What Makes Kidney Function Low

Correction Of Phosphate Balance

If you have stage four or five kidney disease, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it. Phosphate is a mineral that, with calcium, makes up most of your bones. Phosphate is obtained through diet, mainly dairy foods. The kidneys usually filter out excess phosphate. If phosphate levels rise too much, it can upset the normal calcium balance of the body. This can lead to thinning of the bones and furring of the arteries.

You may be asked to limit the amount of phosphate in your diet. Foods high in phosphate include red meat, dairy produce, eggs and fish. Your GP or dietitian should be able to advise you about how much phosphate you can eat. However, there is no advantage in reducing your intake of these foods unless you have a raised phosphate level. Always ask a healthcare professional before changing your diet.

If reducing the amount of phosphate in your diet does not lower your phosphate level enough, you may be given medicines called phosphate binders. These medicines bind to the phosphate in the food inside your stomach and stop it from being absorbed into your body.

To work properly, phosphate binders must be taken just before meals. The most commonly used phosphate binder is calcium carbonate, but there are also alternatives that may be more suitable for you.

The side effects of phosphate binders are uncommon but include:

• nausea
• itchy skin

Can Kidney Disease Be Prevented

Seeing your healthcare provider on a regular basis throughout your life is a good start for preventing kidney disease. About one in every three people in the United States is at risk for kidney disease. Identify and manage any risk factors for developing kidney disease.

• Control your high blood pressure. Normal blood pressure is 120/80.
• Control your blood sugar if you have diabetes.
• Eat a healthy diet. Follow a low-fat, low-salt diet.
• Dont smoke.
• Be active for 30 minutes at least five days a week.
• Maintain a healthy weight.
• Take nonprescription pain relievers only as directed. Taking more than directed can damage your kidneys.

Topics & Points To Cover

• Kidneys have other jobs besides making urine. At this stage, they can’t function as well.
• Gradual/adaptation into symptoms you may feel fine
• Different for everyone – important to know your lab test results, including eGFR and urine albumin values
• Possible symptoms of decreasing kidney function and why they occur later
• There is no change in urine volume or kidney pain
• Fatigue or weakness
• Bad taste in the mouth/food doesn’t taste good
• Feel cold
• Cramping in hands and legs
• Nausea and vomiting

Complications – basic explanation and treatment

Anemia*

May feel tired or weak

Erythropoietin deficiency

May need erythropoiesis stimulating agent

LABS: hemoglobin

Too much phosphorus in the blood

May need phosphorus binding med with meals

LABS: Phosphorus, calcium, VitaminD, iPTH

Malnutrition

May have bad taste in mouth

Poor appetite

Harder to care for self

Fluid overload

May be seen as weight gain, swelling, or shortness of breath

Kidneys may not remove fluid well

Rarely need fluid restriction

Use less salt, take water pills

Metabolic acidosis

Kidneys not removing acid in the blood

May need medication with bicarbonate

LABS: bicarbonate

Fear, grieving with loss of body function

It is OK to talk about it

Sexual complications

Discuss concerns with your doctor

Know how your medications work. Know which medications you can continue taking . Talk with your pharmacist and provider about:

Timing of medication use

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What Is Renal Failure

Renal failure refers to temporary or permanent damage to the kidneys that results in loss of normal kidney function. There are two different types of renal failure: acute and chronic. Acute renal failure has an abrupt onset and is potentially reversible. Chronic renal failure progresses slowly over at least three months and can lead to permanent renal failure. The causes, symptoms, treatments, and outcomes of acute and chronic are different.

Kidney Failure Life Expectancy

Its not possible to know exactly how long a person with kidney failure will live. Every person with kidney failure is different.

In general, the National Kidney Foundation says that a person on dialysis can expect to live for an average of 5 to 10 years as long as they follow their treatment. Some people live for more than 20 or 30 years.

Factors that can play a role in life expectancy include your:

• age
• stage of kidney disease
• other coexisting conditions

Once you reach end stage kidney failure, you will need dialysis or a kidney transplant to live. Missing even one dialysis treatment can decrease your life expectancy.

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Can I Be Active With Kidney Failure

Yes. Physical activity is an important part of staying healthy when you have kidney failure. Being active makes your muscles, bones, and heart stronger. Physical activity also makes your blood travel through your body faster so your body gets more oxygen. Your body needs oxygen to use the energy from food.

You may find that physical activity can also improve your mood and make you feel better.

Talk with your doctor before you start a new exercise routine. Start slowly, with easier activities such as walking at a normal pace or gardening. Work up to harder activities such as walking briskly. Aim to be active on as many days as possible.

