Download hiV aNd ChrONiC kidNEy diSEaSE

hiV aNd
ChrONiC
kidNEy
diSEaSE
WHAT YOU NEED
TO KNOW
HIV AND CHRONIC KIDNEY DISEASE
WHAT YOU NEED TO KNOW
CONTENTS
What Is HIV?.................................................................................... 2
If I Have HIV, Does It Mean I also Have AIDS?................................ 2
Why Do I Need to Know about Kidney Disease?............................ 2
What Are Kidneys and Why Are They Important?............................ 2
What Is Kidney Disease?................................................................. 4
Is Kidney Disease Serious?............................................................. 4
Are People with HIV at Greater Risk for Getting Kidney Disease?..... 5
Why Does HIV Put Me at Greater Risk for Kidney Disease?........... 6
How Will I Know if I Have Kidney Disease?..................................... 7
How Often Should I Be Tested for Kidney Disease?........................ 8
How Is Kidney Disease Treated?...................................................... 8
What Is Kidney Failure?..................................................................10
How Is Kidney Failure Treated?.......................................................10
What Does Hemodialysis Involve?.................................................11
What Does Peritoneal Dialysis Involve?..........................................12
Can a Patient with HIV Have a Kidney Transplant?..........................13
How Can I Lower My Chances for Getting Kidney Disease?..........13
Where Can I Get More Information?..............................................14
www.kidney.org
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1
HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW
What is HIV?
HIV (human immunodeficiency virus) is a virus that infects and
damages your immune system. Your immune system helps your
body defend itself against infection and other disease. HIV attacks
and destroys the disease-fighting cells of your immune system and
leaves your body weak against infection and cancer.
If I have HIV, does it mean
I also have AIDS?
Having HIV does not mean that you have AIDS (acquired immune
deficiency syndrome). But HIV can lead to AIDS if left untreated.
AIDS is the most serious and advanced stage of HIV infection.
Why do I need to know about
kidney disease?
Having HIV may put you at risk for getting chronic kidney disease
(CKD). It’s hard to know exactly how common it is, but some experts
believe that 7 to 30 percent of people with HIV have problems with
their kidneys.
What are kidneys and why
are they important?
Think of your kidneys as a coffee filter. When you make coffee,
the filter keeps the coffee grains inside but allows water to pass
through. Your kidneys do something similar. They keep the things you
need inside your body but filter out things you don’t need.
2
Your kidneys also keep the rest of your body in balance by:
Removing waste and poisons from the body
Balancing the body’s fluids
Helping to control blood pressure
Helping bones stay healthy
Helping to make red blood cells
Normal Kidneys and Urinary Tract
You have two kidneys. Each
kidney is about the size of your
fist. They are located near the
middle of your back, just below the rib cage. Each kidney
has about 1.5 million filters,
called nephrons. Nephrons
remove waste and extra fluid
from your blood in the form of
urine. The urine flows through two tubes, called ureters, to the
bladder. The urine is stored there until you go to the bathroom.
The waste comes from the breakdown of food you eat and
medicine you take, plus normal muscle and organ activity.
www.kidney.org
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3
HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW
WhaT iS kidNEy diSEaSE?
Kidney disease means your kidneys don’t do what they should.
Kidneys can get damaged from a physical injury or a disease like HIV,
diabetes, or high blood pressure. Once your kidneys are damaged,
they cannot filter your blood or do other jobs as well as they should.
There are five stages of kidney disease (shown in the table below).
Your doctor determines your stage of kidney disease based on the
presence of kidney damage and your glomerular filtration rate (GFR),
which is a measure of your level of kidney function.
Stages of Chronic Kidney Disease (CKD)
Stage
Description
Glomerular Filtration Rate (GFR)*
1
Kidney damage (eg, protein in
the urine) with normal GFR
90 or above
2
Kidney damage with
mild decrease in GFR
60 to 89
3
Moderate decrease in GFR
30 to 59
4
Severe reduction in GFR
15 to 29
5
Kidney failure
Less than 15
*Your GFR number tells your doctor how much kidney function you have. As chronic
kidney disease progresses, your GFR number decreases.
iS kidNEy diSEaSE SEriOuS?
