All about chronic kidney disease - Golden Standards

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All about chronickidney disease

Learn more about dialysis andchronic kidney disease

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Definition, causesand symptoms

Stages

Slowing progression

Lifestyle choices

What to eat

Dialysis

Getting a kidney transplant

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Kidney disease occurs when

kidneys can no longer perform

their functions to full capacity.

These functions include removing

extra water and wastes, helping

control blood pressure, keeping

body chemicals in balance,

maintaining strong bones and

telling your body to make red

blood cells. Kidney disease can

happen all of a sudden, or over

time.

All aboutchronic kidneydisease

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Definition, causesand symptomsWhat is chronic

kidney disease (CKD)?Healthy kidneys function to removeextra water and wastes, help controlblood pressure, keep body chemicals inbalance, keep bones strong, tell yourbody to make red blood cells and helpchildren grow normally. Chronic kidneydisease occurs when kidneys are nolonger able to clean toxins and wasteproduct from the blood and performtheir functions to full capacity.This canhappen all of a sudden, or over time.

What is acute renal failure?“Renal” means related to the kidneys.“Acute” means sudden. So acute renalfailure means the kidneys have failedsuddenly, often due to a toxin (a drugallergy or poison) or severe blood loss ortrauma. Dialysis is used to clean theblood and give the kidneys a rest. If thecause is treated, the kidneys may be ableto recover some or all of their function.

What are the main causes ofkidney disease?Diabetes is the number one cause ofkidney disease, responsible for about40% of all kidney failure. High blood

pressure is the second cause, responsiblefor about 25%.Another form of kidneydisease is glomerulonephritis, a generalterm for many types of kidneyinflammation. Genetic diseases,autoimmune diseases, birth defects andother problems can also cause kidneydisease.

I have diabetes.Will my kidneysfail?Diabetes is a risk factor for kidneydisease, but this does not mean yourkidneys will fail.You can care for yourkidneys by controlling your blood sugarand getting regular microalbumin urinetests to see if you are spilling even tinyamounts of protein. Even if you developdiabetic kidney disease, you can workwith your doctor to keep your kidneysworking as long as possible.

Can I catch kidney disease fromsomeone who has it?No. Kidney disease is not contagious;you cannot catch it from someone. Mostkidney disease is caused by diabetes andhigh blood pressure, conditions that canrun in families. If you are a familymember of someone who has diabetes,high blood pressure, or kidney disease, itis a good idea to ask your doctor tocheck your blood pressure and kidney

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function at your next checkup.

What are kidney stones?A kidney stone occurs when substancesin the urine form crystals. Kidney stonescan be large or small. Large ones candamage the kidneys; small ones may beable to pass in the urine. Because crystalshave sharp edges, passing even smallstones can be very painful.Treatmentdepends on what the stones are made of.

What is PTH?Parathyroid hormone (PTH) isproduced by several small, bean-likeparathyroid glands in your neck. Its“job” is to tell your bones to releasecalcium into your bloodstream.Toomuch PTH can become a problem inpeople with kidney disease.

Healthy kidneys convert a hormonecalled calcitriol to its active form ofvitamin D. Calcitriol lets your bodyabsorb calcium from food you eat.Whenyour kidneys are not working well, theystart to make less calcitriol—so even ifyou eat calcium, your body can’t absorbit. PTH kicks in to make sure youalways have enough calcium in yourblood. Over time, this can weaken yourbones.

A blood test can show if your PTHlevels are above normal. If they are, yourdoctor may prescribe a form of activevitamin D.

I have a family member withpolycystic kidney disease (PKD).Should I be tested?Since 60% to 70% of people with PKDhave a family member with PKD, askingyour doctor about being tested seemslike a good idea.The first test used forPKD is an ultrasound to look at thekidneys and see if there are cysts. Nocontrast dye is needed, so this is a non-invasive test. Learning more about PKDmay help you take better care of yourkidney health.The PKD Foundation hasfree information that can help you.Youcan reach them by calling 1-800-PKD-CURE, or visit their website atwww.pkdcure.org.

