Download Are You At Increased Risk for Chronic Kidney Disease

Living Well With Kidney Disease
INTRODUCTION
Established in 1995, National Renal Care (―NRC‖) is the largest private renal therapy provider in
South Africa that has a national network of units with a presence in every major centre
throughout the country.
A Total Kidney Disease Management philosophy has been adopted throughout the
organisation‘s network of units which ensures the delivery of consistent, high quality, holistic
care to patients
In addition to providing the full range of dialysis treatments, NRC offers a range of services that
add measurable value to the patient. NRC‘s ―Living Well with Kidney Disease‖ programme
includes:
Early detection and management of kidney disease via the NRC Healthy Start
Programme®
Nutritional education and guidelines
Anemia management
Patient education and support
This booklet is designed to provide you and your significant others with the necessary
information to help you understand the kidney and kidney disease.
National Renal Care is there to be your guide. It is our mission to help kidney patients and their
families to deal with the physical, emotional and social impact of kidney disease. We want to
help you achieve the best possible quality of life.
Use this booklet to inform your family, friends and employer about kidney failure and dialysis.
Healthy Start Programme - Healthy Start Clinic®
The Healthy Start Programme - Healthy Start Clinic® is unique to National Renal Care in this
country. The primary function of this program is to educate and manage patients with early
kidney disease. The aim is to ensure that the patient remains as healthy as possible and
maintains a high quality of life. Preventative strategies include early detection and treatment,
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meticulous hypertension control, strict glycaemia control, anaemia management and
appropriate dietary and lifestyle changes. All our centers countrywide offer this program, which
include education, dietary advice and psychosocial support.
NATIONAL RENAL CARE UNITS
PROVINCE
UNIT NAME
EASTERN CAPE
EASTERN CAPE
EASTERN CAPE
EASTERN CAPE
EASTERN CAPE
EASTERN CAPE
EASTERN CAPE
EASTERN CAPE
EASTERN CAPE
EASTERN CAPE
EASTERN CAPE
EASTERN CAPE
EASTERN CAPE
Butterworth
Cuyler Clinic / Uitenhage
East London Acutes
East London HD
East London PD
Healthy Start
King Williamstown
Kwadessie
Mthatha
Port Elizabeth Acutes
Port Elizabeth HD
Port Elizabeth PD
Queenstown
FREE-STATE
FREE-STATE
FREE-STATE
FREE-STATE
Bloemfontein
Healthy Start
Kroonstad
PD
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
GAUTENG CENTRAL
Daxina
Garden City HD
Garden City PD
Gauteng Acutes
Healthy Start
HEAD OFFICE
Krugersdorp
Lenmed
Linksfield
Milpark
Mulbarton
Olivedale
Sunninghill
Sunninghill Healthy Start
Union
West Rand Healthy Start
TELEPHONE
(047) 491 3353
(041) 922 9551
(043) 722 1066
(043) 722 1066 / 1071
(043) 722 9016
082 491 2462
(043) 642 6162
(041) 485 5222
(047) 532 2112
(041) 374 5562
(041) 374 5562
(041) 374 9688
(045) 838 1450
(051) 444 5495
078 722 7443
(056) 215 1881
(051) 444 5495
(011) 213 7051
(011) 495 5376/7
(011) 495 5195
(011) 726 5206
082 576 6180
(011) 726 5206
(011) 954 5003
(011) 854 9784
(011) 647 3525
(011) 482 4194
(011) 432 1306
(011) 777 2090
(011) 806 1941/2/3
071 686 6337
(011) 869 2871
082 379 2663
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GAUTENG NORTH EAST
GAUTENG NORTH EAST
GAUTENG NORTH EAST
GAUTENG NORTH EAST
GAUTENG NORTH EAST
GAUTENG NORTH EAST
GAUTENG NORTH EAST
GAUTENG NORTH EAST
GAUTENG NORTH EAST
GAUTENG NORTH EAST
GAUTENG NORTH EAST
Akasia
Benoni
East Rand Healthy Start
Healthy Start
Jakaranda
Jakaranda PD
Montana
Northern Acutes
Pretoria East
Sunward Park
Unitas
(012) 522 1000
(011) 425 9127
082 771 8236
(012) 421 6735 / 6788
(012) 343 2606
(012) 421 6768
(012) 548 7468
(012) 664 3457
(012) 422 2699
(011) 897 1748
(012) 664 3789 / 3902
KWA-ZULU NATAL
KWA-ZULU NATAL
KWA-ZULU NATAL
KWA-ZULU NATAL
KWA-ZULU NATAL
KWA-ZULU NATAL
KWA-ZULU NATAL
KWA-ZULU NATAL
KWA-ZULU NATAL
KWA-ZULU NATAL
KWA-ZULU NATAL
KWA-ZULU NATAL
KWA-ZULU NATAL
KWA-ZULU NATAL
KWA-ZULU NATAL
Alberlito
Ascot Park / City Hospital
Chatsworth
Crompton
Healthy Start
Isipingo Renal Unit
Ladysmith
Margate
Midlands Medical Centre
Natal Acutes
Richardsbay
St Annes
St Augustines HD
St Augustines PD
Umhlanga
(032) 946 1400
(031) 309 4586
(031) 404 7939
(031) 702 6683
079 528 9715
(031) 902 5335
(036) 631 4400
(039) 317 3981
(033) 342 1112
082 574 3665
(035) 780 6307
(033) 345 0878
(031) 268 5133/4/5
(031) 201 6307
(031) 582 5406
LIMPOPO
Venda
(015) 962 6333
MPUMALANGA
Nelspruit
(013) 755 3446
NORTH WEST
NORTH WEST
Ferncrest HD
Ferncrest Acutes
(014) 565 2458
(014) 565 2458
NORTHERN CAPE
Curomed (Kimberley)
(053) 831 7046
WESTERN CAPE
WESTERN CAPE
WESTERN CAPE
WESTERN CAPE
WESTERN CAPE
WESTERN CAPE
WESTERN CAPE
WESTERN CAPE
WESTERN CAPE
WESTERN CAPE
Blaauwberg
Cape Acutes
Christiaan Barnard Memorial
George
Healthy Start
Kuilsrivier
Mitchell's Plain
N1 City
Paarl
PD House Cape Town
(021) 554 9096
082 574 1629
(021) 480 6276
(044) 873 3893
(021) 691 4676
(021) 900 6500
(021) 392 3126 x 2080
(021) 590 4016 / 24
(021) 872 0852
(021) 591 8689
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WESTERN CAPE
WESTERN CAPE
WESTERN CAPE
WESTERN CAPE
Plettenburg Bay
South Peninsula
Swellendam
Vredenburg
(044) 533 6493
(021) 762 6191
(028) 514 2497
(022) 709 7264
KIDNEYS: WHAT ARE THEY?
Healthy Kidneys
The healthy balance of our body‘s chemistry is due in large part to the work of two organs, the
kidneys.
The kidneys are a pair of bean - shaped organs located at the back of the body about the level
of the waist. Each kidney measures 10-15 cm in length and weighs approximately 160 grams.
The entire body‘s blood supply circulates through the kidneys every two minutes. Inside each
kidney are approximately one million tiny units called nephrons. Nephrons filter and remove the
excess fluid and waste products from the blood. The excess fluid and waste products filtered out
of the kidneys are excreted as urine, which travel through tubes called ureters into the bladder.
The bladder is the storage sack for urine. Urine is eventually carried from the body through the
urethra, a tube-like structure leading to the opening from which you urinate.
Each day the two kidneys excrete about 1-2 liters of urine.
Function of the Kidneys
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The kidneys perform the vital job of cleaning the blood of waste products and removing
excess fluid i.e. filtering the blood.
The other functions of the kidney are to maintain the body's balance of various salts such
as sodium, potassium, calcium, phosphate as well as acid.
They release hormones, which influence the bone structure (Vitamin D), the generation
of red blood cells (erythropoietin) and the regulation of blood pressure. (Help remove
waste and excess fluid.)
o Filter the blood, keeping some compounds while removing others
o Control the production of red blood cells
o Make vitamins that control growth
o Release hormones that help regulate blood pressure
Help regulate the amount of certain nutrients in the body, such as calcium and potassium
Kidney Failure
Kidney failure occurs when the kidneys stop working or the level of efficiency is less than 10%.
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When the kidney function deteriorates, the waste products and excess fluid remain in the body.
These waste products and fluids are toxic in large quantities and their accumulation will
eventually lead to nausea, headaches and dizziness.
Your skin may begin to itch and various parts of your body may swell as a result of fluid
retention. This retention of fluid called oedema, will lead to an increase in body weight, resulting
in high blood pressure and respiratory problems.
Kidney failure can lead to blood deficiency (anemia) and hungry bones.
Acute kidney failure occurs when the kidneys suddenly stop working. This condition may be
temporary. Acute renal failure can lead to chronic kidney failure. The cause may be disease,
injury, major surgery or toxic agents.
Chronic kidney failure can develops gradually over a period of time. This is not reversible.
Kidney function never returns.
Causes of Kidney Failure
Chronic kidney disease is a major health problem with the incidence steadily growing over the
last few years. The commonest causes of kidney failure are diabetes mellitus and hypertension,
which are also independent risk factors for cardiovascular disease.
Individuals at risk for chronic kidney disease include family members of patients with end stage
kidney disease. Family members of chronic kidney disease patients are often unaware of
existing renal disease.
Other causes:
Other diseases that can damage kidneys include:
Glomerulonephritis e.g. IgA Nephropathy
S.L.E. (Systemic Lupus Erythematosus)
With these diseases the immune system overacts and inflammation occurs in the kidneys. To
slow the disease process, a doctor may prescribe steroids and other medications.
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Frequent infections
Genetic abnormalities
Analgesic abuse
Family history
Symptoms of Renal Failure
Early on, there may be no symptoms to indicate that the kidneys are not functioning properly.
That is why regular physicals, with blood tests and urine tests, are so important.
Uremia is the medical term to describe symptoms when the kidneys no longer work. When
waste products build up in the blood stream you may feel sick due to the symptoms of uremia.
Symptoms caused by a build-up of waste products in the body include:
Headache
A metallic taste in the mouth or ammonia breath
Trouble sleeping
Muscle cramping at night
Drowsiness
Nausea and vomiting
Loss of appetite. Protein aversion (no longer wanting to eat meat)
Difficulty concentrating
Itching (pruritis)
Symptoms caused by a build-up of fluid in the body include:
Swelling in the face, feet or hands, puffiness around the eyes.
