Patient Education
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What Is Chronic Kidney Disease?
Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.
What Causes Chronic Kidney Disease (CKD)?
The two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Diabetes happens when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure. Other conditions that affect the kidneys are:
• Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney’s filtering units. These disorders are the third most common type of kidney disease.
• Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue.
• Malformations that occur as a baby develops in its mother’s womb. For example, a narrowing may occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This causes infections and may damage the kidneys.
• Lupus and other diseases that affect the body’s immune system.
• Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.
• Repeated urinary infections
What Are The Symptoms of Chronic Kidney Disease (CKD)?
Most people may not have any severe symptoms until their kidney disease is advanced. However, you may notice that you:
• Feel more tired and have less energy.
• Have trouble concentrating
• Have a poor appetite
• Have trouble sleeping
• Have muscle cramping at night
• Have swollen feet and ankles
• Have puffiness around your eyes, especially in the morning.
• Have dry, itchy skin
• Need to urinate more often, especially at night
Anyone can get chronic kidney disease at any age. However, some people are likely than others to develop kidney disease. You may have an increased risk for kidney disease if you:
• Have diabetes
• Have high blood pressure
• Have a family history of chronic kidney disease
• Are older
• Belong to a population group that has a high rate of diabetes or high blood pressure, such as African Americans, Hispanic Americans, Asian, Pacific Islanders, and American Indians.
The Facts About Chronic Kidney Disease (CKD)
• 26 million Americans have CKD and another 20 million more are at increased risk.
• Early detection can help prevent the progression of kidney disease to kidney failure.
• Glomerular filtration rate (GFR) is the best estimate of kidney function.
• Hypertension causes CKD and CKD causes hypertension.
• Persistent proteinuria means CKD.
• High risk groups include those with diabetes, hypertension and family history of kidney disease.
• African Americans, Hispanics, Pacific Islanders, Native Americans and Seniors are at increased risk.
• Three simple tests can detect CKD: blood pressure, urine and serum creatinine.
How Do Your Kidneys Help Maintain Health?
In addition to removing wastes and fluid from your body, your kidneys perform these other important jobs:
• Regulate your body water and other chemicals in your blood such as sodium, potassium, phosphorus and calcium
• Remove drugs and toxins introduced into your body
• Release hormones into your blood to help your body regulate blood pressure, make red blood cells, and promote strong bones
• Hypertension causes CKD and CKD causes hypertension.
• Persistent proteinuria means CKD.
• High risk groups include those with diabetes, hypertension and family history of kidney disease.
• African Americans, Hispanics, Pacific Islanders, Native Americans and Seniors are at increased risk.
• Three simple tests can detect CKD: blood pressure, urine and serum creatinine.
What Does Dialysis Do?
Like healthy kidneys, dialysis keeps your body in balance. Dialysis does the following:
• Removes waste, salt and extra water to prevent theme 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 part of a hospital, or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes.
Are There Different Types of Dialysis?
Yes, there are two types of dialysis: Hemodialysis and Peritoneal Dialysis.
Hemodialysis
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 vein in your neck. This type of access may be temporary, but is sometimes used for long-term treatment.
How Long Do Hemodialysis Treatments Last?
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.
What Is Peritoneal Dialysis and How Does It Work?
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 two major kinds of peritoneal dialysis.
What Are The Different Kinds of Peritoneal Dialysis and How Do They Work?
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 at 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 1-1/2 hours and exchanges are done throughout the night while you sleep.
Will Dialysis Help Cure The Kidney Disease?
No. 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.
Is Dialysis Uncomfortable?
You may have some discomfort when the needles are put into your fistula or graft, but most patients have no other problems. The dialysis treatment itself is painless. However, some patients may have a drop in their blood pressure. If this happens, you may feel sick to your stomach, vomit, have a headache or cramps. With frequent treatments, those problems usually go away.
How Long Has Dialysis Been Available?
Hemodialysis and peritoneal dialysis have been done since the mid 1940’s. Dialysis, as a regular 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.
How Long Can You Live On Dialysis?
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.
Is Dialysis Expensive?
Yes. 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 helps with the costs.
Do Dialysis Patients Feel Normal?
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.
Do dialysis Patients Have To Control Their Diets?
Yes. You may be on a special diet. 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.
Can Dialysis Patients Travel?
Yes. Dialysis centers are located in every part of the United States and in many foreign countries. The treatment is standardized. 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.
Can Dialysis Patients Continue To Work?
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.
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”
Why Do People With Kidney Disease Get Anemia?
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
• Are female
If you are African American or have diabetes and chronic kidney disease, you are more likely to have anemia and get it 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 (which is 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
How Is Anemia Treated?
Your treatment will depend on the exact cause of your anemia. If your anemia is due to kidney disease, you will be treated with:
• Drugs called erythropoiesis-stimulating agents (ESAs). ESAs help your body make red blood cells. ESAs will usually be given to you as an injection under the skin (called a subcutaneous injection) in your doctor’s office.
• Extra iron. Your body also needs iron to make red blood cells—especially when you are receiving ESAs. Without enough iron, your ESA treatment will not work. Iron can be given to you as a pill by mouth, or administered directly into a vein in your doctor’s office or clinic.
What Is The Goal Of Anemia Treatment?
The goal of anemia treatment is to increase your hemoglobin level to at least 11, which is considered to be the lowest level of hemoglobin you need to feel well. As you get closer to or pass this level, you should notice that you have more energy and feel less tired. Not having enough EPO (a hormone made by your kidneys) is the most common cause of anemia in patients with kidney disease. EPO tells your body to make red blood cells. When your kidneys no longer make enough EPO, treatment with an ESA can help.