The effect of dialysis in the management of renal failure

Introduction

Renal failure is also known as kidney failure. Kidneys are the organs that help filter waste products from the blood. They are also involved in regulating blood pressure, electrolyte balance and red blood cell production in the body.

According to Dr Ananye Mandal, he sees renal failure as damage to the function of the kidneys that lead to failure of the normal filtration process. This could be sudden or rapid in onset in case of acute renal injuring or damage or acute. Renal failure may occur due to long term damage to the kidney function leading to chronic renal failure. This disease can be corrected through the use of dialysis, the aim of treatment of renal failure is to remove the cause of failure as much as possible e.g. correction of dehydration stopping medication that cause renal failure etc. Symptoms of kidney failure are due to the build up of waste products in the body that many cause weakness, shortness of breath and confusion inability to remove potassium from the bloodstream may lead to abnormal heart rhythms and sudden death. Initially, there may be no symptoms of renal failure. The diagnosis of kidney failure usually is made by blood test measuring BUN (Blood Urea Nitrogen) Cretinine and GFR (Glomerular filtration rate).

Definition of renal failure

According to Dr. Ananya Mendel, he sees renal failure as damage to the function of the kidneys that leads to failure of the normal filtration process. This could be sudden or rapid in onset in case of acute renal injury or damage to the kidney function leading to chronic renal failure.

According to Wikipedia the free encyclopedia, renal failure is a medical condition in which the kidneys fail to adequately function due to chronic kidney disease or acute kidney injury. New Medical Net stated that it occurs due to damage to the kidney that that makes it not to perform its normal functions.

Types of renal failure

The kidney is a vital organ of the body that helps in the removal of excess fluids as well as wastes from the blood and maintained electrolyte balance in the body. Declining functions of the kidney can lead to renal failure.

Renal failure is classified into two types;

  1. Acute renal failure or acute kidney injury.
  2. Chronic renal failure or chronic kidney injury.

Acute renal injury or acute renal failure

Acute renal injury or acute renal failure is the condition in which kidney decline rapidly. The patient may be present with declining volume of urine, electrolyte imbalance and accumulation of fluids in the body. Depending on the cause of acute renal damage, acute renal injury is further classified as;

  1. Pre-renal failure including causes that reduce the blood flow to the kidney. This includes dehydration, severe fall in blood volume due to shock, blood loss or extensive burns, heart failure cardiogenic shock.
  2. Post-renal failure is caused by obstruction of urine flow from the kidneys, this obstruction may be at the level of the urethra or at the level of the outflow of the urinary bladder.

 Chronic renal disease or chronic renal failure

Chronic renal disease or chronic renal failure develops due to long term disease or damage to the kidney damage caused by disease such as diabetes, high blood pressure, etc.

Acute – on – chronic renal failure

Acute renal failure or acute renal injury develops in patients with chronic renal disease. This is called acute-on-chronic renal failure. This condition is often difficult to distinguish from chronic renal failure and may be life threatening. In fact most people who present with acute renal injury already have some degree of chronic renal injury or already have some degree of chronic renal damage End state renal disease or ESRD. This is a condition where the kidney functions are almost totally absent with less than five percent of normal dried up along with fibrosis. Dialysis or transplantation of a health donor kidney is required for life at this state.

Difference between acute renal failure and chronic renal failure

Acute renal failure is caused by sudden failure of renal functions while chronic renal failure is the result of slow and progressive decline of renal functions.

What is dialysis?

Dialysis is the artificial process of eliminating waste (diffusion) and unwanted water (ultra-filtration) from the blood. Our kidneys do this naturally. Some people however may have failed or damaged kidneys which cannot carry out the function properly. They may need dialysis.

In other words, dialysis is the artificial replacement for lost kidney functions (renal replacement therapy). Dialysis may be used for patients who have become ill and have acute kidney failure (temporary loss of kidney function) or for fairly stable patient who have permanently lost kidney function. When we are healthy, our kidneys regulate our body levels of water, minerals and remove waste. The kidney also produce erythropoietin and 1,2,5 dihydroxycholecalciferol (calcitriol) as part of the endocrine functions of the failed kidney function such as waste removal and fluid removal.