Shortness of breath (due to fluid in the lungs)
Symptoms caused by damage to the kidneys include:
High blood pressure
Making more or less urine than usual. (Feeling pressure when urinating)
Need to urinate more often, especially at night
Urine that is foamy or bubbly (may be seen when protein is in the urine)
Blood in the urine (typically only seen through a microscope)
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Back or flank pain
Symptoms caused by anemia (a shortage of red blood cells) include:
Feeling tired – have less energy
Weakness
Feeling cold all the time
Decreased sexual interest
Shortness of breath
Mental confusion
Desire to chew ice
WHAT ARE THE STAGES OF CHRONIC KIDNEY DISEASE?
Pre-End stage kidney disease is the time between the diagnosis of a kidney disease until the
time you begin treatment with either dialysis or a transplant. Luckily this period often progresses
slowly, over a period of years. This is good news because, if kidney failure is caught early,
medications and lifestyle changes may help slow its progress and keep you feeling your best for
as long as possible. With early diagnosis, it may be possible to slow; stop, or even reverse
kidney disease, depending on the cause. In the table below, the "GFR level," or Glomerular
Filtration Rate (GFR), is a measure of how well your kidneys are cleaning your blood. We can
calculate your GFR, based on a formula.
Stages of Chronic Kidney Disease
Stage
Description
Normal kidney function
Healthy kidneys
90 mL/min or more
Stage 1
90 mL/min or more
Stage 3
Kidney damage with normal or high
GFR
Kidney damage and mild decrease
in GFR
Moderate decrease in GFR
Stage 4
Severe decrease in GFR
Stage 5
Kidney failure
Stage 2
GFR Level
60 to 89 mL/min
30 to 59 mL/min
15 to 29 mL/min
Less than 15 mL/min or on
dialysis
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Stage 1 and 2 may present with the following symptoms:
High blood pressure
Higher than normal levels of creatinine or urea in the blood
Blood or protein in the urine
Evidence of kidney damage in an MRI, CT scan, ultrasound, or contrast X-ray
A family history of polycystic kidney disease
Stage 3:
Anemia (a shortage of red blood cells)
And/or early bone disease may appear
Stage 4:
It‘s time to prepare for dialysis and/or a kidney transplant.
Remember: Managing illness early is much better for your health and much better for you than
waiting until your kidneys have stopped functioning. When it comes to kidney disease, most
patients prefer to have as little disruption to their lifestyle as possible; they must feel that they
have some control to this situation.
WAYS TO MAINTAIN YOUR KIDNEY HEALTH:
Early detection and treatment can often slow down the progression of the disease or stop
chronic kidney disease.
Eat right and lose excess weight
Learn about symptoms of kidney disease
Exercise regularly
Don‘t smoke
Avoid excess salt in your diet
Avoid medication that can be harmful to your kidneys (painkillers)
Control high blood pressure
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Control diabetes
Visit your Doctor regularly
Follow your doctor‘s advice
Visit The NRC Healthy Start clinic to learn about your condition
Talk with your health care team
Blood pressure control
Your kidneys play a role in keeping your blood pressure in a healthy range and blood pressure
in turn, can affect the health of your kidneys. Lifestyle changes such as losing weight,
exercising, eating less salt and drinking less alcohol can help lower your blood pressure.
What is high blood pressure?
Blood pressure measures the force of blood against the walls of your blood vessels. Blood
pressure that remains high over time is called hypertension. Extra fluid in your body increases
the amount of fluid in your blood vessels and makes your blood pressure higher. Narrow or
clogged blood vessels also raise blood pressure. If you have high blood pressure, see your
doctor regularly. High blood pressure makes your heart work harder and, over time can damage
blood vessels throughout your body. High blood pressure is often one of the leading causes of
kidney failure.
Most people with high blood pressure have no symptoms. The only way to know whether your
blood pressure is high is to have it measured by a health professional. The result is expressed
as two numbers. The top number (Systolic) represents the pressure when your heart is beating.
The bottom number (diastolic) shows the pressure when your heart is resting between beats.
According to National Kidney Foundation (NKF) guidelines, you should strive to keep your blood
pressure at or below 130/85 if you have renal failure. If you have diabetes and/or proteinuria
too, their suggested target blood pressure is 125/75.
Patients with hypertension should take their medicine as directed by their doctor. Besides
controlling blood pressure, medications, such as ACE inhibitors and beta-blockers, can also
reduce the risk of kidney failure.
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Diabetes Management
Diabetes is the leading cause of kidney disease.
Diabetes mellitus, usually called diabetes or ‗sugar‖, is a condition that occurs when your body
does not make enough insulin or when your body cannot use normal amounts of insulin
properly.
Insulin is a hormone that regulates the amount of sugar in your blood. High blood glucose can
cause damage to many parts of your body, especially your kidneys, heart, eyes and nerves.
If you have diabetes you can care for your kidneys by controlling your blood sugar and getting
regular micro albumin urine tests to see if you are spilling tiny amounts of protein. Even if you
develop diabetic kidney disease, you can work with your doctor to keep your kidneys working for
as long as possible.
Diabetic Nephropathy is a medical term for kidney disease. Diabetes can cause damage to the
filters in your kidneys over time. As more damage occurs, end stage kidney disease can
develop.
An early diagnosis of diabetes can help your doctor treat the condition before it does more
damage to your body.
Type 1 diabetes (also known as juvenile or insulin dependent diabetes) is easily diagnosed in its
early stages, before kidney damage occurs. However, Type 2 diabetes (also known as adultonset or non-insulin dependent diabetes) often goes undiagnosed for years. Many people who
have Type 2 diabetes do not realize it.
Because Type 2 diabetes may have been present for many years before it is diagnosed, the
high glucose (sugar) content in the blood has had time to damage the tiny blood vessels in the
kidneys. When these blood vessels are damaged, protein that is meant to remain in the body
can leak into the urine. This is a condition called microalbuminuria, and it is an early symptom of
kidney disease.
If you have been diagnosed with Type 1 or Type 2 diabetes, you should have a micro albumin
test done annually. This will help your doctor detect any kidney damage. If your urine test is
positive for albumin (a protein), steps can be taken to help prevent further damage to your
kidneys.
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Practice good blood glucose control
Talk to your doctor, and make sure you are doing all you can to control your sugar levels.
Because the high glucose content in your bloodstream can damage the kidneys, controlling the
level of glucose is an important step in keeping the kidneys healthy. This means, following the
plan your doctor recommends for treating your diabetes. If you have diabetes, strict controls of
your blood glucose levels can help slow the progression of kidney disease.
Keep your hemoglobin HBA1c, which measures blood glucose control over the last two
to three months, to less than 7%.
To reach this level of strict glycemic control, you will need to monitor your blood glucose
closely to avoid hypoglycemia.
You may need to use frequent insulin injections or an insulin pump. Talk to your doctor about
your diabetes treatment options. For Type 1 diabetics, getting regular insulin is crucial in
keeping glucose levels in check. For Type 2 diabetics, diet and exercise may be the primary
treatments for lowering blood sugar levels.
Your doctor may have you test your glucose levels throughout the day.
You may be referred to a dietitian, who can help you make healthier food choices. Lowering
your intake of sugar and refined carbohydrates is important, especially if you are insulin
resistant. Your doctor may also want you to lose excess weight.
Follow your doctor‘s instructions regarding medicines and testing your glucose levels. If the
levels are still too high, tell your doctor so adjustments can be made to your treatment program.
Control your blood pressure levels
Keep high blood pressure under control. This may involve losing weight, eating less salt, limiting
alcohol, avoiding tobacco, and taking prescribed medication.
If you are diabetic and have been diagnosed with high blood pressure (also known as
hypertension), your kidneys have a greater chance of becoming damaged. Patients with high
blood pressure and diabetes are more likely to develop nephropathy. This is because high blood
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pressure places added strain on the tiny blood vessels of the kidneys. Your doctor may
prescribe a medicine called an ACE inhibitor to bring down your blood pressure.
Keep healthy habits
If you have been diagnosed with diabetes, your doctor may ask that you stop certain activities
that could worsen your diabetes or lead to high blood pressure. Activities such as smoking and
drinking alcohol should be avoided.
Exercise is an excellent habit. Your doctor may recommend exercise as part of your treatment.
But before you start a program, ask your doctor if the activity may be right for you.
Commonly asked questions about diabetes:
1. Are some people more likely to get diabetic kidney disease?
Yes. The following risk factors have been linked to increased risk of developing this
disease: high blood pressure, poor glucose (sugar) control, inherited tendency and
diet.
2. I have diabetes. How do I know if my kidneys are affected?
In the early stages, there may not be any symptoms. As kidney function decreases
further, toxic wastes build up, and patients often feel sick to their stomachs and throw
up, lose their appetites, have hiccups and gain weight due to fluid retention. If left
untreated, patients can develop heart failure and fluid in their lungs.
3. Are there tests that can be done to tell if I have kidney disease?
Yes. The diagnosis is based on the presence of abnormal amounts of protein in the
urine. A wide variety of tests can be done to tell if a person has kidney disease. The
most widely used are serum creatinine and BUN (blood urea nitrogen). These are not
very sensitive tests because they do not begin to change until the patient develops
more severe disease. Other more sensitive tests are: creatinine clearance, Glomerular
filtration rate (GFR) and urine albumin.
In patients with Type I (juvenile-onset or insulin-dependent) diabetes, a diagnosis of
early kidney disease can be based on the presence of very small amounts of protein in
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the urine (microalbuminuria). Special methods are needed to measure these small
amounts of protein. When the amount of protein in the urine becomes large enough to
be detected by standard tests, the patient is said to have "clinical" diabetic kidney
disease.
4. How long does it take for kidneys to become affected?
Almost all patients with Type I diabetes develop some evidence of functional change in
the kidneys within two to five years of the diagnosis. About 30 to 40 percent progress
to more serious kidney disease, usually within about 10 to 30 years.
The course of Type II (adult-onset or non-insulin-dependent) diabetes is less well
defined, but it is believed to follow a similar course, except that it occurs at an older
age.
5. What can I do to prevent kidney disease?
There is evidence that careful control of glucose (sugar) helps to prevent kidney
disease in people with diabetes. You should follow your doctor's orders carefully
regarding diet and-medicines to help control your glucose levels.
