Why does Healthy Kidney Publishing Want People to Avoid Dialysis

Robert’s “passion” with kidney disease started when he was 22 years old, and was diagnosed with chronic kidney disease (CKD) from undetermined causes. Over a period of time this lead to kidney failure, dialysis and currently living with a cadaver kidney transplant. He has dealt with every stage and miserable symptom of chronic kidney disease. A transplanted kidney an average last 7 years and doctors told him he would be lucky for that. This was unacceptable to Robert so he became a naturopath (official title for a holistic, alternative medicine doctor) and nutritionist and began his life mission of learning everything about improving kidney disease with natural remedies. For his own sake, and for the sake of the 200 million people worldwide suffering from kidney disease. He has implemented these findings into his personal life surpassing his expectations of having the transplant and living a good quality of life. He also has used these natural remedies for kidney disease clients in his consulting practice for 10 years and now he has written everything down into a 4 pdf guide ebook program, so anyone from around the world can begin helping themselves.

Something that will not surprise our followers is that the body also makes and uses carboxylic acid for similar reasons: to suppress the growth of a multitude of microorganisms from yeast to bacteria.

Humans secrete carboxylic acid through the skin in the form of p-cresol, which is a variation of the surgical phenol. Unfortunately, p-cresol has an unpleasant smell that is associated with underarm odor. Deodorants help with the odor, but also depress the skin’s natural protection by keeping p-cresol and other excretory from being excreted. Regular bathing is the better option, which removes all the excreted toxins and readies the body for whatever comes next.

If too much deodorant is used over time, the body is forced to get rid of the material through the kidneys, which (in the resulting form of p-cresol sulfate) is known to promote chronic kidney disease and make dialysis more likely.

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Infection Control for Peritoneal Dialysis (PD) Patients After a Disaster

During hemodialysis, blood passes from the patient's body through a filter in the dialysis machine, called a "dialysis membrane." For this procedure, the patient has a specialized plastic tube placed between an artery and a vein in the arm or leg. Sometimes, a direct connection is made between an artery and a vein in the arm. This procedure is called a "Cimino fistula." Needles are then placed in the graft or fistula, and blood passes to the dialysis machine, through the filter, and back to the patient. In the dialysis machine, a solution on the other side of the filter receives the waste products from the patient.

Peritoneal dialysis uses the patients own body tissues inside of the belly (abdominal cavity) to act as the filter. The intestines lie in the abdominal cavity, the space between the abdominal wall and the spine. A plastic tube called a "dialysis catheter" is placed through the abdominal wall into the abdominal cavity. A special fluid is then flushed into the abdominal cavity and washes around the intestines. The intestinal walls act as a filter between this fluid and the blood stream. By using different types of solutions, waste products and excess water can be removed from the body through this process.

Peritoneal dialysis (PD) is a practical and widespread treatment for kidney failure. Because a soft tube (catheter) is present in the abdominal cavity for this treatment, special care must be taken by PD patients and their medical providers to prevent infection, especially following natural disasters when flooding may be present, access to medical supplies may be limited, or PD patients who may be living in temporary housing.kidneyhospitalabroad@hotmail.com

Some of the most common symptoms of peritonitis are:

• Abdominal pain
• Abdominal tenderness
• Abdominal distention
• Cloudy PD fluid
• Fever
• Nausea and vomiting

Kidney Failure: Eat Right to Feel Right on Hemodialysis

When you start hemodialysis, you must make many changes in your life. Watching the foods you eat will make you healthier. This publication will help you choose the right foods.

Print this publication and use it with a dietitian to help you learn how to eat right to feel right on hemodialysis. Read one section at a time. Then go through the exercise for that section with your dietitian.

Once you have completed every exercise, keep a copy of this publication to remind yourself of foods you can eat and foods you need to avoid.

There are herbal remedies described in Ayurveda which are very useful in kidney failure.

1. Punarnava Mandur -   This is an ancient ayurvedic formulation which is used together with other herbs like Mutrakrichantak Churna, Rencure Formula and Varunadi Vati to reduce urea and creatinine and avoid dialysis. The results can be seen within a few weeks of using this preparation. It not only helps the kidneys to perform better but also helps to increase the hemoglobin levels naturally. Low hemoglobin is also a problem in renal failure patients.

2. Mutrakrichantak Churna - It is a classical ayurvedic preparation made from various kidney supporting herbs and is effective way to restore the normal function of the kidneys. These herbs work slowly and steadily in a synergistic manner to reduce the creatinine and urea levels. The herbal combination also increases the urine output and reduces the need to use diuretics like Lasix.

3. Rencure Formula  - It is one of the components of Revive kidneys package in which 4 herbal supplements are used together to reduce urea and creatinine levels. The herbal combination works in association with Punarnava mandur and Mutrakrichantak churna to lower down creatinine levels and avoid dialysis.

4. Varunadi Vati - In Hindu mythology, Varun is known as angel of water. It has the powers to control the power of water in this universe. The varun is a tree as well. The latin name is Crataeva nurvala. The tablets made from the bark extract of this tree are called Varunadi vati. In Ayurvedic medicine, the varunadi vati is used for kidney stones, uretheral strictures, urinary tract obstruction, kidney failure, increased urea and creatinine levels and as natural diuretic. This is a rare herbal formulation useful to prevent dialysis.

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How to Avoid Dialysis and Treatment

Although people with type 2 diabetes are at greater risk of kidney problems,but still the stage of arriving in kidney failure can be prevented by taking care of sugar levels. If the stage has already come and the patient is in chronic kidney disease phase, then there are certain ayurvedic herbs which should be used along with whatever treatments are going on. It can be even dialysis also.

Controlling diabetes by lowering blood sugar, dieting, exercising, is very important to keep sugar levels in control. Even blood pressure levels should be kept in control in natural ways rather than consuming pills. Pranayam ( Breathing exercises) are the best to keep things in control. Please check video by Dr. Vikram Chauhan on breathing exercies and how to do them and how to avoid dialysis by regularly doing Pranayam.

Symptoms and Signs of Kidney failure

There are specific interventions, such as limiting salt in the diet that can help prevent the progression of kidney disease in people who have the early signs.

Protein in Urine- In uncontrolled chronic diabetes, the most important sign is the leakage of large amount of proteins in the urine.Very large amounts of protein in their urine -a marker of kidney disease, which is evidence of moderately impaired kidney function or difficult-to-control hypertension.

One particular patient, a man in his mid-50s, had all of the above. At 30 ml/min, his glomerular filtration rate, or GFR-a measure of kidney function-suggested he already had moderate to severe damage. He had a large amount of protein in his urine, poorly controlled hypertension, and poorly controlled blood sugar. After using Ayurvedic remedies for about 1 month, things improved dramatically. Similarly there are many other success stories where patients were on regular twice weekly dialysis and their frequency of dialysis reduced to once in fortnight. We consider this also a big achievement. In many cases, the dialysis was avoided all together, after about 6 months to 1 year of treatment.

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How One Doctor Helps Diabetes Patients Avoid Kidney Dialysis

Kidney failure is one of the most dreaded diseases. Even when one knows, it is coming, there is not much that one can do. Mainstream treatment normally means dialysis or transplant. Both are expensive and very taxing on the patient. Not to mention the difficulty of finding right donor in time. Economic cost of Dialysis in India would be about Rs 2-3 lakhs per year.

There are specific interventions, such as limiting salt in the diet, that can help prevent the progression of kidney disease in people who have the early signs.

Dr. de Boer often sees type 2 diabetes patients after signs of kidney trouble have surfaced. They may have very large amounts of protein in their urine (a marker of kidney disease), which is evidence of moderately impaired kidney function or difficult-to-control hypertension.

One particular patient, a man in his mid-50s, had all of the above. At 30 ml/min, his glomerular filtration rate, or GFR—a measure of kidney function—suggested he already had moderate to severe damage. He had a large amount of protein in his urine, poorly controlled hypertension, and poorly controlled blood sugar.

"His disease was clearly progressive by his recent history," Dr. de Boer explains. "When he learned that he was heading toward dialysis in the next year or less, that was a bit of a shock to him, and it actually motivated him to make a lot of changes."

