More Time But At What Cost
They never say, Are you sure you want to start dialysis? because they believe dialysis is always the appropriate response to kidney failure. Because they believe dialysis always prolongs life, and prolonging life is all that matters.
Experience has given me different lessons.
Dialysis may not be the best option for everyone with kidney failure. Several European studies have shown that dialysis does not guarantee a survival benefit for people over age 75 who have medical problems like dementia or ischemic heart disease in addition to end-stage kidney disease. In fact, it often worsens their quality of life. One study found that elderly people who had dialysis lived on average a year longer than those who didnt but almost all of this added time was spent in the hospital, traveling to and from dialysis, or undergoing dialysis treatments.
Instead, she died two years later at home, pain-free, and surrounded by family. And without the rigors of dialysis.
What Do The Stages Of Chronic Kidney Disease Refer To
The five stages of CKD refer to how well your kidneys are working. Kidney disease can get worse in time. In the early stages , your kidneys are still able to filter waste out of your blood. In the later stages , your kidneys must work harder to filter your blood and may stop working altogether.
The goal at each stage of CKD is to take steps to slow down the damage to your kidneys and keep your kidneys working as long as possible.
How Long Can You Live With Stage 5 Ckd
- If you choose to start dialysis treatment, stage 5 kidney disease life expectancy is five to 10 years on average, though many patients have lived well on dialysis for 20 or even 30 years, according to the National Kidney Foundation .
- If you have a kidney transplant, average, a living donor kidney can function anywhere between 12 to 20 years, and a deceased donor kidney can improve quality of life for 8 to 12 years, as stated by Donate Life America, a nonprofit organization dedicated to organ, eye, and tissue donation.
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What Is Kidney Disease
Having kidney disease means that there is damage to your kidneys and they arent working as well as they should. Kidney disease is called chronic because kidney function slowly gets worse over time. Kidney disease leads to kidney failure, which is also called end-stage kidney disease. At this point, youll need dialysis or a kidney transplant.
What Do Your Kidneys Do
You have two kidneys. They are bean-shaped organs that are located toward your back, on either side of your spine, just underneath the rib cage. Each kidney is about the size of your fist.
Your kidneys have many jobs, but their main job is to filter your blood, getting rid of toxins and excess salt and water as urine. If your kidneys are damaged and dont work as they should, wastes can build up in your blood and can make you sick. Your kidneys also balance the amount of salts and minerals in your body, make hormones that control blood pressure, make red blood cells and keep your bones strong.
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Do What You Can To Manage The Complications Of Kidney Disease
Kidney disease can cause other health problems throughout your body including:
- Heart and blood vessel problems
- Mineral and bone problems
- High blood pressure
- Poor nutritional health
If you have stage 4 kidney disease, you are probably experiencing some of these problems already. Your healthcare professional will work with you to develop a treatment plan to help manage these problems and keep them from getting worse. Treatment may include diet, exercise, and medications. It is very important that you follow your treatment plan because it can greatly improve your quality of life and how long you live. It can also help to slow or even stop kidney disease from getting worse – and it may even stop or delay kidney failure.
What Happens If I Can No Longer Work
If you have to stop work or work part-time because of CKD, you may find it hard to cope financially.
You may be entitled to one or more of the following types of financial support:
- if you have a job but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer for up to 28 weeks
- if you don’t have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance
- if you’re aged 65 or over, you may be able to get Attendance Allowance
- if you’re caring for someone with CKD, you may be entitled to Carer’s Allowance
- you may be eligible for other benefits if you have children living at home or a low household income
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Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for kidney cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the kidney.
- Regional: The cancer has spread outside the kidney to nearby structures or lymph nodes.
- Distant: Includes cancers that have spread to distant parts of the body such as the lungs, brain, or bones.
Stage 4 Of Chronic Kidney Disease
A person with stage 4 chronic kidney disease has advanced kidney damage with a severe decrease in the glomerular filtration rate to 15-30 ml/min. It is likely someone with stage 4 CKD will need dialysis or a kidney transplant in the near future.
As kidney function declines, waste products build up in the blood causing a condition known as uremia. In stage 4, a person is likely to develop complications of kidney disease such as high blood pressure, anemia , bone disease, heart disease and other cardiovascular diseases.
Symptoms of stage 4 kidney disease
Symptoms that are experienced in stage 4 include:
- Fluid retention, swelling of extremities and shortness of breath
- Urination changes
- Kidney pain felt in their back
- Sleep problems due to muscle cramps or restless legs
- Nausea and/or vomiting
- Taste changesa metallic taste in the mouth
- Bad breath due to urea buildup in the blood
- Loss of appetite: People may not feel like eating, and some people report having a metallic taste in their mouth or bad breath.
- Difficulty in concentrating: Having trouble doing everyday things such as balancing a checkbook or focusing on reading the newspaper can occur.