What are the symptoms ofchronic kidney disease?Knowing the symptoms of kidneydisease can help people detect it earlyenough to get treatment. Symptoms caninclude:• Changes in urination—making more

or less urine than usual, feelingpressure when urinating, changes inthe color of urine, foamy or bubbly



urine, or having to get up at night tourinate.

• Swelling of the feet, ankles, handsor face—fluid the kidneys can’tremove may stay in the tissues.

• Fatigue or weakness—a buildup ofwastes or a shortage of red blood cells(anemia) can cause these problemswhen the kidneys begin to fail.

• Shortness of breath—kidney failureis sometimes confused with asthma orheart failure, because fluid can buildupin the lungs.

• Ammonia breath or an ammonia ormetal taste in the mouth—wastebuild-up in the body can cause badbreath, changes in taste or an aversionto protein foods such as meat.

• Back or flank pain—the kidneys arelocated on either side of the spine inthe back.

• Itching—waste buildup in the bodycan cause severe itching, especially ofthe legs.

• Loss of appetite• Nausea and vomiting• More hypoglycemic episodes, if

diabetic

If you believe you have any of thesesymptoms, talk to your doctor aboutyour concerns.This is especiallyimportant if you have a close family

member who has kidney disease, or ifyou have diabetes or high bloodpressure, which are the main causes ofkidney failure.

How can I find out if I havekidney disease?Kidney disease can be detected throughlab tests or by symptoms. High bloodlevels of creatinine and urea nitrogen(BUN) or high levels of protein in yoururine suggest kidney disease. Diabeticsshould have a yearly urine test formicroalbumin, small amounts of proteinthat don’t show up on a standard urineprotein test.

If I have signs of kidney disease,what should I do?After you have basic screening testsdone, if you have signs of kidney diseaseyou should ask for a referral to anephrologist, a doctor specializing intreating kidney disease.A nephrologistwill perform an evaluation and thensuggest medications or lifestyle changesto help slow the progression of kidneydisease.

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Stages

I just found out I havekidney failure. Does

this mean I am goingto die?No. Dialysis or a kidney transplant cankeep you alive when your kidneys fail.The more you learn and take part inyour treatment, the better you can feel.Some people live for decades withkidney failure.

What are the stages of chronickidney disease (CKD)?In chronic kidney disease, the kidneysdon’t usually fail all at once. Instead,kidney disease often progresses slowly,over a period of years.This is good news,because if CKD is caught early,medications and lifestyle changes mayhelp slow its progress and keep youfeeling your best for as long as possible.With early diagnosis, it may be possibleto slow, stop or even reverse CKD,depending on the cause.The NationalKidney Foundation (NKF) recentlypublished information on the stages ofchronic kidney disease. In the tablebelow, the “GFR level,” or glomerularfiltration rate, is a measure of how wellyour kidneys are cleaning your blood.Your doctor can calculate your GFR,

based on a formula.

Stages of chronic kidney disease

In Stage 1 and Stage 2 CKD, there areoften few symptoms. Early CKD isusually diagnosed when there is:• High blood pressure• Higher than normal levels of

creatinine or urea in the blood• Blood or protein in the urine• Evidence of kidney damage in an

MRI, CT scan, ultrasound or contrast

Stage Description GFR Level

Normalkidneyfunction

Healthy kidneys 90 mL/minor more

Stage 1 Kidney damagewith normal orhigh GFR

90 mL/minor more

Stage 2 Kidney damageand milddecrease inGFR

60 to 89mL/min

Stage 3 Moderatedecrease inGFR

30 to 59mL/min

Stage 4 Severedecrease inGFR

15 to 29mL/min

Stage 5 Kidney failure Less than 15mL/min oron dialysis

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X-ray• A family history of polycystic kidney

disease

In Stage 3 CKD, anemia (a shortage ofred blood cells) and/or early bonedisease may appear and should betreated to help you feel your best andreduce problems down the road.

When CKD has progressed to Stage 4,it’s time to begin preparing for dialysisand/or a kidney transplant.

