Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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, 2 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 3 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 4 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 5 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%. 6 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. 7 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) 8 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 9 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 10 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. 11 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. 12 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 13 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 14 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. 15 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: 16 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. 17 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 18 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. 36 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. 37 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. 38 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. 39 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. 40 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. 41 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. 42 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. 43 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? 44 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 45 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: 46 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. 47 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). 48 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. 49 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. 50 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. 51 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. 52 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 53 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. 54 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. 55 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. 56 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 57 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 58