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Each year in the United States, more than 100,000 people are diagnosed with kidney failure, a serious condition in which the kidneys fail to rid the body of wastes. Kidney failure is the final stage of chronic kidney disease (CKD).
Diabetes is the leading cause of kidney disease in the United States. About 30 percent of patients with Type 1 diabetes and 10 to 40 percent of those with Type 2 diabetes will suffer from kidney failure. There are currently about 180,000 people living with kidney failure as a result of diabetes.
Most people know the primary function of the kidneys is to remove waste products and excess fluid from the body, but don’t realize their many other functions:
There are two kidneys, each about the size of a fist, located on either side of the spine at the lowest level of the rib cage.
The artery brings blood and wastes from the bloodstream into the kidneys. Each kidney is made up of a million tiny nephrons. Each nephron has a group of tiny blood vessels called a glomerulus which act as the filtering unit in charge of cleaning the blood as it flows through the kidney. The rate at which the glomerulus filters the blood is called the glomerular filtration rate or “GFR”.
After filtration, the remaining fluid passes into a tubule where chemicals and water are either added to, or removed from, according to the body's needs. Clean blood leaves the kidneys and goes back into the bloodstream through the vein. Waste and extra fluid are removed from the body via urine.
The kidneys filter about 200 quarts of fluid every 24 hours. About two quarts of liquid are removed from the body in the form of urine, and about 198 quarts are recovered.
Risk Factors for Kidney Disease
You may have an increased risk for kidney disease if you:
If you are in one of these groups or think you may have an increased risk for kidney disease, ask your doctor about getting tested.
Kidney disease is defined as having a kidney abnormality or "marker" such as protein in the urine and decreased kidney function for three months or longer. There are many causes of chronic kidney disease. The kidneys may be affected by diseases such as diabetes and high blood pressure. Drugs and toxins can also cause kidney problems including over-the-counter pain relievers taken in large doses taken over an extended period of time. Some kidney conditions are inherited.
Most people with diabetes do not develop kidney disease severe enough to progress to kidney failure. Kidney damage rarely occurs in the first 10 years of diabetes. If kidney disease is diagnosed, it is usually 15 - 25 years before kidney failure occurs. People who live with diabetes for more than 25 years without any signs of kidney disease have a decreased risk of kidney failure.
How diabetes affects the kidneys
Diabetes affects the vascular system and the small blood vessels in the body may be damaged. When the blood vessels in the kidneys are damaged, they cannot clean the blood properly. The body retains more water and salt, which can result in weight gain and ankle swelling. Waste materials will begin to build up in the blood and also result in protein in the urine.
Diabetes may also cause damage to nerves in the body which can create difficulty in emptying the bladder of urine. Pressure from a full bladder can back up and injure the kidneys. If urine remains in the bladder for a long time, an infection can develop from the rapid growth of bacteria in urine with high sugar levels.
Signs of kidney disease in patients with diabetes
Diabetic kidney disease takes many years to develop. In some people, the filtering function of the kidneys is actually higher than normal in the first few years of their diabetes.
The signs of diabetic kidney disease usually show up as an increased excretion of albumin (a protein) in the urine long before any symptoms present.
1. Albumin/protein in the urine
2. High blood pressure
3. Ankle and leg swelling, leg cramps
4. Going to the bathroom more often at night
5. High levels of Blood Urea Nitrogen (BUN) and creatinine in blood
6. Less need for insulin or other diabetic medications
7. Morning sickness, nausea and vomiting
8. Weakness, paleness and anemia
Maintaining Kidney Health
People with diabetes should see their doctor at least 4 times yearly. Like most complications of diabetes, the impact can be mitigated by good self care, glucose control and knowing the causes and symptoms of kidney disease.
Get prompt treatment for urinary tract infections You may have an infection if you have these symptoms:
o Pain or burning when you urinate
o A frequent urge to go to the bathroom
o Urine that looks cloudy or reddish
o Fever or a shaky feeling
o Pain in your back or on your side below the ribs
Early detection and treatment of chronic kidney disease are the keys to keeping kidney disease from progressing to kidney failure. Some simple tests can be done to detect early kidney disease. They are:
Emotional Cost of Kidney Disease
As a person with diabetes you are probably used to having to adjust routines to deal with glucose testing, medications and diet. Kidney disease adds new tasks to that process. You have to learn about a whole new set of anatomy and terms. You may have to make additional changes to your diet, add new medications to your routine and deal with potential side effects. If you have to undergo dialysis you will need to make scheduling adjustments and possibly learn a new skill set.
You also have to go on LIVING! Continuing with your work, studies, family commitments and hobbies are important to your long term health and happiness.