How many people in the U.S.have chronic kidney disease?The National Kidney Foundationestimates that about 20 million adults inthe U.S. have some degree of chronickidney disease (CKD). Of these, about400,000 have Stage 5 CKD, or kidneyfailure—they have a glomerularfiltration rate (GFR) of less than 15mL/min and are on dialysis.Another400,000 have Stage 4 CKD (severe), andabout 7.5 million are at Stage 3(moderate).The rest have some kidneydamage, but have normal or only mildlyreduced kidney function (CKD stages 1and 2).Trends in the data show that thenumbers of people with CKD are rising.Many people with CKD do not knowthey have it. Symptoms are normally

subtle until late in the course of thedisease.With early detection, CKD canusually be slowed.

What is the difference betweencreatinine clearance, glomerularfiltration rate (GFR) and percentkidney function?All three of these tests measure howwell your kidneys are working. Eventhough they are different, the terms areoften used interchangeably.

Creatinine is a waste product thathealthy kidneys can remove from thebody. Creatinine clearance is tested bytaking a 24-hour urine sample and ablood sample, and calculating howquickly your kidneys “clear” your bloodof creatinine.Another way to determinecreatinine clearance is by using anequation that gives an approximate valuebased on blood creatinine level, height,weight and age. Creatinine clearance isreported in milliliters per minute(mL/min). For healthy men, a normalcreatinine clearance is 97 to 137mL/min. For healthy women, a normalcreatinine clearance is 88 to 128mL/min.

Glomerular filtration rate (GFR) tellshow quickly your kidneys are cleaning

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your blood. GFR is also reported inmilliliters per minute.A normal GFR isgreater than 90 mL/min.

Percent kidney function is an estimateof how much function the kidneys haveleft. Because a GFR of 100 millilitersper minute (mL/min) is in the normalrange, it is convenient to assume that100 mL/min is about equal to 100%kidney function. So a creatinineclearance or GFR of 30 mL/min wouldbe called “30% kidney function.”

If you’re interested in the technicalaspects of estimating GFR, see“Estimation of GFR,” Guideline 4 ofthe K/DOQI Clinical PracticeGuidelines for CKD atwww.kidney.org/professionals/doqi/kdoqi/toc.htm.

Laboratory values showing youhave kidney failure

When should I be referred to anephrologist?You should be under the care of anephrologist if your creatinine clearance,a measure of your kidney function, is 30mL/min or lower.This translates to stage4 chronic kidney disease (CKD).

When you first find out you have CKD(even if it is stage 2 or 3), seeing anephrologist at least once can help youdevelop a plan of care.A nephrologistcan help you and your primary caredoctor:• Slow the rate of decline of your

kidney function• Decide if a kidney biopsy might be

useful• Diagnose the type of kidney disease

and whether it might be reversiblewith treatment

• Manage complications of kidney

Test Names Diabetes No DiabetesCreatinine 6.0 mg/dl

or higher8.0 mg/dlor higher

Creatinineclearance

15 mL/minor lower

10 mlLminor lower

GlomerularFiltration Rate(GFR)calculatedfromcreatinine,age, sex, race

15 mL/min/1.73m2 orlower

10 mL/min/1.73m2 orlower

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disease, such as anemia, high bloodpressure, metabolic acidosis andchanges in mineral balance

Where can I learn more aboutkidney disease?It’s great that you want to learn moreabout kidney disease and dialysis so youcan make more informed decisions.DaVita offers a class for people whohave kidney disease as well as theirfamilies. Depending on where you livein the U.S., there may be a class nearyou.

Call DaVita Guest Services toll free at1-800-244-0680 between 5 a.m. to 6:30p.m. (PT) / 8 a.m. to 9:30 p.m. (ET).Learn more about DaVita’s kidneyhealth education program and freeclasses at www.keyconnections.com.

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Slowing progression

How can I slow theprogression of chronic

kidney disease (CKD)?There are many ways to help delay orprevent kidney failure, especially whenCKD is diagnosed in the mild tomoderate stages.Blood pressure control• Keep your blood pressure at 125/75 or

lower if you have diabetes and/orprotein in your urine.

• Keep your blood pressure at 130/85 orlower if you have kidney problems butnot diabetes.

