Dialysis as a third option

Failing kidneys can be treated through several options, in fact, Joe Cosgrove have previously discussed the alternative treatments whereby kidney failure can be handled; however, the most common treatment, as readers might have already guessed is dialysis. Dialysis is often considered by physicians and doctors as a the third option for treating kidney malfunction —dialysis replaces a function of the kidney with a special equipment commonly used to cleanse and filter the blood, where blood goes first through a dialyzer and then back to the body.

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There are two basic types of dialysis: hemodialysis, which happens outside the body, and peritoneal dialysis, which happens inside the body. As mentioned before, the first type of dialysis (hemodialysis) occurs when a person’s blood is passed through an artificial kidney (called dialyser). As with many other conditions and treatments, patients who are to undergo dialysis need to change some habits, in this case, it is advisable for future patients to avoid drinking fluids in excess. This procedure is ordinarily done for four hours, three times a week, and requires access to the patient’s blood either through an intravenous line inserted in the patient’s neck or a fistula: a procedure whereby an artery and a vein are connected surgically on the arm. This normally can take up to three months to be ready as it requires prior assessment and a certain degree of planning. The perks of hemodialysis are that it can be done at home, even when patients are sleeping; nonetheless, it usually takes place at a hospital.

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As for peritoneal dialysis, commonly known as PD, the procedure differs from hemodialysis as the blood is cleansed inside the body through a line carefully place in the inside of the abdomen—or peritoneum—: a tube is allocated close to the belly button inside the peritoneum whereby a solution, called dialysate solution, is carried to the inside of the abdomen and left there for a few hours. This dialysate solution is in charge of cleansing, or rather, diffusing the waste products out of the patient’s blood so that the fluids can re-enter the peritoneum (now cleansed) back again. This procedure is called an exchange and it usually takes 20 up to 30 minutes, and there are ordinarily two ways to perform it and the criterion for choosing one amongst the two variants depends upon the timing of the exchanges — Continuous Ambulatory Peritoneal Dialysis (or CAPD) typically entails four exchanges which patients can do themselves every day using dialysis bags for it. It has some advantages in comparison to hemodialysis since patients can move between exchanges about as normal. Automated Peritoneal Dialysis (or APD) is the procedure where a machine that patients can easily set up just before going to bed performs the exchanges for them at night for usually seven to ten hours. Patients might feel some discomfort once they wake up but certainly will be able to move about as normal as well.

Now that both types of dialysis have been explained, patients should focus on deciding where they want to undergo this treatment, whether at a hospital or at home. There are some obvious advantages of choosing a clinic over home. During dialysis at home, patients require the ability to self-manage themselves and will eventually lead them to learn new skills related to self-caring themselves and problem-solving; however, there are also certain conditions that might make the process of self-caring reliably much harder than initially thought: alcohol, or drug addiction, or cognitive impairment, or another medical condition, or psychological predisposition. This process can be at first a daunting task if patients do not have a reliable helper. Additionally, people who have had various abdominal surgeries or procedures are likely not to be eligible for peritoneal dialysis. In order for patients to easily assess whether they will be able to overcome the challenges commonly associated with having dialysis at home, physicians have agreed upon the fact that, if patients are able to manage and use an ATM machine, or have the dexterity to button a shirt, then it would be fair to assert that they also will be able to manage home dialysis.

There are a few factors that might also lead patients to choose home dialysis over hospitals and clinics: they might live far away from a dialysis clinic, or maybe they feel that they will not be able to comply with the diet and fluids restriction mandatory for this procedure to be effective. Actually, most people end up choosing peritoneal dialysis for personal reasons where the #1 reason is the degree of flexibility and the degree of control they can attain at home. People often perceive that undergoing peritoneal dialysis at home enables them to attain a much higher level of self-management and control, without mentioning the fact that they will not be traveling to a clinic several times a week.

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What can cause kidney failure and how you can prevent it?