Yes. If untreated, kidney disease can lead to kidney failure. If you
develop kidney failure, you will need regular dialysis treatments or a
kidney transplant to stay alive. Many people with kidney disease also
develop heart disease. Early detection and treatment may prevent
kidney disease and its complications from getting worse. That is why it
is so important for people with HIV to be tested for kidney disease.
4
What Are the Symptoms of Kidney Disease?
Most people with early kidney disease do not have
symptoms. In the later stages of kidney disease, you may:
Feel tired or short of breath
Have trouble thinking clearly
Not feel like eating
Have trouble sleeping
Have dry, itchy skin
Have muscle cramping at night
Need to go to the bathroom more often, especially at night
Have swollen feet and ankles
Have puffiness around your eyes, especially in the morning
arE pEOplE WiTh hiV aT
GrEaTEr riSk fOr GETTiNG
kidNEy diSEaSE?
Yes. Having HIV may put you at risk for getting kidney disease. In
fact, it is not unusual for people with HIV to develop kidney disease.
If you have HIV infection, your chances of getting kidney disease are
even greater if you:
Have a high viral load (a large amount of HIV in your blood)
Have a low CD4+ count (a low number of the blood cells that
help fight diseases such as HIV)
www.kidney.org
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5
HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW
Are African American, Hispanic American, Asian, Pacific
Islander, or American Indian
Have diabetes, high blood pressure, or hepatitis C
Have a family member who has kidney disease
Are 65 or older
Have used medications over the course of many years that
damage the kidneys
Risk factors increase your chance of getting kidney disease. The
more risk factors you have, the greater the risk.
Tip
Anti-inflammatory pain-relieving medicines such as ibuprofen
and certain HIV drugs can damage the kidneys. Check with your
doctor before taking any medications, including over-the-counter
or herbal medicines.
Why dOES hiV puT mE aT GrEaTEr
riSk fOr kidNEy diSEaSE?
This happens because:
HIV can harm the nephrons (filters) in your kidneys. When this
happens, the filters do not work as well as they should.
HIV can infect the cells in your kidneys.
If not carefully monitored, some of the medicines used to treat
HIV can harm the nephrons in your kidneys.
6
How will I know if I have
kidney disease?
Most people with early kidney disease do not have symptoms. The
best way to find out is to be tested for it. There are three simple
tests to check for kidney disease:
1. Urine test
Your body needs protein. But it should be in the blood, not the urine.
Having a small amount of protein in your urine may mean that your
kidneys are not doing their filtering job well enough. This can be an
early sign of kidney disease.
2. Blood test
Your doctor should test your blood for a waste product called
creatinine. Creatinine comes from muscle tissue. When the kidneys
are damaged, they have trouble removing creatinine from your blood.
The blood test for creatinine will help your doctor find out how well
your kidneys are working.
But testing creatinine is only the first step. Next, your doctor or lab
must use your creatinine result in a math formula with your age, race,
and sex to find out your GFR. Your GFR tells your doctor how well
your kidneys are working.
. Regular blood pressure checks
3
Having high blood pressure puts you at risk for kidney disease.
Regular blood pressure checks help your doctor find and treat high
blood pressure. This helps lessen your risk for kidney damage.
www.kidney.org
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7
HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW
hOW OfTEN ShOuld i bE TESTEd
fOr kidNEy diSEaSE?
Everyone with HIV should be tested for kidney disease at least once.
This should be done when you first learn you have HIV. Ask your
health care provider if you were ever tested for kidney disease; if
not, get tested. People with HIV who have other risk factors for
kidney disease will need to be tested at least once a year. Check to
see if you have any of the risk factors listed on pages 5–6.
hOW iS kidNEy diSEaSE TrEaTEd?
Treatment depends on your stage of kidney disease and other health
problems you may have (see page 4 for CKD stages chart). Some
patients may be asked to see a kidney doctor (called a nephrologist).
