Hypertension or High Blood Pressure, as it is more commonly known, is one of the silent killers that plagues the general population. It owes its lethal efficiency to the fact that it goes on undetected for months, and even for years, up until a point where significant damage has already been done. Such as it was in my case, where I neglected and took it for granted, in spite of being aware of its past devastation on our family’s medical history. But that’s all in the past, and as I have always told myself, regret is one of the most futile and unproductive of all human emotions. So there’s really nosense in trying to undo what’s already been done.

What about you? Are you also suffering from Hypertension? You know you might be, and worse, you’re not even aware of it. This is a common enough scenario, especially for the population’s poorer class who’s financial capability to seek medical attention is virtually non-existent. Nobody could really blame these people the tendency to take for granted the sensibility of early detection through screening. But if you’ll ask me, however, this should not be an excuse.

Why is high blood pressure dangerous?

The higher the blood pressure, the harder the heart has to work to keep on pumping against increasing resistance. If, in the course of time, the heart muscles tires, it could eventually lead to heart failure. Because of the enormous burden it puts on the arteries, high blood pressure adds to their wear and tear, especially in the target organs, the brain, coronary and kidney vessels. Stroke and Myocardial Infarction (heart attack) are frequent and dangerous consequences of untreated hypertension.

Recognizing high blood pressure

High blood pressure is a Silent Killer simply because it doesn’t show typical symptoms that might serve as early warning signals. In fact, in certain cases, many people feel well and energetic despite their high blood pressure. There is only one way of finding out whether or not you have hypertension and that is to have your blood pressure checked. Measurements must be repeated at least once a year. If an elevated pressure is detected in time, early treatment can help prevent the possible fatal consequences.

Prevention of complications from high blood pressure

Bringing the pressure down relieves the strain on the heart and arteries; this lessen and often eliminates the dangerous consequences of elevated pressure. With proper treatment, high blood pressure can be normalized, or at least brought down to a tolerable level. The treatment does not call for any heroic measures; regular checking of the blood pressure, a few generally painless changes in one’s eating and living habits, and taking the prescribed medication everyday. If detected and treated in time, hypertension should not stop you in leading a normal and productive life. All that is required is determination and close doctor-patient cooperation.

Protect yourself against high blood pressure

A genetic predisposition is a frequent cause of hypertension. It “runs in the family”. Caution is advised if you have a family history of high blood pressure. Your way of living could have an important bearing on whether or when you will develop hypertension. If you are overweight, has a high sodium intake on your diet, under psychological stress, agitated and hyperactive, you’re more likely a candidate, or can exacerbate an existing tendency. Losing weight, cutting down on salt in the diet, and avoiding stress are useful precaution to help you keep your pressure down.

Protect your health why you still can and when you still can. As always, being well-informed is being well-prepared.

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Dialysis patients are required to take monthly laboratory tests. This is to ensure proper monitoring of our body’s blood and chemistry levels. These tests are also used by doctors as reference on how patient’s respond to dialysis, if they are eating right, their responsiveness to EPO shots via their hemoglobin levels, and so on. I have been through this routine tests all my dialysis years and still going through with it. My lab test schedule for the month of May would be performed on my next dialysis session, this coming Thursday to be specific. My past blood test, since I started my treatment, were fairly okay. There are certain blood levels that dialysis patients and doctors use as reference and it’s quite different from the ones normal people use.

Let me state this as an example:

• A normal person’s hemoglobin range: 12 – 14 grams per deciliter (g/dL)
• A dialysis patient’s hemoglobin range: 10 – 12 grams per deciliter (g/dL)

To elaborate this further, I have prepared a list of the common laboratory tests that I take along with their acceptable ranges. The blood levels below are provided for your reference and are to be used as guidelines. Levels may vary upon individual differences or depending on the dialysis unit;s laboratory procedures. It is always advisable to talk to your doctor, nurse, and dietitian about your blood levels.

• Blood Urea Nitrogen (BUN) : 60 – 110 mg/dL
• Creatinine : 8.0 – 20.0 mg/dL
• Potassium (K) : 3.5 – 5.0 mEq/L
• Calcium (Ca) : 8.5 – 10.5 mg/dL
• Blood Sugar (fasting) : 60 – 100 mg/dL
• Blood Sugar : less than 140 mg/dL
• Alkaline Phosphatase : 25 – 100 units/L
• Phosphorus (P) : 2.3 – 4.7 mg/dL
• Sodium (Na) : 135 – 145 mEq/L
• Albumin : 3.8 – 5.5 gm/dL
• Total Protein : 6.0 – 8.0 gm/dL
• Hematocrit (HCT) : 33% – 36%
• Hemoglobin (Hgb) : 10 – 12 gm/dL

Basically, through this monthly lab exams, a dialysis patient, doctor, nurse, and dialysis unit’s medical staff can monitor the patient’s progress while undergoing treatment. For me that has been going through with it for quite a long time now, and for other’s as well, it may sound routinely boring. But I hope this article may serve as reminder on how vital this monthly blood tests are to a dialysis patient.