Two types of blood pressure medicationslow the action of angiotensin, asubstance that may contribute to kidneydisease progression. Studies have shownthat angiotensin-converting enzyme(ACE) inhibitors and angiotensin-receptor blockers (ARBs) can help slowprogression of kidney disease in peoplewith diabetes, even if they do not havehigh blood pressure.The generic namesof some common ACE inhibitors arecaptopril, enalapril, and lisinopril. Somecommon ARBs are losartan, candesartan,and valsartan.

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Blood glucose controlIf you have diabetes, strict controls ofyour blood glucose levels can help slowthe progression of kidney disease.• Keep your hemoglobin A1c, which

measures blood glucose control overthe last two to three months, to lessthan 6.5%.

• To reach this level of strict glycemiccontrol, you will need to monitor yourblood glucose closely to avoidhypoglycemia.

You may need to use frequent insulininjections or an insulin pump.Talk toyour doctor about your diabetestreatment options.

Repairing the damageIn some cases, the kidney disease itselfcan be treated. If you have anobstruction that blocks your urine flow,surgery may help. If you have aninfection, antibiotics may clear it up.

If damage is due to the effects ofprescription or non-prescriptionmedications, your doctor may be able tosuggest a different medication that is lessharmful to your kidneys. If you haveCKD and are prescribed antibiotics, talkto your doctor about the effect it mayhave on your kidneys. Painkillers (even

over-the-counter medicines) can causedamage to your kidneys.Talk to yourdoctor about all medication you take.Sometimes diagnostic studies usingcontrast dye are ordered. It may benecessary for you to have the study, butfirst find out if there are alternativemethods.

Some diseases, such as IgA nephropathy,glomerulonephritis and lupus can causekidney damage when your immunesystem overreacts and inflammationoccurs. It is sometimes possible to slowthe disease process by controlling theimmune system with steroids and/orother medications.

Smoking is a risk factor for fasterprogression of kidney disease, sostopping smoking can also help slowprogression.Avoiding too much proteinand phosphorus in the diet may help, aswell.

Check with your doctor to find outwhether any of these things might helpslow the progress of your kidney disease.

Diet and drugsOngoing research continues on dietarychanges and drugs that may help slowthe progression of CKD. Examples

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include:• Fish oil for IgA nephropathy• Pirfenidone (an anti-fibrotic drug) in

the treatment of focal segmentalglomerulosclerosis (FSGS)

• Dietary intake of antioxidant or anti-inflammatory vitamins and foods

Blood pressure controlStudy after study has confirmed thatgood blood pressure control can helpslow the rate of CKD.This is especiallytrue in people who have diabetes andprotein in the urine (proteinuria).Keeping blood pressure under controlalso helps prevent heart disease andstroke.

According to National KidneyFoundation (NKF) guidelines, youshould strive to keep your bloodpressure at or below 130/85 if you haveCKD. If you have diabetes and/orproteinuria too, the suggested targetblood pressure is 125/75.

Lifestyle changes such as losing weight,exercising, meditating, eating less saltand drinking less alcohol can help loweryour blood pressure.

For most people with CKD, blood-pressure drugs are also needed.The first

blood-pressure drug is likely to be anangiotensin-converting enzymeinhibitor (ACE inhibitor) or anangiotensin-receptor blocker (ARB),because these drugs have been proved toslow the rate of some types of kidneydisease. Other types of blood-pressuredrugs such as a diuretic (water pill) or acalcium-channel blocker may be added,as needed.Ask your doctor what youcan do to keep your blood pressure at ahealthy level.

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What is my role withmy chronic kidney

disease?In most chronic diseases, includingchronic kidney disease (CKD), peoplewho learn a lot about their disease andhow to take care of themselves stayhealthier.The more you know, the moreyou can help yourself.

There is a lot that can be done early inCKD to keep you feeling well and tomaintain your kidney function for aslong as possible.You also may be able tohelp prevent some long-termcomplications of kidney disease, such asbone disease or heart problems, byacting early.Your role is to learn all youcan and work with your care team toget the best possible care.

Diet and exercise are two areas whereyou have a lot of control.Talk with yourcare team to determine individualizeddietary guidelines based on lab tests andyour stage and type of CKD. Stay activeand get plenty of exercise.