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There are Five Stages in Which the Kidney Failure is Determined

Stage 1: When the kidney damage is at preliminary stage, the GFR is more than 90 and above. GFR at 90 and above is considered normal but there are chances that one might at the risk of developing CKD if in their family history someone is affected with diabetes or blood pressure.

Stage 2: When your GFR rate 89 or below it, it is an indication that your kidney functions have started declining and a progression of CKD.

Stage 3: When the moderate rate of GFR is reduced from 59 to 30, then the problem related to bone or anemia are common.

Stage 4: Severe reduction of GFR like at the point 29 to 15 is the indication that kidney failure is on the path of reaching the extreme stage. At this stage, where the doctors usually recommend dialysis.

Stage 5: GFR rate is less than 15; it is condition where kidney becomes inefficient in supporting the life system. In most of the case, kidney transplant is the recommended option.

Though it is often considered that kidney transplant or dialysis is only the preferred option for kidney failure but one can avoid kidney transplant or dialysis without any apprehensions if they are opting for Ayurvedic treatment.

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Access for Peritoneal Dialysis

Peritoneal dialysis occurs inside your body using your body’s peritoneal membrane as a filter. This membrane is a fine layer of tissue that lines your peritoneal (abdominal) cavity, covering organs such as your stomach, liver, spleen and intestines. It has a fine layer of tissues and a rich blood supply.

Peritoneal dialysis uses a soft tube called a catheter. A surgical operation is required to insert the catheter into the peritoneal cavity. The catheter is about 0.5 cm wide and remains in your body until dialysis is no longer needed. One end of the catheter sticks a few centimetres out of your body, so that it can be connected to a bag containing a special fluid. The catheter allows the fluid to enter and leave your peritoneal cavity.

Waste and extra fluid move from your blood into the special fluid, which is then drained from the body. Each time ‘used’ fluid is replaced by fresh fluid, the cycle is called an ‘exchange’. The number of exchanges needed differs from one person to the next.

Four exchanges are usually done each day. Each exchange includes connecting a new bag of fluid, draining out the old fluid and putting the new fluid in. It takes about 30 minutes and can be done almost anywhere, with a few sensible precautions. In between exchanges, the person is free to go about their daily activities.

Exchanges are typically done on waking, at lunch time, at dinner time and prior to going to bed. Some flexibility is available for busy days. CAPD works by gravity. When the drain bag is placed at floor level the fluid drains out. By raising the new dialysate bag above shoulder level, the new dialysate flows into the peritoneal cavity.

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The Benefits of Transplant Versus Dialysis

Some patients may need to spend time on dialysis as they wait for a good match from a deceased donor kidney or search for a living donor kidney. Spending a long time on dialysis does not ruin your chances of having a kidney transplant. But research shows that getting a transplant sooner rather than later is generally the best approach because of the health problems dialysis can cause over time.

On the other hand, patients who receive a kidney transplant typically live longer than those who stay on dialysis. A living donor kidney functions, on average, 12 to 20 years, and a deceased donor kidney from 8 to 12 years.

Patients who get a kidney transplant before dialysis live an average of 10 to 15 years longer than if they stayed on dialysis. Younger adults benefit the most from a kidney transplant, but even adults as old as 75 gain an average of four more years after a transplant than if they had stayed on dialysis.

Moreover, spending a long time on dialysis before transplantation may also compromise the life of the new kidney graft once transplant occurs. Published medical data has shown that the kidney will work much longer in patients transplanted before they start dialysis. Patients who wait for a transplant on dialysis for two years are three times more likely to lose their transplanted kidney than those patients who wait less than six months on dialysis. Even the benefits of a live donor kidney transplant may fade away if you wait too long (more than two years) on dialysis. So given the choice, patients who find a donor match and opt for transplantation tend to do better than those who elect to live on dialysis.

Your transplant team is here to help you evaluate your health options early on, and make the treatment choice that is right for you. We can help you understand the risks and benefits of transplant surgery versus dialysis, and the advantages of having a live donor kidney compared to a deceased donor organ. We will carefully and clearly explain your options, offer advice and support, and help you and your loved ones make the best treatment choice.

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WHEN WILL DIALYSIS OR KIDNEY TRANSPLANTATION BE NEEDED

Nephrology Dialysis Transplantation (ndt) is the leading nephrology journal in Europe and renowned worldwide, devoted to original clinical and laboratory research in nephrology, dialysis and transplantation. ndt is an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association). Published monthly, the journal provides an essential resource for researchers and clinicians throughout the world. All research articles in this journal have undergone peer review.

As the kidneys lose their ability to function, fluid and waste products begin to build up in the blood. Dialysis should begin before kidney disease has advanced to the point where life-threatening complications occur. This usually takes many months or years after kidney disease is first discovered, although sometimes severe kidney failure is discovered for the first time in people who were not previously known to have kidney disease. (See "Patient information: Chronic kidney disease (Beyond the Basics)".)

It is best to begin dialysis treatments when you have advanced kidney disease, but while you still feel well and have no or only mild symptoms of kidney failure. Such symptoms include nausea, loss of appetite, loss of energy, vomiting, and others. You and your doctor will decide when to begin dialysis after considering a number of factors, including your kidney function (as measured by blood and urine tests), overall health, and personal preferences.

Some people with renal failure are not candidates for a kidney transplant. Older age and severe heart or vascular disease may mean that it is safer to remain on dialysis rather than undergo kidney transplantation. Other conditions that might prevent a person from being eligible for kidney transplantation include:

●Active or recently treated cancer
●A chronic illness that could lead to death within a few years
●Poorly controlled mental illness
●Severe obesity (a body mass index greater than 40) (calculator 1 and calculator 2)
●Inability to remember to take medications
●Current drug or alcohol abuse
●History of poor compliance with medications or dialysis treatments
Some people with HIV infection may be eligible for kidney transplantation if their disease is well-controlled.

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Dialysis Raises Hard Questions for Older Patients

Research suggests that older adults who are frail and unable to dress, toilet, bathe, eat on their own or get out of bed in the morning also tend not to live long on dialysis.

“If someone can’t perform multiple activities of daily living, you need to be introspective about whether dialysis adds to their longevity,” said Dr. Leslie Spry, medical director of The Dialysis Center of Lincoln, in Nebraska, and a spokesman for the National Kidney Foundation. “If they’re otherwise relatively healthy and getting around all right, that’s another matter altogether.”

One simple question that draws on the doctor’s clinical judgment — “Would you be surprised if Mr. Smith died within the next six months?” — turns out to be highly predictive of who will survive.

New research from the Mayo Clinic, presented last month at the annual meeting of the American Society of Nephrology, suggests other considerations. The study looked at 379 patients aged 75 and older at the Rochester, Minn., medical center between 2007 and 2011. Slightly more than three-quarters of them began dialysis in the hospital after an acute exacerbation of chronic kidney disease, a severe infection, or an acute kidney injury following surgery.

Those who started dialysis in the intensive care unit (60 percent of the hospital population) did especially poorly. Only 27 percent survived the next six months; 23 percent were alive at one year. Patients who started dialysis in the hospital but outside the I.C.U. had better results initially, but those worsened over time: 12 percent died in the first six months, but only 59 percent were alive after a year.

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How Long Does Someone Live Who is on Dialysis

The United States Renal Data System tracks dialysis mortality rates and issues the USRDS Annual Report there you'll find Section 6 Morbidity & Mortality (PDF link) this is where you'll find the relevant averages for your age and gender.

Remember when looking at statistics that averages are made of extremes. If five patients live two years and one patient lives twenty years, the average life span would be five years. This is called a bimodal distribution and really the average has little meaning to either group.

If you've just heard about dialysis go ahead and look at the statistics, but know there is a lot you can do to stay right of average. For the rest of the story checkout these nonprofit, independent, educational websites: Kidney School, Nocturnal Home Haemodialysis and Home Dialysis Central. You'll learn that with the proper dose, dialysis works well and you can live a life very similar to the one you were meant to live but for severe chronic kidney disease. This 12 part series of educational videos from IKAN Kidney does an excellant job addressing the most common questions people have when they learn they have kidney disease (follow link and press "Play All" at the top of the page to watch them in order, ~43 minutes).