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Most of us already know that our kidneys filter the waste from the food we eat. But few are aware that waste filtration is only one of the numerous jobs our kidneys perform in our body. It also produces hormones that regulates blood pressure, among other things. But do you know that the kidneys are also responsible for our body’s production of Red Blood Cells? Yes, they are, and is described further in this piece of article:

Anemia is common in people with kidney disease. Healthy kidneys produce a hormone called erythropoietin, or EPO, which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs. Diseased kidneys, however, often don’t make enough EPO. As a result, the bone marrow makes fewer red blood cells. Other common causes of anemia include blood loss from hemodialysis and low levels of iron and folic acid. These nutrients from food help young red blood cells make hemoglobin, their main oxygen-carrying protein.

– Source:  NIDDK/NKUDIC

Before I was even diagnosed with kidney failure, I already noticed a slight pallor in my complexion. But ignorant and unaware as I was before, I merely put it down as lacking of exposure to sunlight. I thought that a bit of time under the sun or outdoors would soon resolve this and restore my complexion into a much healthier pallor. I should have known better. Today, six years into my treatment, I am happy to say that I am much well-informed.

Anemia in kidney failure and dialysis patients has two treatment options (It has two, in our clinic, at any rate. First, the more recommended, is by injecting a genetically engineered form of Erythtropoetin or EPO. It is usually administered via injection under the skin and this procedure is much more recommended because the hormone is better absorbed by the body when given through the subcutaneous region. Other patients who can’t tolerate needles has the alternative to take it via intravenous (IV) line, while hooked on a dialysis machine. The intravenous method, however, requires a larger, more expensive dose and may not be as effective.

The second treatment option that my fellow patients in our clinic follow to treat anemia is blood transfusion. Although this is not fully recommended, on the simple fact that there are certain dangers and uncertainties that comes with blood transfusion, it is a lot more cheaper than taking injection twice or thrice weekly. I really can’t blame them, in any case. I guess the little money that a patient could save through this option outweighs the dangers.

In my case I am taking EPO shots twice a week. I was taking 5000 units of Recormon (Erythropoetin or Epoetin Beta) during my earlier days of treatment. Last year I was shifted to Renogen (Epoetin Alfa). Both drugs treat kidney failure-related anemia. The shift was due to economical reasons, since Renogen is a lot more cheaper than Recormon and my body seems to respond much better to the former that the latter.

Though I must advice my fellow patients that they consult with their physicians first before taking EPO injections. This explains why:

The U.S. Food and Drug Administration (FDA) recommends that patients treated with EPO therapy should achieve a target hemoglobin between 10 and 12 grams per deciliter (g/dL). Recent studies have shown that raising the hemoglobin above 12 g/dL in people who have kidney disease increases the risk of heart attack, heart failure, and stroke. People who take EPO shots should have regular tests to monitor their hemoglobin. If it climbs above 12 g/dL, their doctor should prescribe a lower dose of EPO. The FDA recommends that patients whose hemoglobin does not rise to the target level with normal doses of EPO ask their doctor to check for other causes of anemia.

– Source: NIDDK/NKUDIC

So it is imperative that you work closely with your doctor or the medical staff in your dialysis clinic while treating anemia so that they could monitor your progress and perform necessary adjustments whenever the need for it arises.

I know it might be harrowing to think about the complications that comes along with kidney failure and dialysis. But being a dialysis patient myself, I am aware that I don’t have much choice on the matter. I have learned through experience that it’s much better to accept, learn about your illness, and find out ways to relieve yourself of the already difficult life of a dialysis patient. Besides, it always pays to have an optimistic frame of mind.

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Hypertension or high blood pressure runs in our family. Several of my relatives either died of a heart attack or stroke caused by hypertension that’s been left untreated. I had hypertension as early as my high school days, although I am completely unaware of it. It was just brought up to my attention six years ago, when I was first diagnosed with chronic kidney failure. It was both shocking and unbelievable for me at that time. Being a 26 year-old, it’s quite hard to accept at first that I am already suffering from chronic ailments and would probably face medication and treatment for the rest of my life. But there it was, already out in the open.