A silent disease that is affecting more than 26 million Americans and that according to research 1 out of 3 Americans is in risk of developing a kidney failure disease, kidney failure is a disease that can stay silent for several years and only manifest itself once you have already have a lot of damage. Most people are diagnosed when they suffer diabetes or uncontrolled blood pressure, but there are other ways of damaging your kidneys.  There are several causes that are becoming the main causes of Kidney failure, the most frequent ones are diabetes, high blood pressure, obesity, smoking and heart disease. Once there is kidney failure the patient needs to start treatment with dialysis or with a kidney transplant. Joe Cosgrove has a great article about how you can identify if you have kidney failure, where you can follow up after this.

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What is it that Kidneys actually do?

Your kidneys are bean shaped internal organs that are located in your mid back, they have a very special mission: they are the ones in charge of cleaning your blood, maintaining a proper balance of minerals in your body as well as your blood pressure. Your kidneys have a renal artery and a renal vein, and are connected to your ureter, helping you re-absorb water, amino acids and sugar, as well as eliminating toxic waste through your urine.

What causes kidney failure?

There are two causes for having Kidney failure lets see a little bit more about each one:

1. Acute Kidney injuries

There are 3 main causes for suffering acute kidney failure: Having a very low blood flow to the kidneys; having a direct injury to the kidneys or having an excess of urine retained in the kidneys. However there are other reasons you can get Acute kidney failure, like taking some medicines or drugs that affect the kidney function, most common ones are antibiotics that contain gentamicin and streptomycin and pain pills that contain ibuprofen. Some of the symptoms you need to be aware of if you are not urinating enough during the day, if you have swelling in your feet and legs, feeling pain in your lower back and feeling nauseas. These kind of kidney failure can have different types of treatments, it can be with medication if it is not that severe, they can be to balance the amount of fluids in your blood, to control the levels of potassium or of calcium, when the degree of toxicity is higher then the patient will need dialysis to remove the toxins from the blood.

2. Chronic Kidney disease

This is the hardest one to diagnose since it’s being building up for years. Most frequent causes are diabetes, the leading cause for kidney failure right now or high blood pressure for many years that has been uncontrolled, at the moment about 165,000 patients have kidney failure due to high blood pressure. As well as the acute failure, consumption of many medicines that affect the kidneys function can lead to a chronic kidney failure. Most common symptoms you should be aware of are: increase or decrease of daily urine, swelling in several body parts, itchiness or numbness, dry skin, feeling nauseous, weight loss and muscle cramps. If you have a series of these symptoms visit your doctor and ask for a checkup a simple blood test can let your doctor know if your kidneys are failing. In Chronic Kidney disease most of the times the patient will need dialysis, the levels of toxicity in the blood flow is higher than normal and will need a detox to save the kidney from stop working for good. A great quantity of patients will be needing a kidney transplant as well.

How can you prevent kidney failure

  1. If you have diabetes you need to keep your sugar levels controlled under a targeted range that can be discussed with your doctor.
  2. If you have high blood pressure, try taking your meds and eating properly so you can keep it in a 130/80 range. Speak with your physician on how you can control your blood pressure.
  3. Maintain a healthy weight, being overweight can increase the possibility of having high blood pressure, develop a heart disease and even become diabetic.
  4. Keep other levels normal, cholesterol, triglycerides and others checked and in a normal range.
  5. No smoking, tobacco produces atherosclerosis which  that reduces blood flow including to the kidneys.
  6. Avoid taking pain medicine that contains ibuprofen or naproxen in a daily basis. These medicines tend to damage the kidney functions, ask your doctor for other ways of dealing with the pain or taking pills that are less aggressive on your kidneys.

Changing your habits to healthier ones, drinking enough water daily, avoiding medicines that damage your kidneys, exercising regularly are great ways to start preventing kidney failure. With age our body starts changing and all we do to it during our 40 years is reflected, many of our organs start failing because our blood flow decreases and all of the bad decisions we made with bad nutrition, drinking sodas and sugary drinks instead of water and becoming sedentary.