It’s possible to have a full and active lifewith CKD or with kidney failure. Formore information on your role, see the

article on DaVita.com titled “20 Tips fora Good Life with CKD.”

I was diagnosed with kidneydisease. Should I stop exercisingand rest more?While we all need rest, we need exercise,too. It’s been shown that exercise isgood for people with kidney disease. Soyou should try to stay active. If you’vebeen sedentary in the past, talk to yourdoctor about starting a mild exerciseprogram.The key is to start slowly andbuild up gradually. Getting plenty ofexercise is one key to helping yourselffeel great, even with kidney disease.

How can smoking affect myCKD?Smoking is an important risk factor thatcan make kidney disease worse. Heavysmoking, in particular, will work againstyou if you are trying to keep yourkidney function for as long as possible.

The effects of smoking in diabetickidney disease are well-documented.Diabetics who smoke tend to developkidney disease earlier and lose kidneyfunction more quickly than diabeticswho do not smoke, or who quitsmoking. Smoking has also been shownto hasten the progression of other types

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Lifestyle choices

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of kidney disease. In addition, smokingincreases high blood pressure andcardiovascular risks, two health problemsthat often occur along with kidneydisease.

You’ll be taking better care of yourself ifyou can reduce the amount yousmoke—or better yet—quit altogether.If you are willing to quit smoking, talkto your doctor about sustained-releasebuproprion (Zyban®) and nicotinereplacement therapy, as well ascounseling or support to help you quit.

I have Stage 3 kidney disease.Why am I so tired?Fatigue is common in people withkidney disease. Most often, it is causedby anemia, a shortage of red blood cells.When you have anemia, you feel tired,weak, cold or even confused.Anemiaoccurs with kidney disease becausefailing kidneys make less of a hormonecalled erythropoietin, or EPO. EPO tellsyour body to make red blood cells.Treating anemia will give you moreenergy and help prevent damage to yourheart. Synthetic EPO, called Aranesp®,Procrit® or Epogen®, plus ironsupplements, are used to treat anemiabrought on by kidney disease.

How do I know if I have anemia?Your doctor can tell if you have anemiathrough a blood test for hemoglobin orhematocrit. Hemoglobin (Hgb) is theoxygen-carrying pigment that gives redblood cells their color.A normal Hgblevel is 12–16 g/dL in women or 14–18g/dL in men. Hematocrit (Hct) is thepercentage of total blood that is madeup of red blood cells.A normal Hct is37% to 47% in women or 42% to 52%in men.Aranesp®, Procrit® orEpogen®, plus iron supplements, areused to treat anemia from kidneydisease.

What can I do about musclecramps?Cramps—especially leg cramps—arecommon for those with kidney disease.Cramps are thought to be caused byimbalances in fluid and electrolytes, butmay also be caused by nerve damage orblood-flow problems. If you experiencecramps, here are suggestions that mayhelp:

• Stretch the muscle• Massage the area• Take a hot shower or bath• Drink plenty of water (if not on a

fluid restriction)• Wear comfortable shoes

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A number of nephrologists prescribequinine for their patients who arebothered by frequent cramps. Quininedoes have potential risks, so be sure itreally helps you before taking it for alengthy period of time.

What can I do about itching?While problems with itching arecommon for those with kidney disease,it can be difficult to determine thecause. Below are some reasons you maybe itching and what may be done tohelp.• Blood levels of phosphorus or

parathyroid hormone (PTH) that riseas kidney function drops can lead toitchy skin (and other problems). If youhave high phosphorus or PTH levels,your doctor can prescribe aphosphate- binder drug for you totake with meals and snacks to get yourblood levels into the target range.

• Itching can be caused by dry skin.Trya good moisturizing cream or lotion.

• Allergies can cause itching and canhappen at any time, even fromproducts you have used for a longtime.Think about what you could besensitive to in your environment, suchas soaps, lotions, detergents, perfumes,etc.

• Many people find that getting out in

the sun a bit helps with itching,though the reason for this are unclear.

Ask your nephrologist and/ordermatologist for tips on how you candeal with stubborn itching.

Should I be on a low-protein diet?

