About once a month, your dialysis care team will test your blood by using one
of two formulas-URR or Kt/V-to see whether your treatments are removing enough
wastes. Both tests look at one specific waste product, called blood urea
nitrogen (BUN), as an indicator for the overall level of waste products in your
system. For more information about these measurements, see the NIDDK fact sheet
Hemodialysis Dose and Adequacy.
Conditions Related to Kidney Failure and Their Treatments
Your kidneys do much more than remove wastes and extra fluid. They also make
hormones and balance chemicals in your system. When your kidneys stop working,
you may have problems with anemia and conditions that affect your bones, nerves,
and skin. Some of the more common conditions caused by kidney failure are
extreme tiredness, bone problems, joint problems, itching, and "restless legs."
Restless legs will keep you awake as you feel them twitching and jumping.
Anemia and Erythropoietin (EPO)
Anemia is a condition in which the volume of red blood cells is low. Red
blood cells carry oxygen to cells throughout the body. Without oxygen, cells
can't use the energy from food, so someone with anemia may tire easily and look
pale. Anemia can also contribute to heart problems.
Anemia is common in people with kidney disease because the kidneys produce
the hormone erythropoietin, or EPO, which stimulates the bone marrow to produce
red blood cells. Diseased kidneys often don't make enough EPO, and so the bone
marrow makes fewer red blood cells. EPO is available commercially and is
commonly given to patients on dialysis.
For more information about the causes of and treatments for anemia in kidney
failure, see the NIDDK fact sheet
Anemia in Kidney
Disease and Dialysis.
Renal Osteodystrophy
The term "renal" describes things related to the kidneys.
Renal
osteodystrophy, or bone disease of kidney failure, affects 90 percent of
dialysis patients. It causes bones to become thin and weak or formed incorrectly
and affects both children and adults. Symptoms can be seen in growing children
with kidney disease even before they start dialysis. Older patients and women
who have gone through menopause are at greater risk for this disease.
Itching (Pruritus)
Many people treated with hemodialysis complain of itchy skin, which is often
worse during or just after treatment. Itching is common even in people who don't
have kidney disease; in kidney failure, however, itching can be made worse by
wastes in the bloodstream that current dialyzer membranes can't remove from the
blood.
The problem can also be related to high levels of parathyroid hormone (PTH).
Some people have found dramatic relief after having their
parathyroid glands
removed. The four parathyroid glands sit on the outer surface of the thyroid
gland, which is located on the windpipe in the base of your neck, just above the
collarbone. The parathyroid glands help control the levels of calcium and
phosphorus in the blood.
But a cure for itching that works for everyone has not been found. Phosphate
binders seem to help some people; these medications act like sponges to soak up,
or bind, phosphorus while it is in the stomach. Others find relief after
exposure to ultraviolet light. Still others improve with EPO shots. A few
antihistamines (Benadryl,
Atarax,
Vistaril) have been found to help; also,
capsaicin cream applied to the skin may relieve itching by deadening nerve
impulses. In any case, taking care of dry skin is important. Applying creams
with lanolin or camphor may help.
Sleep Disorders
Patients on dialysis often have insomnia, and some people have a specific
problem called the sleep apnea syndrome, which is often signaled by snoring and
breaks in snoring. Episodes of apnea are actually breaks in breathing during
sleep. Over time, these sleep disturbances can lead to "day-night reversal"
(insomnia at night, sleepiness during the day), headache, depression, and
decreased alertness. The apnea may be related to the effects of advanced kidney
failure on the control of breathing. Treatments that work with people who have
sleep apnea, whether they have kidney failure or not, include losing weight,
changing sleeping position, and wearing a mask that gently pumps air
continuously into the nose (nasal continuous positive airway pressure, or CPAP).
Many people on dialysis have trouble
sleeping at night because of aching,
uncomfortable, jittery, or "restless" legs. You may feel a strong impulse to
kick or thrash your legs. Kicking may occur during sleep and disturb a bed
partner throughout the night. The causes of restless legs may include nerve
damage or chemical imbalances.
Moderate exercise during the day may help, but exercising a few hours before
bedtime can make it worse. People with restless leg syndrome should reduce or
avoid caffeine, alcohol, and tobacco; some people also find relief with massages
or warm baths. A class of drugs called benzodiazepines, often used to treat
insomnia or anxiety, may help as well. These prescription drugs include
Klonopin,
Librium,
Valium, and
Halcion. A newer and sometimes more effective
therapy is levodopa (Sinemet), a drug used to treat Parkinson's disease.