Why Do I Need A Gfr Test

Early stage kidney disease doesnt usually cause symptoms. But you may need a GFR test if you are at higher risk of getting kidney disease. Risk factors include:

• Diabetes
• Family history of kidney failure

Later stage kidney disease does cause symptoms. So you may need a GFR test if you have any of the following symptoms:

• Urinating more or less often than usual
• Loss of appetite

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Will Kidney Failure Affect My Sleep

People who have kidney failure may have trouble sleeping. Sleep loss can affect your quality of life, energy level, and mood. Restless leg syndrome, sleep apnea, pain, or itching may make it hard for you to sleep.

You can take a number of steps to improve your sleep habits. For example, physical activity during the day and a warm bath before bed may help you sleep better at night. Avoid caffeine after lunchtime. Avoid alcoholic drinks before bed. Avoid smoking.

Talk with your health care provider if you often feel sleepy during the day or have trouble sleeping at night. Health care providers can treat sleep disorders such as sleep apnea or restless leg syndrome.

How Does Ckd Affect Other Nutrients

A person with CKD may be less tolerant of high sodium levels in their body. A high sodium diet can cause a large amount of fluid in the body, which can result in symptoms of swelling or shortness of breath. Doctors typically use drugs called diuretics to treat these symptoms.

People with CKD also tend to retain more hydrogen in their body.

In the body, hydrogen ions act as acids. If the kidneys are not working properly, there will be higher levels of hydrogen ions in the body. Doctors refer to this as metabolic acidosis. Individuals with metabolic acidosis may require bicarbonate supplements.

The inability of the kidneys to filter blood effectively can result in higher levels of phosphate and lower levels of calcium. This imbalance can cause bone weakness and increase the risk of heart disease and stroke.

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What Will The Doctors Do Then

Find out the cause of your CKD and treat it if possible

Work with you to make important choices on how to manage your condition

Discuss possible lifestyle changes and medication that may relieve symptoms and slow the CKD progression

Assess and reduce your risk of heart disease and strokes

Try to relieve any symptoms

Treat any complications such as anaemia and mineral changes

Stage 5gfr Of 15 Ml/min Or Less

Patients at Stage 5 have chronic CKD. They have a GFR of 15 mL/min or less and have End Stage Renal Disease .The kidneys have lost almost all ability to function effectively at this stage. They will need dialysis or a kidney transplant to live.

Our kidney specialists can work with you to provide individualized evaluation and treatment, taking into consideration your GFR and other factors. To learn more or schedule an appointment at one of our clinics call 412-802-3043 or toll free 1-800-533-UPMC .

You should discuss this result with your kidney specialist.

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Nutrition And Low Kidney Function

Food is what our bodies use for growth, homeostasis, and healing. This is why its important for you to consult with a dietician who is knowledgeable about kidney disease. Youll need to find and maintain a balance between the levels of electrolytes, minerals, and fluid in your body.

A modified diet for chronic kidney disease may include adjustments to your intake of the following food items:

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S To Keeping Your Kidneys Healthy

Start by asking your doctor for blood panel readings of your BUN and creatinine levels and your eGFR numbers.

Test
Kidney damage	Greater than 60 mg/min

Scores from these tests tell you how strong your kidneys are now. Because kidney diseases can be symptom-free, you may not notice anything wrong before youve suffered irreparable damage. To prevent getting in that situation, I advise you to:

Drink lots of water. This is the most important step in keeping your kidneys strong. At a minimum, I recommend you drink one-half ounce of water for every pound you weight, so a 200 pound man would drink 100 ounces of water every day. That may sound like a lot, but its really just ten 12oz glasses a dayabout one 12 oz glass every two hours. Drink more after strenuous exercise or if you live in a dry climate.

Take daily probiotics. Probiotics help your kidneys process waste materials and contribute to overall digestive health. A recent clinical trial involving patients with chronic kidney disease found that the group taking probiotics improved kidney function test scores as well as overall quality of life.

Drink green juice. Green foods aid in detoxification. I juice cilantro, a kidney-friendly herb, with water, lemon juice, and honey. If you dont juice, a greens supplement is a good alternative.

Eat kidney-supportive foods, in addition to cilantro and its relative parsley, try these:

Watermelon

Stop smoking or other uses of tobacco. The toxins damage your kidneys.

Medications For High Blood Pressure

One of the main ways to reduce the progression of kidney damage is to manage high blood pressure. Good control of blood pressure is vital to protect the kidneys.

People with CKD should aim to get their blood pressure down to below 140/90mmHg but if you also have diabetes you should aim to get it down to below 130/80mmHg.