The kidneys play a key role in keeping a person’s blood pressure in a healthy range, and blood pressure, in turn, can affect the health of the kidneys. High blood pressure, also called hypertension, can damage the kidneys and lead to chronic kidney disease (CKD).

– Source NIDDK/NKUDIC

This might seem both alarming and outrageous, but it’s true, and it’s a fact. And I just don’t say it from research or reading journals about it, but I’m saying it from experience. Had I known myself to be inflicted with hypertension, I would have done steps to prevent it from helping destroy my kidneys. My doctor said that besides CGN or Chronic Glomerulonephritis, hypertension became one of the contributing factors that lead to kidney failure. But I was young then, and thought myself impervious to such diseases and conditions. Well, I was wrong, and paid dearly for it.

I am still suffering from hypertension up to this day simply because it’s closely associated with kidney failure. Although I am a lot wiser now than before and medications help me maintain my blood pressure at acceptable levels, I still make it a point to implement ways to keep my hypertension at bay.

• I avoid salty and sodium-rich foods as often as I can. Salt makes you more thirsty and if you drink too much water, you might experience fluid overload that will increase your blood pressure.

• I try to stay cool and avoid staying under the sun too much for the same reason that this would make you want to drink more.

• Avoid fatty and deep fried foods, as well as those that are high in cholesterol. Not only will it trigger your blood pressure to rise significantly but will also put you at risk with stroke and heart attack.

• Consult with your doctor on a regular basis and always take your medications for hypertension. Skipping them would desensitize your body to the drug and would cause dangerous spikes in your blood pressure.

It’s hard enough coping with kidney failure and dialysis alone, and even harder to manage different complications that comes along with it. But with sensible management, eager determination, and abundant amount of faith, things could go as normal as it can be for patients like me.

Be wise. Well-informed is well-prepared.

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I recently wrote an article on why dialysis patients must be sensible on their eating habits, and the equal importance of consulting with your Nephrologist and Renal Dietitian before starting a diet plan. This time, I’m writing about the basic minerals found in food that concerns a dialysis patient, like Protein, Potassium, Phosphorus, Sodium, etc. You can work closely with your renal dietitian to decide on the meal plan that includes some of your favorite foods and is best for you.

Your individual meal plan will be based on your age, your weight, foods you like, your dialysis treatment and other medical conditions such as diabetes, heart disease, and high blood pressure. It will be tailored to your needs but may not meet the specific needs of other patients. Most people with kidney disease must modify their intake of certain nutrients such as protein, potassium, sodium, phosphorus, and fluid. Following the meal pattern suggested by your renal dietitian will help you feel your best.

The following are some things a dialysis patient needs to know about:

• Protein is used to build and repair tissue. Several of the foods you eat contains protein. The best sources are meat, poultry (chicken, turkey, etc.), seafood, dairy products, and eggs. The best source, also called High Quality Protein, comes from red meat like beef, though it produces more excess waste in the body than other sources. Your renal dietitian might limit you from taking these.

• Potassium regulates nerve and muscle function. Since your heart is made mostly of muscle, this mineral plays a vital role in the regulation of heartbeat. Excess potassium in the body is removed by the kidneys. For people with malfunctioning kidneys, dialysis performs this job. But if you accumulate too much potassium in between treatments, it might cause heartbeat irregularities. Worse, your heart might suddenly stop if potassium is left uncontrolled. Almost all foods contain some potassium. Some foods that are very high include bananas, avocados, oranges, tomatoes, winter squash, dried fruits, milk and nuts. How often these foods can be eaten, and/or their portion size may need to be limited.

• Calcium and Phosphorus work together in the body. They are balanced to keep your bones strong and healthy. There’s an imbalance of these minerals in kidney failure but it can be restored with medications and a moderate level of phosphorus in your diet. Since calcium and phosphorus are found in many of the same foods, it is difficult to get enough calcium without getting too much phosphorus. Almost all foods have some phosphorus, but the highest levels are found in dairy products (milk, yogurt, cheese), eggs, meats, dried beans and nuts. You may be asked to take a calcium supplement and a phosphorus “binder”. It is advisable to ask your doctor about it.