It is normal to have concerns about your condition, how you will feel, whether the treatment will hurt, what to expect during treatment and how long you can live with the disease.
The health care are trained to help you make these adjustments and to help you understand all areas of your care. So be sure to discuss all your concerns with the health care team at the treatment center. Make sure to write your questions down as you think of them so you have them for handy reference (it’s easy to forget in the stark light of the doctor’s office).
If you are going to have dialysis or are preparing for a transplant ask to visit the appropriate centers. This can help allay your anxiety, answer questions and help you make the right choices for your health and wellbeing.
Finally, speak to others who have been through the same experience. There is nothing like peer support to allay your concerns and get tips on new coping mechanisms.
Call your local National Kidney Foundation for information and a list of the programs and services available. Find out who your local NKF is by visiting the NKF website at www.kidney.org or by calling 800.622.9010.
Treatment of Kidney Disease
Careful control of diabetes and high blood pressure can help prevent kidney disease or keep it from getting worse. Prescription medications cannot reverse chronic kidney disease, but they are used to treat symptoms and complications and to slow damage to the kidneys.
Because most people with CKD have problems with high blood pressure (either before the onset of KD or during the course of the disease) high blood pressure medicines are commonly prescribed.
Your doctor may need to prescribe several different medications before they find one that effectively controls your blood pressure with a minimum of side effects. Most people take a combination of medicines for the best results.
Kidney disease may progress to kidney failure which is very serious. There are still options for treatment but they are much less pleasant than practicing good diabetes and high blood pressure control. If you are diagnosed with kidney disease it is a good idea to add a kidney specialist or nephrologist to your health care team.
Your primary care physician or your endocrinologist is an obvious place to begin your search for a nephrologist. Your Certified Diabetes Educator or dietitian may also have a list.
Kidney Failure and Treatment
One treatment for kidney failure is dialysis. Dialysis is a treatment that does some of the work your kidneys used to do. Two types of dialysis are available. You and your doctor will decide what type will work best for you based on your medical condition, lifestyle and personal preference.
Hemodialysis is a method where you are connected to a dialysis machine and your blood flows through a tube in your arm to a dialyzer that filters out the waste products and extra fluid. The clean blood flows back to your arm. Hemodialysis treatments are usually performed three times a week and take between 3 – 5 hours depending on the stage of your kidney disease.
Hemodialysis requires the installation of a special “port” so you can be connected to the equipment. There are three general types of ports:
A fistula is the recommended choice because it poses fewer problems and last longer, though it requires a surgical procedure. It is made by joining an artery to a nearby vein under your skin to make a bigger blood vessel.
A fistula should be inserted several months before starting dialysis so it has plenty of time to heal. An evaluation by a vascular surgeon will need to be conducted and an ultrasound evaluation of your vessels may be ordered to see determine the ideal ones for the fistula. This evaluation is called "vessel mapping."
A graft may be used if your blood vessels are not suitable for a fistula. This involves joining an artery and nearby vein with a small, soft tube made of synthetic material. The graft is entirely beneath your skin.
A catheter is the final type used for short term dialysis or as permanent access is a fistula or graft cannot be used. A tube is inserted into a large vein in your neck or chest and the ends of the tubes sit on your skin outside your body.
Hemodialysis treatment may be performed at a dialysis unit or at home. Some people prefer home dialysis because it provides more flexibility. However your home must have the appropriate space for the equipment as well as good water drainage and electric power to operate the dialysis and water purification units.
You will also need to have someone assist you in the process. This can be a family member, friend or an individual you hire. You can be trained to do dialysis at home.
Home dialysis also provides two more options for treatment:
Peritoneal dialysis is a home-based treatment that many people select because it allows them greater flexibility in treatment. In peritoneal dialysis (PD), your blood is cleaned inside your body with the lining of your abdomen (the peritoneum) acting as a natural filter.
A soft tube called a PD catheter is surgically (minor) placed into your belly. During dialysis, a cleansing solution called dialysate flows into your abdomen through this tube. Wastes and extra fluid pass from your blood into the cleansing solution. After several hours, you drain the used solution from your abdomen and throw it away. You then refill with fresh cleansing solution and begin the process again. Removing the used solution and adding fresh solution takes about a half hour and is called an “exchange.” Peritoneal dialysis can be done at home, at work, at school or even during travel.
There are two types of PD: Continuous Cycling Peritoneal Dialysis which requires the use of a machine and Continuous Ambulatory Peritoneal Dialysis which does not.
Medicines used during dialysis
Anemia often develops in advanced cases of kidney disease and your doctor may prescribe:
A nephrologist can explain the different treatment approaches and help patients make the best treatment choices for themselves and their families.
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