6. If my kidneys are already affected, can I keep them from getting worse?
It may be possible to prevent or delay the progression of kidney disease. Since high
blood pressure is one of the major factors that predict which diabetics will develop
serious kidney disease, it is important to take your high blood pressure pills faithfully if
you do have high blood pressure. Your doctor may also recommend that you follow a
low-protein diet, which reduces the amount of work your kidneys have to do. You
should also continue to follow your diabetic diet and to take all your prescribed
medicines.
7. Are there any new treatments that can help me?
Yes. Some studies suggest that a group of high blood pressure medicines called ACE
inhibitors may help to prevent or delay the progression of diabetic kidney disease.
These drugs reduce blood pressure in your body, and they may lower the pressure
within the kidney's filtering apparatus (the glomerulus). They also seem to have
beneficial effects that are unrelated to changes in blood pressure. Patients who take
these medicines may have less protein in their urine. You may want to speak to your
doctor to see if these medicines could help you.
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8. How many people with diabetic kidney disease develop total kidney failure?
About 30 percent of the people with Type I diabetes and about 10 to 40 percent of the
people with Type II diabetes will eventually develop end-stage kidney failure, requiring
treatment to maintain life. Certain population groups, such as African Americans,
Hispanic Americans and Native Americans, have a higher risk of developing kidney
failure from Type II diabetes than Caucasian Americans.
9. If my kidneys do fail, what can I do?
If your kidneys fail, you can receive dialysis treatments or you may be a candidate for a
kidney transplant. Two types of dialysis treatment are available - hemodialysis and
peritoneal dialysis. Your doctor will discuss these treatment options with you. The
decision about which treatment is best for you will be based on your medical condition,
your lifestyle and your personal preference.
Ways to check your kidney health:
Blood and urine tests can tell us how well someone‘s kidneys are functioning. Your doctor may
decide to do blood and urine tests if you are at risk for kidney failure or kidney disease. The
following provides a review of what these tests look for.
Urine tests:
There are two types of urine tests.
One type requires a small amount of urine. It tells a doctor if there is blood, infection,
protein, or cells in the urine.
The other type requires collecting all the urine produced for 24 hours. This test will show
how much urine your kidneys produce in one day. It also measures how much protein is
passed from the kidneys into the urine in one day. Your doctor will be able to see if your
protein levels are normal. Your doctor may also measure the amount of waste from
muscle cells (Creatinine) or from the protein you eat (urea) in your urine to see how well
the kidneys are functioning.
Blood tests
Serum Creatinine:
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Creatinine is the waste product of muscle activity. The kidneys normally filter out this waste.
Blood (serum) levels of creatinine are the most common numbers used by doctors to determine
the damage.
When the kidneys are not functioning, dialysis helps to remove the extra creatinine. Dialysis is
usually started when creatinine clearance falls to less than 14 milliliters per minute.
Glomerular filtration rate (GFR) tells how quickly your kidneys are cleaning your blood. GFR is
reported in milliliters per minute. A normal GFR is greater than 90 mL/min.
Percent kidney function is an estimate of how much function the kidneys have left. Because a
GFR of 100 milliliters per minute (mL/min) is in the normal range, it is convenient to assume that
100 mL/min is about equal to 100% kidney function. So a creatinine clearance or GFR of 30
mL/min would be called "30% kidney function."
Creatinine Clearance
Creatinine clearance is another test of kidney function. Creatinine clearance is tested by taking
a 24-hour urine sample and a blood sample, and calculating how quickly your kidneys "clear"
your blood of creatinine. Another way to determine creatinine clearance is by using an equation
that gives an approximate value based on blood creatinine level, height, weight, and age.
Creatinine clearance is reported in milliliters per minute (mL/min). For healthy men, a normal
creatinine clearance is 97-137 mL/min. For healthy women, a normal creatinine clearance is 88128 mL/min.
Urea
Urea is a waste product from protein breakdown. The kidneys normally filter out this waste.
People with high urea levels may feel sick. Dialysis helps to remove the extra urea. Urea levels
in blood are measured by a test called Blood Urea Nitrogen (BUN).
Potassium
When the kidneys are not functioning properly, potassium may build up. High levels of
potassium can affect the heart rhythm, muscles and nerves.
You can be asked to limit certain foods that are high in potassium.
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Phosphorus
Phosphorous is removed by the kidneys. When the kidneys are not functioning phosphorus can
build up, making the person feel itchy. It can also weaken the bones if the blood level is too
high. It can also cause calcification of blood vessels leading to cardiovascular disease.
Calcium
Calcium is a mineral needed for strong bones and many other purposes in the body.
Parathyroid hormone (PTH)
PTH is produced by several small, bean-like parathyroid glands in your neck. Its "job" is to tell
your bones to release calcium into your bloodstream. Too much PTH can become a problem in
people with kidney disease.
Healthy kidneys convert a hormone called calcitriol to its active form of vitamin D. Calcitriol lets
your body absorb calcium from food you eat. When your kidneys are not working well, they start
to make less calcitriol, so even if you eat calcium, your body can't absorb it. PTH kicks in to
make sure you always have enough calcium in your blood. Over time, this can weaken your
bones.
A blood test can show if your PTH levels are above normal. If the PTH is 2 -3 times higher than
normal, your physician will prescribe a Vitamin D analogue to prevent renal bone disease.
Can I catch kidney disease from someone who has it?
No. Kidney disease is not contagious. You cannot catch it from someone else. Diabetes and
hypertension are the most common conditions that can run in families. If you are a family
member of someone who has diabetes, high blood pressure, or kidney disease, it is a good idea
to ask your doctor to check your blood pressure and kidney function at your checkup.
I have a family member with polycystic kidney disease (PKD). Should I be tested?
Since 60-70% of people with PKD have a family member with PKD, asking your doctor about
being tested seems like a good idea. The first test used for PKD is an ultrasound to look at the
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kidneys and see if there are cysts. No contrast dye is needed, so this is a non-invasive test.
Learning more about PKD may help you to take better care of your kidney health. The PKD
Foundation has free information that can help you.
If you believe you have any of these symptoms, talk to your doctor about your concerns. This is
especially important if you have a close family member who has kidney disease, or if you have
diabetes or high blood pressure, which are the main causes of kidney failure.
How can smoking affect my renal disease?
Smoking is an important risk factor that can make kidney disease worse. Heavy smoking, in
particular, will work against you if you are trying to keep your kidney function for as long as
possible.
The effects of smoking in diabetic kidney disease are well documented. Diabetics who smoke
tend to develop kidney disease earlier and lose kidney function more quickly than diabetics who
do not smoke, or who quit smoking. Smoking has also been shown to hasten the progression of
other types of kidney disease. In addition, smoking increases high blood pressure and
cardiovascular risks, two health problems that often occur along with kidney disease.
You‘ll be taking better care of yourself if you can reduce the amount you smoke—or better yet—
quit altogether. If you are willing to quit smoking, talk to your doctor about sustained-release
buproprion (Zyban®) and nicotine replacement therapy, as well as counseling or support to help
you quit.
What can I do about muscle cramps?
Cramps—especially leg cramps—are common for those with kidney disease. Cramps are
thought to be caused by imbalances in fluid and electrolytes, but may also be caused by nerve
damage or blood flow problems. If you experience cramps, here are suggestions that may help:
Stretch the muscle
Massage
A hot shower or bath
Drink plenty of water
19
Wear comfortable shoes
A number of nephrologists prescribe quinine for their patients who are bothered by frequent
cramps. Quinine does have potential risks, so be sure it really helps you before taking it for a
lengthy period of time.
What can I do about itching?
While problems with itching are common for those with kidney disease, it can be difficult to
determine the cause. Below are some reasons you may be itching and what may be done to
help.
Blood levels of phosphorus or parathyroid hormone (PTH) that rises as kidney function
drops can lead to itchy skin (and other problems). If you have high phosphorus or PTH
levels, your doctor can prescribe a phosphate binder drug for you to take with meals and
snacks to get your blood levels into the target range.
Itching can be caused by dry skin. Try a good moisturizing cream or lotion.
Allergies can cause itching and can happen at any time, even from products you have
used for a long time. Think about what you could be sensitive to in your environment,
such as soaps, lotions, detergents, perfumes, etc.
Many people find that getting out in the sun a bit helps with itching, though the reasons
for this are unclear.
Ask your nephrologists and/or dermatologist for tips on how you can deal with stubborn
itching
When should I be revered to a Nephrologist? (Kidney Specialist)
You should be under the care of a Nephrologist if your GFR is 30 mL/min or lower. This
translates to stage 4 chronic kidney disease (CKD). When you first find out you have CKD (even
if it is stage 2 or 3), seeing a Nephrologist at least once can help you develop a plan of care. A
Nephrologist can help you and your primary care doctor to:
Slow the rate of decline of your kidney function
Decide if a kidney biopsy might be useful
20
Diagnose the type of kidney disease and whether it might be reversible with treatment
Manage complications of kidney disease, such as anemia, high blood pressure,
metabolic acidosis, and changes in mineral balance
Diet and exercise
What to eat
Nutrition and renal disease
Your kidneys normally remove waste products and extra fluid from your blood. These waste
products and fluids come from the foods you eat and liquids you drink. If you have early kidney
failure, some of the waste products and extra fluid remain in your blood. Sometimes, early
kidney failure may progress to total kidney failure. However, if you follow your doctor's orders
carefully, you may be able to slow down this process.
Can a special diet help?
A special diet can help to control the buildup of waste products and fluid in your blood and to
decrease the workload of your kidneys. This diet may also help to slow down the loss of kidney
function. The main goal of the diet is to keep you healthy. Your doctor may recommend a
special diet, depending on the stage of your disease. If and when this diet is ordered for you,
your doctor may want you to see a renal dietitian, who has special training in diet for kidney
disease.
What is the diet like?
In general, the diet used for the early stages of kidney disease controls the amount of protein
and phosphorus you eat. Usually, sodium is also controlled. Getting enough calories to maintain
a healthy weight is very important at this time. The following information tells you where these
nutrients are found in foods.
21
Should I be on a low protein diet?
Protein, found in meats, fish, poultry, dairy products, nuts, and some grains, helps your body
form muscle and tissue. But when your kidneys are not working well, the by products of protein
breakdown can build up in your blood. This can make your kidneys work harder.
Many people with renal disease find that they don't want to eat as much protein as they used to,
because food doesn't taste the same. You may even need to make a special effort to eat
enough protein and calories, because renal disease can reduce your appetite.
