What Is Kidney Dialysis
Because there is no cure for CKD, if you are in late-stage disease, you and your healthcare team must consider additional options. Complete kidney failure, left untreated, will result in death. Options for end stages of CKD include dialysis and kidney transplantation.
Dialysis is a procedure that uses machines to remove waste products from your body when your kidneys are no longer able to perform this function. There are two major types of dialysis.
Hemodialysis: With hemodialysis, your blood is circulated through a machine that removes waste products, excess water and excess salt. The blood is then returned to your body. Hemodialysis requires three to four hours, three times a week and is performed at a clinic, hospital or dialysis center.
Peritoneal dialysis: In peritoneal dialysis, a dialysis solution is run directly into your abdomen. The solution absorbs waste and then is removed via catheter. Fresh solution is added to continue the process of cleaning. You can perform this type of dialysis yourself. There are two types of peritoneal dialysis: continuous ambulatory peritoneal dialysis , which involves a change in dialysis solution four times a day; and continuous cycling peritoneal dialysis . CCPD uses a machine to automatically fill, remove wastes, and refill the fluid during the nighttime.
What Causes Kidney Disease
Kidney diseases happen when your kidneys are damaged and cant filter your blood. The damage can happen quickly when its caused by injury or toxins or, more commonly, over months or years.
- Glomerulonephritis. This type of kidney disease involves damage to the glomeruli, which are the filtering units inside your kidneys.
- Polycystic kidney disease. This is a genetic disorder that causes many fluid-filled cysts to grow in your kidneys, reducing the ability of your kidneys to function.
- Hypertensive nephrosclerosis. Kidney damage caused by chronic, poorly controlled hypertension.
- Membranous nephropathy. This is a disorder where your bodys immune system attacks the waste-filtering membranes in your kidney.
- Obstructions of the urinary tract from kidney stones, an enlarged prostate or cancer.
- Vesicourethral reflux. This is a condition in which urine flows backward refluxes back up the ureters to the kidneys
- Nephrotic syndrome. This is a collection of symptoms that indicate kidney damage.
Whats The Prognosis For Stage 4 Kidney Disease
Theres no cure for stage 4 chronic kidney disease. The goal of treatment is to prevent kidney failure and maintain a good quality of life.
In 2012, researchers found that men and women with low kidney function, especially less than 30 percent, had substantially reduced life expectancy.
They noted that women tend to have longer life expectancy in all stages of kidney disease except stage 4, where theres only a slight difference by gender. Prognosis tends to be poorer with age.
- At 40 years old, life expectancy is about 10.4 years for men and 9.1 years for women.
- At 60 years old, life expectancy is about 5.6 years for men and 6.2 years for women.
- At 80 years old, life expectancy is about 2.5 years for men and 3.1 years for women.
Your individual prognosis also depends on co-existing conditions and what treatments you get. Your healthcare provider can give you a better idea of what to expect.
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Working With Your Care Team
Good healthcare is always a team effort – especially for people with CKD. You should remain engaged with your primary care clinician. Some questions you can ask your primary care clinician, if you have not discussed them with anyone, are as follows:
Do I need a referral to a nephrologist?
If I am seeing a nephrologist, how will the both of you remain updated on my condition?
What changes or symptoms do I need to watch for and tell you about?
Do I need any new treatments? If so, what are my options?
When and how should I prepare for any new treatments?
If you have stage 4 CKD, your primary clinician can refer you to a nephrologist, also known as a kidney doctor. A nephrologist is a doctor who has advanced training in treating kidney disease. There are also other members of a nephrology healthcare team, including a nephrology nurse, nephrology advanced practitioner, renal dietitian, and a nephrology social worker. These members of the healthcare team also have specialized training in kidney disease. Some questions you can ask a nephrology clinician include:
What is wrong with my kidneys?
How severe is my kidney disease?
What can I do about it?
Should I visit a transplant center for an evaluation?
What are my other treatment options?
When and how should I prepare for treatment?
How will both you and my primary care clinician stay updated on my condition?
Coping With Emotions And Finding Support
Living with any chronic disease such as CKD can emotionally challenging. Learning about a new diagnosis is also hard. It is very common to feel sad, scared, frustrated or angry. Having people to turn to for support can be a great help. Do not be afraid to tell others what you are feeling and to ask for help and support when needed. Different kinds of people can give emotional support. They can be family and friends, a co-worker, a spiritual mentor, or members of your healthcare team.
Chronic diseases such as CKD can also bring physical challenges, so, don’t be afraid to seek assistance from family or friends; they want to help.
You can speak to someone who is living with the same disease. They can share their experiences and offer advice from a shared perspective . You can ask your healthcare team for help finding peer support or contact an organization such as the National Kidney Foundation , or ).