• Sodium helps regulate the fluid balance in your body. High-sodium foods may upset this balance in kidney disease. Some foods that have the highest amounts of sodium are cured, processed, and smoked meats and cheeses (ham, bacon, sausage, cold cuts, cheese and snack foods like potato chips, pretzels, corn chips, salted nuts and pickles). Some foods that do not taste salty have a lot of sodium. Examples are soups, ketchup, mustard, relishes, some seasonings, steak sauces, meat tenderizers, canned or packaged foods and restaurant foods, When you prepare foods from scratch, you can control the amount of sodium used, like salt, for instance. Also, avoid using salt substitutes because they’re most likely to be high in potassium, and it’s more harmful to you than sodium.

These are meant to serve as a guide and a patient is still advised to consult with his/her doctor and renal dietitian for individual meal plans. Eating wisely and sensible food choices are vital for a kidney failre patient to stay healthy while undergoing dialysis treatment.

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Diet and nutrition are two important things a dialysis patient must consider. Food gives you energy and helps your body repair itself Your blood picks up nutrients from your food and carries them to all your body cells. These cells take nutrients from your blood and put waste products back into the bloodstream.

Good nutrition is the key to good health for everyone. It is especailly important for people with kidney disease. Even with the help of artificial kidney (dialysis), you cannot get rid of all the wastes and fluids that build up in your body from what you eat and drink. When your kidneys were healthy, they worked around the clock to remove wastes from your blood. Now that your kidneys have stopped working, Dialysis removes wastes from your blood, but between sessions, wastes can build up and make you sick. You can reduce the amount of wastes by watching waht you eat and drink.

If you’re currently undergoing dialysis treatment and is concerned about diet and nutrition, I strongly recommend consulting with your Nephrologist and Renal Dietitian. A Nephrologist is a doctor that especiallizes on kidney diseases and a Renal Dietitian is a dietitian with special training in care for kidney health. They are the people that could help you with your diet concerns and it is imperative that you consult with them first before implementing a meal plan.

This is for the simple reason that every patient has a unique dietary need that should be considered first before proposing an appropriate meal plan. It would also depend on your kidney’s remaining functions. A patient in the earlier stages of kidney failure would have a more restricted diet compared to those who are on the latter stages. This is because they’re already going through dialysis and the machines helps in eliminating excess waste. In my case, I was given a 50-gram protein/ day diet plan. Protein, being an essential mineral that your body needs and produces the most waste as well, will be your doctor’s primary consideration. Along with other minerals like potassium, phosphorus, and calcium, this is where your diet would revolve.

With sensible food choices and smart eating habits, dialysis patients are more likely to stay healthy throughout their treatment. It also minimizes the need for hospitalization, if not totally eliminate it. Together with exercise, a patient has the means to keep kidney failure at bay. One only needs sensibility, discipline, and the determination to abide by the laws that govern their wellness.

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How is dialysis done?

Dialysis is done by using a special fluid called dialysate. Dialysate, a mixture of pure water and chemicals, is carefully controlled to pull wastes out of your blood without removing substances your body needs.

A semipermeable membrane keeps the blood apart from the dialysate. This membrane lets the wastes and fluid in your blood flow through into the dialysate. Your blood cells and larger molecules, like protein that you need, cannot fit through the holes.

What is hemodialysis?

Hemodialysis, the most common treatment option for treating ESRD, is a way of cleaning your blood using a dialysis machine and a special filter called dialyzer. The dialyzer works as an artificial kidney, straining toxins and removing extra fluid that build up because of ESRD. However, the dialyzer does not completely replace your original kidney’s function. Remember, healthy kidneys work 24 hours a day, 7 days a week, while hemodialysis takes a few hours a day, 2-3 days a week.

What happens during hemodialysis?

During a dialysis treatment, two needles connected to hollow plastic tubes are inserted into your fistula or graft. Your blood is pumped out by the machine through one line to the dialyzer to be cleaned. Once cleaned, it is returned to your body through another plastic tube. Your nephrologist will prescribe the length of your treatment, usually four hours a day done three times a week, either Mon/Wed/Fri or Tues/Thurs/Sat, but may vary depending on your body size, laboratory results and medical condition. You will have the same morning or afternoon time for each treatment.

If I have kidney disease, will I need dialysis?

In the early stages of chronic kidney disease, you do not need dialysis. These stages can last for many years. But if your kidneys fail, you will need dialysis or a kidney transplant to keep you alive.

If I have kidney disease, how long will it be before I need to start dialysis?