In all cases, it's crucial to avoid malnutrition. A blood test for albumin, a form of protein, is a
good way to tell if you are getting enough good food. Your albumin level should be 35 g/L or
higher. If you notice weight loss, losses of appetite, or other signs of poor nutrition, talk to your
doctor.
In more severe kidney disease (Stages 4 and 5), the guidelines suggest considering 0.6 grams
of protein per kilogram each day. Some doctors may advise even lower levels, which require
close monitoring. If your diet includes very little protein, your doctor may prescribe supplements
of nutrients you would normally get from protein, like ketoacids and/or amino acids.
To figure out how much protein is in the food you're eating, read labels and use nutrition
reference tables. After a while, you'll have a good sense of how much protein is in a serving of
meat, milk, etc., so you won't have to look everything up. A renal dietitian has special expertise
helping people with kidney disease put together healthy meal plans. Ask your doctor about a
referral to a renal dietitian. Check with your doctor or dietitian before making any changes to the
protein level in your diet.
Your body needs protein every day for growth, building muscles and repairing tissue. After your
body uses the protein in the foods you eat, a waste product called urea is made. If you have lost
kidney function, your kidneys may not be able to get rid of this urea normally. You may need to
reduce the amount of protein you eat to avoid buildup of urea in your body. Protein is found in
two types of foods:
in large amounts in foods from animal sources such as poultry, meat, seafood, eggs,
milk, cheese and other dairy products.
22
in smaller amounts in foods from plant sources such as breads, cereals, other
starches and grains, and vegetables and fruits.
While you may need to limit the amount of protein you eat, it is important that you eat the right
amount of protein. This helps to keep your body healthy.
What about sodium?
You may need to limit the amount of sodium in your diet. This is because high blood pressure,
kidney disease and sodium are often related. Learning to read labels can help you make lower
sodium choices. Sodium is found in many foods, but is especially high in the following:
table salt and foods with added salt such as snack foods, soups and processed
cheese
some canned foods, prepared foods and "fast foods"
foods pickled in brine such as pickles, olives and sauerkraut
smoked and cured foods such as ham, bacon and luncheon meats
What is potassium and why is it important to you?
Potassium is a mineral found in many of the foods you eat. It plays a role in keeping your
heartbeat regular and your muscles working right. It is the job of healthy kidneys to keep the
right amount of potassium in your body. However, when your kidneys are not healthy, you often
need to limit certain foods that can increase the potassium in your blood to a dangerous level.
You may feel some weakness, numbness and tingling if your potassium is at a high level. If your
potassium becomes too high, it can cause an irregular heartbeat or heart attack symptoms.
What is a safe level of potassium in my blood?
Ask your doctor or dietitian about your monthly blood potassium level and enter it here:
If it is 3.5-5.0…………………… You are in the SAFE zone
If it is 5.1-6.0…………………… You are in the CAUTION zone
If it is higher than 6.0……….… You are in the DANGER zone
23
How can I keep my potassium level from getting too high?
You should limit foods that are high in potassium. Your renal dietitian will help you
plan your diet so you are getting the right amount of potassium.
Eat a variety of foods but in moderation.
If you want to include some high potassium vegetable in your diet, leach them before
using. Leaching is a process by which some potassium can be pulled out of the
vegetable. Instructions for leaching selected high potassium vegetables can be found
at the end of this fact sheet. Check with your dietitian on the amount of leached high
potassium vegetables that can be safely included in your diet.
Do not drink or use the liquid from canned fruits and vegetables, or the juices from
cooked meat.
Remember that almost all foods have some potassium. The size of the serving is very
important. A large amount of a low potassium food can turn into a high- potassium
food.
If you are on dialysis, be sure to get all the treatment or exchanges prescribed to you.
Certain medication prescribed to you may increase your potassium and my need
adjustment (ACE inhibitors).
FOOD CHOICES FOR PATIENTS WITH KIDNEY DISEASE
Monique Bailey & Marisa Kriek
–
Renal dieticians : 012 644 1003
–
082 870 6652 (Monique) and 084 437 3283 (Marisa)
The use of this list is to help a patient with renal disease in the beginning before he / she has
seen a dietician. It is however very necessary to get a meal plan from your dietician regarding
portions sizes and amounts of food items that need to be consumed on a daily basis.
24
VEGETABLES - POTASSIUM RESTRICTION
FOODS ALLOWED
Food item
Artichoke, cooked
Broccoli, cooked
Cabbage, cooked
Cabbage, raw
Celery, cooked
Celery, raw
Coleslaw
Cucumber
Leek, cooked
Lettuce
Mixed vegetables
Onion, cooked
Onion, raw
Peas
Pepper, green/red
Pumpkin, summer
Radish, raw
Tomato ketchup/sauce
Portion
30g
½ cup
½ cup
½ cup
1 heaped DSP
1 stick
½ cup
5 slices
½ cup
½ cup
½ cup
1 medium
2 slices
2 heaped TBS
4 slices
½ cup
2 large
1 tablespoon
Daily portions:
FOODS TO LIMIT
Food item
Beetroot, cooked
Brinjal, cooked
Brussels sprouts, cooked
Calabash
Carrots, cooked
Carrots, raw
Cauliflower, cooked
French salad
Green beans, cooked
Mushroom, raw
Patty pan
Pumpkin, white, hubbard
squash, cooked
Spinach, cooked
Sweet corn
Turnip, cooked
Waterblommetjies, fresh
Asparagus, cooked
Tomato, raw
Portion
½ medium
½ cup
½ cup
100g
½ cup
½ cup
½ cup
½ cup
½ cup
½ cup
x3
½ cup
½ cup
¼ cup
½ cup
¼ cup
½ cup
1 small
FOODS TO AVOID
Food item
Beetroot leaves
Butternut
Gem squash
Gherkins
Marog
Mixed vegetables,
tinned
Mushrooms, cooked
Okra, boiled
Pumpkin, leaves
Pickled onions
Spinach, small leaves
Tomato, tinned
Tomato, paste
Tomato and onion stew
Waterblommetjies,
canned
Daily portions:
Daily portions:
Abbreviations:
DSP
Dessertspoon (7ml)
TBS
Tablespoon (12ml)
PLEASE NOTE:
A dietician may individualise a diet, and can include a food in the avoid list according to the
patient‘s preferences and educational level.
The portion sizes are important. If you eat more than the recommended portion sizes in a group,
the fruit or vegetable may move into a higher potassium group.
25
FRUITS – POTASSIUM RESTRICTION
FOODS ALLOWED
Food item
Apple, skin
Cherry
Granadilla
Kumquat
Lemon, with peel
Litchi
Mulberries
Pineapple
Plum
Prickly pear
Strawberry
Dried fruit
Apple
Dates
Pear
Canned/cooked Fruit
Apple
Fruit salad
Litchi
Peach salad
Peach, canned
Pear (in syrup)
Pineapple
Fruit juice
Apple (Liquifruit,
Ceres)
Guava (Liquifruit,
Ceres)
Apricot (Liquifruit)
Litchi (Ceres)
Strawberry (Liquifruit)
Grape (Liquifruit,
Ceres)
Mango (Ceres)
Mango and orange
(Liquifruit)
Orange (Liquifruit,
Ceres)
Peach (Ceres)
Portion
1 small
2 heaped DSP
1 medium
6 medium
½ medium
6
50g
2 med slices
1 medium
1 small
8 medium
5 rings
2 dates
2 halves
½ cup
½ cup
½ cup
1 heaped TBS
½ cup
½ cup
½ cup
FOODS TO LIMIT
Food item
Apricot
Gooseberry
Grapefruit
Guava
Marula, peeled
Minneola, peeled
Melon, green
Naartjie
Pear
Banana
Watermelon
Pawpaw
Canned/cooked Fruit
Fruit cocktail
Gooseberry
Grapefruit
Gauva
Mango
Peach
Pear (canned in fruit
juice)
Portion
2 small
10 berries
half
1 small
100g
100g
1 3cm
slice
1 medium
1 small
1 small
1 slice
4 TBS
½ cup
½ cup
½ cup
½ cup
½ cup
½ cup
½ cup
FOODS TO AVOID
Food item
Avocado peer
Figs
Grapes
Kiwifruit
Mango
Melon, yellow
Num num
Orange
Peach
Dried fruit
Apricot
Currants
Dried fruit sweets
Figs
Peach
Prune
Raisins
Guava roll
Fruit juice
Orange juice (fresh)
Prune juice
½ cup
½ cup
½ cup
½ cup
½ cup
½ cup
½ cup
Canned/cooked Fruit
Apricot
½ cup
½ cup
½ cup
Daily portions:
Daily portions:
Daily portions:
26
How do I get some of the potassium out of my favorite high-potassium vegetables?
The process of leaching will help pull potassium out of some high-potassium vegetables. It is
important to remember that leaching will not pull all of the potassium out of the vegetable. You
must still limit the amount of leached high-potassium vegetables you eat. Ask your dietitian
about the amount of leached vegetables that you can safely have in your diet.
How to leach vegetables.
For Potatoes, Sweet Potatoes, Carrots, Beets, and Rutabagas:
1. Peel and place the vegetable in cold water so they won‘t darken.
2. Slice vegetable 1/8 inch thick.
3. Rinse in warm water for a few seconds.
4. Soak for a minimum of two hours in warm water. Use ten times the amount of water to
the amount of vegetables. If soaking longer, change the water every four hours.
5. Rinse under warm water again for a few seconds.
6. Cook vegetable with five times the amount of water to the amount of vegetable.
For Squash, Mushrooms, Cauliflower, and Frozen Greens:
1. Allow frozen vegetable to thaw to room temperature and drain.
2. Rinse fresh or frozen vegetables in warm water for a few seconds.
3. Soak for a minimum of two hours in warm water. Use ten times the amount of water to
the amount of vegetables. If soaking longer, change the water every four hours.
4. Rinse under warm water again for a few seconds.
Cook the usual way, but with five times the amount of water to the amount of vegetable.
27
What can I do about loss of appetite?
