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Kidney Failure: What to Expect

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Kidney Failure: What to Expect Kidney Failure: What to Expect How does kidney failure affect a word “renal” refers to the kidneys. Even people who have dialysis treatments person’s health? may experience some of the problems of idney failure can affect a person’s uremia if they skip treatments or eat foods health in several ways. Some not recommended for people on dialysis. Kpeople experience fatigue, some lose their appetite, and some have leg cramps. These problems are caused by Can uremia be avoided? waste products that build up in the blood, People with kidney failure can avoid a condition known as uremia. Healthy most of the problems of uremia by having kidneys remove waste products from the regular dialysis treatments and limiting blood. When the kidneys stop working, foods that contain sodium, potassium, uremia occurs. and phosphorus. People who have CKD should see a kidney specialist—called a The kidneys also make hormones and nephrologist—regularly to track the pro- balance the minerals in the blood. When gression of the disease so they can begin the kidneys stop working, most people appropriate treatment before uremia develop conditions that affect the blood, occurs. bones, nerves, and skin. In addition to fatigue, loss of appetite, and leg cramps, Even though health care providers can some of the more common problems treat most of the complications of CKD caused by kidney failure are itching, sleep and ESRD, people with these conditions problems, restless legs, weak bones, joint should know what to expect when their problems, and depression. kidneys fail. When is uremia likely to occur? What problems can occur during Uremia is likely to occur when a person hemodialysis? reaches the final stages of chronic kidney During the first few weeks of disease (CKD). People with CKD often hemodialysis—a type of dialysis that uses feel no symptoms until the kidneys are a machine to circulate blood through a severely damaged. Usually when people filter outside of the body—many people develop symptoms, their kidney failure find that rapid changes in the body’s has progressed to the point where they water and mineral balance can cause prob- must have regular blood-filtering treat- lems. Muscle cramps and hypotension—a ments called dialysis or receive a kidney sudden drop in blood pressure—are two transplant to stay alive. Kidney failure common side effects. Hypotension can treated by dialysis or transplant is called make people feel weak, dizzy, or sick to end-stage renal disease (ESRD). The their stomach. National Kidney and Urologic Diseases Information Clearinghouse Many people need a few months to adjust to How does kidney failure affect the hemodialysis. Side effects can often be treated quickly and easily, so people should always report appetite? problems to their health care provider and dialysis People who have uremia often lose their appe- staff. Many side effects of hemodialysis treatments tite. Some people find that food tastes different. can be avoided by following a diet tailored for Some no longer like foods they once craved. In hemodialysis patients, limiting liquid intake, and fact, many people feel sick to their stomach at the taking medications as directed. thought of eating. But getting enough protein and calories is important for staying healthy. People with kidney failure should talk with the renal dieti- How does kidney failure affect the tian at their dialysis clinic or transplant center to blood? find foods that are appealing and provide needed In addition to uremia, kidney failure can also cause nutrients. anemia, a condition in which the red blood cells are fewer or smaller than normal, which means How does kidney failure affect the skin? less oxygen is carried to the body’s cells. Anemia Many people treated with hemodialysis complain can cause extreme fatigue and can worsen existing of itchy skin, usually on the back, chest, head, or heart problems. limbs. The itching is often worse during or just Anemia is common in people with CKD, as well after dialysis treatment due to the waste prod- as those on dialysis, because the damaged kidneys ucts that are not removed from the blood during slow the production of the hormone erythropoie- dialysis. tin (EPO), which helps the bone marrow make red The problem can also be due to the damaged kid- blood cells. Less EPO means the body has fewer neys’ inability to balance the levels of the minerals red blood cells, resulting in anemia. A synthetic calcium and phosphorus in the blood. The result- form of EPO is commonly prescribed for people ing low levels of blood calcium trigger four pea- on dialysis. sized glands in the neck, called the parathyroid glands, to release parathyroid hormone, which How does kidney failure affect the draws calcium from the bones back into the blood. heart and blood vessels? The high levels of parathyroid hormone can cause itching. Some people feel much better after having People with