Depending what stage your kidney disease is and how quickly it progresses, you may never need dialysis, or you may need dialysis right away. Dialysis is usually recommended when your kidney function is about 10-15% of normal, or about 25% if you have diabetic kidney disease, or if you have severe symptoms caused by your kidney disease, like shortness of breath, fatigue, muscle cramps, or nausea and vomiting. If you are not having symptoms, you may be able to wait a bit longer. Since chronic kidney disease often happens slowly, sometimes people do not even know how bad they feel until they start dialysis and begin to feel much better! It is important to start getting ready for dialysis or a transplant well in advance.

I am in Stage 4 kidney disease and can’t have a transplant. Can I do dialysis for the rest of my life?

Yes, dialysis is something you can do for the rest of your life. Some people have been on dialysis for 30 years or more without getting a transplant. How long you can live on dialysis, and how well you do, will depend on a number of things, including:

• How healthy you are, other than kidney disease
• How positive your attitude is (optimists live longer, depression can be treated)
• Whether you receive good quality medical care and dialysis
• How much you learn about dialysis and take an active role in your care.

Will I have to quit work when I start dialysis?

No. You dont have to quit work when you start dialysis.

Can I travel on dialysis?

Yes. With proper planning, you can travel while on dialysis. Start small—with day trips and quick weekend getaways. Then you can build up confidence and work up to longer vacations. Your center can forward a copy of your dialysis prescription and other records to the center you will visit.

If you do peritoneal dialysis, you can take your supplies with you, or have them shipped to your destination. Check with your PD nurse. Your PD nurse can help you learn safe ways to do your exchanges while camping or taking a driving trip.

Once I am on dialysis, will my kidneys get better?

The chances that your kidneys will get better depend on what caused your kidney failure. Kidney failure is divided into two general categories, acute and chronic. Acute (or sudden) kidney failure is often temporary. In chronic kidney failure, the kidneys normally do not heal.

In acute kidney failure, kidney function may recover with or without dialysis. But when the damage to your kidneys has been continuous and progressive over a number of years, as it is in chronic kidney disease, then the kidneys usually do not get better since the damage is considered irreversible. Hence, long-term dialysis is needed. While your kidneys will not get better once you are on dialysis, you may feel significantly better and live life to the fullest.

»data courtesy of Philippine Society of Nephrology«

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What will happen if I refuse pre-ESRD care?

Refusing pre-ESRD care may result in accelleration of kidney damage and earlier development of or worsening of complications of CKD, such as anemia, loss of appetite and fatigue. In short, progression to ESRD or early death may become inevitable. Cardiovascular complications such as heart enlargement and heart failure may also set in earlier. Hence, refusal may result in more frequent hospitalizations, bigger expenses, emotional trauma, and poor quality of life. Moreover, you may not be prepared well for eventual need for renal replacement therapy, resulting in hasty and risky initiation of dialysis.

What is my role with my Chronic Kidney Disease?

There is a lot that can be done early in CKD to keep you feeling well and to maintain your kidney function for as long as possible. You also may be able to help prevent some long-term complications of kidney disease, such as bone disease or heart problems, by acting early. Your role is to learn all you can and work with your care team to get the best possible care.

Diet and exercise are two areas where you have a lot of control. Talk with your care team and your dietitian to determine individualized dietary guidelines based on lab tests and your stage and type of CKD. Stay active and get plenty of exercise.

I was diagnosed with kidney disease. Should I stop exercising and rest more?

While we all need rest, we need exercise too. It’s been shown that exercise is good for people with kidney disease. So, you should try to stay active. If you’ve been sedentary in the past, talk to your doctor about starting a mild exercise program. The key is to start slowly and build up gradually.

What to eat

Should I be on a low protein diet?

Protein, found in meats, fish, poultry, dairy products, nuts, and some grains, helps your body form muscle and tissue. But when your kidneys are not working well, the byproducts of protein breakdown can build up in your blood. This can make your kidneys work harder.

Some studies of low protein diets show that they can slow the progression of kidney failure. But other studies show that such diets do not help. Due to these mixed results, and the need to maintain good nutrition, doctors differ about the need to limit protein for people with chronic kidney disease (CKD). The answer is often moderation.

In all cases, it’s crucial to avoid malnutrition. A blood test for albumin, a form of protein, is a good way to tell if you are getting enough good food. Your albumin level should be 4.0 g/dL or higher. If you notice weight loss, loss of appetite, or other signs of poor nutrition, talk to your doctor.

Should I be on a low phosphorus diet?

Ask your doctor – the answer will often be yes. Phosphorus is a mineral found mostly in dairy products and meats. Your body uses it to form strong bones and teeth. But starting in moderate CKD, your kidneys begin to lose the ability to remove extra phosphorus from your body. Because too much phosphorus can harm your bones, it makes sense to eat less phosphorus. Some experts think 800 to 1,200 mg. of phosphorus per day is a good target. Foods high in protein tend to be high in phosphorus, too.

