Nephrons are the tiny units in each kidney which give them functionality. We have about 1 million of these in each kidney.
Kidneys do a lot more for your body then you realize. They maintain our fluid balances, balance out some of the hormones in our bodies such as the parathyroid hormone, clean and filter wastes, and play a role in bone health through the processing of calcium. They also filter things like potassium.
When kidneys don’t do their jobs properly, the fluid balances and processing of other wastes become greatly disturbed. This deteriorating process happens over many years in many cases, or, if kidneys are suddenly injured, can suddenly stop working. That is known as acute renal failure.
Common Causes of CKD
Diabetes is the number one cause of CKD. This is because high blood glucose levels disturb the nephrons in the kidney little by little until they are no longer a functional unit. This is why poorly controlled diabetes gradually reduces the kidney function.
Hypertension is another way in which the kidneys become destroyed. Since the heart’s pumping action is working too quickly in hypertension, the blood vessels are taking repeated damage. Eventually, the blood vessels become damaged within the scope of your kidneys, and therefore the kidneys will no longer filter wastes. You will have a fluid buildup that begins, and kidneys are damaged even more.
Urinary Tract and Kidney Infections
Chronic urinary tract infections over time will likely produce damage to the kidneys. Untreated Urinary Tract Infections can easily travel up to the kidney area, and produce a more serious kidney infection. Kidney infections, (pyelonephritis), quickly destroy nephrons, and can even cause acute renal failure.
Stages of CKD
In stage one of CKD, this is only mild damage. A blood creatnine test will show a GFR of 90-100.A GFR is the glomerular filtration rate. This is a determining factor of how well kidneys are functioning.
It is doubtful that you will notice anything at this stage. Kidneys can hold up well not functioning fully.Some people never go on to develop more stages depending on their medical conditions and how well they are controlled.
In stage two of CKD, you would have a GFR of about 60-89. You likely will not have any symptoms at this stage, but sometimes protein of the urine will begin showing. Foamy urine is a good indication of protein.
In stage three of chronic kidney disease, you may notice that you are urinating at night often. It is possible to feel more fatigued, and there may be signs of anemia present. It is also not totally uncommon to be experiencing cramps in the legs or itchy dry skin.Your GFR rate is below 60 at this point.
In stage four, you will need to see a nutritionist for a special diet that works on limiting your phosphorus, potassium, and sodium. You may start to make less urine then normal, retaining fluids, (have edema and swelling in the extremities), and feeling overall unwell. Both you and your doctor will start making future plans for some type of dialysis. Your GFR will likely display results from 15-29, which is a big loss of kidney functioning.
Stage 5 is a critical stage of kidney failure. People are symptomatic at this stage to a high degree, having swelling in the extremities, nausea and vomiting, and hardly any urine production, (maybe a teaspoonful), if they are lucky. Kidneys are not filtering anything, and this is where you are placed on dialysis for survival. Your kidney doctor will now have you on some other medications such as potassium binders, and calcium binders in order to keep down toxins in the blood between dialysis treatments.
If you are having hemodialysis you will have choices of learning to do this yourself at home or do this in a center three times a week. A fistula is placed in the arm for access in dialysis to clean the blood.
Peritoneal dialysis uses a catheter that is placed into the abdominal area. This is a common choice for many people as the restrictions are not as many as for those on hemodialysis. You do peritoneal dialysis several times daily at home, and since this is the case, fluids are not as restricted.
Kidney transplants are not always easy to get, but you can always get on the list for a donor or check woth family members to see if they are a compatible donor. It is often a long process.
As you can see from reading here, the care of your kidneys are very very important. This is why it important to work closely with your doctor and have bloodwork done on a regular basis to monitor kidney function, and try to keep kidney function as long as possible.
Chronic kidney disease and acute kidney injury (also known as acute renal failure) cause the kidneys to lose their ability to filter and remove waste and extra fluid from the body. Hemodialysis is a process that uses a man-made membrane (dialyzer) to:
Remove wastes, such as urea, from the blood.
Restore the proper balance of electrolytes in the blood.
Eliminate extra fluid from the body.
For hemodialysis, you are connected to a filter (dialyzer) by tubes attached to your blood vessels. Your blood is slowly pumped from your body into the dialyzer, where waste products and extra fluid are removed. The filtered blood is then pumped back into your body.
There are different types of hemodialysis. Talk about these with your doctor to decide which one might be best for you.