- Nerve problems: Numbness or tingling in the toes or fingers is a symptom of CKD.
Seeing a doctor when you have stage 4 CKD
At stage 4, its necessary to see a nephrologist . The nephrologist examines the patient and orders lab tests to gather information to recommend treatment.
Looking at treatment options when you have stage 4 CKD
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How Long Can You Live With Kidney Failure On Dialysis
Kidneys of humans play a major role to filter waste products present in the blood. Dialysis refers to a treatment procedure and is a substitute for a large number of regular functions performed by kidneys. The functions performed by dialysis include:
Regulating Fluid Balance- Dialysis performs most of the functions of a persons failed kidneys. Particularly, it performs the prime job of regulating the fluid balance of a person. Dialysis prime functions at a glance are-
Waste Removal- Removal of wastes, extra water and salt to prevent them to form in our body
Maintaining Balance: Maintain a safe level of various chemicals in the blood, which include potassium, phosphorous and sodium bicarbonate.
Regulating B.P Helps in controlling the blood pressure.
Therapeutic Goal: Treat Renal Secondary Hyperparathyroidism
Because calcitriol increases GI calcium and phosphorus absorption, make sure to achieve tight phosphorus control before initiating calcitriol therapy.
- Control hyperphosphatemia to achieve IRIS CKD stage goal .
- Then measure PTH and ionized calcium to document inappropriate PTH levels and low or normal ionized calcium concentration.
- Begin calcitriol therapy administer on an empty stomach.
- Monitor monthly for hyperphosphatemia, hypercalcemia, and alterations in renal function.
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Lifestyle Treatment For Stage 4 Kidney Disease
Additional treatment for stage 4 kidney disease included lifestyle changes. These can be part of both your medical and nutritional interventions. They include:
- Increase daily exercise
- Improve sleep heath
Increase Daily Exercise
Exercise is important for kidney health. For those with CKD exercise should be approached with caution. Too little or too much intense exercise could be problematic for people with this condition.
It is important to get moving and be active no matter what stage of CKD you have. Types of exercises you can incorporate include
- Aerobic exercises
Aerobic exercises will improve heart function and lower blood pressure.
Weight lifting will build muscle which can help manage blood sugar.
Balance exercises will help to prevent falls.
Implementing stretching will improve your muscle strength and overall health.
If you are not already exercising, it is best to talk to your doctor or kidney specialist. They will help you find an exercise plan that is easy to incorporate into your daily routine.
It is also important to note that some people with CKD may have limitations with their exercise. You should not exercise if
- Your doctor told you not to exercise
- Your body feels tired and needs to rest
Learn more about exercise for kidney health in this post.
Stress Management
Unmanaged stress and anxiety can weaken your kidneys. Even just having a lot on your plate can cause the body to become stressed out. Mellow out with these activities:
When Do Most Cases Of Chronic Kidney Disease Occur
Since kidney tissue cannot regenerate if destroyed, the kidneys have a large amount of reserve capacity to perform their various functions. At least 2/3 of the kidneys must be dysfunctional before any clinical signs are seen.
At least 2/3 of the kidneys must be dysfunctional before clinical signs are seen.
In many cases, this means that the destruction has been occurring for months to years before failure has become evident.
In dogs, chronic kidney disease is associated with aging, and in simple terms can be considered to be the wearing out of the kidney tissues. The age of onset is often related to the size of the dog. For most small dogs, the early signs of kidney disease occur at about ten to fourteen years of age. However, large dogs have a shorter life span and may undergo kidney failure as early as seven years of age.
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What Is Needed To Prepare For Dialysis
Dialysis is a treatment that you have for the rest of your life and it becomes a part of your everyday routine. Even the decision of which method is the best for you personally will take some time to make. That also applies to the preparations such as the surgical procedures that are necessary. For peritoneal dialysis, a needs to be inserted into the abdominal cavity and attached to the abdominal wall. After a recovery period of two to four weeks, peritoneal dialysis can be started. For hemodialysis, an arteriovenous fistula needs to be created using surgery. This is a connection between a vein and an artery in the forearm that is used to access the bloodstream in hemodialysis. Its best to plan the procedure several months before starting dialysis. This is because several examinations need to be done first, and the shunt needs several weeks to develop so that it can be used over the long term.
Creating a shunt apparently works better if you are first transferred to a kidney specialist long enough before dialysis is started. That is what researchers from the found based on 15 studies with a total of about 5,600 participants. Complications such as shunt infections were less common too. By analyzing other studies, the researchers also found out that life expectancy increases when a kidney specialist is involved early on.
Slowing And Treating Kidney Disease Progression
Medications that can help people with kidney disease, though there is no cure. Certain blood pressure drugs, including ACE inhibitors and ARBs, may slow disease progression and delay kidney failure, even in people without high blood pressure.
