Chronic Kidney Disease (CKD) Facts:
1. 37 million Americans adults suffer from CKD. That's 15%! It breaks down to one in seven American adults, As many as nine out of ten don't even know they have CKD.
2. 1 in 3 adults are currently at risk for developing CKD. This increases to 1 in 2 over a lifetime.
3. High blood pressure and uncontrolled diabetes are the two leading causes of CKD.
4. Other risk factors include family history, age, ethnicity, kidney stones, infections, cysts & obesity.
5. Kidney disease is the 9th leading cause of death in the US. 13 people die each day waiting for a kidney on the transplant list.
6. Every 30 minutes, your kidneys filter all of the blood in your body by removing waste and excess fluid.
7. Most people have two kidneys, but it is possible to live with only one.
8. Early detection can help prevent the progression of kidney disease to kidney failure.
What is a nephrologist?
A nephrologist is a medical doctor who specializes in the care and treatment of the kidneys. The term nephrologist comes from the Greek word “nephros”, which means kidney or renal, and “ologist,” which refers to someone who studies. Nephrologists are also called kidney doctors. Nephrologists are educated in internal medicine and then undergo more training to specialize in treating patients with kidney diseases. They commonly treat chronic kidney disease (CKD), polycystic kidney disease (PKD), acute renal failure (ARF), kidney stones and high blood pressure. They are educated on all aspects of kidney transplantation and dialysis.
What does a nephrologist do?
A nephrologist generally sees patients who are referred by their primary care physicians or general physicians for problems related to the kidneys, high blood pressure or other certain types of metabolic disorders. If someone feels they are having problems with their kidneys, they can seek out the care of a nephrologist. When a kidney doctor first meets with a patient, he or she will usually go over the patient’s medical history and do a complete physical.
A nephrologist will then do blood and urine tests to determine how well the patient’s kidneys are functioning. He or she may also order a kidney ultrasound. When necessary, a nephrologist may perform a kidney biopsy in order to better determine what is wrong with the kidneys. If a nephrologist finds that a patient’s kidneys are not functioning as they should, he or she will help diagnose the cause and prescribe a treatment plan. However, a nephrologist is not a surgeon and typically does not perform operations. Treatment of kidney cancer, prostate operations and removal of kidney stones are usually handled by a different type of physician known as a urologist.
Who should see a nephrologist?
A person may be referred to a kidney doctor if he or she is experiencing:
- Acute renal failure
- Chronic kidney failure
- High blood pressure that does not respond to medication
- Repeat kidney stones
- Blood loss in the urine
- Protein loss in the urine
- Abnormal electrolyte (sodium, potassium, calcium, etc...) levels
What do your kidneys do and how do they fail?
Although kidneys are relatively small (each one is about the size of your fist), when they are healthy, they process 100% of the body's blood supply. They also perform many other important functions.
They clean the waste from your blood, manage the fluid in your body, control your blood pressure, make red blood cells and balance acidity and mineral composition. Kidneys fail when they are no longer able to clean waste from the blood and balance fluid and mineral levels.
Diabetes can cause damage to the kidneys, which is called diabetic nephropathy. This is the most common cause of kidney disease in the US. A buildup of excess sugar in the body can damage the blood vessels, including those in the kidneys.
High blood pressure can also cause damage to the kidneys. It is the second most common cause of kidney disease in the US. If high blood pressure damages the blood vessels to the kidneys, the kidneys will not be able to remove waste and extra fluid. The extra fluid can cause blood pressure to rise even more. Over time, the vessels can thicken and narrow leading to reduced blood supply to the kidneys.
Glomerular diseases are the third leading cause of kidney failure. When someone suffers from a glomerular (kidney) disease, it means that their glomeruli are no longer working the way they should and waste products begin to build up causing swelling throughout the body.
Polycystic kidney disease (PKD) is an inherited disorder that is associated with large, fluid filled cysts that grow within the kidneys. The cysts press against the kidney tissue until it stops working effectively. However, this usually takes many years.
Kidney disease can also be caused by birth defects, autoimmune diseases (including lupus), obstructions and chronic urinary tract infections. Regardless of the cause, there is no cure for chronic kidney failure. However, dialysis can be a life-saving solution. A kidney transplant is another option for some people.