In-center hemodialysis. You go to a hospital or a dialysis center. Hemodialysis usually is done 3 days a week and takes 3 to 5 hours a day.
Home hemodialysis. After you are trained, you do your dialysis treatments at home. Hemodialysis is usually done 3 days a week (or every other day). Discuss with your doctor how long each session needs to be. A session could be as long as 6 hours, which may help you feel better.
Daily home hemodialysis. After you are trained, you do your dialysis treatments at home. Hemodialysis is done 5 to 7 days a week. Each session takes about 3 hours.
Nocturnal home hemodialysis. After you are trained, you do your dialysis treatments at home. Hemodialysis is done 3 to 7 nights a week. Each session is done overnight (about 6 to 8 hours).
Before treatments can begin, your doctor will need to create a site where the blood can flow in and out of your body during the dialysis sessions. This is called the dialysis access. The type of dialysis access you have will depend in part on how quickly you need to begin hemodialysis.
Fistula. A fistula is created by connecting an artery to a vein in your lower arm. A fistula allows repeated access for each dialysis session. It may take several months for the fistula to form. A fistula may not clot as easily as other dialysis access methods. A fistula is the most effective dialysis access and the most durable. Complications include infection at the site of access and clot formation (thrombosis).
Graft. A vascular access that uses a synthetic tube implanted under the skin in your arm (graft) may be used if you have very small veins. The tube becomes an artificial vein that can be used repeatedly for needle placement and blood access during hemodialysis. A graft does not need to develop as a fistula does, so a graft can sometimes be used as soon as 1 week after placement. Compared with fistulas, grafts tend to have more problems with clotting or infection and need to be replaced sooner. A polytetrafluoroethylene (PTFE or Gore-Tex) graft is the most common type used for hemodialysis.
Venous catheter. A tube, or catheter, may be used temporarily if you have not had time to get a permanent access. The catheter is usually placed in a vein in the neck, chest, or groin. Because it can clog and become infected, this type of catheter is not routinely used for permanent access. But if you need to start hemodialysis right away, a catheter may be used until your permanent access is ready.
Hemodialysis for acute kidney injury may be done daily until kidney function returns.
What To Expect After Treatment
About once a month, you will have blood tests to make sure you are getting the right amount of hemodialysis. These tests are done to help find out how well hemodialysis is working. Your weight before and after each session will be recorded, as will the length of time it takes to complete the dialysis session. If you have hemodialysis at home, you will need to keep records of your weight before and after each session and the length of each session.
Why It Is Done
Hemodialysis is often started after symptoms or complications of kidney failure develop. Symptoms or complications may include:
Signs of uremic syndrome, such as nausea, vomiting, loss of appetite, and fatigue.
High levels of potassium in the blood (hyperkalemia).
Signs of the kidneys’ inability to rid the body of daily excess fluid intake, such as swelling.
High levels of acid in the blood (acidosis).
Inflammation of the sac that surrounds the heart (pericarditis).
Hemodialysis is sometimes used when acute kidney injury develops. Dialysis is always used with extra caution in people who have acute kidney injury, because dialysis can sometimes cause low blood pressure, irregular heart rhythms (arrhythmias), and other problems that can make acute kidney injury worse.
How Well It Works
Hemodialysis may improve your quality of life and increase your life expectancy. But hemodialysis provides only about 10% of normal kidney function. It does not reverse chronic kidney disease or kidney failure.
Dialysis has not been shown to reverse or shorten the course of acute kidney injury. But it may be used when fluid and electrolyte problems are causing severe symptoms or other problems. Some people who develop acute kidney injury stay dependent on hemodialysis and will go on to develop kidney failure.
The normal range is 3.5-5.0 mEq/L or that is the normal range for 95% of the population, so you may fall outside of that range and be totally normal. If you are below that level, we call it hypokalemia, and if you are above that level, we call it hyperkalemia. These word come from hypo (meaning under) or hyper (meaning over), kalium (meaning potassium), and emia (meaning a condition of the blood).
What Are They Looking For:
Hypokalemia especially below 3.0 mEq/L is the most worrying and tends to result in muscle weakness, muscle cramps, constipation, and even flaccid paralysis.
Hyperkalemia is most concerning above 5.5 mEq/L though symptoms are more nonspecific including malaise, palpitations, muscle weakness, and potentially cardiac arrhythmia and sudden cardiac death.