More frequent and/or longer dialysis has a significant positive impact on mortality. Dialyzing every night, over night, as I do, improves your expected mortality to the point that it rivals having a kidney transplant from a deceased donor. Keep in mind too that these numbers are based on historic results; because of constant improvements in drugs and treatment, no one knows how long someone starting dialysis today can expect to live. No one knows how long you, a unique individual, will live.

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Dialysis Modality Selection

Among patients over the age of 65 with ESRD in the United States, in-center HD is the initial modality for 93–98% of patients, peritoneal dialysis (PD) is the initial modality for 2–5% of patients, preemptive kidney transplant for 0–2% of patients, and home HD for <1% (Figure 2). Our discussion of modality selection focuses on comparisons of in-center HD vs. PD, as outcomes data for home HD, particularly in the elderly, are limited. For the same reasons, we also consider various PD modalities together.

To assess the relative importance of these events in patients with different life expectancies, we estimated the NNT with PD vs. HD with a CVC to prevent one sepsis hospitalization. We first calculated the remaining lifetime risk of sepsis hospitalization for each modality. We then estimated the absolute risk reduction associated with PD, allowing us to calculate the NNT. Next, we compared this to the NNT after incorporating the age-specific modality transfer rates (Supplementary Information online), assuming that patients who switch from PD to HD do so with a CVC.

Recent observational studies suggest that survival of incident PD patients in the US has improved over time, and is now comparable to survival of incident HD patients. A notable exception is the subgroup of diabetic patients ≥65 years of age with comorbidity. In this subgroup survival with PD has improved over time but remains lower than for HD. Paradoxically the improvement in PD survival for most patient subgroups has occurred as PD utilization has declined, perhaps pointing to unmeasured selection bias.

If survival is comparable or nearly comparable with PD and HD, what other modality-related outcomes matter? A variety of outcomes have been considered in the literature, including modality transfer, peritonitis, sepsis, access procedures, quality of life and satisfaction with care. Modality transfer occurs more commonly with PD vs. HD, and is most often attributable to medical causes—recurrent peritonitis, ultrafiltration failure, and catheter malfunction. Modality transfer is associated with greater treatment burden, higher costs of care and possibly greater morbidity; thus it may be an outcome that clinicians and patients would like to avoid. Although in some countries older patients have similar or lower rates of transfer from PD to HD as compared with younger patients, in the US older patients are more likely to transfer from PD to HD, and less likely to transfer from HD to PD as compared with younger patients (Supplementary Information online). In contrast to modality transfers, serious infection related morbidity occurs more commonly among HD patients, particularly those dialyzed through central venous catheters (CVCs). Serious infection rates for both modalities decline slightly between the ages of 65–85, and then increase over the age of 85 for patients on HD. The competing effects of infectious morbidity and modality transfer may explain the observation that early mortality is lower for PD vs. HD, whereas late mortality is higher. That is, PD confers an early benefit from avoiding infectious morbidity associated with a CVC, but a higher late risk due to the high rate of modality failure and transfer to HD with a CVC.

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Life Expectancy With and Without Dialysis

Patients both with CKD and with end-stage renal disease (ESRD) experience symptoms, although there are dialysis-specific symptoms related to the treatment itself. Recent studies have evaluated symptom burden in conservatively managed patients. Common symptoms including fatigue, itch, drowsiness, dyspnea, edema, pain, loss of appetite, dry mouth, and poor concentration at stage 5 CKD occur in 50–85% of conservatively managed patients. Psychosocial issues are usually not a prominent feature till close to end of life. There are a number of validated tools which can help in the assessment of symptoms including the second edition of the textbook 'Supportive Care for the Renal Patient'.

Health-related quality of life (HRQOL) has become an important clinical and research outcome for patients with advanced kidney disease. A number of dialysis-specific mediators have been identified as contributing to decrements in HRQOL, including rigors of dialysis treatment, psychosocial and vocational adjustments, loss of independence and functional status, and metabolic derangements as a result of kidney disease. Given the impact of dialysis on HRQOL, studies have examined whether patients not opting for dialysis experience similar derangements in quality of life.

De Biase et al. found that the quality of life in conservatively managed patients was comparable to that of patients on hemodialysis. In particular, though conservatively managed patients had worse unadjusted physical health (SF36), there was no difference in mental health scores between those receiving conservative management versus hemodialysis. In the UK, Da Silva-Gane et al. measured the quality of life [Short-Form, Hospital Anxiety and Depression Scale and Satisfaction with Life Scale (SWLS)] in elderly patients with advanced kidney disease who had opted either for dialysis or for conservative kidney management. Patients were followed every 3 months for up to 3 years. Baseline patients opting for conservative management were older, more dependent, and had higher comorbidities than those who opted for dialysis. Conservative patients had poorer physical health and higher levels of anxiety; however, mental health, depression symptoms, and global satisfaction with life were similar between groups. Importantly, patients who initiated dialysis experienced a significant decrease in global satisfaction with life score which did not subsequently recover (Fig. 3). For elderly patients with geriatric syndromes and poor functional status, it remains unclear whether dialysis initiation impacts life satisfaction.

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Symptoms of Kidney Disease

At any stage of kidney disease, knowledge is power. Knowing the symptoms of kidney disease can help you get the treatment you need to feel your best. If you or someone you know has one or more of the following symptoms of CKD, or you worry about kidney problems, see a doctor for blood and urine tests. Remember, many of the symptoms can be caused by other health problems. The only way to know the cause of YOUR symptoms is to see your doctor.

"When you go to use the restroom, you couldn't get it all out. And it would still feel just like tightness down there, there was so much pressure."

"My urine is what I had started noticing. Then I was frequently going to the bathroom, and when I got there, nothing's happening. You think, 'Hey, I've got to go to the john,' and you get there: 2, 3 drops."

"I was passing blood in my urine. It was so dark it looked like grape Kool-Aid. And when I went to the hospital they thought I was lying about what color it was."

"About 2 years ago, I was constantly going to the bathroom all the time, my back was always hurting and I was wondering why...and they diagnosed that kidney problem."

"And then you're having to get up all time through the night, and then you have the side ache, a backache, and you can't move."

"At night, I would get a pain in my side. It was worse than labor pain. And I'd be crying and my husband would get up, everybody, rubbing my legs."

What Are the Advantages of the Different Types of Dialysis

Regardless of which type of dialysis is chosen , patients have certain responsibilities such as following a diet program, watching their fluid intake and taking special vitamins and other medicines to control blood pressure and calcium and phosphorus balance.

For many patients, the major advantage of hemodialysis is minimal participation in the treatment. However, patients are required to adhere to a specific schedule and travel to the dialysis unit. Hemodialysis also requires stricter diet control and fluid control than peritoneal dialysis.

For those patients preferring more independence, peritoneal dialysis allows for more flexible scheduling and can be performed at home. The patient still must undergo a certain amount of dialysis each day, but can alter the exact timing of the dialysis procedure. On the other hand, peritoneal dialysis must be done every day of the week.

The major problem with peritoneal dialysis is infection. The patient has a plastic tube that goes from the peritoneal cavity to the outside of the body and this is a potential site for the entry of bacteria into the body. Great emphasis is placed on cleanliness and technique during the training sessions.

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Dementia Risk Lower in Peritoneal Dialysis Initiators

Dialysis may be used for patients who have become ill and have acute kidney failure (temporary loss of kidney function), or for fairly stable patients who have permanently lost kidney function (stage 5 chronic kidney disease).

When we are healthy our kidneys regulate our body levels of water and minerals, and remove waste. The kidneys also produce erythropoietin and 1,25-dihydroxycholecalciferol (calcitriol) as part of the endocrine system. Dialysis does not correct the endocrine functions of failed kidneys - it only replaces some kidney functions, such as waste removal and fluid removal.

In a retrospective study of 121,623 patients initiating dialysis, Dawn F. Wolfgram, MD, of the Medical College of Wisconsin in Milwaukee, and colleagues found that those who started on PD had a 25% decreased risk of dementia compared with those who started on HD, after adjusting for age, gender, and other potential confounders. They obtained similar results when patients were matched by propensity score.

“This is the largest study to date in support of the hypothesis that the HD process itself, rather than simply the presence of ESRD, may contribute to the well-known higher prevalence of dementia among persons with ESRD,” the authors wrote in Peritoneal Dialysis International.