A dietitian may be helpful too. Your treatment may include:
Medicine for your HIV infection (called antiretroviral therapy)
Studies show that controlling HIV can help prevent kidney disease.
For most people, more than one HIV drug may be needed to
control HIV.
Tip
Some drugs used in HIV treatment have a lower risk of kidney
damage than others. Ask your doctor about HIV drugs with a
lower risk of causing kidney damage.
8
Medicine for high blood pressure
High blood pressure can increase your chances of getting kidney
disease or kidney failure. For most people with HIV and kidney
disease, blood pressure should be no higher than 125/75. You will
probably need a medication called an ACE (angiotensin converting
enzyme) inhibitor or an ARB (angiotensin receptor blocker) to control your blood pressure. In many cases, more than one high blood
pressure medicine may be needed to reach this target.
Protecting kidney function by taking ACE inhibitors or ARBs
You may be asked to take high blood pressure medicines (called
ACE inhibitors or ARBs) even if your blood pressure is normal. Research suggests that these medicines can slow the loss of kidney
function in people with HIV and kidney disease—even in people
with normal blood pressure.
Controlling blood sugar if you have diabetes
The best way to prevent or slow kidney damage is to keep your
blood sugar controlled. This is usually done with diet, exercise,
and, if needed, insulin or pills (called hypoglycemic drugs).
Controlling high cholesterol with diet and medication
Many people with kidney disease have high cholesterol in the
blood. High blood cholesterol increases your risk for heart disease.
Your doctor will check your cholesterol at least once a year. If it is
too high, you may need drugs and exercise to help lower it.
Treating anemia
People with kidney disease often get anemia (low red blood cell
count). Why does this happen? Healthy kidneys help your body
make red blood cells. If you have kidney disease, your kidneys may
not be able to do this very well and you may get anemia. Medicines
called ESAs (erythropoiesis-stimulating agents) and iron supplements are used to treat anemia.
www.kidney.org
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9
HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW
Treating mineral and bone disorders
Many people with kidney disease have mineral and bone disorders. Mineral and bone disorders can make your arteries stiffen
and become narrow from the extra calcium and phosphorus in your
blood. This slows blood flow to your heart and can lead to heart
attack and death. You may need special medicines to help prevent
and treat mineral and bone disorders. You may also need to eat
fewer foods that contain phosphorus, such as dairy, nuts, seeds,
dried beans, and peas.
Following an exercise program approved by your doctor
Controlling your weight with diet and exercise
Starting treatment for kidney failure if your kidneys fail
WhaT iS kidNEy failurE?
Kidney failure means your kidneys no longer work well enough to
keep you alive. There is no cure for kidney failure. But there are
treatments to replace the work of your failed kidneys.
hOW iS kidNEy failurE TrEaTEd?
There are three possible treatments for kidney failure:
Hemodialysis
Peritoneal dialysis
Kidney transplantation
10
Your health care team can discuss these different treatments with
you and answer all your questions. If you need treatment for kidney
failure, they will help you choose one based on your general health,
lifestyle, and treatment preference.
hat does
W
hemodialysis involve?
Hemodialysis is usually
done three times a
week for several hours
each session. It can
be done at a dialysis
center or at home. In
hemodialysis, your
blood flows through
a machine that has
a filter which cleans
the blood. This filter
is called an artificial
kidney or dialyzer. To
get your blood into the
artificial kidney, two
needles are inserted
into a vein in your arm
during dialysis treatment. A special surgery is required to prepare a
suitable vein in the arm to be used for hemodialysis. Hemodialysis is
the most common form of treatment for kidney failure.
www.kidney.org
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11
HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW
What does peritoneal
dialysis involve?
Peritoneal dialysis can be done at home, at work, or while traveling.
In this type of dialysis, your blood is not cleaned outside the body as
with hemodialysis. Instead, fluid and waste products are removed by
using your own belly. Here’s how it works.
A soft tube, called a catheter,
is placed inside your belly.
This is done by minor surgery.
This catheter is the connection that allows a cleansing
fluid to flow into your belly.