Protein, found in meats, fish, poultry,dairy products, nuts and some grains,helps your body form muscle and tissue.But when your kidneys are not workingwell, the byproducts of proteinbreakdown can build up in your blood.This can make your kidneys workharder.

Some studies of low-protein diets showthat they can slow the progression ofkidney failure. But other studies showthat the diets do not help. Due to thesemixed results, and the need to maintaingood nutrition, doctors differ about theneed to limit protein for people withchronic kidney disease (CKD).Theanswer is often moderation.

Many people with CKD find that theydon’t want to eat as much protein as

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What to eat5



they used to, because food doesn’t tastethe same.You may even need to make aspecial effort to eat enough protein andcalories, because CKD can reduce yourappetite.

In all cases, it’s crucial to avoidmalnutrition.A blood test for albumin, aform of protein, is a good way to tell ifyou are getting enough good food.Youralbumin level should be 4.0 g/dL orhigher. If you notice weight loss, loss ofappetite, or other signs of poornutrition, talk to your doctor.

So, how much protein do you need?K/DOQI national guidelines for kidneydisease suggest a daily protein intake of0.75 grams per kilogram of body weightfor mild to moderate CKD (stages 1, 2or 3). Divide your weight in pounds by2.2 to learn what you would weigh inkilograms. For example, 176 lbs. dividedby 2.2 is 80 kg. If this were your weight,you would need 80 x 0.75, or 60 gramsof protein per day.

In more severe kidney disease (stages 4and 5), the guidelines suggest 0.6 gramsof protein per kilogram each day. Somedoctors may advise even lower levels,which require close monitoring. If yourdiet includes very little protein, your

doctor may prescribe supplements ofnutrients you would normally get fromprotein, such as ketoacids and/or aminoacids.

To figure out how much protein is inthe food you’re eating, read labels anduse nutrition reference tables.After awhile, you’ll have a good sense of howmuch protein is in a serving of meat,milk, etc., so you won’t have to lookeverything up.A renal dietitian hasspecial expertise helping people withkidney disease put together healthy mealplans.Ask your doctor about a referralto a renal dietitian. Check with yourdoctor or dietitian before making anychanges to the protein level in your diet.

Should I be on a low-phosphorusdiet?Ask your doctor—the answer will oftenbe yes. Phosphorus is a mineral foundmostly in dairy products and meats.Yourbody uses it to form strong bones andteeth. But starting with moderate CKD,your kidneys begin to lose the ability toremove extra phosphorus from yourbody. Because too much phosphorus canharm your bones, it makes sense to eatless phosphorus.

Some experts think 800 to 1,200 mg of

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phosphorus per day is a good target.Food labels are not required to listphosphorus, so you will need to talk toa renal dietitian or find a nutritionreference guide and look up foods.You’ll soon learn the phosphorus valuesof the foods you eat most often.

If you are also on a lower-protein diet, alow-phosphorus diet is easier—foodshigh in protein tend to be high inphosphorus, too.Your doctor may wantyou to limit dairy servings each day andtake a calcium supplement.Taken withmeals, calcium supplements act asphosphate “binders,” because they lockon to extra phosphorus and keep yourbody from absorbing it.

Should I be on a low-potassiumdiet?Having the right level of potassium inyour body helps all your muscles worksmoothly—including your heart. So, tostay as healthy as you can, you need tokeep just the right level of potassium inyour blood (not too much, not toolittle). Keeping potassium at the rightlevel all the time is one of the jobs thathealthy kidneys do for your body.Whenkidneys start to fail, they lose this ability.

Your potassium level should be checked

regularly with a blood test. If your levelsare too high, your doctor will ask you tostart a low-potassium diet.

Many foods have potassium, but some—including avocados, dried fruits (such asraisins, apricots and prunes), potatoes,oranges, bananas and salt substitutes—are very high in potassium. If you needto limit potassium, your dietitian willhelp you learn which foods have morepotassium and which foods have less.