Dr. Wolfgram's team noted that their study “emphasizes the need for clinicians to regularly assess cognitive function among persons undergoing dialysis.” By helping clinicians tailor management to patients' cognitive abilities, early recognition of dementia may improve patient outcomes, they stated.

PD was the initial dialysis modality for 8,663 of the 121,623 study subjects. The mean age of the total cohort was 69.2 years.

The researchers used U.S. Renal Data System data for incident ESRD patients during calendar years 2006–2008. For all patients, they obtained Medicare claims data for 2004 through 2009, which includes ICD-9 comorbid disease diagnosis codes.

“Our use of Medicare data allowed us to exclude people who carried a dementia diagnosis at baseline, or who were recognized as having dementia during the 90 days after they initiated dialysis,” they wrote. “Thus we were not simply documenting that persons with dementia are unlikely to be able to initiate PD, a therapy which requires greater involvement of patients in care.”

The investigators also acknowledged study limitations. For example, they pointed out that non-medical factors impact the choice between PD and HD. “Physicians are more likely to encourage patients with subtle evidence of cognitive impairment to choose HD as their initial modality, biasing our results toward higher dementia risk in those initiated on HD. Although we excluded patients with pre-existing dementia from our analysis, it is possible that significant differences in baseline cognitive function between the PD and HD groups affected our results.”

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What does the patient do during dialysis

Patients generally go to the dialysis unit three times a week for treatment. For example, the schedule is either Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday. Before treatment, patients weigh themselves so that excess fluid accumulated since the last dialysis session can be measured. Patients then go to assigned chairs that are like lounge chairs. The area of the graft or fistula (the connection between the artery and vein), is cleaned thoroughly. Two needles are then inserted into the graft or fistula. One takes the blood to the machine where it is cleaned. The other needle allows blood that is returning to the patient to go back into the patient's body.

Treatments last from 2 ½ to 4 ½ hours. During this time, the dialysis staff checks the patient's blood pressure frequently and adjusts the dialysis machine to ensure that the proper amount of fluid is being removed from the patients body. Patients can read, watch television, sleep, or do other work during treatment.

In this process, the patient weighs herself/himself to determine the fluid to be used. The patient then puts on a mask and cleans the peritoneal catheter site. Fluid that has been allowed to stay in the peritoneal cavity is drained back into the plastic bag that originally contained the fluid. The patient then disconnects this bag and connects a new bag of solution that is allowed to drain into the peritoneal cavity. Once the fluid is in the body, the new bag is rolled up and placed in the patient's underwear until the next treatment. This procedure usually takes 30 minutes to accomplish and must be done four to five times a day.

As an alternative to this treatment, some patients on peritoneal dialysis use a machine called a "cycler." This cycler is used every night. Five to six bags of dialysis fluid is used on the cycler and the machine automatically changes the fluid while the patient sleeps.

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Helping your mind when you're on in-center dialysis

In addition to helping your body, diet and exercise help keep your mind sharp and centered. It’s amazing what a good phosphorus level and fresh air can do for your mind. Again, your dietitian will have lots of ideas of how to make your food plan work for you, and your doctor and social worker can provide for more information on exercise opportunities.

You may also want to read up on kidney disease and dialysis to learn all you can about what you are experiencing. Peace of mind comes from knowing you are doing the best for yourself. Education will help you make good decisions about your treatment. You’ll also stimulate your mind by learning new things.

Read the daily paper, keep a journal, send letters to friends, listen to music, visit an art museum or do any other activity that requires thinking. Staying involved in the world around you keeps your mind active.

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Your Emotions and Chronic Kidney Disease

CKD can overwhelm a patient. There is new information to become aware of, a new treatment plan to begin. Your energy will be directed to your treatment and physical well-being. This can be exhausting. But you must also take control of your mental state.

You cannot allow feelings like fear or anxiety to bulldoze your mental landscape. Knowledge about chronic kidney disease and dialysis can help you become familiar with your illness and its treatment. You won’t feel as fearful or anxious if you know what to expect. Feeling calm can help you sort out things and you’ll be able to deal with your disease more effectively.

Feelings of denial are a severe problem in the long-term prognosis for your health. Denial leads to what is called “non-compliance”—that is, disregard for your healthcare team’s instructions regarding dialysis treatment, diet and fluid intake. Healthcare workers often see patients who come to dialysis in distress. They have missed several dialysis treatments or have not been following their fluid requirements. They often rely on dialysis to make them feel better. But sometimes dialysis cannot reverse the effects of non-compliance. Hospitalization may be required. Do not let this be you. CKD is a serious illness. Listen carefully to your healthcare team and follow their recommendations. If you do not understand something, ask questions.

Anger can isolate and prevent you from seeking help or solace from people who care about your health. Although expressing your anger can help it diminish, it may lead to more frustration because you do not understand the root of it. You may be lashing out at people who are not the cause of your anger. This can strain relations with those around you. Talking about why you are angry can help you determine its cause.  

Depression can affect how you make decisions regarding your treatment. Since a patient on dialysis must be actively involved in their day-to-day treatment regarding fluid intake and diet, you must have a clear mind in order to make the best decisions. Depression can make you put off decisions, or even purposely make unwise ones. If your doctor diagnoses you with major depression, he may prescribe some anti-depressants. But first, he must know what you are feeling. He cannot know unless you tell him.

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Diabetic Kidney Disease Linked to Reduced Mitochondrial Function

Diabetic kidney disease is the leading cause of end-stage renal disease, but few biomarkers of this condition are available, wrote Kumar Sharma, MD, Director of the Center for Renal Translational Medicine at University of California San Diego (UCSD), and colleagues reported online ahead of print in the Journal of the American Society of Nephrology.

Dr. Sharma's team sought to identify such biomarkers by using gas chromatography-mass spectrometry to quantify 94 urine metabolites in three screening and validation cohorts:

Patients with diabetes mellitus and CKD (DM+CKD)

Patients with diabetes mellitus but not CKD (DM–CKD)

Healthy controls

Compared with levels in healthy controls, 13 metabolites were significantly reduced in the DM+CKD group, and 12 of the 13 metabolites remained significant when compared with the DM–CKD group. Analysis of bioinformatics data indicated that 12 of the 13 differently expressed metabolites are linked with mitochondrial metabolism and suggested suppression of mitochondrial activity in persons with DM+CKD.

“This work provides strong evidence that reduced mitochondrial function is a dominant feature of human diabetic kidney disease,” Dr. Sharma said in a UCSD statement.

The researchers found that a specific cellular pathway likely plays a key role to reduce mitochondrial function and content, meaning that new treatments that restore and increase mitochondrial function and content could ameliorate or even arrest CKD.

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Are There Early Signs of Kidney Cancer

When someone has skin cancer, they might see an unusual growth on their skin. For example, breast cancer is often found when a woman discovers a lump in her breast. Because the kidneys are so deep inside the body, it’s harder to find kidney cancer just by looking or feeling for growths.

Although mammograms and colonoscopies can screen for breast and colorectal cancers, there is no screening test for kidney cancer in people who aren’t at high risk for the disease.

Imaging tests like computed tomography (CT) or magnetic resonance imaging (MRI) can spot cancer in the kidneys. Yet these tests are costly, and they often can’t differentiate between kidney cancer and noncancerous growths.

Usually, doctors only recommend CT or MRI scans for people who are at very high risk for kidney cancer because of an inherited condition, like von Hippel-Landau disease.

Kidney cancer often doesn’t cause symptoms until the tumor has already grown. The most common symptom is blood in the urine, called hematuria. If the amount of blood is too small to be seen with the naked eye, it can be found on a urine test.

It’s important to remember: noticing blood in your urine doesn’t mean that you have kidney cancer. Other conditions—from infections to kidney stones—can also produce this symptom.

When Your Care Partner Is in Denial About Your Kidney Disease

If you live with kidney disease, you’re already familiar with the symptoms and feelings it can cause for you. But the emotional side effects you may have experienced since diagnosis — fear, anger, sadness, denial — could be felt by your dialysis care partner, too.

Your care partner may fear losing you, or losing the quality of life you both enjoyed before you needed dialysis. Sometimes care partners of dialysis patients use denial as a way to protect themselves from a reality they’re not yet ready to accept.

