In normal renal physiology, the kidneys remove waste and excess water from the body and release hormones such as renin (which regulates blood pressure), erythropoietin (which stimulates red blood cell production), and vitamin D (which promotes normal bone structure). However, in kidney failure or End Stage Renal Disease (ESRD), renal function becomes compromised and waste products and toxic materials start to accumulate rather than get excreted. This may cause permanent irreversible damage to the body’s cells, tissues, and organs. In End Stage Renal Disease, the kidneys function at less than 20% of their required capacity, and renal replacement therapy in the form of haemodialysis, peritoneal dialysis or kidney transplantation becomes a requirement.
Risk Factors for End Stage Renal Disease
- inflammatory diseases
- chronic infections
- chronic diseases
- blockage in the urinary collecting system
- genetic disorders (rare)
Symptoms of End Stage Renal Disease
- itching
- nausea and vomiting
- puffiness surrounding the eyes
- swollen hands and ankles
- lack of appetite
- decreased urination
- haematuria (blood in the urine)
- anaemia
- sleep disturbances
- hypertension
If creatinine level in the blood increases to 900μmol/l and kidney failure is confirmed, treatment can be initiated in the form of dialysis (haemodialysis or peritoneal dialysis) or kidney transplant.
Haemodialysis vs Peritoneal Dialysis
Haemodialysis
Haemodialysis is a process that works based on the principle of diffusion, by which the blood of a patient with end stage renal disease is pumped out of the body and into a machine to be filtered and cleaned from excess waste products and water.
Haemodialysis is a fast process in which most often, the patient ends up feeling exhausted. The patient may also experience a hypovolaemic shock, which can be reversed quickly through the same pump by IVI (reversal usually takes just around 2 minutes to be completed).
The higher the bloodflow, the better the blood filtration; the larger the needle, the better the bloodflow.
Heparin is administered so as to help avoid blood clotting during the haemodialysis process.
The Haemodialysis process should be repeated 3 times a week on alternate days for 3 to 5 hours per visit.
HAEMODIALYSIS ADVANTAGES:
- performed in the dialysis centre amongst healthcare professionals
- regular contact with other service receivers and providers
- permanent access required via an internal route
- treatment is performed 3 times per week
HAEMODIALYSIS DISADVANTAGES:
- traveling to and from dialysis centre is required per treatment
- restricted diet and fluid intake required
- fixed schedule for treatment
- minimum two needle sticks are performed per treatment
- rendered immobile during treatment
‘Washout Syndrome’ in Haemodialysis
- weakness
- fatigue
- tremor
- starts towards end of treatment or minutes following treatment
- lasts 30 minutes or 12-14 hours in a dissipating form
Peritoneal Dialysis
In peritoneal dialysis, dialysis solution is passed into the peritoneal cavity through a catheter. With this method, it is the peritoneum itself that acts as a filter.
There are two different peritoneal dialysis methods:
- Continuous Ambulatory Peritoneal Dialysis (CAPD) performs 4 exchanges throughout the day in 45 mins per session;
- Automated Peritoneal Dialysis (APD) performs an exchange during the night while the patient is asleep.
PERITONEAL DIALYSIS ADVANTAGES:
- the patient is directly involved in self-care
- the patient has more control over self-treatment
- may be performed during the night (using the Automated Peritoneal Dialysis method)
- less restrictions required in relation to diet and fluids
- this method is the closest to normal kidney function
- ideal for patients with underlying heart disease due to it causing less severe cardiovascular instabilities
PERITONEAL DIALYSIS DISADVANTAGES:
- body image change
- 4 exchanges are required per day
- permanent external catheter
- risk of infection
- storage space is required for supplies
- in Automated Peritoneal Dialysis, the patient is restricted/tied to the dialysis machine during the night
PERITONITIS:
If bacteria manages to travel into the peritoneum, the patient suffers from peritonitis, which is an inflammation of the peritoneum. This causes the peritoneum to weaken, and eventually, may require the patient to be switched to haemodialysis instead.
Kidney Transplantation
In kidney transplantation, a (compatible) kidney is removed from a living (donor) relative, friend, or a brain-dead individual, and is then surgically placed into the patient with end stage renal disease.
Unfortunately, this method is not always recommended. Medication is given to patients following kidney transplantation which suppresses their immune system so the body accepts the new kidney. This however may worsen the patients’ general health, and so, for this reason, a patient may not be deemed fit enough to undergo kidney transplantation.
KIDNEY TRANSPLANTATION ADVANTAGES:
- better quality of life
- better health
- no diet and fluid intake restriction required
- frequent dialysis treatment is not required
- reduced medical cost
- less severe cardiovascular instabilities are caused in patients with underlying cardiovascular disease
KIDNEY TRANSPLANT DISADVANTAGES:
- surgery-related pain and discomfort
- risk of kidney transplant rejection by the patient’s body
- increased risk of infection
- ongoing medication is required for life
- frequent visits to the physician are required
Additional Notes…
- Kidney function includes: removal of waste products, maintaining water balance, maintaining electrolyte balance, maintaining pH balance, Vitamin D metabolism, and excretion of drugs and poison.
- A higher amount of creatinine is usually found in men, and especially in individuals with a higher muscle mass.
- Urea results from breakdown of protein. In pregnancy, urea is very low as protein is required for fetal growth.
- The kidneys have no function in temperature control.
- Hypertension causes kidney damage over the years, unless controlled.
- Obesity is a risk factor for kidney failure.
- Kidney failure causes water imbalance in the body. If water is consumed excessively by a patient with kidney failure, oedema may result. Thus, water should be consumed in moderation.
- The normal range of potassium level should be between 3.5-5.1; At potassium level 7, muscles cease to work – this includes the cardiac muscle a.k.a. the heart.
- A patient with renal failure is prone to acidosis. Urine is acidic, and so, if a patient with kidney failure doesn’t excrete urine as necessary, the acid stays in the blood, leading to acidosis.
- NSAIDs such as Catafast, Voltaren, Brufen and Arcoxia cause kidney problems if taken long term, thus, should be consumed under medical supervision.
- EGFR stands for Estimated Glomerular Function Rate – which is an estimate of how the filtration in the kidneys is functioning. A normal EGFR is usually around 100. An adult around 60 years of age normally has an EGFR of about 70. An EGFR of 15 shows urgent dialysis requirement.
- Chronic Renal Failure can only be indicated by blood tests and urine sampling. An EGFR of around 50 usually exhibits no symptoms. Patients with renal failure usually start exhibiting certain symptoms when the EGFR is somewhere between 10-30 – when dialysis should have been started at around EGFR 50.
- In diabetes, hyperfiltration of the kidneys is commonly found due to the kidneys being uncontrollable. In this case, glucose should be eliminated if possible, so as to promote a decrease in the damage being incurred to the body through hyperfiltration. During hyperfiltration, EGFR is usually somewhere around 120-130, however, at some point it drops abruptly to around 30 or less, indicating kidney failure.
- Following kidney transplantation, the new kidney is not placed in its usual location – it is placed under the belt, to the side. Due to this positioning, a patient with a kidney transplant can easily rupture if the abdomen is hit, and so, sports, fighting, etc., are not recommended for such patients.
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Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing.
Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.
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