What can I do about loss ofappetite?Poor appetite is a common symptom ofadvanced kidney disease. Even if you arenot hungry, it is important to eat andkeep good nutrition.Well-nourishedpeople with kidney disease stay healthierand live longer.As kidney functiondrops, you may notice that protein foodssuch as eggs, meat, chicken and fish losetheir appeal, or even taste funny.Youneed calories and quality protein to feelyour best.To get good nutrition, try to:• Eat more bland, starchy foods or

whatever appeals to you• Eat small portions of protein foods, at

a cold temperature—such as egg salador tuna salad, or a cold chickensandwich

• Avoid cooking smells if they bother

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you—cook ahead and freeze meal-sized portions that you can microwave,or look for low-salt convenience foods

• Try a liquid nutritional drink likeBoost® or Ensure® once a day. (It isbest not to rely on these drinksentirely, as their protein, phosphorusand potassium content are not madefor people with kidney disease.)

• Graze all day—have several small mealsinstead of one large one

• Watch cooking shows on television totempt your appetite

• Boost the protein content of yourmeals by adding egg whites, egg whitepowder or protein powder

• Get help from a renal dietitian if lackof appetite continues. Becausenutrition is so important, many privateinsurance plans and Medicare do coversome nutritional help for people withkidney disease.

Finally, if you are in late-stage CKD andyour appetite or nutritional well-beingdo not improve, this may be a sign thatyou should start dialysis. Many peoplefind their appetite improves after sometime on dialysis.

If I have kidneydisease, will I needdialysis?

In the early stages of chronic kidneydisease, you do not need dialysis.Thesestages can last for many years. But ifyour kidneys fail, you will need dialysisor a kidney transplant to keep you alive.

If I have kidney disease, howlong will it be before I need tostart dialysis?Depending what stage your kidneydisease is and how quickly it progresses,you may never need dialysis—or youmay need dialysis right away. Dialysis isusually recommended when yourkidney function is about 10% to 15% ofnormal.

Can I take a tour of a dialysiscenter before I start dialysis?Yes, that’s a great idea.To arrange yourtour at a DaVita dialysis center, pleasecall DaVita Guest Services at 1-800-244-0680 between 5 a.m. to 6:30 p.m.(PT) / 8 a.m. to 9:30 p.m. (ET).

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Dialysis

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My doctor said I will need to goon dialysis in six months to ayear.What does this mean?It is time for you to learn about thetreatment options for kidney failure:peritoneal dialysis, hemodialysis andkidney transplant.You have somechoices to make. If you plan to doperitoneal dialysis, which is a homedialysis option, you will need to have atube surgically placed in your abdomen.If you plan to do hemodialysis, whetherin a center or at home, you will need tohave surgery soon to create an accessand allow it to heal. If you want akidney transplant, you will need to talkwith your doctor about how to get onthe transplant list or ask a friend orfamily member to donate a kidney.

When should I start dialysis?National Kidney Foundation guidelinesrecommend that you start dialysis whenyour kidney function drops to 15% orless—or if you have severe symptomscaused by your kidney disease, such asshortness of breath, fatigue, musclecramps, or nausea and vomiting.Yourdoctor will help you decide when tobegin dialysis, based on your symptomsand lab tests that measure how muchkidney function you have left.

Private insurance generally coverstreatment for kidney failure wheneveryour doctor says it is needed. If youdon’t have private insurance, you may beable to get coverage through federal orstate-funded health care programs, suchas Medicare or Medicaid.

Most people (about 93% of those whoapply) qualify for Medicare when theyneed dialysis or a transplant, even if theyare under age 65. Medicare pays for 80%of treatment for kidney disease whenkidney function has dropped to 10% to15%, or when your doctor justifies it.

If you are not having symptoms, youmay be able to wait a bit longer.However, some doctors believe thatstarting dialysis as soon as Medicare orinsurance covers it is wise, since it cantake a long time to recover if you letyourself get very ill. Since chronickidney disease often happens slowly,sometimes people do not even knowhow bad they feel—until they startdialysis and begin to feel much better.

It is important to start getting ready fordialysis or a transplant well in advance—when your kidney disease reaches Stage4 (severe, with glomerular filtration rate,or GFR, less than 30 mL/min).

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Learning about the types of dialysis andtransplant options will help you make achoice that is best for you.Any type ofdialysis will require surgery—usuallyoutpatient—to allow access for yourtreatments, and this should be done wellin advance to allow time for healing.