Online communities are also available for people to share their experiences, ask questions and get answers:
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Definition And Ascertainment Of Exposure And Outcome Variables
The origin for time-to-event analyses was defined as the date of the first nephrology clinic visit. The interim exposure variable of interest was progression to Stage 4 CKD during the follow-up period defined by two or more consecutive eGFR values <30 mL/min/1.73 m2 with the date of the second reading taken as date of progression to Stage 4 CKD. In comparison with the number of patients who progressed to Stage 4 , we determined the number of patients with an eGFR decline of 57% or more from baseline on two or more consecutive measurements. An eGFR decline of 57% is equivalent to a doubling of serum creatinine, which is an accepted surrogate outcome in clinical trials.
The primary outcomes of interest included death, first AKI hospitalization and first all-cause hospitalization prior to ESRD. We considered AKI hospitalization to include the first admission with an AKI code as a primary or secondary diagnosis. We ascertained the first all-cause hospitalization over the follow-up period without restriction on the reason for hospitalization or length of stay. ESRD was defined as the need for chronic renal replacement therapy . In a secondary analysis, we partitioned all-cause hospitalization, whether associated with AKI or not, into those with or without a primary or secondary CV diagnostic code , henceforth referred to as CV-related hospitalization and non-CV-related hospitalization, respectively.
What Medications Are Prescribed For People With Chronic Kidney Disease
Depending on the cause of your kidney disease, you may be prescribed one or more medications. Medications your nephrologist may prescribe include:
- An angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker to lower your blood pressure.
- A diuretic to help your body eliminate extra fluid.
- Medications to lower cholesterol levels.
- Erythropoetin, to build red blood cells if you are anemic.
- Vitamin D and calcitrol to prevent bone loss.
- Phosphate binder if your kidneys cant eliminate phosphate.
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How To Treat Kidney Disease In Dogs
Once a dog is in stages 3 or 4 of kidney failure, about 70%-75% of the function is already lost, and in most cases, is gone for good. Because chronic disease cant be cured, treatment is aimed at supportive care and treating failures secondary effects. Some common secondary issues dogs can suffer from with kidney disease include anemia, hyperphosphatemia , hypokalemia , dehydration, nausea or vomiting, urinary tract infections, and anorexia. By addressing these concerns, this dogs can buy some time and live out a more comfortable and happy life.
Treatment guidelines for chronic kidney disease are based on the IRIS guidelines.
- Use drugs with side effects concerning the kidneys with caution. These include NSAIDs and some antibiotics.
- Increased fluid intake to correct dehydration and to prevent dehydration. This includes keeping several sources of freshwater available at all times, adding water to food, or feeding more of a wet food diet than dry.
- Treat underlying urinary tract infections if present.
- Monitor bloodwork changes and trends with regular bloodwork and urine tests.
- Treat secondary effects of kidney disease. Most dogs arent clinically ill at this stage, but they may have changes such as high blood pressure, high blood phosphorus, or protein leaking into the urine.
- All the same steps as in Stage 1.
- Start a specific diet.
Can Chronic Kidney Disease Be Prevented
Chronic kidney disease cannot be prevented in most situations. The patient may be able to protect their kidneys from damage, or slow the progression of the disease by controlling their underlying conditions such as diabetes mellitus and high blood pressure.
- Kidney disease is usually advanced by the time symptoms appear. If a patient is at high risk of developing chronic kidney disease, they should see their doctor as recommended for screening tests.
- If a patient has a chronic condition such as diabetes, high blood pressure, or high cholesterol, they should follow the treatment recommendations of their health care practitioner. The patient should see their health care practitioner regularly for monitoring. Aggressive treatment of these diseases is essential.
- The patient should avoid exposure to drugs especially NSAIDs , chemicals, and other toxic substances as much as possible.
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Dog Kidney Failure Stages
The;International Renal Interest Society ;has developed guidelines to help us better understand chronic disease, the diagnosis of this disease, the stages of this disease, and the best course of treatment and management based on the stage. These stages are based on tests such as blood creatinine levels, the SDMA test, blood pressure, and the level of proteinuria .
There are 4 stages of chronic kidney disease according to the IRIS guidelines.
Control Other Health Problems
You may have other disorders, such as diabetes and high blood pressure, which can damage your kidneys. One of the goals of your treatment is to make sure these are well-controlled. Ask your healthcare professional what you can do to keep these conditions under control – and do it! Some of the things your healthcare professional may ask you to do:
- Take medications called angiotensin converting enzyme inhibitors or angiotensin receptor blockers as part of your therapy. Studies have shown that these medications help to protect your kidney function. You may also need other blood pressure medications to control your blood pressure.
- Lose weight if you are overweight
- Cut down on salt in your diet to control blood pressure
- If you have diabetes, monitor your blood sugar, follow your diet and take your medications as prescribed
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Questions To Ask Your Doctor
Managing your phosphorus is one of many things your doctor might talk about when you are diagnosed with kidney disease.
