Your kidneys are crucial to your health. They filter out waste products from your blood, remove excess fluids and help balance certain chemicals in your body. When they are damaged by disease or injury, they lose the ability to do their job. Unfortunately, kidneys cannot heal themselves. Any damage is usually irreversible. We are lucky however, because we have more kidney power than we need. Most people are born with two kidneys, but can function easily with just one. However, if you lose 85 to 90 percent of your kidney function, you enter what is called end stage renal disease (ESRD). The incidence of ESRD has increased by almost 8 percent per year for the past 5 years, resulting in more than 300,000 patients needing treatment in the United States. When you enter ESRD there are only two choices, dialysis and transplantation.
When the kidneys fail, it can be sudden or it can develop gradually and get worse over time. Chronic kidney failure may exist for years. As it progresses, the result can be ESRD. The number one cause of both chronic and ESRD is diabetes. Twenty five percent of all cases are the result of diabetes. The problem is that the excess sugar in the blood stream damages the nephrons. The medical term is diabetic nephropathy. The number two cause of ESRD is high blood pressure. High blood pressure results in some 30 percent of the cases in the United States. The tiny blood vessels in the kidneys are damaged and can no longer effectively filter out the waste in our blood. It can also be a double whammy of sorts for diabetics because many also have high blood pressure.
There are some other major causes of ESRD. Polycystic kidney disease PKD, an inherited condition that results in cysts that eventually take over the kidney. Injury or trauma that can cause muscle damage and breakdown and result in sudden failure of the kidneys. Poisons, some over-the-counter painkillers may cause kidney damage if taken over long periods of time. Untreated infections or other disease such as cancer.
As if kidney failure wasn?t enough, there are other complications of ESRD, particularly for the young. Ninety percent of people undergoing dialysis suffer a bone disease called renal osteodystrophy. Children suffer problems because they are still growing bones. It can result in deformities. The elderly, especially women can also suffer more because they are already at risk for osteoporosis. Some kidney patients also suffer from anemia. This is a result of the kidneys decreased ability to make EPO, which helps the bone marrow make red blood cells. Peripheral neuropathy is another potential complication of ESRD. Another complication involves an elevation of potassium. Severe deviation of potassium, in either direction from its normal range, can be life threatening. The kidneys are in charge of controlling this delicate range.
Dialysis is used to treat ESRD. It is also used when kidneys fail temporarily, perhaps during an infection or as the result of an injury. There are two types of dialysis, hemodialysis and peritoneal dialysis. Both methods cleanse the blood without using the kidneys. Both require effort on the part of the patient and making the choice of which to use is something that requires consultation with your doctor and with other caregivers, including family and friends, who may be required to help.
Hemodialysis involves a machine that is used to filter the blood, an artificial kidney if you will. Before you start hemodialysis an entrance to your blood vessels has to be created. This is usually done by minor surgery to your arm or leg. Sometimes an artery and a vein are joined under your skin to create a bigger blood vessel called a fistula. Occasionally, a small plastic tube is inserted to connect the artery and the vein; this is called a graft. The actual treatment usually occurs at a hospital or dialysis center. The treatments can occur at home, but a trained person is still required to help. The time required varies on the amount of kidney function left and other factors. Most people can expect to spend 3 to 4 hours, three times a week, connected to the kidney machine. During that time you can read, write, watch TV, as long as you stay in one place.
Peritoneal dialysis happens inside your body, in the abdomen. A short tube, called a catheter is placed into your belly. A fluid called