Chronic Kidney Disease Stage 3: assessment, management, risk factors and tips to prevent it

Kidneys_

Image courtesy of Becky Striepe at Flickr.com

Stage 3 CKD is something that has to be taken seriously. In a previous post in this same blog, we talked about the 5 stages of Chronic Kidney Disease. We understood that stage 1 and stage 2 are not that serious and that the illness can be managed with diets and good habits. We also learned that Chronic Kidney disease in these two stages is invisible and that is very hard to detect unless other tests are done. We also learned that stage 3 is divided into two stages and that is here where the thing gets really serious (especially in stage 3B) and that it will be most likely that the patient needs treatment, medications, special diets and future dialysis and specific kidney treatments. Stage 4 and 5 are the last stages where the kidney is already working under 50% and the patient will need a transplant and a serious and well-managed treatment combined with diets and medications and we learned that stage 5 is already terminal and the patient has to be managed very carefully.

Today we are going to take a look at stage 3A within a Chronic Kidney Disease, the way it should be assessed and managed, the risk factors every patient has and some tips to prevent the progression of stage 3 in CKD.

Assessment and management of Stage 3 CKD

Most Stage 3 CKD patients are not at high risk and can be managed with primary care. The objective becomes to identify the patients that are in risk of passing on to stage 3B  and its associated risks.

The most important symptoms or pointers in stage 3A of patients at risk are: When the patient´s proteinuria is ACR>70 or PCR>100; the patient has a declining GFR and he or she is at a young age. After these pointers, doctors have to ask themselves if the patient is functioning well, if the patient has a history of this illness and if there has been any urinary abnormalities or other specific indicators.

The first value that has to be determined is the creatinine levels to see if they are elevated. Then compare them with previous tests and values. If previous tests don’t exist, there has to be a 14-day gap to take another test and compare values and it has to take them to the lab as deteriorating renal function needs rapid assessment.

As for the clinical assessment, the tests focus on heart failure or direct assessment of bladder enlargement. This can be done by imaging which can indicate the level of obstruction that doctor suspect. Here urine tests become ever more important because they can indicate the amount of proteinuria by ACR/PCR that can be seen in the body and this is a reliable indicator of progressive renal disease.

Management of Stage 3 CKD

In this stage, there is always a big cardiovascular risk. The idea is that the person starts having a healthier lifestyle and quit bad habits such as smoking, and starts a discipline in their exercise and eating habits. There should also be a cholesterol lowering therapy or approach if there are already any macrovascular disease symptoms. In this stage of CKD, the patients tend to be over 60 or 70 years old and most of them do not go onto stage 4. However, there should be a close assessment and control over diseases such as heart attacks, strokes, and narrowing of other arteries.

Stage 3 CKD risk factors

When we talk about risk factors we are mainly talking about cardiovascular events. The patient has to be monitored on his or her proteinuria, hematuria, and declining GFR levels and they must be closely managed. This is an accurate indicator that the CKD is progressing. The idea of understanding these risk factors is that doctors can accurately attack the kidney disease either by reducing the risk of having cardiovascular complications or by prescribing treatments that slow down or stop the progression of CKD.

Tips to prevent stage 3 CKD

Basically, there are three ways a person can prevent the body reaching stage 3 CKD: the first one is to have a kidney-friendly diet; the next one is to have a very good discipline when it comes to medications, and the third one is to exercise.

As for a kidney-friendly diet the idea is to eat the correct amount of calories, cut down on  phosphorus-rich foods because it is very hard for the kidney to process this type of food and avoid high-potassium foods (if  there is a possibility of a dietician it is a good idea because people can understand the amount of  potassium they can take.

Medications include drugs to prevent risk factors such as blood sugar levels and blood pressure.

Exercising and non-smoking become very important at this stage just to prevent the progression of CKD and to help the patient live his life as normal as possible.

Be sure to also read this post about The Most Significant Early Symptoms Of Kidney Disease

A Brief History of Dialysis

National Museum of Health and Medicine_kidney

Image courtesy of MilitaryHealth at Flickr.com

Dialysis is a procedure commonly used to help filter the waste present in the blood when the kidneys simply can’t do it. As a medical procedure, it has been around for more than 70 years, helping patients have normal lives or at least livable ones.