kidney failure, particularly dialysis most of their four parathyroid glands removed. patients, have far higher rates of heart and blood As long as one parathyroid gland remains, it can vessel problems than people without kidney regulate the calcium and phosphorus balance in problems. Heart attacks are the leading cause of the blood. hospitalization and death among dialysis patients. Kidney failure also raises the risk of other cardio- Damaged kidneys cause phosphorus to build up vascular problems such as blockage of blood to the in the blood, which can also cause itching. Often, heart and congestive heart failure. People who medications called phosphate binders—such have kidney failure need to monitor their cardio- as calcium carbonate (Tums), calcium acetate vascular health, take all prescribed medications, (PhosLo), sevelamer hydrochloride (Renagel), or and follow their health care provider’s instructions lanthanum carbonate (Fosrenol)—are prescribed for diet and exercise. with meals and snacks to bind phosphorus in the bowel, decreasing its absorption into the blood. The resulting lower blood phosphorus levels seem to ease the itching for some people. Reducing the dietary intake of phosphorus can also help. 2 Other people find relief after exposure to ultravio- How does kidney failure affect the let light. Ultraviolet light can be absorbed simply by spending time in sunlight or near a light box, joints? a therapeutic device that uses several fluorescent Kidney failure can cause pain, stiffness, and fluid lights. Still others improve with EPO shots. A few in the joints, the points where two or more bones antihistamines, such as diphenhydramine (Benad- come together. These symptoms result from amy- ryl) and hydroxyzine (Atarax, Vistaril), have been loidosis, a condition in which an abnormal protein found to help. People should consult their health in the blood called amyloid is deposited in tissues care provider before starting any therapy that and organs, including the joints and tendons—the includes over-the-counter medications. tough bands of tissue that connect muscles to bones. Healthy kidneys filter amyloid protein out A cure for itching that works for everyone has of the blood, but dialysis filters are not as efficient not been found. In some situations, a health care as the kidneys in removing amyloid. Dialysis- provider may refer people to a dermatologist, a related amyloidosis is common in people who doctor who treats people with skin problems. have been on dialysis for more than 5 years. No treatment to reverse amyloidosis has been found, How does kidney failure affect the although a successful kidney transplant may stop the disease from progressing. Health care provid- bones? ers can advise people on the best ways to relieve Kidney failure weakens the bones due to a condi- their pain. tion called chronic kidney disease-mineral and bone disorder. As discussed in the previous sec- tion, kidney failure can throw off the balance of How does kidney failure affect sleep? calcium and phosphorus in the blood, causing the People who have kidney failure often have parathyroid glands to produce too much para- insomnia—trouble getting to sleep and staying thyroid hormone. The high level of parathyroid asleep. Insomnia and other sleep disorders can hormone draws calcium from the bones into the worsen a person’s quality of life. People with blood, leaving the bones without enough cal- kidney failure should discuss these problems with cium. Chronic kidney disease-mineral and bone their health care provider. disorder describes the imbalance of calcium and Some people suffer from sleep apnea syndrome, phosphorus and how this imbalance weakens the which may be related to the effects of advanced bones. The condition affects 90 percent of dialysis kidney failure on breathing. Episodes of apnea are patients, both children and adults, causing bones breaks in breathing during sleep. Over time, these to become thin, weak, or malformed. Symptoms sleep disturbances can lead to day-night reversal— can be seen in growing children with kidney dis- insomnia at night, sleepiness during the day. This ease even before they start dialysis. Older patients condition can cause headaches, depression, and and women who have gone through menopause fatigue. Some treatments may work with people are at greater risk for this disorder. Controlling who have sleep apnea, whether they have kidney parathyroid hormone levels prevents damage to failure or not. These treatments include losing bones. Usually, overactive parathyroid glands are weight, changing sleeping position, and wearing controllable with an adjustment in dialysis treat- a mask connected to a small machine that gently ment, medications, or changes in diet. In some pumps air continuously through a hose into the cases, removal of most of the parathyroid glands nostrils—nasal continuous positive airway pres- may be useful. Reducing dietary intake of phos- sure, commonly known as CPAP. phorus can also help prevent bone disease.
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