Poor appetite is a common symptom of advanced kidney disease. Even if you are not hungry, it
is important to eat and keep good nutrition. Well-nourished people with kidney disease stay
healthier and live longer. As kidney function drops, you may notice that protein foods, such as
eggs, meat, chicken and fish lose their appeal, or even taste funny. You need calories and
quality protein to feel your best. To get good nutrition try to:
Eat blander, starchy foods or whatever appeals to you
Eat small portions of protein foods, at a cold temperature—like egg salad or tuna
salad or a cold chicken sandwich
Avoid cooking smells if they bother you—cook ahead and freeze meal-sized portions
that you can microwave, or look for low-salt convenience foods
Try a liquid nutritional drink like Boost® or Ensure® once a day (It is best not to rely
on these drinks entirely, as their protein, phosphorus and potassium content is not
made for people with kidney disease.)
Graze all day—have several small meals instead of one large one
Watch cooking shows on television to tempt your appetite
Boost the protein content of your meals by adding egg whites, egg white powder or
protein powder
Get help from a renal dietitian, if lack of appetite continues. Because nutrition is so
important, many private insurance plans and Medicare do cover some nutritional
help for people with kidney disease.
Finally, if you are in Stage 5 Renal disease and your appetite or nutritional well-being does not
improve, this may be a sign that you should start dialysis. Many people find their appetite
improves after some time on dialysis
Bone Disease in Chronic Kidney Failure
Phosphorus
Phosphorus is a mineral normally removed by the kidneys. When the kidneys are not
functioning phosphorus can build up, making the person feel itchy. It can also weaken the bones
28
if the blood level is too high. Phosphorus is a mineral found in your bones. Along with calcium,
phosphorus is needed for building healthy strong bones, as well as keeping other parts of your
body healthy.
Why is phosphorus important to you?
Normal working kidneys can remove extra phosphorus in your blood. When you have Kidney
Disease your kidneys cannot remove phosphorus very well. High phosphorus levels can cause
damage to your body. Extra phosphorus causes body changes that pull calcium out of your
bones, making them weak. High phosphorus and calcium levels also lead to dangerous calcium
deposits in blood vessels, lungs, eyes, and heart. Phosphorus and calcium control is very
important for your overall health.
What is a safe blood level of phosphorus?
A normal phosphorus level is 0.8-1.4 moll/L.
Should I be on a low phosphorus diet?
Phosphorus is a mineral found mostly in dairy products and meats. Your body uses it to form
strong bones and teeth. But starting in moderate renal disease, your kidneys begin to lose the
ability to remove extra phosphorus from your body. Because too much phosphorus can harm
your bones, it makes sense to eat less phosphorus.
Some experts think 800 to 1,200 mg. of phosphorus per day is a good target. Food labels are
not required to list phosphorus, so you will need to talk to a renal dietitian or find a nutrition
reference guide and look up foods. You'll soon learn the phosphorus values of the foods you eat
most often.
If you are also on a lower protein diet, a low phosphorus diet is easier-foods high in protein tend
to be high in phosphorus, too. Your doctor may want you to limit dairy servings each day and
take a calcium supplement. Taken with meals, calcium supplements act as phosphate "binders,"
because they lock on to extra phosphorus and keep your body from absorbing it.
Bone disease is common in patients with chronic kidney failure. Their bones tend to become
thin and weak, which causes them to break easily or to begin to hurt. This happens because
calcium is lost from the bones.
29
What causes this problem?
Kidney disease affects the bones in the following ways:
1. A change occurs in the balance between two important minerals in your body-- calcium
and phosphorus--leading to loss of calcium from your bones.
2. Four small glands (parathyroid glands), which help to regulate calcium in your body,
become too active.
3. Not enough vitamin D is changed to an active form that can be used by the body.
Your doctor will examine you and do certain blood tests and, in some cases, a bone biopsy.
These tests help the doctor decide what type of bone disease you have and what treatment is
best for you.
Each of these factors affect bones in a different way:
1. Phosphorus is in most foods you eat and your kidneys usually remove whatever is not
needed in the body. When your kidneys have stopped working normally, phosphorus
may build up in your blood. Too much phosphorus in your blood leads to loss of calcium
from your bones, which weakens them over time.
Eating foods that are low in phosphorus can help to prevent phosphorus from building up
in your blood. (See information on diet.) You may also need to take a medicine called a
phosphorus binder, which keeps phosphate from being absorbed from your food.
2. As phosphorus stays in your body when your kidneys can no longer remove it, calcium
levels of the blood tend to drop. This causes four small glands in your neck (parathyroid
glands) to become too active. When this happens, calcium is removed from your bones
over a long period of time, causing them to weaken.
This problem can also be helped through changes in your dialysis treatments, a low
phosphorus diet and by taking certain medicines such as calcium and vitamin D.
Sometimes, surgery is necessary to remove some of these glands
30
3. Vitamin D is an important vitamin that affects your calcium balance. Normally, vitamin D
from the food you eat, from vitamin and mineral supplements and exposure to sunlight is
changed by the kidneys into an "active" form that can be used by the body. If your
kidneys have failed, they can no longer do this important job. Fortunately, the active form
of vitamin D is available as a medicine i.e. vitamin D analogue, that can be ordered for
you by your doctor if needed.
4. In general, over-the-counter vitamin D supplements should be avoided by people with
kidney disease. Check with your doctor about the right supplements for you. The amount
of vitamin D found in the foods you eat is not a problem.
How can diet help prevent bone disease?
By reducing phosphorus in your diet, you can help to prevent the amount of phosphorus in your
blood from becoming too high. Foods high in phosphorus include: dairy products such as milk
and cheese, dried beans and peas, nuts and peanut butter, and beverages such as cocoa,
colas and beer. Using non-dairy creamers and recommended milk substitutes is a good way to
reduce the amount of phosphorus you eat.
What treatments are available for bone disease?
Your treatment may include one or more of the following:
Reducing phosphorus in your diet
Taking a medicine called a phosphate binder (Titralac / Renagel)
Taking medicine with a form of vitamin D (One Alpha / Rocaltrol)
Taking calcium supplements
An exercise program approved by your doctor
An operation to remove some of the parathyroid glands
Calcium and phosphorus are stored in bone, teeth and blood and help regulate many essential
body functions, including digestion, transmission of nerve signals, muscle contraction and blood
clotting.
The body carefully controls the amount of calcium in the blood. A low calcium level
(hypocalcaemia) can cause muscle cramps, abdominal spasms and low blood pressure. A high
blood calcium level (hypocalcaemia) results in muscle weakness, bone pain, high blood
pressure and abnormal heart function.
31
The body also regulates phosphorus levels. Very low phosphorus can lead to coma and even
death. (Not common in patients with kidney disease.) High phosphorus levels, which are more
common, can eventually, lead to calcium and phosphorus deposits in the heart, skin, joints and
blood vessels.
The role that calcium and phosphorus imbalances play in heart disease has received a lot of
attention lately. Recent studies have shown that high calcium and phosphorus levels can place
dialysis patients at increased risk for heart disease. These studies have shown that poor control
of phosphorus is linked with calcification, or hardening, of cardiac tissues and an increased risk
of cardiac events (heart attacks) and even death.
When calcium and phosphorus levels fall outside their normal ranges, the parathyroid glands
release parathyroid hormone (PTH) into the bloodstream. In people with healthy kidneys, PTH
helps maintain calcium and phosphorus levels by:
Drawing calcium from the bones into the bloodstream;
Making calcitriol, a hormone formed in the kidneys. Calcitriol increases the
absorption of calcium and phosphorus from the gut;
Helping the kidneys to get rid of extra phosphorus from the body; and
Prevents the kidneys of getting rid of calcium into the urine.
In patients with kidney disease, the kidneys make very little calcitriol. Because of low levels of
calcitriol, the kidneys are not activated to reabsorb calcium or phosphorus. Due to kidney failure,
calcium and phosphorus levels are not in balance.
32
Foods high in phosphate
Monique Bailey & Marisa Kriek
Renal dieticians: 012 644 1003
Limit the following foods to reduce blood phosphate levels and prevents soft tissue calcification:
Eat 1 small Pilchard or 1 large Sardine or 30g Cheddar/ Gouda/ Mozzarella cheese or 1 boiled
Egg just _____ per week! (Includes meals at home and at dialyses)
30g = 1 match box piece
Use ____ portions of Dairy daily. 1 Portion = ½ cup Milk or custard (home made) or yoghurt or ice
cream per day.
Avoid:
Bacon
Blaauwkrantz/ Roquefort/ Camambert/ Parmesan/ Feta cheese
Tinned Oysters, liver
Pizza
Cheese spread/ wedges (Melrose/ Nestlé/ Laughing Cow)
Dried beans, lentils, dried soup mix, soya beans, Baked beans, Toppers
Marmite, Bovril,
Nuts, Peunuts, Peanut butter
Tribe
Chocolate, Fudge, Toffees
Milo, Hot Chocolate, Horlicks, Ovaltine
Instant puddings
All bran/ Muesli/ Pronutro/ Weet bix cereal
Home made rusks, Muffins, Sponge cake, Swiss roll
Puddings/ cakes and pies made with egg and milk
Beer
Coca Cola, Pepsi, Tab
Cremora (only 2 teaspoons/day)
Abbreviations: P: High in Phosphate; K: High in Potassium
33
What are medications for phosphorus control?
Your doctor may order a medicine called a phosphate binder (Titralac) for you to take with
meals and snacks. This medicine will help control the amount of phosphorus your body absorbs
from the foods you eat. There are many different kinds of phosphate binders. Pills, chewable
tablets, and powders are available. Some types also contain calcium, while others do not. You
should only take the phosphate binder that is ordered by your doctor or dietitian.
Medications are also needed to help control calcium and phosphorus levels. To help bind extra
phosphorus from the blood, most will need to take phosphate binders with meals and snacks.
Types of phosphate binders include calcium-based, aluminum-based, magnesium-based, and
polymer-based binders. In some patients, the use of calcium-based binders, especially when
used with vitamin D therapy, may put patients at risk of high calcium levels and other
complications. The use of aluminum and magnesium-based binders are typically not used
anymore due to their side effects.
Vitamin D therapy sends a signal to the parathyroid gland to slow down the making of PTH.
This helps to prevent many of the unwanted complications of secondary hyperparathyroidism.
Remember and follow the 3 D's for healthy bones:
Diet. Eat foods low in phosphorus
Drugs. Take your phosphate binders with meals and snacks, as directed, and
Dialysis. Stay for your full treatment - every treatment.