Like most medical procedures, dialysis also has a story to be told, one that dates back to the 1940’s when the first dialysis machine was invented by a Dutch physician called Willem Kolff. Since the day this first machine was invented, to nowadays, dialysis has evolved incredibly, reaching the point where many patients are able to live with it for many years and still have regular lives.

In this article, Joe Cosgrove will share a bit of history related to dialysis and the great impact is has had in medical history and the lives of millions of people in time.

The 1940s: The beginning

At the beginning of the 1940’s a physician named Dr. Willem Kolff invented a device that worked as an artificial kidney. Thanks to his invention, Kolff is considered to be the pioneer of dialysis. As a physician, Kolff spent about 10 years of his career developing an artificial kidney in the Netherlands while working at the University of Groningen Hospital. He was first inspired to create this type of artifact when visiting the University Hospital and watching how a young man would irremediably die because his kidneys couldn’t filter waste anymore.

Once motivated to create something that could help those experiencing kidney failure, Kolff decided to go to research about ways to remove waste from the blood once the kidneys stopped working. Then he found an article written by the pharmacologist John Abel in 1913 about hemodialysis in animals. Thanks to this article, Kolff dedicated himself to the cause of developing an artificial kidney for humans.

Kolff had a hard time developing this device since he was sent to a remote hospital to serve at during war. Despite the poor conditions he kept on moving forward and improvised many times with many different materials (including sausage skins) to create something that could remove waste away from the blood.

By the year 1943 and after overcoming a great share of difficulties, Kolff’s invention was finished and was tested without any success on numerous patients, until in 1945, it helped an old woman overcome a uremic coma.

The machine Kolff invented is considered to be the first dialyzer of our times and its structure remained almost untouched for ten years as the best alternative for physicians to treat patients who were suffering from kidney failure. Probably Kolff didn’t know it back then, but his machine turned out to be one of the most important medical inventions in history and helped to save the lives of thousands.

The 1950s: Evolution of the dialyzer

At the beginning of the 1950’s, Kolff’s dialyzer had already been improved and used to treat injured soldiers fighting during the war. It had also been used to treat end-stage renal disease and acute renal failure patients. However, during the middle of the 20th century, not many doctors were optimistic about the usage of Kolff’s dialyzer because they believed a human made machine couldn’t resemble the kidneys’ function and they also found it difficult for the human veins to stand such treatment in the long term.

It was in Boston where a professor named Dr. Belding Scribner came up the idea of plugging the patient to the dialyzer by using flexible tubes made of a new plastic called Teflon. This way the tubes could be introduced inside the arteries and veins, keeping the circulatory access opened thanks to the usage of a tiny device with the shape of a “U”. This u-shaped device was called The Scribner Shunt.

By using this device patient no longer needed to get a new incision when going under the dialysis treatment. Even though this method isn’t used today, it helped other doctors develop new techniques to access the circulatory system that were useful to treat those who had acute kidney failure.

The 1960s: A decade of changes

Scribner was the first person on earth to open a dialysis facility in 1962. Problems started to appear when the number of patients who wanted and needed to be treated exceeded the capacity of the clinic – with only six available machines. Scribner needed to find a way to decide which patients were getting the dialysis done since many of them actually were close to death.

By this moment, Scribner decided to create an anonymous committee of people who could make that decision for him. This committee was composed of local people and doctors who worked in the kidney fields. Although this Solomonic choice created controversy, in time this committee was seen as the first bioethics committee of all time and changed the relationship common people had with the offer of health services.

The Past 60 Years

During the past 60 years, the history of dialysis has gone under several changes, new machines have been developed, new materials have been invented and many people in the world depend on this treatment to survive. We still know medical pioneers like Kolff or Scribner that are concerned about the way medicine evolves and is being practiced.