There are many types of blood pressure drugs. Medicines called angiotensin converting enzyme inhibitors are used to control high blood pressure in people with CKD.

As well as reducing blood pressure around the body and reducing the strain on blood vessels, ACE inhibitors give additional protection to the kidney.

ACE inhibitors include:

Side effects of ACE inhibitors include:

• a persistent, dry cough
• tiredness or weakness
• headaches

Most of these side effects should pass within a few days, although some people continue to have a dry cough.

If the side effects of ACE inhibitors are particularly troublesome, you can be given an alternative medication called an angiotensin-II receptor blocker . This group of medicines includes:

• candesartan
• losartan

The side effects of ARBs are uncommon, but can include dizziness.

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Become Your Own Expert

Many kidney patients choose to take an active role in their care and treatment. You can too by logging on to the PatientView website, where you may be able to keep track of all your medications, test results, scans and medical letters. You may also be able to see your medical history and get information about a wide range of tests .

You need to be referred to Patient View by your kidney unit so make sure you ask them to do this.

• For more ways to take control of your kidney disease visit our How can I help myself? section.

And for further information about kidney tests visit:

What Is Peritoneal Dialysis

Peritoneal dialysis uses the lining of the abdominal cavity as the dialysis filter to rid the body of waste and to balance electrolyte levels. A catheter is placed in the abdominal cavity through the abdominal wall by a surgeon, and it is expected to remain in place for the long term. The dialysis solution is then dripped in through the catheter and left in the abdominal cavity for a few hours after which, it is drained out. During that time, waste products leech from the blood flowing through the lining of the abdomen and attach themselves to the fluid that has been instilled by the catheters. Often, patients instill the dialysate fluid before bedtime and drain it in the morning.

There are benefits and complications for each type of dialysis. Not every patient can choose which type he or she would prefer. The treatment decision depends on the patient’s illness and their past medical history along with other issues. Usually, the nephrologist will have a long discussion with the patient and family to decide what will be the best option available.

Dialysis is lifesaving. Without it, patients whose kidneys no longer function would die relatively quickly due to electrolyte abnormalities and the buildup of toxins in the bloodstream. Patients may live many years with dialysis but other underlying and associated illnesses often are the cause of death.

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Signs Of Kidney Disease

You’re more tired, have less energy or are having trouble concentrating. A severe decrease in kidney function can lead to a buildup of toxins and impurities in the blood. This can cause people to feel tired, weak and can make it hard to concentrate. Another complication of kidney disease is anemia, which can cause weakness and fatigue.

You’re having trouble sleeping. When the kidneys aren’t filtering properly, toxins stay in the blood rather than leaving the body through the urine. This can make it difficult to sleep. There is also a link between obesity and chronic kidney disease, and sleep apnea is more common in those with chronic kidney disease, compared with the general population.

You have dry and itchy skin. Healthy kidneys do many important jobs. They remove wastes and extra fluid from your body, help make red blood cells, help keep bones strong and work to maintain the right amount of minerals in your blood.Dry and itchy skin can be a sign of the mineral and bone disease that often accompanies advanced kidney disease, when the kidneys are no longer able to keep the right balance of minerals and nutrients in your blood.

You feel the need to urinate more often. If you feel the need to urinate more often, especially at night, this can be a sign of kidney disease. When the kidneys filters are damaged, it can cause an increase in the urge to urinate. Sometimes this can also be a sign of a urinary infection or enlarged prostate in men.

Live Well With Chronic Kidney Disease

Taking an active role to manage your CKD will help you feel better and improve your overall well-being.

Taking an active role in managing your chronic kidney disease can improve your overall well-being. Learn what you can do to feel your best.

Kidneys that work properly are critical to keeping you healthy. If you have CKD, your kidneys cant filter blood as well as they should, and this can lead to other health problems, such as heart disease and stroke.

While its not possible to reverse kidney damage, you can take steps to slow it down. Taking prescribed medicine, being physically active, and eating well will help. Youll also feel better and improve your overall well-being.

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What Is The Prognosis And Life Expectancy For Kidney Failure Can It Be Prevented

The outlook for kidney failure depends upon the underlying condition that caused it. Kidney function may return to normal, especially if it is due to an acute obstruction and that obstruction is relieved. Other causes of decreased kidney function leading to kidney failure are due to underlying disease and occur slowly over time.

Prevention is the best chance to maintain kidney function, and controlling high blood pressure and diabetes over a lifetime can decrease the potential for progressive kidney damage. Chronic kidney failure may be managed to help monitor electrolyte and waste product levels in the bloodstream. Major abnormalities can be life-threatening, and treatment options may be limited to dialysis or transplant.

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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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