People may be in denial about anything that makes them feel vulnerable or threatens their sense of control. Your care partner may be afraid of losing you, or may fear the lifestyle change that results from your treatments, whether you do in-center hemodialysis, home hemodialysis (HHD) or peritoneal dialysis (PD). By practicing denial, your care partner is temporarily insulating himself or herself against something that’s sorrowful or daunting to think about at the moment.

There is a time when denial can actually be a healthy coping mechanism to adjust to bad news. Your care partner may need several days or weeks to process the facts about your CKD and how your lives will change as a result. As time goes on, your partner may begin to absorb the reality of the situation and approach it more rationally. However, if denial continues after a prolonged period, it can paralyze a person when action is necessary, especially when a loved one is sick and needs treatment.

Kidney Disease: High- and Low-Potassium Foods

People who have problems with their kidneys need to watch how much potassium they include in their diet. That is because the kidneys regulate potassium. If they aren’t working correctly, the potassium may not be flushed out of the body properly.

To minimize potassium buildup, a person with chronic kidney disease should stick to a low-potassium diet of between 1,500 and 2,000 milligrams (mg) per day. Limiting phosphorus, sodium, and fluids may also be important for people with kidney dysfunction.

Torey Jones Armul, MS, RDN, CSSD, a national spokesperson for the Academy of Nutrition and Dietetics, offers a couple of rules of thumb:

Avoid high-potassium foods like potatoes, bananas, whole grains, milk, and tomato products.

Watch portions on all foods.

Be careful with coffee. The National Kidney Foundation recommends that people who should limit their potassium should limit their coffee in take to 1 cup per day
There are still plenty of nutritious, delicious, low-potassium options for people with kidney disease, Armul says. These include berries, squash, corn, rice, poultry, fish and non-dairy substitutes.

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What Kind of Changes Do I Need to Make on A Renal Failure Diet?

If your kidneys failure, you need treatment to replace the work they normally do. The treatment options are dialysis or a kidney transplant. Each treatment has benefits and drawbacks. No matter which treatment you choose, you'll need to make some changes in your life, including how you eat and plan your activities. But with the help of healthcare providers, family, and friends, most people with kidney failure can lead full and active lives.

You will need to limit the amount of protein you eat to help decrease waste in your blood. Foods that are high in protein are meat, poultry (chicken and turkey), fish, eggs, and dairy (milk, cheese, yogurt). Your caregiver will tell you how much protein to eat each day.

You may need to limit the amount of phosphorus you eat. Your kidneys cannot get rid of extra phosphorus that builds up in your blood. This may cause your bones to lose calcium and weaken. Foods that are high in phosphorus are dairy products, beans, peas, nuts, and whole grains. Phosphorus is also found in cocoa, beer, and cola drinks. Your caregiver will tell you how much phosphorus you should have in your diet each day.

You will have to limit sodium if you have high blood pressure or extra fluid in your body. Limit your sodium intake to 1500 mg each day. Table salt, canned foods, soups, salted snacks, and processed meats, like deli meats and sausage, are high in sodium.

You may need to limit potassium if your caregiver tells you that your potassium blood levels are too high. Potassium is found in fruits and vegetables. You may have to limit fruits and vegetables that are high in potassium.

You may need to limit the amount of liquids you drink each day. If your body retains fluids, you will have swelling and fluid may build up in your lungs. This can cause other health problems, such as shortness of breath.

(The root cause of renal failure is fibrosis and hardening of glomeruli. Fibrosis is triggered by the micro-circulation disturbance, which results in ischemia and oxygen deficiency. Ischemia and oxygen deficiency incur renal endothelial cells damages, consequently, damaged endothelial cells will attract inflammatory cells infiltration and release pathologic inflammatory mediators. Under this circumstance, fibrosis can be activated. So blockage of fibrosis becomes vital point to treat renal failure.)

Micro-Chinese Medicine can dilate blood vessels and improve blood circulation, which solve the micro-circulation disturbance fundamentally. Moreover, Micro-Chinese Medicine is anti-inflammatory. So it is able to protect endothelial cells from being infiltration by inflammatory cells. Last but not the least, Micro-Chinese Medicine can help anti-coagulation and anti-thrombosis.

Many Diabetes Patients Feel Pill Burden

Prescribing fixed-dose combinations of diabetes medications may reduce the pill burden many patients feel, according to new research published in Diabetes Care.
German researchers surveyed more than 3,800 patients with type 2 diabetes (more than 6 years) and 600 physicians about medication regimens. The vast majority of providers agreed that multiple pills made it harder for diabetes patients to adhere to treatment.

Most patients were taking 3 to 6 total pills daily. Seniors, half of whom took more than 6 tablets daily, felt particularly burdened, because many required assistance with taking their medications.

Most patients identified their medication by appearance, such as by the pill’s shape, size, and color. Two-thirds agreed that using the right medication becomes harder when its appearance changes, for example, because of a product switch. Half of the patients worried they would forget to take their pills or take the wrong kind or dose.
Physicians were well aware of the problems, and many opted to use fixed-dose combinations of medication to reduce the pill burden.

What Is Immunotherapy

Immunotherapy is a biotherapy which is designed by our doctors to treat the immune system damage. More than 95% of kidney diseases are related to immune system disorder, such as IgA Nephropathy, Lupus Nephritis, Diabetic Nephropathy etc.

Immune kidney disease is easy to relapse, because the current treatment usually focuses om the symptoms and complications of kidney damage, which fails to control the immune system disorder. Thereby, once patients have cold, bleeding or fever etc, their immune system disorder will flare up, which causes kidney damages come back.

Immunotherapy can rebuild a new immune system and uses the immune system to fight against the kidney disease, which can prevent the relapse of kidney damage from the root. To get details of immunotherapy, you are suggested to read the six steps of immunotherapy.

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How do I get started walking for my kidney health?

1. Warm up the body and stretch before every walk (Be sure to consult your doctor about warm up exercises before attempting them.) It usually takes only five minutes and can be gentle and enjoyable. Here are some suggestions to help you begin (perform each move for 5-10 seconds):

Arms: Reach both arms toward the ceiling and clasp your hands together for about 5-10 seconds. Next, stretch your arms out to the side and rotate them forward in a small, circular motion; repeat this by rotating arms backward. Then cross one arm over your chest, using the other arm to hold it in place; repeat move on other arm.
Calves, hamstrings and back: Gently bend forward, reaching for toes.
Thighs: Standing straight, bend your right knee and use your right hand to guide your foot towards the buttocks. Hold this position and repeat on the left side. If you have difficulties balancing on one foot, hold on to a chair or table to help stabilize yourself.

2. Walk for 30 minutes or more, at least three times per week. If that’s a challenge, do what is manageable and slowly work up to it.

3. Cool down by slowing the pace for the last five minutes of your walk. This allows the body to come back to a more relaxed state.

What is Micro-Chinese Medicine Osmotherapy

After more than 25 years' research and experiment, a set of Treatment System has been established in Huaxia Kidney Disease Hospital with its own characteristics. The core technology system is a natural herbal remedy, which is called Micro-Chinese Medicine Osmotherapy.

Micro-Chinese Medicine Osmotherapy develops on the basis of Traditional Chinese Medicine Osmotherapy. Traditional Chinese Medicine, known as Chinese Herbal Medicine, is extracted from plants for use in the treatment of disease and certain medical conditions. It is the world's most ancient form of medicine.

The treatment mechanism of this therapy is to block kidney fibrosis, repair damaged renal intrinsic cells and rebuild the normal kidney structure. And the realizing of these purposes is based on Chinese medicine curative effects like dilating blood vessels, anti-inflammation, anticoagulation, preventing blood viscosity and degrading extracellular matrixes. These stages are named as block, repair and rebuild.

