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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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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Alternate Night Home Hemodialysis Improves Anemia

Healthy kidneys clean your blood and remove extra fluid in the form of urine. You need dialysis if your kidneys no longer remove enough wastes and fluid from your blood to keep you healthy. Hemodialysis is the most common method used to treat advanced and permanent kidney failure.

Nocturnal home hemodialysis (NHHD) performed on alternate nights improves anemia and decreases the need for an erythropoiesis-stimulating agent (ESA) compared with conventional hemodialysis, according to a new study.

Clara K. Y. Poon, MD, of Princess Margaret Hospital in Hong Kong, and colleagues compared 23 patients receiving NHHD with 25 in-center patients receiving conventional hemodialysis (CHD). In the NHHD group, mean hemoglobin levels increased significantly from 9.37 g/dL at baseline to 11.34 g/dL at 24 months, the investigators reported online ahead of print in Hemodialysis International.

During that same period, the mean weekly ESA requirement decreased significantly from 103.4 U/kg to 47.3 U/kg. In the CHD group, mean hemoglobin levels were 9.5 g/dL at baseline and 9.3 g/dL at 24 months, a non-significant difference. The weekly ESA requirement increased significantly from 89.7 U/kg to 105.9 U/kg. In addition, 26% of the NHHD patients were able to discontinue ESA therapy compared with none of the CHD patients, according to the researchers.

The NHHD group experienced greater increase in standard Kt/V compared with the CHD group.

“NHHD with an alternate night schedule improves anemia and reduces ESA requirement as a result of enhanced uremic clearance,” the authors concluded.

Dr. Poon's team commented that NHHD on alternate nights may be superior to NHHD performed 6 or 7 times a week in terms of anemia management. They cited a cohort study in which investigators examined anemia parameters in patients receiving daily long nocturnal hemodialysis and those undergoing short daily hemodialysis and CHD.

The study, published in the American Journal of Kidney Diseases (2003;42 (S1):S18–S23), found that all patients lost a significant amount of blood in hemodialysis tubing and as a result of laboratory testing compared with baseline, the groups undergoing dailiy hemodialysis experienced a significantly greater amount of blood compared with the CHD group.

“Hence, prolonged and more frequent hemodialysis may increase total blood loss to the blood circuit and it may offset the benefits to anemia by long duration of hemodialysis,” Dr. Poon's team noted.

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