procedure.
How the biopsy is done
A kidney biopsy is usually done in a hospital. An overnight stay may be needed to watch for any complications. You may be awake with only light sedation, or asleep under general anesthesia. You will be lying face down with a pillow under your rib cage. If the biopsy is done on a transplanted kidney, you will be lying on your back.
Percutaneous biopsy: The kidney is found using a sonogram, X-ray images, or both. Sometimes, an injection of dye into your veins may be needed to help the doctor find the kidney and important blood vessels.
Once the site for the biopsy is found, your skin is marked, then cleaned where the biopsy needle will be inserted. You will receive a local anesthetic to numb the area where the biopsy needle enters. You will be asked to take in a deep breath and hold it as the doctor puts in the needle. When the needle pushes through the skin to the kidney, you may feel a “pop” or pressure. It is important to stay still and to hold your breath (about 45 seconds or less). Sometimes two needle passes are needed to get enough tissue for diagnosis.
When enough kidney tissue is taken, the needle is removed and a bandage is placed over the needle puncture site.
Open kidney biopsy: Some patients should not have a needle biopsy because they may have a history of bleeding problems. For these patients, an open operation may be done where the surgeon can actually see the kidney to get tissue for study.
After the test
You may need to rest in bed for 12 to 24 hours after the biopsy, as directed by the doctor. Staying still on the bed helps to heal the site where the kidney tissue was taken and lessen the chance of bleeding.
Your blood pressure and pulse are checked often to look for any signs of bleeding inside your body, or other complications. Blood tests are also done. You may eat and drink fluids after the biopsy. If your blood tests, blood pressure and pulse are stable, you should be allowed to leave the hospital the next day.
Your doctor will talk to you about physical activity and things to watch for after going home from the hospital. Heavy lifting, strenuous exercise, including contact sports, and sexual intercourse should be avoided for two weeks after the biopsy.
If you had an open biopsy, be sure to ask your doctor for any specific instructions you need to follow after the surgery.
—Source: The National Kidney Foundation
Dialysis is a treatment that does some of the things healthy kidneys do. It is needed when your own kidneys can no longer take care of your body’s needs. You need dialysis when you develop end stage kidney failure – usually by the time you lose about 85 to 90 percent of your kidney function.
Like healthy kidneys, dialysis keeps your body in balance. Dialysis does the following:
- Removes waste, salt and extra water to prevent them from building up in the body
- Keeps a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate
- Helps to control blood pressure
Is kidney failure permanent?
Not always. Some kinds of acute kidney failure get better after treatment. In some cases of acute kidney failure, dialysis may only be needed for a short time until the kidneys get better.
In chronic or end stage kidney failure, your kidneys do not get better and you will need dialysis for the rest of your life. If your doctor says you are a candidate, you may choose to be placed on a waiting list for a new kidney.
Where is dialysis done?
Dialysis can be done in a hospital, in a dialysis unit that is not pat of a hospital, or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes.
Types of Dialysis
There are two types of dialysis – hemodialysis and peritoneal dialysis.
In hemodialysis, an artificial kidney (hemodialyzer) is used to remove waste and extra chemicals and fluid from your blood. To get your blood into the artificial kidney, the doctor needs to make an access (entrance) into your blood vessels. This is done by minor surgery to your arm or leg.
Sometimes, an access is made by joining an artery to a vein under your skin to make a bigger blood vessel called a fistula. However, if your blood vessels are not adequate for a fistula, the doctor may use a soft plastic tube to join an artery and a vein under your skin. This is called a graft. Occasionally, an access is made by means of a narrow plastic tube, called a catheter, which is inserted into a large wein in your neck. This type of access may be temporary, but is sometimes used for long-term treatment.
The time needed for your dialysis depends on:
- How well your kidneys work
- How much fluid weight you gain between treatments
- How much waste you have in your body
- How big you are
- The type of artificial kidney used
Usually, each hemodialysis treatment lasts about four hours and is done three times per week. A type of hemodialysis called high-flux dialysis may take less time. You can speak to your doctor to see if this is an appropriate treatment for you.
In this type of dialysis, your blood is cleaned inside your body. The doctor will do surgery to place a plastic tube called a catheter into your abdomen (belly) to make an access. During the treatment, your abdominal area (called the peritoneal cavity) is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line your peritoneal cavity. Extra fluid and waste products are drawn out of your blood and into the dialysate. There are several kinds of peritoneal dialysis but two major ones are: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Continuous Cycling Peritoneal Dialysis (CCPD).
Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of peritoneal dialysis that is done without machines. You do this yourself, usually four or five times a day at home and/or work. You put a bag of dialysate (about two quarts) into your peritoneal cavity through the catheter. The dialysate stays there for about four or five hours before it is drained back into the bag and thrown away. This is called an exchange. You use a new bag of dialysate each time you do an exchange. While the dialysate is in your peritoneal cavity you can go about your usual activities at work, at school or at home.
Continuous Cycling Peritoneal Dialysis (CCPD) usually is done at home using a special machine called a cycler. This is similar to CAPD except that a number of cycles (exchanges) occur. Each cycle usually lasts 1 ½ hours and exchanges are done throughout the night while you sleep.
Dialysis does some of the work of healthy kidneys, but it does not cure your kidney disease. You will need to have dialysis treatments for your whole life unless you are able to get a kidney transplant.
- You may have some discomfort when the needles are put into your fistula or graft, but most patients have no other problems. If this happens, you may feel sick to your stomach, vomit, have a headache or cramps. With frequent treatments, those problems usually go away.
- Hemodialysis and peritoneal dialysis have been done since the mid 1940s. Dialysis, as a major treatment, was begun in 1960 and is now a standard treatment all around the world. CAPD began in 1976. Thousands of patients have been helped by these treatments.
- We do not yet know how long patients on dialysis will live. We think that some dialysis patients may live as long as people without kidney failure.
- Dialysis costs a lot of money. However, the federal government pays 80 percent of all dialysis costs for most patients. Private health insurance or state medical aid also help with the costs.
- Many patients live normal lives except for the time needed for treatments. Dialysis usually makes you feel better because it helps many of the problems caused by kidney failure. You and your family will need time to get used to dialysis.
- You may be on a special diet on dialysis. You may not be able to eat everything you like, and you may need to limit how much you drink. Your diet may vary according to the type of dialysis.
- Dialysis centers are located in every part of the United States and in many foreign countries. The treatment is standardized so travel is possible. You must make an appointment for dialysis treatments at another center before you go. The staff at your center may help you make the appointment.
- Many dialysis patients can go back to work after they have gotten used to dialysis. If your job has a lot of physical labor (heavy lifting, digging, etc.), you may need to get a different job.
—Source: The National Kidney Foundation
American Association of Kidney Patients – www.aakp.org
American Kidney Fund – www.akfinc.org
American Society of Nephrology – www.asn-online.org/
Guide to Lowering Blood Pressure –www.nhlbi.nih.gov/health/resources/heart/hbp-guide-to-lower
Kidney Patient Guide – www.kidneypatientguide.org.uk
Kidney School – www.kidneyschool.org
National Kidney and Urological Diseases Information and Clearing House – http://kidney.niddk.nih.gov
The National Kidney Foundation, Inc. – www.kidney.org