34
AVOID THE FOLLOWING FOODS THAT ARE VERY HIGH IN SALT/ POTASSIUM AND
PHOSPHATE
HIGH IN SALT
Food item
MEAT PRODUCTS
All canned and processed meat, fish or
chicken e.g. bully beef, sardines, pilchards
All smoked or salted meat- and fish products
e.g. ham, shellfish, frankfurters, bacon,
biltong, ‗Droë wors‘, salami, vienna‘s, pork
sausages, polony,
Meat pies, chicken pies, sausages (e.g.
Boerewors), sausage rolls, anchovies, fish
paste, soya mince
Roquefort cheese, Camembert, Parmesan
cheese
Consumption of large amounts of cheese
Tongue, liver, kidneys, brain
OTHER PRODUCTS
Commercial grain foods (e.g. Corn flakes,
Cocopops, Rice krispies) and biscuits and
cakes (Madeira cake, Date loaf)
Salt biscuits/crackers, potato chips, salted
nuts or peanuts
Canned and instant soups
Marmite, Bovril, Sandwich spread
Tomato sauce, tomato puree, tomato paste,
tomato juice
Worcester sauce, Soya sauce, Chutney,
Chilli sauce
Meat sauce powders, Bisto, Meat tenderiser
Meat extract blocks e.g. Oxo
HIGH IN POTASSIUM
Food item
MEAT PRODUCTS
Briyani with lentils, dried beans, dried
peas, lentils, split peas, peanuts, nuts
(all types), peanut butter
OTHER PRODUCTS:
Potato baked in skin, potato chips,
sweet potato baked in skin, chilli bites
(bhadjia)
Rich fruit cake, Wheat bran, Date loaf,
Samoosa, All bran flakes, Weet – Bix,
Pronutro, croissants, egg noodles,
home made rusks, hot cross buns,
muesli, muffins, pancakes, salted
popcorn, Savoury snacks (crips),
sponge cake, swiss roll, puddings
(made with egg and milk)
Soak peeled / cut potatoes and sweet
potatoes for 2 hours.
HIGH IN PHOSPHATE
Food item
MEAT PRODUCTS
Bacon, baked beans, blue
mould, blaauwkrantz,
Roquefort, Parmesan (very
hard, ripe), soya mince
(patty, sausage), canned
fish (pilchards, sardines),
oysters (canned), liver
(chicken, beef, sheep)
Consumption
of
large
amounts of cheese and
eggs,
brains,
cheese
spreads and wedges, feta,
marmite, Bovril, dried fish
(bokkems)
OTHER:
All bran, Weet Bix,
Pronutro, Muesli,
croissants, egg noodles
home made rusks, hot
cross buns, sponge cake,
swiss roll
MILK PRODUCTS
Kulfi (ice cream, sorbet),
condensed milk,
evaporated milk, Numel
milk
powder,
Ovaltine
powder, milk chocolate
(brown, white), yoghurt with
curry
spice
(khuri),
chocolate coated nuts and
raisins, dark chocolate, high
protein
milk
drinks,
Cremora, Coffee-mate
OTHER PRODUCTS HIGH IN PHOSPATE OR POTASSIUM:
Coffee, tea, mahew (K)
All types of beer (P), Ciders (sweet) (P), Cola drinks (Coke, Pepsi) (P), Wine (K), Flavoured grape liquor (K)
Golden syrup (K), fruit gums (K), brown sugar (K)
Assortes chocolates (K & P), chocolate coated bars (with nuts and raisins) (K & P), Dark bitter chocolate (K & P),
dried fruit sweets (K), fudge (K & P), toffee (K & P), health bars (K & P), liquorice all sorts (K), marzipan (K), peanut
brittle (K)
Olives (salt)
Abbreviations: P: High in Phosphate; K: High in Potassium
35
Phosphorus binders like Titralac or Ultra Tums are exactly what they sound like, medications
that stick to or "bind" phosphorus. Phosphorus binders are like sponges in that they soak up
phosphorus while it is still in the stomach. Bound phosphorus cannot enter the blood and is
passed out of the body in stool. Therefore, phosphorus levels are better controlled.
Since the binding takes place in the stomach, it is important to have the binder in the stomach at
the same time as the food. Then the binder "sponge" can soak up the phosphorus from the
food. If the binder is forgotten or taken a half hour after the meal, the phosphorus in the food
will still get into the blood.
Besides taking the binder at the right time, it is also important to take the right number of
binders:
(1) The larger the meal, the more binders are needed. Just like the more water spilled, the
more sponges are needed. If Joan ate 2 hamburgers instead of one, she would need more
Ultra Tums.
(2) The higher the phosphorus content in the meal, the more binders is needed. If Joan were
to have a cheeseburger instead of a hamburger, she would need more binders as cheese
adds more phosphorus to her meal. Again, Joan planned ahead by talking to her dietitian
about this event, so she knew how many Ultra Tums to take with that meal.
Hopefully, this new theme will make it easier to remember the importance of phosphorus
control. Joan says, "Rate your Plate and Get the Sponge" every time you eat, even with
snacks. This is the key to controlling your phosphorus.
CHOLESTEROL AND CHRONIC KIDNEY DISEASE
What is cholesterol?
Cholesterol is a fat-like substance found in your blood. Your body can make cholesterol as well
as get it from eating meats and other animal food products.
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Why is cholesterol important?
Too much cholesterol can build up in your blood vessels. This build up can narrow vessels and
lead to a blockage, preventing blood from getting to a certain area of your body. When this
occurs in your heart vessels, it is called coronary heart disease and can cause a heart attack.
In people with chronic kidney disease, heart disease is very common. It is suggested that
people with renal disease have cholesterol labs drawn at least yearly. Your doctor may want to
do them more frequently if something has changed with your health.
What other items are used to measure risk for heart disease?
Aside from high LDL cholesterol levels, the risk for heart disease increases with the following
risk factors:
cigarette smoking
obesity
high blood glucose
low HDL cholesterol
age (men > 45 years old; women > 55 years old)
high blood pressure or on antihypertensive medications
diabetes mellitus
family history of early heart disease
other forms of vessel narrowing diseases.
People with renal disease may have some added risk factors that lead to heart disease:
large calcium intake from diet or medication
high blood phosphorus levels
high parathyroid hormone levels
high homocysteine levels
whole body inflammation.
People who are physically inactive or who eat foods that are high in saturated fat and
cholesterol are also at risk for developing heart disease.
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What can I do to decrease my risk for heart disease?
Lifestyle Changes:
Increase physical activity to 30 minutes every day at a moderate level. This will help:
 raise HDL cholesterol
 lower LDL cholesterol in some people
 lower blood pressure
 improve diabetic control
 improve heart function.
Obtain and maintain a healthy weight
Talk to your doctor and dietitian
Do not smoke.
Do not drink alcohol excessively. (Limit alcohols to 1 drink a day with physician
approval.)
Diet changes:
Choose foods that are low in saturated fat and cholesterol. See ―Tips to reduce fat and
cholesterol in your diet.‖
Decrease use of trans fatty acids since they can raise LDL cholesterol.
Use plant stanols and sterols found in regular or ―light‖ specially formulated margarinelike spreads. Increase soluble fiber. (Fruits and vegetables and grains are good sources
of fiber.)
Talk with your dietitian for assistance with safely and gradually increasing fiber in your
diet.
Treatment of Other Risk Factors:
Control hypertension and diabetes.
Treatment for these diseases can include medications, diet changes and increased
physical activity.
Your doctor and dietitian can help you with lifestyle changes to best treat these diseases.
What about medications to help lower my risk for heart disease?
Medications are available for lowering LDL cholesterol and triglycerides, but heart disease
medications work the best when diet and life style changes have already been made.
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Who can I talk to about specific questions I have to reduce my risk for heart disease?
Your doctor can talk to you about how best to treat your risk for heart disease.
A pharmacist can answer questions you might have about any medications the doctor
has prescribed for you.
A dietitian can help you in making healthy food changes to your diet.
Tips to Reduce Fat and Cholesterol in Your Diet
Choose lean meats, poultry and fish. The loin and round cuts of meat tend to be leaner
than rib cuts and organ meats.
Trim all visible fat from meat and remove skin from poultry.
Steam, broil, roast or bake meat, poultry and fish. Place the food on a rack to allow the
fat to drain away from the food. Do not fry foods.
Choose fresh fruits and vegetables. Steam, boil, bake or microwave vegetables. Do not
fry foods.
Use nonstick pans or vegetable sprays for sautéing.
Use herbs and spices to season foods instead of sauces, butter or margarine.
Try wine, lemon juice, or flavored vinegar to give flavor with limited fat and calories.
Use jelly, jam, honey or syrup instead of butter or margarine on toast, waffles, pancakes
or muffins.
Use fat free or reduced fat versions of high-fat foods. For example, use fat-free sour
cream in place of regular sour cream or use 1% or skim milk in allowed amounts.
Limit hydrogenated and partially hydrogenated fats. These can be found in some
margarines, peanut butters, packaged baked goods and snacks, and fried foods. Try
baked crackers instead of fried crackers. Buy grilled or baked items when eating out.
Use two grams of plant stanols or sterols per day. These are sold as specially formulated
margarine-like spreads. Your dietitian can assist you with finding these products.
Limit products made with coconut, palm kernel, palm oil, lard, shortening, bacon fat and
cocoa butter.
Use canola or olive oils instead of shortening, butter or other oils when cooking. These
monounsaturated fats will not lower your HDL level.
Try sherbet or ice milk instead of ice cream.
Read food labels on the foods you buy. Do not be misled by foods that are cholesterol
free but contain large amounts of saturated fat that your body will turn into cholesterol.
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Staying Fit With Kidney Disease
Physical fitness is very important in today's world. Everyone is enjoying the benefits of greater
strength and feeling better. Exercise keeps your body strong and healthy.
Can I take part in vigorous physical activity?
Yes. In the past, it was thought that people with kidney disease would not be able to join in
vigorous activity. We know now that patients who decide to follow an exercise program are
stronger and have more energy.
How does exercise benefit me?
With exercise, it becomes easier to get around, do your necessary tasks and still have some
energy left over for other activities you enjoy.
In addition to increased energy, other benefits from exercise may include:
improved muscle physical functioning
better blood pressure control
improved muscle strength
lowered level of blood fats (cholesterol and triglycerides)
better sleep
better control of body weight.
Do I need to see my doctor before starting exercise?
Yes. Before beginning any exercise program, be sure to check with your doctor.
When planning a directed exercise program, you need to look at four things:
type of exercise
length of time you spend exercising
how often you exercise
how hard you work while exercising.