Here are some questions you can bring with you to your appointment to ask your nephrologist:
- Do I need to worry about my phosphorus level at my stage of kidney disease?
- What should my phosphorus levels be?
- How often should I have my phosphorus blood levels checked?
- When should I start thinking about limiting the phosphorus in my diet?
- Should I take phosphate binders?
- Are there different types of phosphate binders?
- Which binder should I take?
- When do I need to take my phosphate binders? Before I eat a meal, after, or during?
- How often do I need to take phosphate binders?
- How many phosphate binders should I take?
- Would you recommend any other medicines?
- Can exercise help lower my phosphorus?
- Will dialysis remove any phosphorus?
- What happens if my phosphorus is not controlled? What symptoms should I look out for?
Albuminuria And Prognosis Of Stage 4 Kidney Disease
Besides GFR variable, doctors may also look for other variables such as albumin.
Albuminis a protein found in your blood, which is required by the body to supportseveral body functions. For examples its necessary to help repair bodystissues, protect the body from infection, and build muscles.
So wecan say there is nothing wrong of albuminuria in the body as long as its inthe blood. But the story is different when its found in the urine.
Albuminin the urine could be a signal that thekidneys dont work as well as normal ones. How severe the problem is going tobe is equivalent to the amount of albumin found in your urine.
Moreamounts of albumin in the urine mean more likely for the kidneys with CKD toturn serious or progress to a failure, see the table below !
Colorson the table above represent the risk for the progression of chronic kidneydisease to turn into a failure! They are as follows:
Thetable suggests that abnormal level of albumin in the urine is common in stage 4kidney disease. And the risk for the disease to become kidney failure increasesdrastically when albuminuria is 300 mg /g or higher .
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Signs To Watch Out For
While cats with chronic kidney disease can live for years while undergoing treatment, there may come a point where their kidneys have become too damaged to keep them stable. When this happens, you might observe a few symptoms that are different from the minor ones your cat was displaying before.
What Does Early Kidney Disease Do To My Bones
As you read above, you need healthy kidneys to keep healthy bones. When you have kidney disease your bones are also at risk.
In the very early stages of CKD, you will probably not have any problems with how your body controls your phosphorus. However, if your kidney disease gets worse, you may also start to have problems controlling your phosphorus.
Talk to your doctor about what your phosphorus levels should be. Learn about the tests and symptoms of bone disease here
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Study Cohort Characteristics And Event Rates
The 1607 subjects with Stage 3 CKD had a mean age of 69 years and mean eGFR of 43 mL/min/1.73 m2 with baseline characteristics and comorbid illnesses presented in Table;. Over a median follow-up time of 2.66 years , there were 344 patients who progressed to Stage 4 CKD, 68 who developed a 57% decline in eGFR and 47 who developed ESRD. The number of available creatinine values and the time between measurements were similar between subjects who did and did not progress . Among the 344 patients who progressed to Stage 4 CKD, 57 were Stage 3A and 287 were Stage 3B at baseline. At the time of last follow-up, the mean eGFR in patients who progressed to Stage 4 CKD was 24 compared with 46 mL/min/1.73 m2 in those who did not progress. During the same time period, 188 patients died, 143 were hospitalized with AKI and 688 were hospitalized for any reason prior to ESRD. The unadjusted rates per 100 patient-years of death, AKI hospitalization and all-cause hospitalization prior to ESRD were higher in patients who progressed to Stage 4 CKD when compared with patients who did not progress .
Rates of mortality and hospitalization. The rate per 100 patient-years in all patients, those who progressed to Stage 4 CKD and those who did not for each outcome prior to ESRD is depicted. AKI, acute kidney injury; ESRD, end-stage renal disease.
What Is The Treatment And Management Of Chronic Kidney Disease
There is no cure for chronic kidney disease. The four goals of therapy are to:
Strategies for slowing progression and treating conditions underlying chronic kidney disease include the following:
- Control of blood glucose: Maintaining good control of diabetes is critical. People with diabetes who do not control their blood glucose have a much higher risk of all complications of diabetes, including chronic kidney disease.
- Control of high blood pressure: This also slows progression of chronic kidney disease. It is recommended to keep blood pressure below 130/80 mm Hg if one has kidney disease. It is often useful to monitor blood pressure at home. Blood pressure medications known as angiotensin converting enzyme inhibitors or angiotensin receptor blockers have special benefit in protecting the kidneys.
- Diet: Diet control is essential to slowing progression of chronic kidney disease and should be done in close consultation with a health care practitioner and a dietitian. For some general guidelines, see the Chronic Kidney Disease Self-Care at Home section of this article.
The complications of chronic kidney disease may require medical treatment.
- Allergic reactions
Diuretics also may cause a decline in kidney function especially if fluid is removed rapidly from the body.
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