If you do have high blood pressure, its important to control it because it can damage the blood vessels in the kidneys, worsening CKD. Your doctor can prescribe blood pressure medicine and may recommend reducing the salt in your diet.
Many cases of kidney disease are linked to diabetes, so controlling your blood sugar is vital, with medication if necessary. Take care to monitor your blood sugar levels regularly and try to stay at a healthy weight.
When there is kidney damage, phosphorus can build up in the body and weaken bones. Talk with your doctor about avoiding foods high in phosphorus, such as dairy products, processed meats, beer, soda, and chocolate.
Potassium is another mineral that can build up in the body when you have kidney disease. Too much potassium increases the risk of a heart attack. Ask your doctor about avoiding foods that are high in potassium, such as bananas and broccoli.
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Understanding Stage Iv Kidney Disease
You receive a chronic kidney disease diagnosis when your kidneys are damaged and can’t function properly. Kidney damage often happens as a result of a physical injury or a health condition like diabetes or high blood pressure.â
Damaged kidneys can’t filter blood well enough to keep you healthy. Other important kidney functions include:
- Balancing fluids in your body
- Regulating hormones
- Keeping bones healthyâ
- Producing red blood cellsâ
If your doctor gives you a stage four chronic kidney disease diagnosis, itâs important for you to know how you can manage your condition. Take steps to maintain a healthy diet and lifestyle to prevent complications like:
- Problems with your heart and blood vessels
- Anemia, or low red blood cells
- Problems with your bones
- Lack of energy from poor nutrition
What Is Good Kidney Disease Care
According to a national review, kidney disease services should:
- identify people at risk of kidney disease, especially people with high blood pressure or diabetes, and treat them as early as possible to maintain their kidney function
- give people access to investigative treatment and follow them up to reduce the risk of the disease getting worse
- give people good-quality information about managing their condition
- provide information about the development of the disease and treatment options
- provide access to a specialist renal team
- give people access to transplant or dialysis services if required
- provide supportive care
Your treatment for kidney disease will need to be reviewed regularly.
It may be helpful for you to make a care plan because this can help you manage your day-to-day health. Your kidney disease specialist nurse may be able to help with this.
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Why Does It Happen
The kidneys are two bean-shaped organs, the size of your fist, located on either side of the body, just beneath the ribcage. The main role of the kidneys is to filter waste products from the blood before converting them into urine. The kidneys also:
- help maintain blood pressure
- maintain the correct levels of chemicals in your body which, in turn, will help heart and muscles function properly
- produce the active form of vitamin D that keeps bones healthy
- produce a substance called erythropoietin, which stimulates production of red blood cells
Chronic kidney disease is the reduced ability of the kidney to carry out these functions in the long-term. This is most often caused by damage to the kidneys from other conditions, most commonly diabetes and high blood pressure.
Read more about the causes of chronic kidney disease
When Is Dialysis Started
To find out whether someone is at risk of kidney failure or already has it, people with chronic kidney disease have regular check-ups. Doctors look for the symptoms listed above. They also measure the glomerular filtration rate to monitor how well the kidneys are working.
People with healthy kidneys have a GFR of 85 to 135 mL/min/1.73 m2 of body surface area. This value decreases with age thats normal and isnt necessarily a sign of kidney disease.
But if the kidneys become increasingly weaker in someone with chronic kidney disease, the GFR will continue to drop. The point at which dialysis become necessary isnt determined by one specific GFR value. The symptoms that could be signs of kidney failure play a much more decisive role or if there are major changes in blood pressure or fluid imbalances. If there are no such symptoms, dialysis can still be put off. The typical symptoms usually start to occur at a GFR of 5 to 10 mL/min/1.73 m2 though.
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New Research To Guide Your Choice
In 2004, researchers began theInitiating Dialysis Early and Late study.4The plan was to recruit 800 people withCKDand follow them for three years to find out who would live longer:
- Those who started dialysis early, at aGFRof 1014 mL/min, or
- Those who started dialysis late, at aGFRof 57 mL/min.
The findings of theIDEALstudy are now out,5and they are not what most nephrologists expected. Of the 828 people who were randomly chosen to start treatment early or late:
- 404 people started early, and 152 died.
- 424 people started later, and 155 died.
There wasno significant differencein survival between the two groups. And, the late-start group got to have an extra six months or so off of dialysis!
Three other non-random studies have found that starting dialysis early does not help youand it may even be harmful.
- A French study of 541 people done in 20052006 found that late starters had more illnesses and a higher risk of emergency dialysis starts. However, they lived just as long as early starters.6
- A Swedish study followed 901 people who chose to start dialysis early or late. Late starters were84% more likely to survivethan those who started early.7
- A U.S. study found that starting dialysis earlier may beharmfulfor patients. Researchers looked at survival of 81,176 people who did not have diabetes. The risk of death wentupthe earlier dialysis began. Those who started treatment with aGFRof 5.09.9 mL/min were more than twice as likely to live.8