Chronic kidney diseases: medical tips

Advice for chronic renal failure.

What are the symptoms of chronic kidney disease?

The symptoms of chronic kidney disease (CKD) are generally so non specific that they go unheeded. They can include fatigue, loss of appetite, thirst, bone pain and sleepiness. Skin can look dehydrated and hair can be more brittle. High blood pressure is present in nearly all patients with chronic kidney disease and can be difficult to keep in check. Diuresis occurs more frequently and people need to get up during the night to urinate. People with advanced acute kidney disease may develop a reduction in diuresis.

How to diagnose chronic kidney disease?

Just a few tests are needed: a urine test measuring proteinuria, azotemia and creatinine allows for an evaluation with a diagnosis. Further tests can be conducted by the patient's GP to determine the patient's general condition, e.g. CBC to diagnose the onset of anemia, glycemia to diagnose insulin resistance and the balance of electrolytes such as sodium, potassium, calcium and phosphorus to check for related imbalances, if any.

For all specific diagnosis it is crucial to see a nephrologist, i.e. a kidney doctor who investigates the symptoms via a kidney or bladder ultrasound test and via further instrumental and blood tests - e.g. ABG analysis for metabolic acidosis. The nephrologist will monitor the patient's progress over the following years and prescribe preventative and interventional therapies. Clinical studies have highlighted that CKD patients who start seeing a nephrologist from the onset of CKD generally do not end up in dialysis or, if they do, they go on dialysis later. In general, the quality of life and general living conditions improve and there is increased life expectancy.

What can we do?

  • Check blood pressure on a regular basis
  • In diabetic patients keep glycemia under control with an appropriate diet and therapy
  • Avoid nephrotoxic drugs
  • Adopt an appropriate diet and therapy to prevent high cholesterol and triglycerides levels
  • Do not smoke
  • Prevent infections
  • Maintain a moderate low-protein diet to help kidneys have a lighter workload and keep to the correct intake of minerals (sodium), potassium and phosphorus

When to start dialysis?

Patients need to start dialysis when kidneys can no longer function normally. Dialysis helps the body stay healthy and preserve its correct balance because:

  • it removes excess waste, fluids and minerals, preventing waste and fluid accumulation inside the body
  • maintains the good balance of certain substances, such as potassium and bicarbonate in the blood

If patients are affected with CKD, their kidneys will never heal and they will need to be on dialysis for the rest of their lives. If the nephrologist suggests that kidney transplant is necessary, dialysis patients can opt to be included in a waiting list for a kidney transplant.

What is the haemodialysis?

In haemodialysis an artificial kidney is used to filter blood from wastes and extra fluids. To get blood out of the body into the artificial kidney a vascular access into one of the patient's blood vessels must be created. That can be an arteriovenous fistula (AV) or a central venous catheter (CVC).

Is kidney dialysis painful?

Aside from a slight discomfort when needles are inserted into the fistula, patients generally do not report any other problems. Dialysis is painless and patients are able to eat a meal, watch TV, talk or read a book during the procedure.

Impact on patient's lifestyle

Dialysis helps patients feel better, as it resolves a number of disorders associated with kidney failure. However, patients and their families need some time to get used to the dialysis routine.

If you wish to travel or spend a holiday out of your home town, remember that dialysis procedures are standardized and dialysis centres can be found everywhere. All you need to do is to get in contact and discuss your needs with the Dialysis unit's staff. It is also advisable for patients to take walks and avoid a sedentary lifestyle.

How do eating habits change?

That depends on the condition of each patient. In general, dialysis patients can eat normally but they must reduce the intake of fluids and foods containing potassium - potatoes, fruit, vegetables.