Both conditions are equally worrying if symptomatic and not treated. Hyperkalemia increases mortality from cardiovascular events whereas hypokalemia increases mortality from end-stage renal disease.
For such a little particle, potassium incorporates a number of organs. The heart, kidney, muscles, gastrointestinal tract, and adrenal gland just to name a few. All of these systems work together to keep everything level, so when there is extreme deviation it could be a sign of something problematic. These changes normally result from chronic diseases that have other symptoms associated with them though knowing the potassium level can help better elucidate the cause.
All of the treatments looks to bring the potassium level back in normal range to alleviate symptoms and then treat the underlying condition. In the setting of hypokalemia, potassium supplements are given either in an oral or intravenous form. Hyperkalemia on the other hand is a little more challenging because the body may no longer be able to excrete excess potassium on its own resulting in a need for diuretics or even hemodialysis.
Hypokalemia can result from various medical conditions, such as diabetic ketoacidosis, Cushing’s syndrome, and Bartter Syndrome, but is much more likely to be caused by poor diet, diarrhea, and certain diuretics.
Hyperkalemia on the other hand can result from congenital adrenal hyperplasia, Addison’s disease, and tumor lysis syndrome; but is more likely to be the result of medication and some degree of renal insufficiency.
Take Home Point:
If your potassium levels are a little outside of the normal range and you feel fine, your doctor is unlikely to pursue that further. Being on the low end means you probably could increase you intake some and being on the high end means you might want to take a look at your current medications.
Our kidneys, like the lungs are paired organs that work equally to eliminate wastes in the body while removing excess water from the blood. Surprisingly, a human body could survive with one kidney alone and is able to live a normal life. No organ in the body could replace the function of the kidneys. There are certain instances that render the functions of both kidneys, making our bodies unable to process waste materials like urine. Kidney illnesses are characterized from mild to life-threatening problems. More often, people that suffer from kidney failures undergo treatment called hemodialysis were the blood is being filtered via a machine, removing wastes materials that is poisonous to the body and getting rid of excess fluids in the blood. Some only uses dialysis in short period of time until their kidneys are able to function, while others with complete kidney failure, the procedure are a lifetime process. People that undergo dialysis are required to follow a strict diet. Sad to say there are a lot restrictions regarding the diet of a renal patient.
Low sodium foods
A person who undergoes dialysis is not allowed to eat high sodium foods. Sodium attracts water like a magnet, since the function of the kidneys of a renal patient is low to none, excess fluids inside the body is very deadly. Medical experts and doctors are very strict regarding the diet of a renal patient; they know that one wrong move could be fatal.
Low potassium foods
Potassium like sodium also attracts fluid in our body. Although they could cancel each other out excess quantities to both fluids would be unhealthy to renal patient. Potassium rich foods are very abundant to the market. We all know that fruits are very beneficial to our health, however, there are certain types of fruits that is not appropriate to a renal patient. Mangos, avocados, watermelons and papaya are some of the potassium rich fruits, while apple and pineapple are allowed in the diet of a renal patient. Carrots, celery, cucumber, red pepper, and green pepper are low potassium vegetables are included to the diet of the dialysis patient.
A renal patient is required to monitor his or her fluid intake, excess fluids could cause damage to remaining healthy organs in the body. Soups and Oatmeal should be taken at a minimal manner.
The diet of a renal patient is very fragile. We must familiarize ourselves of the allowed and not allowed foods, if not their conditions could worsen. The key to any diet is balance; if we could attain that, our heath would be secured.
In the early days of dialysis, the thought was that the person would not be living a very interesting or fun life – that they would only face clinic visits, doctors and nothing more. This is not true any longer, especially in those patients who are otherwise healthy and active. There is an estimated 217,000 Americans who are going through dialysis on an ongoing basis, with a cost of just over 11 billion dollars.
The amount of dialysis that you have to do, the length of time that it will take for each treatment and the dietary restrictions that you will have will vary from patient to patient and will be determined by the doctor and nutritionist based on lab values for your blood and urine. In addition, your weight and the stage of your kidney disease or the type of kidney disease that you have will determine how often or how long your treatments will take. There are two types of kidney dialysis: hemodialysis and peritoneal dialysis, with the majority (90%) of patients having the former. During this type of treatment, the blood is circulated outside of the body to a machine which cleans and extracts the waste products before it is returned to the body.