Conservative Care and Types of Donors

Joe Cosgrove has spoken widely about kidney malfunctions and the alternative treatments that exist and serve as a different approach to addressing common kidney diseases.  Kidney failure is something that can be treated using different approaches — like dialysis, for instance. When to start dialysis and when to start dialysis can be easily assessed after having a quick look at kidneys that are currently failing.

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In order to understand this in more detail, readers should be aware of how kidneys work exactly: it is often talked about balance and health, where the kidneys are the ones responsible for that first word: balance; whether it is food or body chemistry or blood pressure, the kidneys work alongside other major organs to keep this equilibrium, or balance for this matter, going and functioning on a daily basis while eliminating and filtering out all the waste byproducts and products created by the body’s metabolism. If kidneys start to fail, meaning they cannot longer hold this balance, the body starts to struggle at keeping such equilibrium and is more likely to retain fluids, or food, or could result in having abnormal potassium and sodium levels, or could rise blood pressure, etc. which will result in increasing the risk for a serious kidney illness. If this were to happen, the body would absolutely need another way to filter and balance all these fluids and electrolytes, and this, as readers might have already guessed, is where the decision of dialysis or kidney transplant comes in.

Although the need for a kidney transplant or a dialysis might be imperative, it, nonetheless, takes a time to plan it. A person’s primary physician will likely star planning either a transplant or a dialysis when a person’s GFR (which stands for Glomerular Filtration Rate) is around 20, which is the equivalent to a 20% kidney function, in case readers want to have something to have a deeper understanding; nevertheless, this does not necessarily mean that a dialysis or a kidney transplant is immediately needed as most people start dialysis when their GFR is around 13 or so. Actually, doctors and physicians have started questioning whether it is necessary to start dialysis based on just a number since the people who started dialysis this earlier did not seem to show a major improvement in their condition. Now, doctors and kidney specialists are leaning towards starting dialysis once the patient has already shown symptoms of kidney failure like severe fatigue, nausea, decreased appetite, shortness of breath, etc. This symptoms assessment might be a little tricky and deceptive, mostly if the patient is suffering from something else, which is why now doctors in charge of assessing a patient should include a nephrologist in their teams to recognize the symptoms that would improve after dialysis.

Moreover, people often start thinking about their plausible treatment options a year before they need to start dialysis since it takes three to six months to make dialysis happen, which is why there are several dialysis options instead of just one. One option would be actually doing nothing: patients might feel this way because of where they are in life. They might feel that perhaps their best choice would be letting their kidney failure run its course, which is the attitude that describes the “Conservative Care”. Conservative Care suggests that patients should aim at maintaining their kidney function for as long as possible through diet and medication, knowing that the decline of their kidney function will not stop, and will ultimately lead to death. This option is generally considered by people who are also suffering from other severe medical conditions who are candidates for transplants and feel that the liability and discomfort caused by dialysis outrun the potential benefits.

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The next option would be to acquire a donated kidney, either from a living person — generally a relative or a friend — or from a deceased donor. As readers might imagine, not everyone is a candidate for receiving a donated kidney, which is why doctors and physicians might take some time to find out whether the transplant is the most suitable option for patients. Since there are two types of kidneys, deceased donor kidneys are not immediately available; in fact, up to 20% of people who are on dialysis are waiting for a kidney transplant, which is why it takes five up to 8 years to have one. If the having a transplant is possible after prior assessment, it is definitely the best options as it allows receivers to live longer and better than if they were on dialysis, which is why it is advisable to start thinking on the other type of kidney donor: the living donor. People usually consult their friends or relatives first since the likelihood of them matching the receiver are higher; they will last longer unlike kidneys coming from a deceased donor and the transplant can happen earlier: even before dialysis.