What are the symptoms of kidney disease?
Many people who have chronic kidney disease don't know it because the early signs can be very subtle. It can take many years to go from chronic kidney disease (CKD) to kidney failure. Most people with CKD live out their lives without ever reaching kidney failure. People with stage 3 CKD have about an 80% chance of never having their kidneys fail. Kidney disease can be detected with 2 simple lab tests.
At any stage of kidney disease, knowledge is power. Knowing the symptoms of kidney disease can help you get the treatment you need to feel your best. If you or someone you know has one or more of the following symptoms of CKD, or you worry about kidney problems, see a doctor for blood and urine tests. Remember, many of the symptoms can be caused by other health problems. The only way to know the cause of YOUR symptoms is to see your doctor.
Symptom 1: Changes in Urination - Kidneys make urine, so when the kidneys are failing, the urine may change.
You may have to get up at night to urinate.
Urine may be foamy or bubbly.
You may urinate more often, or in greater amounts than usual, with pale urine.
You may urinate less often, or in smaller amounts than usual, with dark-colored urine.
Your urine may contain blood.
You may feel pressure or have difficulty urinating.
Symptom 2: Swelling - Failing kidneys don't remove extra fluid, which builds up in your body causing swelling in the legs, ankles, feet, face, and/or hands.
Symptom 3: Fatigue - Healthy kidneys make a hormone called erythropoietin (a-rith'-ro-po'-uh-tin), or EPO, that tells your body to make oxygen-carrying red blood cells. As the kidneys fail, they make less EPO. With fewer red blood cells to carry oxygen, your muscles and brain tire very quickly. This is anemia, and it can be treated.
Symptom 4: Skin Rash/Itching - Kidneys remove waste from the bloodstream. When the kidneys fail, the build-up of wastes in your blood can cause severe itching.
Symptom 5: Metallic Taste in Mouth/Ammonia Breath - A build-up of wastes in the blood (called uremia) can make food taste different and cause bad breath. You may also notice that you stop liking to eat meat, or that you are losing weight because you just don't feel like eating.
Symptom 6: Nausea and Vomiting - A severe build-up of wastes in the blood (uremia) can also cause nausea and vomiting. Loss of appetite can lead to weight loss.
Symptom 7: Shortness of Breath - Trouble catching your breath can be related to the kidneys in two ways. First, extra fluid in the body can build up in the lungs. And second, anemia (a shortage of oxygen-carrying red blood cells) can leave your body oxygen-starved and short of breath.
Symptom 8: Feeling Cold - Anemia can make you feel cold all the time, even in a warm room.
Symptom 9: Dizziness and Trouble Concentrating - Anemia related to kidney failure means that your brain is not getting enough oxygen. This can lead to memory problems, trouble with concentration, and dizziness.
Symptom 10: Leg/Flank Pain - The most common causes of CKD do not cause any pain. Much of the pain that is near the kidneys is not caused by a kidney problem. But some people who have CKD do have pain.
Some people with kidney problems may have pain in their upper back (where the kidneys are) or on the same side as the affected kidney.
Polycystic kidney disease (PKD), causes large, fluid-filled cysts on the kidneys and sometimes the liver can cause pain. Kidney infections and kidney stones can cause severe pain, often in spasms. Bladder infections can cause burning when you urinate. People who have medullary sponge kidney say it is painful.
What are the stages of chronic kidney disease?
With chronic kidney disease, the kidneys don't usually fail all at once. Instead, kidney disease often progresses slowly over a period of years. Nephrologists look at creatinine and GFR (Glomerular Filtration Rate) to best measure kidney function. Creatinine is a waste product that comes from muscle activity. When kidneys are working well, they remove creatinine from the blood. As kidney function slows, creatinine levels rise. A math formula is used to determine GFR. GFR is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute.
There are 5 stages of chronic kidney disease:
Stage 1 - Normal or high GFR (GFR > 90 mL/min)
Stage 2 - Mild CKD (GFR = 60-89 mL/min)
Stage 3A - Moderate CKD (GFR = 45-59 mL/min)
Stage 3B - Moderate CKD (GFR = 30-44 mL/min)
Stage 4 - Severe CKD (GFR = 15-29 mL/min)
Stage 5 - Kidney Failure (GFR <15 mL/min)
What is dialysis?