To get started with dialysis, especially hemodialysis, the doctor will make a fistula, or entrance, via minor surgery in the leg, arm or neck. In some cases, especially with smaller or younger patients, a small plastic graft will be added to make a larger vessel for access. The blood is then circulated through the machine and back to the body after passing through a special fluid called dialysate, which removes the impurities and waste products.
During the other type of dialysis, the patient is more involved in the procedure, making them more accountable for their own health and wellbeing. It is accomplished by using the peritoneal membrane as a filter. This membrane is a sac that surrounds the abdominal organs and is semi-permeable. The small particles of waste products go through the membrane but blood cells cannot. The problem with this type of dialysis is that the patient is responsible for introducing the dialysate fluid through a catheter and then draining it back out after three to four hours, adding in new fluid at this point. Draining takes about half an hour and is then done about five more times per day. While the patient is freed from having to go to a clinic for several hours a day, it can be a problem for some to keep up the schedule on their own, requires careful washing to prevent infection and also may not be an option for those who are very large.
Prevention, Diet and Good Nutrition for Kidney
During the five stages of kidney disease, the dietary needs will change. During the earliest stages, the changes may be only minor. In the secondary stages, the protein and other nutrients will be reduced to keep the disease from progressing. In the final stage, also known as end stage renal disease, the need for protein is increased, even higher than what is considered to be a normal amount. The right amount of protein must be determined for each patient – too much or too little can be dangerous.
For instance, some of the diets that have been popular in the past, including the high-protein diets, can be dangerous to the kidneys and can cause other problems to the health as well. Some protein sources, especially those suggested by these diets, can be high in fat and calories, making them even more problematic as well. Even when protein is recommended, it should be from healthy sources, including plants and healthy protein supplements instead of the higher fat animal proteins.
Working with a nutritionist becomes very important during every stage of kidney disease so that the kidneys can be protected as much as possible. A healthy diet also prevents other health conditions from getting worse and creating further problems for the kidneys. For instance, a healthy, low-fat and low-salt diet can help to control the blood pressure, which is a number one factor in developing or worsening kidney disease. A healthy diet also works to keep the weight regulated as well. Being overweight can also cause a strain on the kidneys and makes other conditions more serious as well. Simply losing a few pounds can help to regulate the blood pressure and other conditions of the body.
Another factor that must be considered is the amount of fluids that are included in the diet. The average person is typically slightly dehydrated on a normal basis – the thinking of most doctors is that if you are feeling thirst, you are already dehydrated or well on the way to it. On the other hand, having too many fluids in the body can be a problem as well, diluting the amount of the important electrolytes that are needed. An electrolyte imbalance can lead to mental confusion or cloudy thinking, aches and pains and heart rhythm irregularities. In some people with kidney disease, the amount of fluids that are allowed will be restricted because the kidneys are not removing enough of the excess from the body, leading to swelling in and around the organs.
Diet, Dialysis Options and Lifestyle: Two Case Studies
Shelley and Byron are both facing dialysis: Shelley will be using hemodialysis, while Byron will be using peritoneal dialysis at his own home. Shelley, a stay-at-home mother and student, schedules her dialysis for times when her children are at school as much as possible and brings her own schoolwork with her while she is undergoing treatment. Byron, who works full time outside his home, begins his treatment at home and completes the other steps throughout the day. His watch’s alarm feature goes off whenever he needs to drain. His boss is very sympathetic and allows him the time that he needs to complete the process.
In addition to the dialysis, Shelley and Byron will both be working with a nutritionist very carefully so that they can both understand the dietary needs that they have now and may face in the future. For Shelley, she is in a later stage of kidney disease than Bryon is, so her protein need is much higher. She is not only encouraged to get quite a bit of protein from food sources, but is also going to use protein supplements to make sure that she gets the right amount.
Byron, on the other hand, is being told to reduce his protein intake slightly at this point in his disease. In addition, he is being asked to reduce the amount of salt and fat in his diet. Using the DASH (Dietary Approaches to Stop Hypertension) diet will be beneficial to him, not only to reduce the salt intake and control his blood pressure but also to help him keep his weight in check at the same time. Instead of higher fat protein foods, Byron will be using protein supplements, keeping his calorie count down but his protein intake where it is supposed to be.
Both Shelley and Byron will be using a protein supplement which gives them high-quality, highly digestible protein in many fruit-based flavors for added palatability. The size of each serving is remarkably small and the calorie count is equally as small (100 per serving).