It is always expected in the future to come for specialists to be able to create new solutions that may help patients live longer, happier and have regular lives despite the fact they need to undergo dialysis treatment several times per week. History is still being written and hopefully, the years to come will be full of great surprises in this important medical field.

Everything You Need to Know About A Dialysis Machine

As Joe Cosgrove has pointed out before in this blog, kidney plays a vital role in the functioning of the human body. Without them, the waste present in the blood couldn’t be removed, and most individuals would die within a few days. Sadly, these bean-shaped organs can fail and when that happens, the best option for patients is to go under dialysis.

Dialysis is a medical procedure that works as an artificial kidney. It takes place when a person’s blood is filtered with the help of a dialysis machine. This machine aims to mimic the regular functions of human kidneys. This way, it is able to remove toxic waste from the blood as well as the extra water that may be present in it.

dialysis_dialysis machine

Image courtesy of Matt Kowalczyk at Flickr.com

Each dialysis machine is built up in a similar way and healthcare providers and technicians know how to operate them in order to help patients filtering their blood. There is a list of parts and components that need to be well known by technicians in order to properly handle the dialysis machine. Below, you will find a list of these components with a brief description of each one of them.

Pumps

The most common type of pump used during dialysis is known as Peristaltic pumps. These are tubes meant to drive different fluids, such as blood, water, saline, and dialysate. This type of tubes is ideal for dialysis since they let a higher volume of fluids flow without letting them be touched by human hands. Also, dialysis pumps are a flexible system that helps to push fluids forward with the help of motors (AC or DC motors) which speed can be regulated by the technician.

Some pumps are connected to a sensory system that allows them to automatically regulate the flowing pressure of fluids depending on the patient’s needs. Nevertheless, in order to properly function, pumps need to be configured in advance based on the type of fluid that is going to pass through them

Valves

Dialysis machines need to have a few electronic valves to operate properly. This happens since dialysis machines need to use variable mixing ratios that are only possible when different valves open and close at different times. This type of valves are solenoids which can be controlled with precision thanks to the action of stepper motors or another mechanism.

Sensors

Most dialysis machines use different types of sensors. This happens because they need to monitor and regulate different parameters that take place during the dialysis procedure. Some of these parameters include motor speed, temperature, oxygen saturation, dialysate pressure, dialysate membrane pressure, and airflow.

Nowadays, dialysis machines usually have digital outputs that allow the technicians to know what is going on during the dialysis procedure. When they don’t have these digital outputs the signal sent by the sensors needs to be amplified and digitized before reaching the controller. In order to be more accurate, a series of ADC resolutions are used and the sampling speed varies.

Cleaning system

A dialysis machine can be used to treat many different patients. This is why it needs to be cleaned before each session and components that are going to be reused must be properly sterilized too. Each machine can be cleaned in a different way, but most of them have the same system.

Technicians need to heat water to high temperatures so it can sterilize the tubes and each part of the dialysis machine when it runs through them. The inner and outer circuit of the machine needs to be cleaned with that water by activating the cleaning mode of the machine. However, there are different types of machines that require this process to be monitored and controlled.

Syringe

The syringe is an external element used to pump substances into the dialysis machine. This procedure is needed since the blood tends to clog the machine’s pumps and a drug called heparin needs to be injected into the tubes to keep them unclogged. The syringe is attached to the pumps in most machines.

renal-dialysis-technician

Image courtesy of wistechcolleges at Flickr.com

Dialyzer

The dialyzer is probably the most important piece of the dialysis machine because it is where the blood is filtered. Here a filtering membrane and a cleaning solution called dialysate can be found. The dialyzer is, in general terms a blood compartment.

Dialysate Solution

The dialysate is a solution made of purified water, an acid and bicarbonate that can be found inside the dialyzer. It is meant to remove waste from the blood thanks to the action of the minerals and electrolytes present in the solution. Dialysate never mixes with the blood; it simply takes waste away with the help of a filtering membrane.

Once the blood is cleaned and filtered thanks to the combined action of both the dialyzer and dialysate, it is pumped back into the patient’s body. This process takes place in the form of a moving current since only one pint of blood can be treated at the time.