Sleep disorders may seem unimportant, but they can impair your quality of
life. Don't hesitate to raise these problems with your nurse, doctor, or social
worker.
Amyloidosis
Dialysis-related amyloidosis (DRA) is common in people who have been on
dialysis for more than 5 years. DRA develops when proteins in the blood deposit
on joints and tendons, causing pain, stiffness, and fluid in the joints, as is
the case with arthritis.
Working kidneys filter out these proteins, but dialysis filters are not as
effective.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
There are several types of kidney cancer, including renal cell cancer (renal adenocarcinoma or hypernephroma), transitional cell carcinoma, and Wilms tumor. Symptoms of kidney cancer include blood in the urine, an abdominal lump or mass, chronic pain in the side, and tiredness. Treatment of kidney cancer--which may include surgery, arterial embolization, radiation therapy, biological therapy or chemotherapy--depends upon the stage of the disease and the patient's overall health.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
Sleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. OSA is caused by the collapse of the airway during sleep. OSA is diagnosed and evaluated through patient history, physical examination and polysomnography. There are many complications related to obstructive sleep apnea. Treatments are surgical and non-surgical.
Amyloidosis is a group of diseases resulting from abnormal deposition of certain proteins (amyloids) in various bodily areas. The amyloid proteins may either be deposited in one particular area of the body (localized amyloidosis) or they may be deposited throughout the body (systemic amyloidosis). There are three types of systemic amyloidosis: primary (AL), secondary (AA), and familial (ATTR). Primary amyloidosis is not associated with any other diseases and is considered a disease entity of its own. Secondary amyloidosis occurs as a result of another illness. Familial Mediterranean Fever is a form of familial (inherited) amyloidosis. Amyloidosis treatment involves treating the underlying illness and correcting organ failure.
Polycystic kidney disease (PKD) is characterized by numerous cysts in the kidneys. Polycystic kidney disease is a genetic disorder. There are two major inherited forms of PKD, autosomal dominant PKD, and autosomal recessive PKD. Symptoms include headaches, urinary tract infections, blood in the urine, liver and pancreatic cysts, abnormal heart valves, high blood pressure, kidney stones, aneurysms, and diverticulosis. Diagnosis of PKD is generally with ultrasound, CT or MRI scan. There is no cure for PKD, so treatment of symptoms is usually the general protocol.
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
Arsenic comes in two forms, inorganic and organic. Organic arsenic poisoning is usually not poisonous to humans; however, inorganic arsenic in large enough amounts can lead to shock and death. Symptoms of arsenic poisoning include nausea, abdominal pain, diarrhea, dehydration, dark urine, vertigo, delirium, shock, and death. Treatment for arsenic poisoning includes Hemodialysis and a variety of drugs.
Fabry disease (Fabry's disease, alpha-galactosidase-A) is a genetic disorder with symptoms such as burning sensations in the hands, small-raised reddish-purplish blemishes on the skin, fever, decreases sweating, and GI difficulties. Fabry disease patients are at increased risk of heart attack, heart disease, kidney failure, and stroke. Symptoms of Fabry disease can be treated with medication.
Hemolytic uremic syndrome (HUS) is a diseases in which blood clots within the capillaries. Causes associated with HUS include E. Coli, birth control pills, pneumonia, medications such as chemotherapy, Ticlid, and quinine. Symptoms of HUS include gastroenteritis, abdominal cramping, vomiting, and bloody diarrhea. Diagnosis of HUS includes medical history, physical examination, and medical tests. Treatment includes rest, fluids, possible hospitalization for blood transfusion or complications due to kidney failure.
Renal osteodystrophy is a bone disease. The kidneys fail to maintain required levels of phosphorous and calcium in the blood. Renal osteodystrophy is common in patients with kidney disease and affects dialysis patients. Diagnosis is performed with a blood sample, and in some cases a bone biopsy. Medication is the general treatment for renal osteodystrophy.
Depression in the elderly is very common. That doesn't mean, though, it's normal. Treatment may involve antidepressants, psychotherapy, or electroconvulsive therapy.
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