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Here are some tips on each:
Type of Exercise
Choose continuous activity such as walking, swimming, bicycling (indoors or out), skiing,
aerobic dancing or any other activities in which you need to move large muscle groups
continuously.
Low-level strengthening exercises may also be beneficial as part of your program. Design your
program to use low weights and high repetitions, and avoid heavy lifting.
How Long to Exercise
Work toward 30 minutes a session. You should build up gradually to this level.
There is nothing magical about 30 minutes. If you feel like walking 45 to 60 minutes, go ahead.
Just be sure to follow the advice listed under "When should I stop exercising?" in this brochure.
How Often to Exercise
Exercise at least three days a week. These should be non-consecutive days, for example,
Monday, Wednesday and Friday. Three days a week is the minimum requirement to achieve the
benefits of your exercise.
How Hard to Work While Exercising
This is the most difficult to talk about without knowing your own exercise capacity. Usually, the
following ideas are helpful:
Your breathing should not be so hard that you cannot talk with someone exercising with
you. (Try to get an exercise partner such as a family member or a friend.) You should
feel completely normal within one hour after exercising. (If not, slow down next time.)
You should not feel so much muscle soreness that it keeps you from exercising the next
session.
The intensity should be a "comfortable push" level.
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Start out slowly each session to warm up, then pick up your pace, then slow down again
when you are about to finish.
The most important thing is to start slowly and progress gradually, allowing your body to adapt
to the increased levels of activity.
When should I exercise?
Try to schedule your exercise into your normal day. Here are some ideas about when to
exercise:
Wait one hour after a large meal.
Avoid the very hot times of the day.
Morning or evening seems to be the best time for exercising.
Do not exercise less than an hour before bedtime.
When should I stop exercising?
If you feel very tired
If you are short of breath
If you feel chest pain
If you feel irregular or rapid heart beats
If you feel sick to your stomach
If you get leg cramps
If you feel dizzy or light-headed.
Are there any times when I should not exercise?
Yes. You should not exercise without talking with your doctor if any of the following occurs:
you have a fever.
you have changed your dialysis schedule.
you have changed your medicine schedule.
your physical condition has changed.
you have eaten too much.
the weather is very hot and humid, unless you exercise in an air-conditioned place.
you have joint or bone problems that become worse with exercise.
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If you stop exercising for any of these reasons, speak to your doctor before beginning again.
Why is exercise important to me?
Exercise is important for many reasons:
It helps you lose excess weight and keep the weight off.
It helps prevent many diseases including diabetes, high blood pressure, heart
disease, chronic kidney disease, cancer, osteoporosis and arthritis.
It helps prevent high blood cholesterol.
It helps build strength and endurance.
It helps prevent injuries.
It builds self-confidence and self-esteem.
Is it important to stretch before and after exercising?
Yes. Stretching before and after exercising helps to prevent injuries and strengthens your
muscles and bones.
I’m so busy. How can I find time to exercise?
Anyone can work some exercise into the daily schedule. You can do many exercises at home,
outdoors or even at work. Here are some suggestions:
Exercise while watching TV. You can do stretching exercises or use free weights or
exercise equipment such as an exercise bike.
Exercise around the neighborhood. You can bike to the store, work in the garden,
mow the lawn or take out a ball or frisbee and offer to play a game with the kids.
Exercise at work. Park your car at a distance or get off the bus a stop early and walk
10 minutes to the office. Take the stairs instead of the elevator, take a brisk walk on
your lunch hour, or join the team if your company participates in recreational sports.
How can I make exercise a habit?
Choose something you like to do.
Find a partner, someone to exercise with you.
Alternate your routine: walk one day, dance the next.
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Make exercise fun: exercise with a group or exercise to music.
Stay positive: don‘t worry if you do not see progress right away. It may take weeks
before you notice any change.
Check your progress: see if you can walk a longer distance or exercise for longer
periods of time without getting tired.
Treating Anemia in Chronic Renal Failure: EPO
What is erythropoietin? Why is it important?
Erythropoietin (EPO) is a hormone that prevents anemia (low red blood cell count) by helping
you make red blood cells. Anemia causes fatigue and low energy levels. It occurs when there
are not enough red blood cells to carry oxygen from the lungs to supply all the body's needs.
Why do patients with kidney disease develop anemia?
Almost all the body's EPO is made in the kidneys. Kidney disease may damage the cells that
make EPO, leading to anemia.
How is EPO used? Who will give it to me?
EPO is given by injection. It may be injected directly into a vein (intravenous) during dialysis or
under the skin (subcutaneous). It may be given by a dialysis nurse or by the patients
themselves.
How long will I need EPO?
Probably for as long as you are on dialysis.
Do all kidney patients need EPO?
No. EPO is needed only by those patients whose hematocrit is less than 30 percent.
Why must my iron count be checked all the time?
If your body does not have enough iron, EPO is wasted. If your iron count shows that you need
extra iron, it can be given to you by injection or pills.
Will EPO cure or improve my kidney failure?
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No. EPO is not a substitute for dialysis or for other therapy. However, it should make you feel
much better.
Will I ever need blood transfusions again?
EPO should eliminate the need for blood transfusions unless you have a severe loss of blood
such as that caused by bleeding ulcers or some surgical procedures. In these situations, a
transfusion may be necessary since EPO acts slowly to increase the hematocrit.
Does EPO need to be refrigerated?
Yes. However, a temporary loss of electricity will not cause EPO to "go bad." Please do not let
EPO freeze or get too warm. If you inject EPO yourself, always inspect your EPO vial before
using it for your injection. Never use any EPO that is cloudy or discolored or has particles in it. If
you have any questions about this, ask your doctor or nurse.
Do any other medications interfere with EPO, and does EPO interfere with any
medications?
In general, EPO does not interfere with any other medications. At the present time, other
medications do not seem to affect the action of EPO.
Understanding Why You Need Iron
The Role of Iron
Erythropoietin needs adequate body iron stores to work since iron is essential for the production
of red blood cells. It aids in normal immune function, and can help ward off infection. Without
adequate iron intake, chronic kidney disease patients are likely to become anemic. Symptoms
of anemia include: lack of energy, severe tiredness, poor appetite, inability to sleep, depression,
shortness of breath, chest pain, and feeling cold.
Inadequate Absorption
it can be especially difficult for chronic kidney disease patients to receive adequate amounts of
iron. Kidney patients are often unable to absorb iron into their bloodstream through the GI tract
as well as other people, and every time you lose 1cc of blood, you lose 1 mg of iron. Our body
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normally contains 2-4 grams of iron. Hemodialysis patient‘s use about 3gms of iron per year.
For this reason, hemodialysis patients may find it even more challenging to absorb iron than
peritoneal patients. However, iron treatment is usually necessary for all kidney patients.
Iron Treatments
There are several ways to treat iron deficiency:
Oral Supplements
many different brands of oral iron supplements are available. Oral iron should be taken 1 hour
before meals or 2 hours after meals and should never be combined with phosphate binders.
Side effects may include dark stools, constipation and gastrointestinal irritation.
Intravenous Iron
The kidney disease quality outcomes initiative (KDOQI) recommends the administration of
intravenous iron to dialysis patients requiring erythropoietin. The IV iron can be administered
either during hemodialysis treatments or during clinic visits for the peritoneal dialysis patients.
How do you know if you are iron deficient?
Certain lab values are very important to become familiar with. Discuss these with your doctor.
Blood tests to check your red blood cells:
Hemoglobin: Between 11 and 12g/dl
Hematocrit: Between 33 and 36 percent
Blood tests to check your iron:
Ferritin: More than 100 ng/ml and less than 800 ng/ml
Transferrin Saturation: Between 20 percent and 50 percent.
WHAT IS DYALISIS?
Dialysis is the major treatment for kidney failure. It is the medical word for filtering waste
products and removing fluid from your body that your kidneys are no longer able to remove.
There are two forms of dialysis:
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Haemodialysis and Peritoneal Dialysis
Haemodialysis
Haemodialysis is a process by which excess waste products and water are removed from the
blood by using a dialyser, also known as an artificial kidney.
This form of treatment means the blood is transported outside the body through the dialyser via
a specially created vein in the forearm known as arterio-venous fistula, or a vascular catheter
inserted in the veins of the neck.
This process requires the use of a machine.
In haemodialysis, the blood channels through tubing to the dialyser. The dialyser is a bundle of
hollow fibres made up from a semi-permeable membrane. The membrane is thin film with
thousands of microscopically small holes. The holes allow water and small dissolved
substances to pass through but retain the proteins and blood cells, which are too large.
During the dialysis treatment the blood is allowed to flow on one side of the membrane and
dialysate solution on the other, and exchange (diffusion) takes place from the blood to the
dialysate solution and visa-versa. The dialysate solution has a salt composition similar to blood
but without the waste products.
Usually one session takes about 4 hours.
The actual dialysis treatment is controlled and monitored by a dialysis machine. This consists of
a blood unit and fluid unit.
The pump in the blood unit pumps blood from the patient through the dialyser and back to the
patient via the blood tubes.
The fluid unit controls the mixture of the dialysate solution.
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Access
In order to have chronic haemodialysis, you need to have surgery to create access, a
way to carry the blood to the dialyser.
The most common type of chronic access used nowadays is: Arterio-venous (A.V) fistula
and the Arterio-venous (AN) graft.
The fistula is created internally and is used for a prolonged length of time.
Your surgeon makes a fistula under the skin by joining an artery and vein, allowing
arterial blood to flow directly into the vein.
Due to arterial pressure, the vein will increase in size and thicken; it takes about 4-8
weeks for the fistula to mature.
A fistula makes it easy to put a needle into the vein to allow blood flow through the
dialyser using the blood pump.
The graft is an artificial blood vessel used to join an artery and vein. It is used when
patients own blood vessels are too small for fistula construction.
The graft may be either straight or looped and is close to the surface of the skin.
The graft may be of artificial material or can be obtained from the patients own body e.g.
vein in the thigh.
Temporary access can be created in cases that need urgent dialysis and cannot wait for
a few weeks for the fistula to mature.
These include the subclavian catheter, internal jugular catheter (and arterio-venous
shunt).
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The subclavian catheter is a set of tubing which is inserted into the subclavian vein near
the neck.
The internal jugular catheter is placed into the veins at the side of the neck.
The subclavian and internal jugular catheter cannot be used beyond a few weeks as it
tends to get blocked or the site of insertion may become infected.
The shunt is surgically created with an artificial material, and has a short life span i.e. 6
months.