Should I be on a low potassium diet?

Having the right level of potassium in your body helps all your muscles work smoothly, including your heart. When kidneys fail, they start to lose this ability.Your potassium level should be checked regularly with a blood test. If your levels are too high, your doctor will ask you to start a LOW potassium diet. Many foods have potassium, but some like avocados, dried fruits like raisins, apricots and prunes, potatoes, oranges, bananas and salt substitutes are very high in potassium.

What can I do about loss of appetite?

Poor appetite is a common symptom of advanced kidney disease. Even if you are not hungry, it is important to eat and keep good nutrition. As kidney function drops, you may notice that protein foods, such as eggs, meat, chicken and fish lose their appeal. You need calories and quality protein to feel your best. To get good nutrition try to:

• Eat more bland, starchy foods or whatever appeals to you
• Eat small portions of protein foods.
• Try a liquid nutritional drink like Nepro® once a day
• Graze all day—have several small meals instead of three large ones
• Boost the protein content of your meals by adding egg whites, egg white powder or protein powder
• Get help from a renal dietitian, if lack of appetite continues.

Finally, if you are in Stage 5 CKD and your appetite or nutritional well-being does not improve, this may be a sign that you should start dialysis. Many people find their appetite improve after some time on dialysis.

What are the treatment options for end-stage renal disease (ESRD)?

There are three types of treatment for kdiney failure: hemodialysis, peritoneal dialysis and transplantation. Dialysis is a medical term that means cleaning the blood by artificial means. During dialysis, wastes and extra fluid that build up due to kidney failure are removed from the blood using a dialyzer (artificial kidney) or your own abdomen (peritoneal membrane). Kidney transplantation involves receiving a kidney transplant from another person (donor) through surgery. The new kidney (graft) is placed in your abdomen and will do the work your damaged kidneys did.

» data courtesy of Philippine Society of Nephrology «

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What are the signs and symptoms of CKD?

Knowing the symptoms of kidney disease can help people detect it early enough to get treatment. Signs and symptoms of CKD include:

• Changes in urination – making more or less urine than usual, feeling pressure when urinating, changes in the color of urine, foamy or bubbly urine, or having to get up often at night to urinate.
• Swelling of the feet, ankles, hands, or face – fluid the kidneys can’t remove may stay in the tissues.
• Fatigue or weakness – a build-up of wastes or a shortage of red blood cells (anemia) can cause these problems when the kidneys begin to fail.
• Shortness of breath – kidney failure is sometimes confused with asthma or heart failure, because fluid can build up in the lungs.
• Ammonia breath or an ammonia or metal taste in the mouth – waste build-up in the body can cause bad breath, changes in taste, or an aversion to protein foods like meat.
• Back or flank pain – the kidneys are located on either side of the spine in the back.
• Itching – waste build-up in the body can cause severe itching, especially of the legs.
• Loss of appetite, resulting in weight loss
• Nausea, especially at the sight of food or in the morning, and vomiting
• Muscle cramping at night
• Trouble concentrating
• Trouble sleeping at night
• More episodes of low blood sugar, if diabetic
• High blood pressure, or worsening hypertension
  

How do I know if I have chronic kidney disease? What laboratory tests do I need?

Kidney disease can be detected through laboratory tests or by signs and symptoms. Markers of kidney damage include abnormalities in the composition of the blood or urine or abnormalities in imaging tests. High blood levels of creatinine and urea nitrogen (BUN) or high levels of protein in your urine suggest kidney disease. Glomerular filtration rate, or estimated creatinine clearance and endogenous creatinine clearance are tests which will tell you how well your kidneys are working.

• In Stage 1 and Stage 2 CKD, there are often few or no symptoms. Early CKD is usually diagnosed when the following signs are present, alone or in combination:
• High blood pressure
• Higher than normal levels of creatinine or urea in the blood
• Blood or protein in the urine
• Evidence of kidney damage or multiple cysts or enlarged or small kidneys in an ultrasound, CT scan, MRI, or contrast X-ray
• Abnormal looking filters (nephrons) on kidney biopsy

In Stage 3 CKD, anemia (a shortage of red blood cells) and/or early bone disease may appear and should be treated to help you feel your best and reduce problems down the road. When CKD has progressed to Stage 4, abnormal levels of blood or urine electrolytes such as sodium, potassium, calcium, and phosphorus, as well as acids may be detected.