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Kidney-Friendly Foods from the Pacific Northwest

Berries off the beaten path

Maybe after touring the apple country it’s time for a little hike. After all, Brenda believes strongly in exercise, “The single most important thing patients can do to improve their health is to increase their amount of physical activity as they are able. Physical activity can do so much for a person’s psychological outlook, which in turn can affect their capacity to be an active participant on their health care team,” she advises. Brenda also suggests you bring a basket for berry picking on your hike. Oregonand Washington are blanketed with an abundant supply of fresh berries. A few hours hike in almost any direction can yield a basket filled to capacity with strawberries, blueberries, raspberries, blackberries, loganberries, gooseberries, boysenberries, Marionberries, tayberries, huckleberries, cranberries, or lingonberries. Ninety percent of the raspberries in North America come from Oregon and Washington. These berries are often included as an interesting flavor counterpoint to a variety of meats and seafood. Most purists agree, however, that nothing beats the classic combination of fresh berries and a small amount of cream to keep it renal friendly.

Wild Pacific Northwest salmon

Celebrate the salmon during the Wenatchee River Salmon Festival in Leavenworth, Washington during the month of September. Whether these popular fish are swimming upstream or in a tasty sauce on your plate; salmon is ever-present in the Pacific Northwest. It has been the staple food for Native Americans, early French fur traders, European settlers and now modern-day residents. This versatile and healthy fish can be baked, broiled, boiled, fried, poached, grilled, pickled, smoked, canned and eaten raw. You can serve it with lemon shallot butter, mint pesto, peach chutney, cilantro sour cream, teriyaki glaze, coconut milk, ginger crust, molasses and mustard, Jack Daniels® cream sauce, blackberry reduction, olive oil and garlic, Texas barbecue sauce and Szechwan spices, just to name a few. Brenda’s favorite salmon recipe, Salmon Steaks with Herb Dressing, is a great addition to the dialysis diet.

Apple orchards and other fresh fruits

Boasting close to 300 days of sunshine each year, the Pacific Northwest crops supply approximately one third of the apples to American grocery stores. This is in addition to 160,000 tons of Bartlett pears, 34,000 tons of sweet cherries, plus prunes, plums, grapes, apricots, peaches, figs and quince. Even after much of the fruit is exported from the region, local roadside fruit stands and wild varieties remain for the locals to enjoy. Living in central Washington provides easy access to inexpensive and delicious produce. With such a seasonal diversity of fresh fruits, it’s no wonder local dishes include these flavorful ingredients in appetizers, soups, desserts, sauces, garnishes, chutneys and even brandies.

Apple Country Tours provide an opportunity to sample the fruit and get an appreciation of how it is grown and prepared for your local grocery. The customized bus tours take you through the scenic Wenatchee Valley allowing you to see and experience working family orchards, antique packing line demonstrations and commercial packing line methods used today. Brenda’s recipe for Apple Tostada is a sweet treat to remind you of your time in the apple orchards. This recipe is recommended for all the renal diets.

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Dialysis: Questions and Answers

If I have kidney disease, how long will it be before I need to start dialysis?

That depends on what stage your CKD is in and how quickly it progresses.

If I have kidney disease, will I need dialysis?

The early stages of CKD can last for many years and you don’t need dialysis. But if your kidneys fail, dialysis or a kidney transplant will be needed to keep you alive.

When should I start dialysis?

National Kidney Foundation (NKF) guidelines recommend you start dialysis when your kidney function drops to 15 percent or less—or if you have severe symptoms caused by your kidney disease, like shortness of breath, fatigue, muscle cramps or nausea and vomiting. Your doctor will help you decide, based on lab tests that measure how much kidney function you have left and on your symptoms.

I can't have a transplant—can I do dialysis for the rest of my life?

Yes, dialysis is something you can do for the rest of your life. And, most people on dialysis enjoy a good quality of life. Some people have been on dialysis for 30 years or more without getting a transplant. How long you can live on dialysis, and how well you do, will depend on a number of things, including how healthy you are, your attitude, your quality of healthcare and how much you take an active role in your care.

Sign up for no-cost Kidney Smart® education class to learn more about kidney disease. Also, check into joining a kidney patient organization or the DaVita.com discussion forums to connect with others like you.

If I start PD, how often will I have to get treatments?

PD is commonly done on a nightly basis using an automated cycler machine while a person sleeps. A patient will typically be connected to the cycler for 8 to 10 hours each night and be free of dialysis during the day. Some people will choose to do manual PD, which usually means doing four to five exchanges per day. Each exchange takes 20 to 30 minutes, and they need to be spread out over the whole day to clean the blood well.

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What Is Dialysis and When Do I Start

In the early stages of chronic kidney disease (CKD), you do not need dialysis. The stages of chronic kidney disease can last for many years. But if your kidneys fail, you will need dialysis or a kidney transplant to keep you alive.

National Kidney Foundation guidelines recommend you start dialysis when your kidney function drops to 15% or less — or if you have severe symptoms caused by your kidney disease, such as: shortness of breath, fatigue, muscle cramps, nausea or vomiting. Your doctor will help you decide when to start dialysis, based on results of lab tests that measure how much kidney function you have left and on your symptoms.

Private insurance generally covers treatment for kidney failure whenever your doctor says it is needed. If you don’t have private insurance, you may be able to get coverage through federal or state funded health care programs, such as Medicare or Medicaid.

Most people (about 93% of those who apply) qualify for Medicare when they need dialysis or a transplant, even if they are under age 65. Medicare pays for 80% of treatment costs of kidney disease when kidney function has dropped to 10 – 15%, or when your doctor justifies it.

If you are not having symptoms, you may be able to wait a bit longer before you begin dialysis. However, some doctors believe that starting dialysis as soon as Medicare or insurance covers it is wise, since it can take a long time to recover if you let yourself get very ill. Since chronic kidney failure often happens slowly, sometimes people do not even know how bad they feel, until they start dialysis and begin to feel much better.

It is important to start getting ready for dialysis or a transplant well in advance — when your kidney disease reaches Stage 4 (severe, with glomerular filtration rate, or GFR, less than 30 mL/min). Learning about the types of dialysis and transplant options will help you make a choice that is best for you. Any type of dialysis will require surgery — usually outpatient — to allow access for your treatments, and this should be done well in advance to allow time for healing.

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What Vitamins Should I Take or Avoid on Dialysis?

Everyone needs vitamins to maintain health, and most people get them from the foods they eat. Because there are diet restrictions on dialysis, dialysis patients need to make sure they are getting the nutrients they need for good health and usually need a special renal vitamin supplement. Talk to your doctor about your nutritional needs and ask if you need a prescription for a renal vitamin.

Water-soluble vitamins

Hemodialysis and peritoneal dialysis reduce water-soluble B and C vitamins. Renal diets also tend to be low in B vitamins and vitamin C. The easiest way to replace these vitamins without getting too much is by taking a special renal multivitamin once a day. Be sure to take it after hemodialysis on treatment days.

If you take over-the-counter vitamins, read the label. Over-the-counter vitamins often have 1,000% to 2,000% of the RDA of some B vitamins — and these high doses could be toxic to someone whose kidneys don't work. Look for B vitamin levels of about 100% of the U.S. recommended daily allowance (RDA). The exceptions are two B Vitamins that help red blood cell formation: folic acid and vitamin B-6. These are recommended for dialysis patients at levels several times the RDA.

Limit vitamin C to about 60 mg per day. High levels of vitamin C can cause oxalate crystals to form in people with reduced kidney function.

B and C Vitamins	Amount	% of RDA
Vitamin B-1 (Thiamin)	1.5 mg	100%
Vitamin B-2 (Riboflavin)	1.7 mg	100%
Vitamin B-3 (Niacin)	20 mg	100%
Vitamin B-6 (Pyridoxine)	10 mg	500%
Folic Acid	1 mg	250%
Vitamin B-12 (Cobalamin)	6 mcg	100%
Biotin	300 mcg	100%
Pantothenic Acid	10 mg	100%
Vitamin C	60 mg	100%

Fat-soluble vitamins

Avoid vitamin A supplements. Since this vitamin is fat-soluble, not water-soluble, it can build up to higher than normal levels in people on dialysis.

Vitamin E is also fat-soluble and is not removed by dialysis. However, some nephrologists recommend 400 to 800 IU per day of natural-source vitamin E, because some studies have found that it can help dialysis patients. Ask your doctor if he or she recommends vitamin E for you.