Types of dialysis

Haemodialysis:  The blood circulates outside the body of the patient. It goes through a machine that has special filters. The blood comes out of the patient through a gotheter (flexible tube) that is inserted into the vein. The filter does what the kidney does. It filters out waste products from the blood. The filtered blood then returns to the patient’s veins. Haemodialysis usually lasts about three to four hours each week. The duration of each session depends on how well the patient’s kidney work and how much fluid weights the patient has gained between treatments.

The following people may have haemodialysis done at home;

  1. People who can and want to learn how to do it at home.
  2. People whose condition has been stable while on dialysis.
  3. People who are willing to carry on doing it at home.
  4. People who do not suffer from other diseases can carry out haemodialysis.
  5. People whose home can be adapted for haemolysis equipment.

Peritoneal dialysis: A sterile (dialysis) solution rich in mineral and glucose is run through a tube into the peritoneal cavity. The abdominal body cavity around the intestine where the peritoneal membrane acts is a semi-permeable membrane. The abdomen is the area between the chest and the hips. It contains the stomach, small intestine, large intestine, liver, gall bladder, pancreas and spleen. Peritoneal dialysis uses the natural filtering ability of the peritoneum. In other words, peritoneal dialysis uses the lining of the abdomen as a filter of waste products from the blood. The dialysis is left there for some time so that it can absorb waste products. This exchange or cycle is generally repeated several times during the day with an automated system, it is often done over night. The elimination of unwanted water (ultrafiltration) occurs through osmosis as the dialysis solution has a high concentration of glucose. It results in osmotic pressure which causes the flow.

Why is dialysis necessary?

Approximately 1,500 litres of blood is filtered by a healthy person either do not work properly or not all and build up of waste in their blood without dialysis the amount of waste product in the blood would increase and eventually reach levels that would cause coma and death. Dialysis is also used to remove toxins or drugs from the blood.

Signs and symptoms of renal failure

As the kidneys fail to excrete waste from the blood adequately, they tend to accumulate in the body. There is commonly elevated level of blood creatinine. Creatinine is a component released from the damage muscle tissue and excreted normally by the kidney. In case of renal damage, the blood levels of creatinine begin to rise. Some of the other features include passing of proteins and blood in urine over long term. This may lead to abnormal fluid and electrolyte levels in blood. Abnormal levels of minerals and electrolytes including sodium potassium, calcium and phosphate can also lead to anaemia. Kidney failure is also due to the build up of waste products in the body that may cause weakness, shortness of breath and confusion. Inability to remove potassium from the bloodstream may lead to abnormal heart rhythms and sudden death. Initially, there may be no symptoms of renal failure. The diagnosis of kidney failure usually is made by blood tests measuring BUN (Blood Urea Nitrogen), creatinine and GFR (Glomerular filtration rate).

Causes of renal failure

Renal failure may be caused by acute and chronic failure due to several factors. Acute renal failure for example may be brought about by problems affecting the flow of blood to the kidney (including kidney stones, posterior urethral valves, etc.) chronic renal failure commonly results from term or chronic damage to the kidney function.

Treatment of renal failure

The aim of treatment of renal failure is to remove the cause of failure as much as possible e.g. correction of dehydration stopping medication that cause renal failure, etc.

Another main aim is to restore or take over the function of the kidney as the filter using dialysis. Acute renal failure may require hospitalization and correction of the mineral and electrolyte imbalances along with the causative factor.

 Dietary management for renal failure

Fluid and fluid control

Kidneys help control the amount of fluid that leaves the body. If the kidney disease progresses, the kidney may be unable to regulate the removal of fluid from your body and as a result your doctor may ask to limit your fluid intake. Too much fluid may cause swelling, shortness of breath or high blood pressure.

What exactly is a fluid?

