Living with Chronic Kidney Disease
March is National Kidney Month. Kidney disease is becoming more common in the U.S. than ever before. The National Institute of Health reports that today, 27 million Americans are living with the condition, and the aging of the Baby Boomers will mean a steady increase in cases in upcoming years. The impact on our healthcare system is significant, with the costs of the disease accounting for almost a quarter of all Medicare payments.
When a person has chronic kidney disease (CKD), the kidneys are no longer working well enough to filter the blood and eliminate extra fluid, minerals and waste from the body. Most often, CKD is the result of another disease process, such as diabetes, uncontrolled high blood pressure or congestive heart failure. A smaller percentage of cases result from injury to the kidneys, or damage from the harmful effects of certain medications. Obesity and age are also considered to be risk factors, and the disease is more common in African-Americans and people of Hispanic descent.
When a senior has chronic kidney disease, controlling the condition is a team effort, with care providers, family and the patient cooperating to ensure the best outcome.
Chronic kidney disease is not curable, but the condition may be stabilized. If the disease progresses to end-stage renal disease (kidney failure), dialysis or kidney transplant are necessary to keep the person alive. More than 400,000 people in the U.S. are on dialysis, and more than 20,000 have a functioning transplanted kidney.
What are the Symptoms of CKD? Unfortunately, there are usually no symptoms in the earliest stages of CKD. Later, a patient may notice vague signs, such as a change in the frequency of urination, nausea, swelling, fatigue or muscle cramping. The kidneys eliminate waste and clean the blood, and also produce hormones and help balance chemicals in the body. So, as kidney function continues to decrease, other problems can emerge, including anemia, bone and joint problems, insomnia and itching.
How is CKD Diagnosed? By the time the patient notices anything is amiss, the disease may have progressed dangerously. So it is important for people who are at risk to be screened. The person's healthcare provider will conduct a series of blood and urine tests to look for an excess of substances that the kidneys normally remove. Ultrasound, x-ray and other imaging may also be used in diagnosis; in some cases, a biopsy is necessary.
Treatment for Chronic Kidney Disease and Kidney Failure
Early Stages: Few cases of kidney disease can be reversed, but the progression can be slowed and managed—sometimes for years—by controlling diabetes, high blood pressure, heart disease and other underlying conditions that damage the kidneys. Taking medications as prescribed is very important. The person's healthcare provider may also recommend lifestyle changes such as exercise, special diet, smoking cessation, and stress reduction.
Later Stages: Kidney disease may progress to total kidney failure, sometimes called end-stage renal disease (ESRD). Without medical treatment, a person can not survive with such a low level of kidney function. The two major treatment options at this point are dialysis and kidney transplant.
Option One: Dialysis
One easy way to understand how dialysis works is to think of the dialysis machine as an artificial kidney doing all the filtering and cleansing work of the natural organ. There are two types of dialysis: hemodialysis and peritoneal dialysis.
What to Expect with Hemodialysis
About 90 percent of dialysis patients receive hemodialysis, in which the blood is circulated outside the body and cleaned inside a machine before returning to the patient. To receive hemodialysis, the patient generally goes to a kidney dialysis center several times each week. Home dialysis is also available for some patients.
The first step in beginning dialysis is the creation of a vascular access—an opening in the body to allow the blood to be removed, moved through the dialysis machine and returned to the body. Once the vascular access is established, dialysis begins.
While some patients find the needle insertion difficult at first, most get used to it after the first couple of weeks. More challenging is the adjustment to the rigorous schedule of dialysis—usually three times weekly, for three to five hours, at an outpatient dialysis center. Patients must restructure their lives to accommodate dialysis, changing family and work schedules. This change sometimes leads to depression, which should be addressed with the person's care team.
Home hemodialysis is becoming more common. New portable machines make it possible for some patients to perform their own treatment, once they have received several weeks of training. Most often, a family member or friend also attends the training, to serve as an assistant. The patient returns to the clinic regularly for tests to assure that the treatments are working properly. Most patients who choose home dialysis say the convenience offers a significant quality of life advantage.
What to Expect with Peritoneal Dialysis
The other main type of dialysis, peritoneal dialysis, uses the patient's own peritoneal membrane as a filter. The peritoneal membrane is a sac around the abdominal organs. The membrane is semi-permeable, which means that waste can get through it but larger blood cells cannot.
A plastic tube called a peritoneal catheter is surgically implanted into the patient's abdomen. Then several times a day, the patient slowly empties about two quarts of dialysis fluid through the catheter into the abdomen. As the patient's blood is exposed to the fluid through the membrane, impurities in the blood are drawn through the membrane wall and into the dialysis fluid. The solution contains a sugar called dextrose that pulls wastes and extra fluid into the abdominal cavity. These wastes and fluid then leave the body when the dialysis solution is drained and discarded.
Some peritoneal dialysis patients use a machine that exchanges the fluid during the night while the patient sleeps.
With the many dialysis decisions to make, it is important to work with the care team to determine which regimen is best for the patient's condition and lifestyle.
Option Two: Kidney Transplantation
With a kidney transplant, a single healthy kidney from a donor is placed in the patient's body. The single kidney does the work of both failed kidneys.
The first step is a complete medical workup to determine whether the patient is a good candidate for the procedure. If the medical evaluation indicates a reasonable chance of success, the next step is to procure a donor kidney.
In some cases, a family member or other person volunteers to donate one of his or her kidneys. The potential donor is evaluated to see if the kidney would be a good match, and if the donor is in good health.
If there is no living donor, the patient is put on a waiting list to receive a kidney from a recently deceased person. The name of the kidney patient is registered with the Organ Procurement and Transplantation Network (OPTN), which maintains a centralized computer network linking all regional organ gathering organizations. The waiting period depends on the supply of organs, but it is not "first come, first served"; an available organ usually goes to the recipient who is the best match. Blood type, antibodies and other physical compatibilities are evaluated as the decision is made.
Once a donor kidney is found, the surgeon places the new kidney inside the lower abdomen and connects the artery and vein of the new kidney to the patient's artery and vein. The patient's own kidneys are usually not removed. A general anesthetic is given during the surgery, which usually lasts approximately four hours. If there is a living donor, both the patient and the donor will have surgery at the same time. The patient remains hospitalized for at least a week.
Many transplant recipients report feeling better the minute they wake up from surgery. But transplant surgery is not the end of the process. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) points out that a kidney transplant is not a cure—it is a "condition" that requires lifelong treatment. The patient must take medications to prevent the body from rejecting the new organ. These drugs can have negative side effects when taken over years, and careful monitoring of the dosage is important.
Sometimes the patient's body rejects the new kidney; in that case, the patient can register for subsequent transplants, and can go back on dialysis again while waiting.
For More Information
The National Institute of Diabetes and Digestive and Kidney Diseases, one of the National Institutes of Health, offers extensive consumer information on their Kidney and Urologic Diseases Information Clearinghouse.
The National Kidney Foundation website features information and support for people with kidney disease, and for family caregivers.
To learn how home-care can help you or a loved one manage chronic kidney disease and other health conditions, see "Living with a Chronic Illness: Home Care Can Help" in this issue of Caring Right at Home.
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