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All About Kidney Disease, Dialysis, and Transplantation




Straightforward Takeaways

  • Get checked for kidney disease!

  • About 30 million Americans have some form of chronic kidney disease. It’s often asymptomatic until it’s too late. If left untreated, Chronic Kidney Disease can become End Stage Renal Disease, requiring a person to be treated with dialysis or a kidney transplantation.

  • Dialysis only does a fraction of what a kidney does. Healthy kidneys work 24/7, eliminating waste and fluid in the form of urine. Dialysis is often done only three times a week. As a consequence, living on dialysis is often debilitating and short lived. The average life expectancy of a person on dialysis now (2023) is about three years.

  • If clinically eligible, a person with ESRD should get a kidney transplant. While there is no “cure” for ESRD, as a treatment, transplantation is lightyears better in terms of quality of life and longevity. Why? Transplantation actually gives you a kidney, from a deceased or living donor that works 24/7.

  • Living donor kidneys on average last up to twice as long as those from deceased donors.

  • If you’re told by one transplant center you are ineligible for a transplant, it might be worth getting a second opinion from another center.


Millions of individuals all around the globe have kidney disease. Also known as renal disease, it refers to a condition in which the kidneys are damaged or deteriorate and cannot function properly. The kidneys are vital organs responsible for filtering waste and excess fluid from the blood, maintaining electrolyte balance, regulating blood pressure, and producing hormones that help regulate other bodily functions. If left untreated kidney disease can be fatal. This article will cover Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD) and the treatments of Dialysis and Kidney Transplantation. But first…


Why Are the Kidneys So Important?


The kidneys remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and re-absorption. This process is necessary to maintain a stable balance of body chemicals.

The critical regulation of the body's salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism.

The kidneys are powerful chemical factories that perform the following functions:

  • remove waste products from the body

  • remove drugs from the body

  • balance the body's fluids

  • release hormones that regulate blood pressure

  • produce an active form of vitamin D that promotes strong, healthy bones

  • control the production of red blood cells


What is Chronic Kidney Disease?

According To The Mayo Clinic


Chronic kidney disease (CKD), also called chronic kidney failure, involves a gradual loss of kidney function. The two leading causes of CKD are diabetes and high blood pressure. Treatment for chronic kidney disease focuses on slowing the progression of kidney damage, usually by controlling the cause. But, even controlling the cause might not keep kidney damage from progressing. Chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant.


Symptoms

In the early stages of chronic kidney disease, you might have few signs or symptoms. You might not realize that you have kidney disease until the condition is advanced. Signs and symptoms of chronic kidney disease develop over time if kidney damage progresses slowly. Loss of kidney function can cause a buildup of fluid or body waste or electrolyte problems. Depending on how severe it is, loss of kidney function can cause:

  • Nausea

  • Vomiting

  • Loss of appetite

  • Fatigue and weakness

  • Sleep problems

  • Urinating more or less

  • Decreased mental sharpness

  • Muscle cramps

  • Swelling of feet and ankles

  • Dry, itchy skin

  • High blood pressure (hypertension) that's difficult to control

  • Shortness of breath, if fluid builds up in the lungs

  • Chest pain, if fluid builds up around the lining of the heart

Signs and symptoms of kidney disease are often nonspecific. This means they can also be caused by other illnesses. Because your kidneys are able to make up for lost function, you might not develop signs and symptoms until irreversible damage has occurred. When CKD progresses to its most advance stage, it is called End Stage Renal Disease.



What is End Stage Renal Disease?

According to Johns Hopkins


End-stage renal failure, also known as end-stage renal disease (ESRD), is the final, permanent stage of chronic kidney disease, where kidney function has declined to the point that the kidneys can no longer function on their own. A patient with end-stage renal failure must receive dialysis or a kidney transplantation in order to survive for more than a few weeks.

Doctors can diagnose the disease with blood tests, urine tests, kidney ultrasound, kidney biopsy, and CT scan.


What is Dialysis?

According to the NHS


There are 2 main types of dialysis: hemodialysis and peritoneal dialysis.

Hemodialysis

Hemodialysis is the most common type of dialysis and the one most people are aware of. During the procedure, a tube is attached to a needle in your arm.

Blood passes along the tube and into an external machine that filters it, before it's passed back into the arm along another tube.

At dialysis centers, this is usually carried out 3 days a week, with each session lasting around 4 hours.

It can also be done at home. Some examples of a home dialysis schedule include:

  • 4 times a week for 4 hours

  • 5 times a week for 3 hours

  • 6 days a week for 8 hours overnight

Peritoneal dialysis

Peritoneal dialysis uses the inside lining of your abdomen (the peritoneum) as the filter, rather than a machine. Like the kidneys, the peritoneum contains thousands of tiny blood vessels, making it a useful filtering device. Before treatment starts, a cut (incision) is made near your belly button and a thin tube called a catheter is inserted through the incision and into the space inside your abdomen (the peritoneal cavity). This is left in place permanently.

Fluid is pumped into the peritoneal cavity through the catheter. As blood passes through the blood vessels lining the peritoneal cavity, waste products and excess fluid are drawn out of the blood and into the dialysis fluid. The used fluid is drained into a bag a few hours later and replaced with fresh fluid. Changing the fluid usually takes about 30 to 40 minutes and normally needs to be repeated around 4 times a day. If you prefer, this can be done by a machine overnight while you sleep.


What is kidney transplantation?

According to UCLA


Kidney transplantation is widely recognized as an effective, and preferred, therapeutic option for the treatment of end-stage renal disease. Kidney transplant is a surgery done to replace a diseased kidney with a healthy kidney from a donor.

there are different types of transplants to consider:

Living donor: A person who donates one of their kidneys to someone in need. Living donors may be blood relatives or individuals with emotional ties to the transplant candidate. Finding a living donor match dramatically shortens your waiting time, increases long-term transplant kidney and patient survival, and gives you the flexibility of scheduling your date of surgery. People who donate a kidney can live healthy lives with one healthy kidney. However, only 1 in 5 donors are healthy enough to donate a kidney

Deceased donor: A kidney from an individual who has suffered brain or cardiac death and they generously donate their organs for transplant. The waiting time for a deceased donor kidney can be multiple years. A person getting a deceased donor transplant most often gets just one kidney, but in rare situations, he or she may get two kidneys from a deceased donor. The diseased kidneys are usually left in place and the transplanted kidney is placed in the lower belly on the front side of the body.


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