Gone are the days when kidney dialysis patients had no life except to visit their physicians or hospitals for treatments. These days, those who are receiving dialysis treatments are doing the things they always did before beginning their treatments, especially those who, aside from needing dialysis, are otherwise healthy and active. There are hundreds of thousands of Americans who are dealing with kidney disease, and more than 215,000 are currently going through dialysis treatments.
No two dialysis patients are alike, and the amount of treatments that are needed for each patient, the length of time for the treatments, and dietary restrictions are different for every patient. In fact, a patient’s weight, as well as how advanced their kidney disease is, are both factors in the amount of treatments that will be needed. A physician will be able to advise patients as to what their dietary needs are, depending on blood and urine samples taken at that time.
There are two types of kidney dialysis treatments, hemodialysis and peritoneal dialysis. The more common of the two treatments is hemodialysis, with about 90% of all patients undergoing this type of treatment. Hemodialysis is a treatment that allows the blood to circulate outside of the body into a machine. This machine cleans the blood and removes any waste product before returning the blood back to the patient’s body.
With peritoneal dialysis, the patient must be more hands-on with their own treatment. This is done by using the peritoneal membrane as a filter for the blood, and the waste filters through, leaving the clean blood behind. Patients are expected to do this type of dialysis themselves, and are required to put the dialysate fluid into a catheter, draining it after three or four hours, and then refilling it. The draining process takes about one half hour, and must be done four or five times daily. Because this type of treatment requires careful cleaning around the area to avoid any infections, this may not be the optimal procedure for those who are extremely obese.
Both types of dialysis treatments will begin with a physician performing a minor surgery to make a small entrance in the leg, arm or neck. Some patients may receive a plastic graft added on to make access for dialysis easier. This is especially common in children and senior citizens. Once the entrance has been created, dialysis treatments of either type may begin.
The Proper Nutrition For Good Kidney Health
There are five stages of kidney disease, and each stage has different nutritional requirements for patients. There may only be a few minor changes in the beginning stages, and as the disease progresses, especially in the secondary stage, the intake of protein and other necessary nutrients is actually reduced, which can help to keep the disease from progressing any further.
By the time the patient reaches the final stages of the disease, their protein intake will be increased greatly, although it is still possible for patients to get too much protein. Too much or too little can cause adverse health effects, and it is best that patients use a diet plan that is specifically created for them by a physician, dietitian or nutritionist. It is advised that patients do not use popular fad diets, especially those that are high in protein, as they often are also high in fat and calories. Specialized diet plans often use such dietary sources of protein as vegetable protein. (Soy is terrific)
One of the biggest causes of kidney diseases, and something that can worsen existing kidney disease, is high blood pressure. A diet that is high in protein but low in fat and sodium will help keep blood pressure in check as well as regulate weight, which also plays a role in kidney disease.
Fluids are necessary as well, although depending on the patient, the intake of fluids may be restricted in order to avoid swelling in and around the organs. One great way for patients to get the protein and fluid they need is to use a liquid protein supplement.
Protein Supplements Can Help
In addition to protein shots there are other terrific protein supplements available, including protein powders, liquid protein and protein bars/snacks. Protein supplements are made from a variety of protein sources, including whey, casein, rice, soy and egg, some of which are complete proteins and some incomplete. A complete protein is one that contains all 22 of the essential and non-essential amino acids.
Protein Powders – This is the most versatile type of protein supplement and can be used in a number of ways. Protein powders are available in many delicious flavors, including chocolate and vanilla for shakes, berry and fruit punch for smoothies and slushies, and unflavored for adding to recipes. For a quick and easy protein smoothie, just blend two scoops of berry or fruit punch protein powder, one cup of orange juice, one cup of frozen berries and one banana.
Liquid Protein – Ready-made protein shakes and smoothies are available, which are portable and easy to take anywhere. Liquid protein supplements also make excellent meal replacements. They can be used to create your own drinks and can be added to certain recipes. Many liquid protein supplements are milk-based, so if you are allergic to milk or lactose intolerant, you should opt for a supplement made with soy or rice proteins.
Protein Bars/Snacks – There are many different delicious protein bars available that make great snacks as well as meal replacements. In addition to bars, there are many other types of snacks, including jerky. Remember that no matter what type of supplement is being used, it is always best to check with a physician before using them and before starting any type of diet plan, especially for patients with kidney disease.