Care of the Fistula/Graft
Keep area clean and dry.
Feel for thrill sensation at both ends of fistula/graft at least twice weekly.
Inspect fistula for redness, swelling, tenderness, or warmth to touch to detect infection.
Avoid constrictive clothing, jewellery etc. that may block the fistula.
No blood pressure, blood taking, or intravenous administration should be done on the
fistula arm.
Avoid excessive pressure on puncture sites after dialysis.
Rotate needling sites to prevent aneurysm.
If injury occurs at site, apply pressure over bleeding and seek immediate medical help.
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Advantages and Disadvantages Haemodialysis
Advantages
Staff performs treatment
No equipment at home
Treatment 3 times/week
No external access
Regular contact with staff and other patients
Disadvantages
Travel to centre
Fixed dialysis times
Two needles inserted each treatment
Wastes build up between treatments
Diet and fluid restrictions
Peritoneal Dialysis
Peritoneal dialysis is performed by introducing dialysate solution into the peritoneal (abdominal)
cavity through a silastic catheter.
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The natural membrane lining of the peritoneal cavity acts as a filter where waste products and
excess fluid from the body pass through the membrane into the dialysate solution.
The dialysate solution used is sterile and contains salts and a high content of glucose (sugar).
The glucose will cause water from the blood stream to be drawn into the peritoneal cavity.
A peritoneal dialysis procedure is called an exchange because used solution is removed and
replaced with fresh solution.
You connect long tubing set to the short tubing you are wearing (attached to catheter). The
lower bag is for draining used solution from the peritoneal cavity and when empty, you are ready
to fill with fresh dialysate solution from the upper bag.
The fluid surrounds the internal organs; it does not go into the stomach or other organs.
The dialysate solution is left in the peritoneal cavity for several hours to collect waste products
and excess fluid from the blood.
The most common forms of peritoneal dialysis used today are C.A.PD. and A.PD.
Continuous ambulatory peritoneal dialysis (C.A.PD.) functions much like the kidneys do.
Constantly cleaning the blood as long as there is dialysate solution in the cavity.
Typically you do exchanges four times a day i.e. when awaking, lunch time, late afternoon, and
bedtime (every 5-6hours).
C.A.P.D. gives you constant dialysis, 24 hours a day seven days a week.
Automated Peritoneal Dialysis (A.PD.) is dialysis at home with a cycler machine.
Each night before you go to sleep, you connect your PD catheter to a long tubing set, attached
to dialysate bags on the cycler. The machine does the exchanges while you sleep. The machine
is quiet and does not wake you. The tubing is long enough for you to sleep comfortably and
walk several feet.
The peritoneal catheter called a tenckhoff is a small soft tube; it is placed into the peritoneal
cavity surgically. You will typically stay overnight in hospital.
Just a few centimeters of the catheter is outside your body. Most is inside you body.
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The catheter is left in place so dialysis can be done. It provides a small opening in which
dialysate solution can be placed.
Training for Peritoneal Dialysis is provided on a national basis at all National Renal Care units
and is normally done on an out-patient basis.
Patients on Peritoneal Dialysis lead very normal lives; many patients continue to work, go to
school or are active in the community and can even travel.
Disposables are delivered to your home or your travel destination free of charge.
Advantages and Disadvantages Peritoneal Dialysis
Advantages
Self-care
No needles
Greater independence
Flexible diet
Flexible schedule
Blood pressure control
Blood sugar control
Less stress on body
Disadvantages
Daily exchanges
No off days
Permanent catheter
Some risk of infection
Some possible weight gain
Living with Dialysis
The dependence on artificial life support devices, adherence to strict medical regimes and
increase in financial obligations and a decrease in physical and social functioning, frequently
result in feelings of depression, anxiety, worthlessness and hostility.
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All members of your family unit are affected by your renal disease. Family members may need
to assume new roles.
For the person who is ill, losing former roles either temporary or permanently, can be frightening
and depressing.
These include unemployment or being too ill to do family chores, to name a few. There are
changes in roles or lifestyles that may occur in your own family.
Family members may need to be responsible for you at first, but continuing to treat you as if you
are too sick to care for yourself, can place a huge burden on the family. Due to your illness you
may need to depend on your family at first, this may be hard to accept, especially if you are a
very independent person.
Sex may be a difficult topic to many, but it is important to discuss it in order to understand the
physical and emotional changes that occur with renal failure.
A chronic illness such as renal failure will change one's desire for sexual intimacy.
For men impotence or the inability to maintain an erection may occur and women may
experience difficulty with arousal.
Men and women may just show a lack of interest, which can strain a sexual relationship. It is
important to talk these concerns over with your doctor or nurse.
Being a kidney patient doesn't mean you can't have a satisfying relationship.
Kidney failure and the treatment may be difficult to accept at first however with time, support
and education you can adjust.
You must learn to live with dialysis as part of your life. Learn is the key word for you as a
dialysis patient if you are going to make the most of life.
You will need to learn to understand and accept your illness and learn what it means to be a
kidney patient. You will need to learn to eat and drink the right things, to take medication and
exercise appropriately.
Communication is vital, talk about your feelings and experiences with someone you trust.
Talking and sharing about what is happening to you will decrease your feelings of loneliness
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and increase your feelings of being supported and loved. Share your thoughts and feelings with
family, friends and your medical treatment team. Talking to other patients is helpful.
Once you are feeling better it will be important to return to as many of your past activities as
possible. With your doctors permission you may return to work, your hobbies, clubs etc. Getting
back into old routines will help you feel that sense of normality again.
When is dialysis needed?
You need dialysis if your kidneys no longer remove enough wastes and fluid from your blood to
keep you healthy. This usually happens when you have only 10 to 15 percent of your kidney
function left. You may have symptoms such as nausea, vomiting, swelling and fatigue.
However, even if you don't have these symptoms yet, you can still have a high level of wastes in
your blood that may be toxic to your body. Your doctor is the best person to tell you when you
should start dialysis.
Can dialysis patients continue to work?
Yes. Many dialysis patients continue to work or return 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
change your duties.
TRANSPLANTATION
How Transplantation Works
Kidney transplantation is a procedure that places a healthy kidney from another person into your
body. This one new kidney takes over the work of your two failed kidneys.
A surgeon places the new kidney inside your lower abdomen and connects the artery and vein
of the new kidney to your artery and vein. Your blood flows through the new kidney, which
makes urine, just like your own kidneys did when they were healthy. Unless they are causing
infection or high blood pressure, your own kidneys are left in place.
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Kidney Transplantation
The Transplant Process
Your Doctor’s Recommendation
The transplantation process begins when you learn that your kidneys are failing and you must
start to consider your treatment options. Whether transplantation is to be among your options
will depend on your specific situation. Transplantation isn‘t for everyone. Your doctor may tell
you that you have a condition that would make transplantation dangerous or unlikely to
succeed.
Medical Evaluation at a Transplant Center
If your doctor sees transplantation as an option, the next step is a thorough medical evaluation
at a transplant hospital. The pretransplant evaluation may require several visits over the course
of several weeks or even months. You‘ll need to have blood drawn and x rays taken. You‘ll be
tested for blood type and other matching factors that determine whether your body will accept
an available kidney.
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The medical team will want to see whether you‘re healthy enough for surgery. Cancer, a serious
infection, or significant cardiovascular disease would make transplantation unlikely to succeed.
In addition, the medical team will want to make sure that you can understand and follow the
schedule for taking medicines.
If a family member or friend wants to donate a kidney, he or she will need to be evaluated for
general health and to see whether the kidney is a good match.
The most important member of the healthcare team is YOU, the patient.
Patients should take an active role in their care. It is important that you follow the instructions of
your doctor, nurse, dietitian and social worker about all aspects of your care.
You are an important member of the healthcare team. If you are unsure about any aspect of
your treatment, don't hesitate to ask questions. If you are finding it difficult to adhere to your
doctor's instructions regarding diet, supplements and medication, discuss ways to improve your
adherence with your dietitian.
By empowering yourself and those around you to take an active interest role in your care, you
can ensure yourself a longer, happier and more productive life.
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Resources: Organizations That Can Help
National Renal Care
www.nrc.co.za
+27 11 726 5206
American Association of Kidney Patients
100 South Ashley Drive
Suite 280
Tampa, FL 33602
Phone: 1-800-749-2257 or (813) 223-7099
Email: [email protected]
Internet: www.aakp.org
American Kidney Fund
6110 Executive Boulevard
Suite 1010
Rockville, MD 20852
Phone: 1-800-638-8299 or (301) 881-3052
Email: [email protected]
Internet: www.akfinc.org
Life Options Rehabilitation Program
603 Science Drive
Madison, WI 53711-1074
Phone: 1-800-468-7777 or (608) 232-2333
Email: [email protected]
Internet: www.lifeoptions.org
National Kidney Foundation, Inc.
30 East 33rd Street
New York, NY 10016
Phone: 1-800-622-9010 or (212) 889-2210
Email: [email protected]
Internet: www.kidney.org
Additional Reading
If you would like to learn more about kidney failure and its treatment, you may be interested in reading
AAKP Patient Plan
This is a series of booklets and newsletters that cover the different phases of learning about kidney
failure, choosing a treatment, and adjusting to changes.
American Association of Kidney Patients
100 South Ashley Drive
Suite 280
Tampa, FL 33602
Phone: 1-800-749-2257 or (813) 223-7099
Email: [email protected]
Internet: www.aakp.org
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Kidney Disease: A Guide for Patients and Their Families
American Kidney Fund
6110 Executive Boulevard
Suite 1010
Rockville, MD 20852
Phone: 1-800-638-8299 or (301) 881-3052
Email: [email protected]
Internet: www.akfinc.org
Newsletters and Magazines
Family Focus Newsletter (published quarterly)
National Kidney Foundation, Inc.
30 East 33rd Street
New York, NY 10016
Phone: 1-800-622-9010 or (212) 889-2210
Email: [email protected]
Internet: www.kidney.org
For Patients Only (published six times a year)
ATTN: Subscription Department
18 East 41st Street
20th Floor
New York, NY 10017-6222
Renalife (published quarterly)
American Association of Kidney Patients
100 South Ashley Drive
Suite 280
Tampa, FL 33602
Phone: 1-800-749-2257 or (813) 223-7099
Email: [email protected]
Internet: www.aakp.org
www.ikidney.com
www.nrc.co.za
www.davita.com
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