The cleansing fluid is called
dialysate.
What happens next is an
amazing process: the lining of
your belly (called the peritoneal membrane) acts as a natural filter; it lets the wastes and
extra fluid in your blood pass
through it into the cleansing fluid. At the same time, the lining holds
back the important things your body needs, like red blood cells and
nutrients. Once the filtering process is finished, you drain the used
cleansing fluid into an empty bag. You discard the bag and connect a
new bag of fluid to begin the cycle again. This bag exchange is usually done four to six times during a 24-hour period.
12
CaN a paTiENT WiTh hiV haVE
a kidNEy TraNSplaNT?
Yes. Transplantation is available through clinical trials or as part of routine care at transplant centers across the United States. Your health
care provider can give you more information about transplantation.
A kidney can come from someone who has died, or from a living
person who wishes to donate a kidney.
hOW CaN i lOWEr my ChaNCES
fOr GETTiNG kidNEy diSEaSE?
Many people with HIV do not get kidney disease or kidney failure.
Talk to your health care provider about your chances of getting
kidney disease. If you have HIV, you can lower your chances by:
Checking your blood pressure as often as your doctor
recommends and taking steps to keep it under control
Asking your doctor to test you for kidney disease at least
once each year if you:
– Have a large amount of HIV in your blood
– Have a low level of blood cells that help fight HIV (CD4+ cells)
– Are African American, Hispanic American, Asian, Pacific
Islander, or American Indian
– Have diabetes, high blood pressure, or hepatitis C
Taking all your HIV medications as prescribed
Asking your doctor about HIV drugs that have a lower risk
of causing kidney damage
Controlling your blood sugar if you have diabetes
Taking medicines to control your blood glucose, cholesterol,
anemia, and blood pressure if your doctor orders them for you
www.kidney.org
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13
HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW
WhErE CaN i GET
mOrE iNfOrmaTiON?
To learn more about HIV and chronic kidney disease, contact
the National Kidney Foundation (NKF) at 800.622.9010 or visit
www.kidney.org. You may be interested in asking for a free
copy of the following NKF booklets:
About Chronic Kidney Disease: A Guide for Patients
and Their Families (11-50-0160) [Spanish: 11-10-0166]
What You Need to Know When You Have
Chronic Kidney Disease (11-50-0132)
GFR (Glomerular Filtration Rate): A Key to Understanding
How Well Your Kidneys Are Working (11-10-1813)
Warning Signs of Kidney and Urinary Tract Disease
(11-10-0203)
Choosing a Treatment for Kidney Failure (11-10-0352)
Hemodialysis: What You Need to Know (11-50-0214)
[Spanish: 11-50-0219]
Peritoneal Dialysis: What You Need to Know (11-50-0215)
[Spanish: 11-50-0221]
Kidney Transplant (11-10-0304)
For additional information,
check the A-Z Guide on the
NKF Web site: www.kidney.org
National Kidney Foundation (NKF)
30 East 33rd Street
New York, NY 10016
800.622.9010
14
You may also want to contact:
www.aidsinfo.nih.gov
AIDS Info
P.O. Box 6303
Rockville, MD 20849-6303
800.448.0440
notes
HIV AND CHRONIC KIDNEY DISEASE: WHAT YOU NEED TO KNOW
notes
16
notes
www.kidney.org
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17
More than 26 million Americans have chronic kidney
disease, and most don’t even know it. Millions more are
at increased risk. The National Kidney Foundation, a major
voluntary health organization, seeks to prevent kidney and
urinary tract diseases, improve the health and well-being
of individuals and families affected by these diseases, and
increase the availability of all organs for transplantation.
Through its affiliates and divisions nationwide, the
foundation conducts programs in research, professional
education, patient and community services, public
education, and organ donation.
A Curriculum for CKD Risk Reduction and Care
30 East 33rd Street
New York, NY 10016
800.622.9010
www.kidney.org
© 2008 National Kidney Foundation, Inc. All Rights Reserved.
Sponsored by
11-10-0290