I am in Stage 4 kidney diseaseand can’t have a transplant. CanI do dialysis for the rest of mylife?The questions “How long can someonelive?” and “How well can someonelive?” are very common when you needto go on dialysis and you’re scared.Yes,dialysis is something you can do for therest of your life. Some people have beenon dialysis for 30 years or more withoutgetting a transplant. How long you canlive on dialysis, and how well you do,will depend on a number of things,including:• How healthy you are, other than

kidney disease• How positive your attitude is

(optimists live longer; depression canbe treated)

• Whether you receive good-qualitymedical care and dialysis

• How much you learn about dialysisand take an active role in your care.

Nobody lives for 30 years or more ondialysis by accident—it takes a lot ofknowledge and effort.You are doing theright thing by learning all you can.Youmay also want to check into joining akidney patient organization, such as achapter of the National KidneyFoundation (www.kidney.org), or theAmerican Association of KidneyPatients (www.aakp.org). Or learn moreabout kidney disease by visiting KidneySchool at www.kidneyschool.org.

If I start hemodialysis, how oftenwill I have to get treatments?The usual schedule for hemodialysistreatments is three times a week, eitherMon./Wed./Fri. or Tues./Thurs./Sat.You will have the same morning orafternoon time for each treatment, ifyou choose in-center hemodialysis.Thelength of your treatment depends onwhat your doctor prescribes for you.Three to five hours is common, plustime to travel to and from the center,and often some waiting time when youarrive. If you don’t like the treatmentschedule you get, you can ask to be on awaiting list for a different time, or switchto a different center.You could alsoconsider an at-home dialysis option.

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If I start PD, how often will Ihave to get treatments?Peritoneal dialysis (PD) is mostcommonly done on a nightly basis usingan automated cycler machine while aperson sleeps.A patient will typically beconnected to the cycler for 8 to 10hours each night and be free of dialysisduring the day. Some people will chooseto do manual PD, which usually meansdoing four to five exchanges per day.Each exchange takes 20 to 30 minutes,and they need to be spread out over thewhole day to clean the blood well.Acommon manual PD schedule might beto do one exchange upon waking, oneat lunchtime, one at dinner, and one atbedtime.A cycler can be used togetherwith a manual exchange.The cycler canbe used at night with only oneexchange during the day.

When should I startthe process to get a kidneytransplant?

If your kidneys are failing, a kidneytransplant may be a treatment option foryou.The balance of risks and benefitsvaries, though, depending on your ageand other health problems. If you want akidney transplant, you must contact atransplant center and ask for a transplantevaluation. It is not automatic. Only atransplant team can tell you that you aredefinitely eligible (or not eligible) for atransplant.

You can contact one or more transplantcenters and start to be evaluated when itseems likely that you will need dialysiswithin two to three years. Most kidneytransplants are successful—more than90% of transplants are still working oneyear later. Recent studies have foundthat the odds of good results aresomewhat better with a “preemptive”transplant, done before dialysis isneeded. Preemptive transplant requires awilling living kidney donor—probably arelative, spouse or friend. In 2001, 42%of kidney transplants came from living

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Getting a kidneytransplant7



donors.

If you do not have a living donor, youcan ask to be placed on a nationalwaiting list to receive a cadaver kidneyfrom someone who has recently died—usually in an accident.

Can I get on the kidneytransplant waiting list before Istart dialysis?Yes, you may want to be evaluated for atransplant before you start dialysis.Afteryour evaluation is done and you get onthe waiting list, credit for waiting timestarts when your kidney function dropsto less than about 20%.This is measuredby a glomerular filtration rate (GFR) of20 mL/min or less. Long waitingtimes—often years—are very commonfor kidney transplants from cadaverdonors.

How will my doctor treattransplant rejection?If you have acute or chronic transplantrejection, your doctor may change yourmedication, or even hospitalize you. Forexample, if your cyclosporine dose isharming your transplanted kidney, yourdoctor might lower your dosage andchange your other medications.Allmedication changes must be made byyour transplant team.

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All about chronic kidney disease - Golden Standards