If I have signs and symptoms of kidney disease, what should I do?
You should ask for a referral to or consult a nephrologist, a specialist in kidney diseases. If CKD or risk factors for CKD are detected early, medications and lifestyle changes may help slow its progress and keep you feeling your best for as long as possible. With early diagnosis, it may be possible to slow or even stop progression of CKD, depending on the cause. As such, early referral to a nephrologist is very important in initiating an appropriate action plan. A nephrologist can help you and your primary care doctor to:

• Slow the rate of decline of your kidney function
• Decide if a kidney biopsy might be useful
• Diagnose the type of kidney disease and whether it might be reversible with treatment
• Manage complications of kidney disease, such as anemia, high blood pressure, metabolic acidosis, and changes in mineral balance

It may be prudent for a non-nephrologist to screen patients at increased risk for CKD and to institute risk reduction strategies when possible. Alternatively, he may refer them to a nephrologist for pre-ESRD care. You may visit http://www.keeponline.org on how to go about early evaluation.

I just found out I have chronic kidney disease. Does this mean I am going to die soon?

No. In the early stages of CKD, you may experience little or no symptoms at all and you can still go about your usual daily chores and lifestyle. In the latter stages, particularly end-stage renal disease, dialysis or a kidney transplant can keep you alive when your kidneys fail. The more you learn and take part in your treatment, the better you can feel. Some people live for decades with kidney failure.

What are the treatment options for CKD? What is pre-ESRD care?

Pre-ESRD care is care aimed at helping delay or prevent progressive kidney failure and ameliorating its complications. It may take the form of lifestyle and dietary modifications, as well as drug treatment in most cases. It encompasses control of blood pressure and diabetes, identification of reversible causes of kidney damage, prevention and treatment of anemia, bone disease, and cardiovascular complications of CKD. It also includes adequate preparation for eventual renal replacement therapy, be it dialysis or kidney transplantation.
Blood glucose control

If you have diabetes, strict control of your blood glucose levels can help slow the progression of kidney disease.

• Keep your hemoglobin A1c, which measures blood glucose control over the last two to three months, to less than 6.5%.
• To reach this level of strict glycemic control, you will need to monitor your blood glucose closely to avoid hypoglycemia.

Blood pressure control

• Keep your blood pressure at 120/70 or lower if you have diabetes and/or protein in your urine.
• Keep your blood pressure at 130/80 or lower if you have kidney problems but not diabetes.

Lifestyle changes such as losing weight, exercising, eating less salt and drinking less alcohol

Repairing the damage

If you have an obstruction that blocks your urine flow, surgery may help. If you have an infection, antibiotics may
clear it up.

Stop medications that may damage your kidneys. Most painkillers can cause damage to your kidneys. Your doctor may be able to suggest a different medication that is less or not harmful to your kidneys. Sometimes diagnostic studies are ordered with contrast dye. It may be necessary for you to have the study, but first find out if there are alternative methods.

Some diseases, such as IgA nephropathy, glomerulonephritis, and lupus can cause kidney damage when your immune system overreacts and inflammation occurs. It is sometimes possible to slow the disease process by controlling the immune system with steroids and/or other medications.
Smoking is a risk factor for faster progression of kidney disease, so stopping smoking can also help slow progression. Avoiding too much protein, potassium- and phosphorus-rich foods in the diet may also help.

» data courtesy of Phil. Society of Nephrology «

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I have been meaning to share some FAQ’s on kidney failure these past few days. Though I wasn’t able to get the chance because of my dialysis schedule. But finally, I am posting this now to promote awareness on kidney failure.

My heartfelt thanks to the Philippine Society of Nephrology, where I got this information, and to Dr. Bien Manlutac, the author of this FAQ’s and had been our nephrologist at Philippine Kidney Dialysis Foundation…

What are the kidneys?

Kidneys are paired bean-shaped, fist-sized blood-cleansing organs of the body. They are attached to the urinary bladder by tubes called ureters whichconvey urine formed in the kidney. Each kidney contains hundreds of thousands of tiny filters called glomeruli, which are interconnected by tubules, to form a network of nephrons, the working units of the kidneys. Around 200 quarts of blood is pumped by the heart to the kidneys via the renal arteries. Unclean blood passes through 140 miles of tubes and filters in both kidneys, resulting in urine formation. Filtered or cleaned blood then goes back into the circulation via the renal veins. Urine stored in the bladder is then passed out through the urethra located in the genital organs.

What do kidneys do?