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Hyperphosphatemia Raises Coronary Artery Calcification (CAC) Risk in Peritoneal Dialysis

Hemodialysis is a treatment that replaces the work of your own kidneys to clear wastes and extra fluid from your blood. People who receive in-center HD travel to the clinic three times a week and sit in a chair for 3 to 4 hours each time while their blood is cleaned. This basic process is the same for home hemodialysis, except that you and a care partner are trained to do your treatment at home.

Hyperphosphatemia is an independent risk factor for coronary artery calcification (CAC) progression in patients undergoing peritoneal dialysis (PD), according to a Chinese study presented at Kidney Week 2014.

Additionally, serum phosphorus levels are associated with nutritional intake and adequacy of dialysis treatment.

Da Shang and colleagues in the Division of Nephrology at Fudan University in Shanghai, China, looked at 207 adults with end-stage renal disease (ESRD) who had been on PD for more than 6 months as part of a prospective, observational cohort study. They were divided into either slow or rapid progression groups (131 patients and 76 patients, respectively) depending on the velocity of CAC progression. The median interval of the first and last CAC score measurements was 24.6 months.

On multivariate analysis, hyperphosphatemia was associated with higher transferrin, serum albumin, and normalized protein catabolic rate (nPCR), as well as lower hemoglobin, residual creatinine clearance (Ccr), and PD Ccr.

Age, body mass index, and serum phosphorus were found to be independent risk factors of CAC progression.

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Daily Home Hemodialysis May Have Edge vs. Peritoneal Dialysis

If your kidney diagnosis is new, you may feel overwhelmed, confused and angry. But there are some important things you can do to help yourself. Learn all you can about your different treatment options and take an active role in decisions about your care. Hemodialysis (HD) is a life-preserving treatment for hundreds of thousands of Americans with kidney failure. But the standard schedule of in-center HD three times a week is, at best, inconvenient, and at worst, hard on the heart.

Daily home hemodialysis (DHD) is associated with fewer hospital admissions and a lower risk of modality failure than peritoneal dialysis (PD), according to a new study. DHD patients spent fewer days in the hospital.

The study is the first to address the comparative clinical effectiveness of DHD compared with PD, investigators Rita S. Suri, MD, of the Centre Hospitalier de l'Université de Montréal, and colleagues noted in an online report in Kidney International.

Using prospensity scoring, the researchers matched 1,116 DHD patients to 2,784 U.S. Renal Data System (USRDS) home PD patients. They also matched 1,187 DHD patients to 3,173 USRDS patients receiving in-center conventional hemodialysis (CHD). The hospitalization rate was significantly lower with DHD than PD (0.93 vs. 1.35 hospitalizations per patient-year), which translated into a 27% decreased risk of hospitalization, the researchers reported.

The DHD patients spent a mean 5.2 days per patient-year in the hospital compared with 9.2 days per patient year in the PD group, and a significantly higher percentage of DHD patients than PD patients remained admission-free during follow-up (52% vs. 32%). The proportion of patients who switched to back to in-center HD was significantly greater in the PD than the DHD group (44% vs. 15%).

Hospitalization rates for DHD patients and patients receiving in-center CHD do not differ significantly (0.93 vs. 1.10 admissions per patient-year). The risk of cardiovascular-related admissions, however, was 32% lower with DHD than CHD and the risk of infectious and access-related hospitalizations were 15% and 25% higher, respectively, with DHD.

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Lupus Nephritis Need Not Prevent Renal Transplants

Kidney damage from lupus can be mild or severe. It can cause damage to the filtering units (glomeruli) of the kidney. Since these filtering units clear your blood of waste, damage to them can cause your kidneys to work poorly or not at all. About 90 percent of lupus patients will have some kidney damage, but only two to three percent actually develop kidney disease severe enough to require treatment.

Investigators reviewed outcomes from adults who had attended a lupus clinic at the Toronto Western Hospital in Toronto, Ontario, from 1970 to 2012. Among the 1,645 lupus patients treated in that interval, 25 had nephritis and underwent kidney transplantation. Most of these patients were white (40%) and African Canadian (28%). The remaining patients were Asian or members of other ethnic groups. None of them had any clinical evidence of lupus in the year before transplantation.

Two of the patients had a completely non-functional kidney post-transplant. Another four had graft failure, one within five years of transplant surgery and the remaining three after a longer period, with an average time to graft failure of 5.75 years. Of the 19 (76%) patients with graft survival, the graft survived at least five years in eight patients, with a mean graft survival among these eight patients of 5.7 years.

The four patients with graft failure and 19 with graft survival had roughly similar characteristics, except that the average age in the graft-survival group was higher (40 vs. 29.8 years). Significantly more whites and African-Canadians had graft survival than graft failure, at seven and one, and six and one, respectively.

In addition, the average time between lupus diagnosis and transplant was 15.5 year in the graft-survival group and 4.5 years in the graft-failure group. The respective average durations of dialysis prior to transplant were 5.8 and 3.9 years.

Three of the individuals in the graft-survival group died an average of 5.6 years post-transplant. The cause of death was not related to renal disease in two patients and unknown in the third. Another patient was lost to follow-up. In the graft-failure group, three patients died an average of six years post-transplant, and all the deaths were related to renal disease. The remaining patient is still living.

One (25%) of four patients in the graft-failure group had positive lupus serology a year before transplantation compared with nine (47%) of 19 patients in the graft-survival group. At one year post-transplant, the proportion of patients with lupus serology in the graft-failure group rose to 66%, while it fell to 42% in the other group.

“I presume that older patients had quiescent lupus disease activity for a longer period compared to the other patients, and it is possible that the severity of lupus disease activity tends to ameliorate [or] weaken years after the diagnosis of lupus,” said lead investigator Zahi Touma, MD, PhD, of the University of Toronto Lupus Clinic at the Toronto Western Hospital, in explaining the results.

In another poster presented at the rheumatology meeting, Dr. Touma and three other co-investigators analyzed the timeframe for either partial (at least 50% decrease from baseline in proteinuria) or complete, recovery from proteinuria in lupus nephritis patients. They determined that partial or complete recovery from proteinuria may be a better end point in clinical studies of this patient population because it tracks parallel to complete response but happens somewhat more quickly, which is an advantage in studies that do not last for decades. kidneyhospitalabroad@hotmail.com

Minorities, Uninsured Lack Care of ESRD in Lupus Nephritis

No one knows what causes the disease. Your family history and things in your environment such as infections, viruses, toxic chemicals or pollutants (car fumes, factory smoke) may play a role in causing the disease. Wherever immune complexes are deposited, immunofluorescence staining is positive for complement and for IgG, IgA, and IgM in varying proportions. Epithelial cells may proliferate, forming crescents. Classification of lupus nephritis is based on histologic findings

In the United States, minorities and those who lack private insurance are less likely to receive adequate care for end-stage renal disease (ESRD) due to lupus nephritis (LN), according to research published online Feb. 18 in Arthritis & Rheumatology.

Laura C. Plantinga, Sc.M., of Emory University in Atlanta, and colleagues analyzed data for 6,594 patients initiating treatment for LN-ESRD, from July 2005 through September 2011, to assess factors associated with quality of care.

The researchers found that, compared with white patients, black and Hispanic patients were less likely to receive pre-ESRD care (odds ratios [ORs], 0.73 and 0.72, respectively) and less likely to be placed on the waitlist for kidney transplant (hazard ratios [HRs], 0.78 and 0.82, respectively).

Compared with patients with private insurance, patients with Medicaid (HR, 0.51) or without insurance (HR, 0.36) were less likely to be placed on the waitlist. Only 24% of patients had a permanent vascular access, and uninsured patients were even less likely to have placement of vascular access (OR, 0.62).

"LN-ESRD patients have suboptimal ESRD care, particularly with regard to vascular access placement," the authors write. "Minority race/ethnicity and lack of private insurance were associated with inadequate ESRD care."

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Plant-Based Phosphorus Best for Kidney Disease (CKD) Patients

There is evidence that treatment can prevent or delay the progression of CKD, reduce or prevent the development of complications, and reduce the risk of cardiovascular disease (CVD). When symptoms are severe they can be treated only by dialysis and transplantation (end-stage kidney disease).

