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Chronic Renal Failure

Chronic Kidney Disease Symptoms

The kidneys are remarkable in their ability to compensate for problems in their function. That is why chronic kidneys disease may progress without symptoms for a long time until only very minimal kidneys function is left.

Because the kidneys perform so many functions for the body, kidneys disease can affect the body in a large number of different ways. Symptoms vary greatly. Several different body systems may be affected. Notably, most patients have no decrease in urine output even with very advanced chronic kidney disease.

  • Fatigue and weakness (from anemia  or accumulation of waste products in the body)
  • Loss of appetite, nausea and vomiting
  • Need to urinate frequently, especially at night
  • Swelling of the legs and puffiness around the eyes (fluid retention)
  • Itching, easy bruising, and pale skin (from anemia)
  • headaches, numbness in the feet or hands (peripheral neuropathy), disturbed sleep, altered mental status (encephalopathy from the accumulation of waste products or uremic poisons), and restless legs syndrome
  • High blood pressure , chest pain  due to pericarditis (inflammation around the heart)
  • Shortness of breath from fluid in lungs
  • Bleeding (poor blood clotting)
  • Bone pain and fractures
  • Decreased sexual interest and erectile dysfunction

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Self-Care at Home

Chronic kidney disease is a disease that must be managed in close consultation with your healthcare provider. Self-treatment is not appropriate.

There are, however, several important dietary rules you can follow to help slow the progression of your kidney disease and decrease the likelihood of complications.

This is a complex process and must be individualized, generally with the help of your healthcare provider and a registered dietitian.

The following are general dietary guidelines:
  • Protein restriction: Decreasing protein intake may slow the progression of chronic kidney disease. A dietitian can help you determine the appropriate amount of protein for you.
  • Salt restriction: Limit to 4-6 grams a day to avoid fluid retention and help control high blood pressure.
  • Fluid intake: Excessive water intake does not help prevent kidney disease. In fact, your doctor may recommend restriction of water intake.
  • Potassium restriction: This is necessary in advanced kidney disease because the kidneys are unable to remove potassium. High levels of potassium can cause abnormal heart rhythms. Examples of foods high in potassium include bananas, oranges, nuts, and potatoes.
  • Phosphorus restriction: Decreasing phosphorus intake is recommended to protect bones. Eggs, beans, cola drinks, and dairy products are examples of foods high in phosphorus.

Other important measures that you can take include:

  • Carefully follow prescribed regimens to control your blood pressure and/or diabetes.
  • Stop smoking
  • Lose excess weight

In chronic kidney disease, several medications can be toxic to the kidneys and may need to be avoided or given in adjusted doses. Among over-the-counter medications, the following need to be avoided or used with caution:

  • Certain analgesics - Aspirin nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen [Motrin, for example])
  • Fleets or phosphosoda enemas because of their high content of phosphorus
  • Laxatives and antacids containing magnesium and aluminum such as Milk of Magnesia and Mylanta
  • Ulcer medications H2-receptor antagonists - cimetidine (Tagamet), ranitidine (Zantac), (decreased dosage with kidney disease)
  • Decongestants like pseudoephedrine (Sudafed) especially if you have high blood pressure
  • Alka Seltzer, since this contains a lot of salt
  • Herbal medications

If you have a condition such as diabetes, high blood pressure, or high cholesterol underlying your chronic kidney disease, take all medications as directed and see your healthcare provider as recommended for follow-up and monitoring.

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Dialysis

In end-stage renal disease, kidney functions can be replaced only by dialysis or by kidney transplantation. See the Transplant section for more information about transplants. There are two types of dialysis 1) hemodialysis and 2) peritoneal dialysis.

Hemodialysis

Hemodialysis involves circulation of blood through a filter on a dialysis machine. Blood is cleansed of waste products and excess water. The acid levels and the concentration of various minerals such as sodium and potassium in the blood are normalized. The blood is then returned to the body.

Long-term dialysis requires access to a blood vessel so that the machine has a way to remove and return blood to the body. This may be in the form of a dialysis catheter or an arteriovenous fistula or graft.

A catheter may be either temporary or permanent. These catheters are either placed in the neck or the groin into a large blood vessel. These catheters are prone to infection and may also cause blood vessels to clot or narrow.

The preferred access for hemodialysis is an arteriovenous fistula wherein an artery is directly joined to a vein. The vein takes two to four months to enlarge and mature before it can be used for dialysis. Once matured, two needles are placed into the vein for dialysis. One needle is used to draw blood and run through the dialysis machine. The second needle is to return the cleansed blood.

An arteriovenous graft is placed in patients who have small veins or in whom a fistula has failed to develop. The graft is made of artificial material and the dialysis needles are inserted into the graft directly.

These venous access devices usually can be placed with local anesthesia on an outpatient basis.
Hemodialysis typically takes three to five hours and is needed three times a week.
You will need to travel to a dialysis center for hemodialysis.
Home hemodialysis is possible in some situations. A care partner is needed to assist you with the dialysis treatments. A family member or close friend are the usual options, though occasionally patients may hire a professional to assist with dialysis. Home hemodialysis may be performed as traditional three times a week treatments, long nocturnal (overnight) hemodialysis, or short daily hemodialysis. Daily hemodialysis and long nocturnal hemodialysis offer advantages in quality of life and better control of high blood pressure , anemia, and bone disease.

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