Healthy kidneys function like 24-hour cleansing machines of the blood, removing from it wastes such as urea and creatinine, and extra water from the body. They also produce several hormones such as renin that help control and maintain normal blood pressure, and erythropoietin which stimulate bones to make red blood cells that carry oxygen to your whole body. They also keep body chemicals like salt, potassium, calcium, phosphorus, acids and bases in balance and keep bones strong.

What is kidney failure?

Kidney failure is a condition where the kidneys stop working normally. There are two kinds of kidney failure: acute renal failure (ARF) and chronic kidney disease (CKD). In both conditions, the kidneys fail to efficiently remove wastes and extra fluid from the body. Imbalances in the amounts of salt, potassium, calcium, phosphorus, and acids may also occur in both.

What is acute renal failure?

Acute renal failure means the kidneys have failed suddenly, often due to a toxin, a harmful drug, severe blood loss, trauma, infection, or blockage to urine flow. It is temporary in most cases and normal or near-normal kidney function often returns. However, it may progress to CKD if left untreated. In severe cases, dialysis may be necessary for a short time while the kidneys heal.

What is chronic kidney disease (CKD)?

Chronic kidney disease is characterized by either permanent kidney damage that developed progressively and slowly over time, or decreased level of kidney function with or without kidney damage for three months or more, with the potential to either cause progressive loss of kidney function or complications resulting from decreased kidney function.

What are the stages of CKD?

CKD is classified into 5 stages based on the level of glomerular filtration rate (GFR). Stage 1 is the mildest stage while stage 5, or end-stage renal disease (ESRD) is the most severe stage of kidney damage.

What is Pre-ESRD?

Pre-ESRD corresponds to CKD stages I to IV. It is the time between diagnosis of a kidney disease until the time renal replacement therapy is begun, either as dialysis or kidney transplantation. It may be brief lasting only a few weeks, or it may be months or even years.

What are the risk factors for CKD?

Older age, family history of CKD, history of acute renal failure, reduction in kidney mass and low birth weight place an individual susceptibleto developing CKD. Diabetes, high blood pressure, autoimmune diseases, systemic infections, urinary tract infections, urinary stones, lower urinary tract obstruction, drug toxicity, and cancer can directly initiate kidney damage. Higher level of spillage of protein in the urine (albuminuria), higher blood pressure, poorly controlled diabetes and smoking can cause acceleration of kidney damage and faster decline in kidney function.

What are the main causes of kidney disease?

Diabetes is the number one cause of kidney disease, responsible for about 40% of all kidney failure. High blood pressure is the second cause, responsible for about 25%. Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney’s filtering units, is the third leading cause.

Other less common causes include:

* Inherited diseases, such as polycystic kidney disease
* Malformations during fetal development
* Lupus and other diseases that affect the body’s immune system.
* Obstructions caused by kidney stones, tumors or an enlarged prostate gland in men.
* Repeated urinary infections.

I have diabetes. Will my kidneys fail?

Diabetes is a strong risk factor for kidney disease, but this does not necessarily mean your kidneys will fail. Tight control of your blood sugar and certain medications can delay or prevent progression of kidney failure. Spillage of protein or albumin in the urine is the first sign of diabetic kidney disease. Even if you develop diabetic kidney disease, you can work with your doctor to keep your kidneys working as long as possible.

Can I catch kidney disease from someone who has it?

No. Kidney disease is not contagious, but it may be inherited. Most kidney diseases are caused by diabetes and high blood pressure, conditions that can run in families. If you are a family member of someone who has diabetes, high blood pressure, or kidney disease, it is a good idea to ask your doctor to check your blood pressure and kidney function at regular intervals.

I have a family member with polycystic kidney disease (PKD). Should I be tested?

Since 60-70% of people with PKD have a family member with PKD, asking your doctor about being tested seems like a good idea. The first test used for PKD is an ultrasound to look at the kidneys and see if there are cysts.

Does frequent holding of urination cause CKD?

No, unless one suffers from vesico-ureteral reflux disease (VURD) which may damage the kidneys in the long term.

Will eating too much salty foods lead to CKD?

Eating too much salty foods does not necessarily lead to CKD. However, it can eventually lead to
high blood pressure among those who are at risk, such as those with a family history of hypertension. It can also worsen pre-existing hypertension, a leading cause of CKD. Among those with moderate kidney failure or end-stage renal disease, it can lead to water retention resulting to edema or swelling of the feet, and water in the lungs.

Does drinking too much cola or soft drinks lead to CKD?

No, but it may increase blood levels of phosphorus and potassium among those with moderate CKD.

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