Fluids are any food that is liquid or anything that welt into a liquid at room temperature. Examples of fluid include the following;

  • Coffee
  • Tea
  • Sodas
  • Ice cream
  • Gelatine
  • Milk liquid creamer
  • Water
  • Wine and beer

If your doctor advices you to decrease drink each day, these tips may help you;

  1. Drink only when thirsty. Do not drink out of habit or to be social, eat less so that you will feel less thirsty.
  2. Suck on lemon wedge.
  3. Suck on ice chips (measure small units into a cup). Brush your teeth three to four times a day. This is to prevent mouth from drying out.
  4. If you have diabetes, control your blood sugar.
  5. Chew sugarless gum or suck on sugarless hard candy.
  6. Take your medications with sips of fluid.
  7. When dining out ask your beverage to be served in a child-size glass.
  8. Measure how much fluid your favourite cup or glass holds so you will be able to monitor the amount of fluid you drink.
  9. After measuring out the total amount of fluid you can drink for the day, place water in a container; during the day drink only from this container so you can keep an eye on the amount of fluid you have consumed.

The renal diet – protein

Before making any changes to your diet, make sure you discuss them with your doctor or dietitian.

Diet plays an important role in the management of kidney disease. The diet your physician will ask you to follow will be based on your level of kidney function, your body size and any other medical condition you may have. Your diet may be helpful in delaying the need for dialysis.

Protein is needed to maintain muscles, aid in building resistance to infections, repair and replace body tissue. As your body breaks down protein foods, waste products called urea are formed. As kidney function declines, urea builds up in the bloodstream. Eating too much protein may cause urea to build up more quickly. This will make you feel sick. Eating less protein may be helpful in reducing your blood urea levels.

Reducing protein intake must be monitored by your doctor and dietitian. Examples of foods high in protein are;

  1. Meat
  2. Poultry
  3. Milk products
  4. Eggs

Foods low in protein includes the following;

  1. Fresh beans (pinto, kidney, navy)
  2. Grains
  3. Vegetables

You need both high quality and low quality protein in your diet. Your physician will determine how much protein should be in your diet.

Renal diet – sodium

Sodium is needed by the body for many functions such as controlling muscle contraction and balancing blood pressure. Healthy kidneys remove excess sodium in the urine. As kidney function declines (weakness of the kidney), sodium and fluids may accumulate in the body. Fluid retention may cause swelling in the eyes, head and/or ankles. To keep sodium level imbalance, your doctor may ask you to limit the sodium in your diet.

Foods high in sodium include the following;

  1. Table salt
  2. Potato chips
  3. Nuts
  4. Bacon
  5. Cold cuts
  6. Cheese
  7. Canned, dehydrated or instant soup
  8. Canned vegetables
  9. Processed dinner mixes (such as hamburger)

Low sodium alternatives

  1. Season with a variety of spices like garlic and oregano
  2. Use lemon.

References

Barclay L. CKD: KDIGO Guidelines Recommend Wider Use of Statins. Medscape Medical News. Available at http://www.medscape.com/viewarticle/817504. Accessed March 16, 2014.

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC, 2005). Kidney Disease Statistics for the United States. US Department of Health and Human Services. Available at http://kidney.niddk.nih.gov/kudiseases/pubs/kustats/#7. Accessed March  9, 2014.

Wiggins, K.J., Johnson, D.W., Craig, J.C. & Strippoli, G.F. (2007)  Treatment of peritoneal dialysis-associated peritonitis: a systematic review of randomized controlled trials. Am J Kidney Dis. 50(6):967-88.

Suckling, R.J., He, F.J. & Macgregor, G.A. (2010) Altered dietary salt intake for preventing and treating diabetic kidney disease. Cochrane Database Syst Rev. CD006763.

Tonelli, M. & Wanner, C. (2013). Lipid Management in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2013 Clinical Practice Guideline. Ann Intern Med. 21(15): 456 – 87

United States Renal Data System (2009). Annual Report of the United States Renal Data System. Available at http://www.usrds.org/. Accessed March 8, 2014.

Xue, J.L., Ma, J.Z., Louis, T.A. & Collins,  A.J. (2001). Forecast of the number of patients with end-stage renal disease in the United States to the year 2010. J Am Soc Nephrol. 12(12):2753-8

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