Researchers led by Anuja Shah, MD, of Harbor-UCLA Department of Nephrology, and fellow researchers measured urine phosphorus in 5 different stage 4 or 5 CKD patients who were living in a metabolic balance ward. Their goal was to measure the effects of 5 different dietary sources of phosphorus (plant, inorganic, meat, dairy, mixed) to study their effects on intestinal phosphorus absorption as well as 24-hour urinary phosphorus excretion.

Patients were examined on five separate occasions in two-week intervals each, and diets included 800 mg of calcium as well as 1,000 mg of phosphorus per day.

They found that the plant-based diet demonstrated the lowest urinary phosphorus excretion while the inorganic-based diet had the highest.

“Inorganic phosphorus is the most readily intestinal absorbed source of dietary phosphorus,” the authors noted. “This is the first study to examine the effects of five different food sources of phosphorus on intestinal phosphorus absorption in CKD patients.”kidneyhospitalabroad@hotmail.com

Higher Phosphorus, Cardiovascular Disease (CVD) Not Linked in Kidney Disease (CKD) Patients

People with any stage of CKD have an increased risk of developing heart disease or a stroke. Severity can vary but most cases are mild or moderate, occur in older people, do not cause symptoms and do not progress to kidney failure. Providers must communicate tough messages—from giving a kidney disease diagnosis to discussing renal replacement therapy options—that can be difficult both for the patient to hear and for the provider to deliver.

Using data from the Kaiser Permanente Southern California database, Dean Kujubu, MD, and colleagues at the Department of Nephrology & Hypertension at Kaiser Permanente Los Angeles Medical Center conducted a cross-sectional study of 195,097 patients across various estimated glomerular filtration rate (eGFR ranges (90 or higher, 60-89, 30-59, and less than 30 mL/min/1.73 m2) from January 1999 to December 2009.

The study excluded patients who were on dialysis or who had kidney transplants. The primary outcome was a composite of coronary artery disease (CAD), congestive heart failure (CHF), and cerebrovascular accident (CVA).

Overall, each 0.5 mg/dL increment in serum phosphorus was not associated with the primary outcome, but it was associated with a 58% increased odds of CHF.

Among patients with an eGFR of greater than 89 mL/min/1.73 m2, each 0.5 mg/dL increase in serum phosphorus was associated with 23% increased odds for the composite endpoint.

“In a large, diverse population, we did not observe increased risk of prevalent CAD, CHF, and CVA with higher serum phosphorus levels among individuals with eGFR of less than 89 ml/min,” the authors concluded.

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Phosphorus Pyramid for CKD Provides Diet Advice

It's a Cyclical Ketogenic Diet, or CKD for short. CKD basically means that you cycle periods of low carb, high protein, and high fat with periods of high carb, high protein, and low fat. If your potassium becomes too high, it can cause an irregular heartbeat or a heart attack. The majority of time you will be consuming a low carb diet, with a period set aside each week for carbing-up. This isn't for the fun of it; there are real scientific reasons for this, reasons with exciting implications for the bodybuilder.

“The phosphorus pyramid herein proposed is an original, visual, user-friendly tool for nutritional education. It can support patients and caregivers in making the right food choices by encouraging adherence to dietary prescriptions, which is a crucial component for CKD-MBD,” Adamasco Cupisti, MD, of the University of Pisa in Italy, and colleagues wrote in BMC Nephrology (2015;16:9).

Phosphorus is a concern at all stages of CKD, the researchers noted. The pyramid can help both CKD and dialysis patients understand what to eat and what to avoid, with appropriate tailoring. Here are some basic nutrition strategies:

In non-dialysis patients, consider restricting protein intake. (Those on dialysis require extra protein.) In a mixed diet, each gram of protein is usually accompanied by 12–14 mg of phosphorus.

Shift from phosphorus-rich foods to low phosphorus foods. Take into consideration bioavailability. Plant foods contain phosphorus but less than half of the mineral content is absorbed by the body. The phosphoric acid in soft drinks, by comparison, is almost completely absorbed.

Boil foods to reduce their mineral content, including phosphorus (then discard the water). According to one study, boiling reduces phosphorus by 51% for vegetables, 48% for legumes, and 38% for meats.

Try to identify and avoid phosphate additives. Processed foods contain considerable amounts of added phosphorus, including from preservatives.

The Phosphorus Pyramid

The food pyramid color codes food items similar to a traffic light: greens for go, yellows for slow, and reds for stop.

It consists of 6 levels with foods arranged by their phosphorus content, phosphorus to protein ratio (no more than 12 mg/g is favorable) and phosphorus bioavailability. Here's an overview of each level from 1 (low phosphorus) to 6 (high phosphorus):

Green: Foods with a very low phosphorus content include protein-free foods, fruit, vegetables, egg white, olive oil, and sugar. These items are not limited, unless a patient is overweight, diabetic, or receiving dialysis.

Light green: Foods with phytate, a less absorbable form of phosphorus, include cereal, rice, pasta, white bread, and legumes. 2–3 servings per day.

Yellow: Among meats, choose lamb, rabbit, ham, or fish (e.g., trout, tuna, cod, hake, and sole). Avoid farmed fish because it has been fed with phosphorus to promote growth. Also choose milk and yogurt. No more than 1 serving per day.

Orange: Foods with a higher phosphorus to protein ratio include turkey, offal, shrimp, squid, salmon, and soft cheeses. No more than 1 serving per week.

Orange-Red: Foods with a very high phosphorus content include nuts, egg yolk, and hard cheeses. No more than 2-3 servings per month.

Red: Processed foods with phosphorus-containing additives include colas, processed meat, and processed cheese. Avoid as much as possible.

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Tight Blood Pressure Control Benefits Some Polycystic Kidney Disease (ADPKD) Patients

In the United States about 600,000 people have PKD. Although kidneys usually are the most severely affected organs, polycystic kidney disease can cause cysts to develop in your liver and elsewhere in your body. However 17% of cases initially present with observable disease in one kidney, with most cases progressing to bilateral disease in adulthood.

Rigorous blood pressure control can reduce the rate of increase in total kidney volume (TKV) in young hypertensive patients with autosomal dominant polycystic kidney disease (ADPKD) and relatively preserved kidney function, a researcher reported at the 2014 Kidney Week meeting.

“Low blood pressure treatment in healthy young hypertensive ADPKD patients with renin-angiotensin-system blockade is well tolerated and safe and results in a 14.2% slower rate of total kidney volume growth over 5 years, is associated with reduced left ventricular mass index, urinary albumin excretion, and renal vascular resistance,” said Arlene B. Chapman, MD, of Emory University in Atlanta.

Dr. Chapman presented the findings of a placebo-controlled, double-blind study of 558 hypertensive ADPKD patients aged 15–49 years who had an estimated glomerular filtration rate (eGFR) above 60 mL/min/1.73 m2.

She and her colleagues compared the effect of the ACE inhibitor lisinopril alone or in combination with the angiotensin receptor blocker (ARB) telmisartan and the effect of low versus standard blood pressure (BP) on the annual percent change in TKV. The researchers defined low BP as 95–110/60–75 mm Hg and standard BP as 120–130/70–80 mm Hg.

Results showed that subjects in the low BP group experienced a 14.2% slower annual increase in TKV than the standard BP group (5.6% vs. 6.6% per year), but did not differ significantly between the patients receiving lisinopril alone or in combination with telmisartan.

Dr. Chapman and her colleagues also found that the low BP group experienced a significantly greater decrease in left ventricular mass index and urine albumin excretion than the standard BP group (-1.17 vs. 0.57 g/m2 per year and -3.77% vs. -2.43%, respectively). Tighter BP control did not significantly affect overall change in eGFR.

In a companion double-blind, placebo-controlled trial, the results of which also were presented at the meeting, Vicente E. Torres, MD, PhD, of Mayo Clinic in Rochester, Minn., and collaborators studied 486 ADPKD patients aged 18–64 years with stage 3 chronic kidney disease and 5–8 years of follow-up. Patients were randomized to receive lisinopril and placebo or lisinopril and telmisartan titrated to achieve a BP of 110–130/70–80 mm Hg.

Treatment with lisinopril alone or in combination with telmisartan lowered urinary aldosterone excretion and adequately controlled BP. The researchers observed no significant difference in the composite primary outcome (time to death, end-stage renal disease, or a 50% reduction from the baseline eGFR) and rate of eGFR decline.

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