Dialysis is a treatment that does some of the things done by healthy kidneys. It is needed when your own kidneys can no longer take care of your body's needs. You need dialysis when you develop end stage kidney failure - usually by the time you lose about 85 to 90 percent of your kidney function and have a GFR of <15.
When your kidneys fail, dialysis keeps your body in balance by: Removing waste, salt, and extra water to prevent them from building up in the body, keeping a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate and helping to control blood pressure.
Dialysis can be done in a hospital, in a dialysis unit that is not part of a hospital, or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes.
You may have some discomfort when the needles are put into your fistula or graft, but most patients have no other problems. The dialysis treatment itself is painless. However, some patients may have a drop in their blood pressure. If this happens, you may feel sick to your stomach, vomit, have a headache or cramps. With frequent treatments, those problems usually go away.
Dialysis does some of the work of healthy kidneys, but it does not cure your kidney disease. If your kidneys have failed, you will need to have dialysis treatments for your entire life, unless you are able to get a kidney transplant. Life expectancy on dialysis can vary depending on your other medical conditions and how well you follow your treatment plan. Average life expectancy on dialysis is 5-10 years. However, many patients have lived well on dialysis for 20, sometimes even 30 years.
Talk to your healthcare team about how to take care of yourself and stay healthy on dialysis.
What types of dialysis are there?
There are two types of dialysis. There is hemodialysis and peritoneal dialysis.
Hemodialysis is the most common type of dialysis. In hemodialysis, your blood is allowed to flow, a few ounces at a time, through a special filter that removes waste and extra fluids. The clean blood is then returned to your body. Removing the harmful wastes and extra salt and fluids helps control your blood pressure and keep the proper balance of chemicals like potassium and sodium in your body. To get your blood into the filter, the doctor needs to make an access (entrance) into your blood vessels. This is done by minor surgery to your arm or leg. Sometimes, access is made by joining an artery to a vein under your skin to make a bigger blood vessel called a fistula. However, if your blood vessels are not adequate for a fistula, the doctor may use a soft plastic tube to join an artery and vein under your skin. This is called a graft. Occasionally, access is made by means of a narrow plastic tube, called a catheter, which is inserted into a large vein in your neck. This type of access may be temporary, but is sometimes used for long-term treatment. If a candidate, you may be able to do hemodialysis at home. In-Center hemodialysis while you sleep could also be an option for you.
In peritoneal dialysis, your blood is cleaned inside your body. The doctor will do surgery to place a plastic tube called a catheter into your abdomen (belly) to make an access. During the treatment, your abdominal area (called the peritoneal cavity) is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line your peritoneal cavity. Extra fluid and waste products are drawn out of your blood and into the dialysate.
There are two major kinds of peritoneal dialysis: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD). Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of peritoneal dialysis that is done without machines. You do this yourself, usually four or five times a day at home and/or at work. You put a bag of dialysate (about two quarts) into your peritoneal cavity through the catheter. The dialysate stays there for about four or five hours before it is drained back into the bag and thrown away. This is called an exchange. You use a new bag of dialysate each time you do an exchange. While the dialysate is in your peritoneal cavity, you can go about your usual activities at work, at school or at home.
Automated Peritoneal Dialysis (APD) usually is done at home using a special machine called a cycler. This is similar to CAPD except that a number of cycles (exchanges) occur. Each cycle usually lasts 1-1/2 hours and exchanges are done throughout the night while you sleep.
How can I prevent kidney failure?
The best way to prevent kidney failure is to prevent CKD. If you have CKD, work with your doctor to slow it down. You may not be able to fix the damage that is already done, but you might be able to keep the damage from getting worse. If you have diabetes and high blood pressure, it is very important for you to manage these and keep your numbers in range. Diabetes and high blood pressure account for two thirds of all cases of chronic kidney disease.
Other ways to help protect your kidneys are to:
- Eat a diet low in fat and salt
- Exercise most days of the week
- Have regular check-ups with your doctor
- Take prescribed medications as directed
- Avoid tobacco
- Limit alcohol
- Stay hydrated
*References: DaVita, National Kidney Foundation and American Association of Kidney Patients