What is kidney disease

Chronic kidney disease is a condition where kidneys are damaged due to certain health conditions, reducing their functional ability. This happens gradually over time, usually months to years. As kidney disease progresses, it may eventually lead to kidney failure. This is dangerous because the fluid, waste and toxic substances that are normally removed from the body by the kidneys start to build up in the body. When this occurs, you will require dialysis or a kidney transplant to maintain life.

Dialysis, along with certain medicines and a careful diet, does what the damaged kidneys can no longer do. It removes the wastes and extra fluid from the blood. A kidney transplant is another option for some people. Researchers are hopeful that someday all causes of kidney failure may be prevented.

1. Slight kidney damage with normal or increased filtration;

2. Mild decrease in kidney function;

3. Moderate decrease in kidney function;

4. Severe decrease in kidney function; and

5. Kidney failure requiring dialysis or transplantation.

Are you at risk?

Kidney and urinary tract disease are very common health issues for the Australian community, with 1 in 3 being at increased risk of developing kidney disease.

Almost 1 million Australian adults over the age of 25 suffer from diabetes. Only half of these individuals are aware that they have diabetes. As the number of people with diabetes grows, so will the number of diabetics who develop kidney disease.

More than one third of our adult population have high blood pressure or hypertension. Hypertension affects the majority of patients with kidney disease, and is the primary cause of kidney failure. 

If you have any of the following symptoms, please consult your doctor and ask that your kidneys be checked:

• Blood in your urine or very dark urine

• Urine that is foamy or bubbly

• Swelling of your face, feet or hands

• Shortness of breath from fluid in the lungs

• Unexplained fatigue, tiredness or weakness

• High blood pressure

• Diabetes

• Smoking

• Over 50 years of age

• Overweight

• Family history of kidney disease

• Aboriginal or Torres Strait Islander descent

• Pacific Islander ancestry

How do you prevent kidney failure?

Anyone can get kidney disease. However, new research has created a great deal of interest through the possibility of diagnosing kidney disease early, and offering preventative treatment before the kidneys are completely destroyed. There are several tests that can detect kidney disease. Your doctor can perform the initial testing procedures.

The two main causes of kidney disease are diabetes and high blood pressure or hypertension.

• Diabetes mellitus;

• High blood pressure (hypertension);

• Glomerulonephritis;

• Polycystic kidney disease (PCKD);

• Renovascular disease;

• Chronic pyelonephritis;

• Lupus erythematosus;

• Kidney stones;

• Urinary tract infections; and

• Analgesic nephropathy and drugs

Most of these conditions occur over a long period of time and cause damage to both kidneys. Even if further deterioration can be stopped the damage already done is usually permanent.

Early diagnosis and careful management of these conditions can delay and even prevent the onset of kidney failure. In many cases of chronic kidney failure no cause can be determined.

Don’t smoke as there is no safe level of smoking and it damages blood vessel walls.

Maintain your weight within a healthy range for your height with a well balanced diet. Regular moderate exercise of 30 minutes on all, or most, days of the week will also help control your weight.

You can look after the health of your kidneys by having an annual check-up with a doctor, including:

• Blood pressure check

• Urine checked for blood and protein

• Full kidney function blood test

What are my treatment options?

Patients who are experiencing chronic kidney disease usually have two choices of treatments. They can go on dialysis or have a transplant. These treatments usually commence when less than 10% of kidney function remains.

Dialysis is a treatment process that helps to replace the work of kidneys by cleansing/filtering the blood and removing excess fluids. Dialysis helps a patient feel better and live longer, but it will not cure kidney failure. However, this treatment has been proven to be effective and is currently used by more than 7,000 Australians.

There are two types of dialysis, Haemodialysis and Peritoneal Dialysis. In some cases, the renal physician may recommend one over the other due to medical reasons, however, the choice is totally up to the patient.

Other factors that need to be considered when making dialysis choice include:

• Place of residence and how often the treatment is required

• The impact of dialysis on a personal and family level

• How the method fits into work, study, social life, leisure activities, business and holiday travel requirements

Both forms of dialysis work equally well when carried out as instructed and, when the patient has taken measures to maintain their health as recommended by their physician. Patients are not required to commit permanently to one form of dialysis. In some cases, a patient may need to change over because of medical reasons. Each form of dialysis treatment lasts between 4-6 hours and is performed 3 times per week. In some cases, dialysis may last longer and need to be more frequent.

Haemodialysis

Haemodialysis is a treatment where the blood is cleansed outside the body using a machine to temporarily rid the body of harmful wastes, extra salt and extra water. This can be performed at home, or in a satellite, self-care or hospital renal unit.

ADVANTAGES

• Can be performed at home to the patient’s convenience

• Involvement by patient, their partner and family

• It can be scheduled to fit into lifestyle

• Reduced time spent in transit and in hospital

DISADVANTAGES

• Overcoming fear of needles and self-cannulation

• Self-motivation

• Requires stable and supportive family or network of friends

• Need to be medically stable

The cost of haemodialysis in public hospitals and satellite units is covered by Medicare. Private treatments are covered by private health insurance. For home treatments, the cost of all necessary equipment is covered by the government. Patients are responsible for the maintenance and safe storage of equipment. In some cases, the patient may have to pay for extra equipment such as a recliner chair and cost of plumbing.

Dialysis machines can put stress on water and power supply. However, many local authorities do provide rebates and concessions for patients.

Peritoneal dialysis

Peritoneal dialysis is a procedure that removes extra water, wastes and chemicals from the body. This type of dialysis works inside the body and uses the lining of your abdomen to filter your blood.

ADVANTAGES

• Continuous dialysis means that a steady blood chemistry is maintained

• Self-care dialysis

• Simple to learn and perform (1-2 weeks training)

• Minimal fluid and dietary restrictions

• No needle punctures required

• Ease of travel as it is compact and portable

• Minimal cardiovascular stress

• Overnight dialysis

DISADVANTAGES

• Potential to develop peritonitis – inflammation of peritoneal membrane due to bacterial infection (can be lowered by disconnecting delivery system and good hygiene)

• Potential protein loss – body protein escapes through peritoneal membrane and into peritoneal solution (can be combated by increasing protein intakes through diet)

• Potential increase in fat and cholesterol, leading to narrowing of blood vessels (can be overcome by doing regular exercise and medication)

• Peritoneal catheter as a permanent access point in the body for dialysis

• Daily dialysis schedules

• Possible weight gain

• Storage space needed for supplies

Kidney transplant surgically replaces the failed kidney with a healthy kidney from another person. In order for a transplant to take place, patients must be matched with a suitable kidney. If a family donation is not possible, patients are required to go on the waiting list. On average, successful transplant can grant survival for 15 years. This form of treatment provides a better quality of life and life expectancy than dialysis. However, transplant may not suit those with severe heart and vascular disease.

Possible complications after transplant

• Rejection: The body resists foreign cells or tissue of donor kidney.

• Symptoms: Fever, decreased urine output, fluid retention and increase in weight, tenderness over the kidney and elevated blood pressure – most can be reversed with drug treatment.

• Unsuccessful transplant: If the kidney doesn’t function, even after medical treatment, then it will be removed. Patients will resume dialysis and they are usually permitted to go back on the waiting list.

After a successful transplant, patients can return to normal activities within 3-6 months. Patients who wish to have a baby are advised that they should wait until at least 1-2 years of good kidney function as there is an increased risk of pregnancy issues such as premature births and hypertension in transplant patients. Please discuss this with your doctor.

Organ donation

There are almost 2,000 people on the national waiting list for organs and tissues, and some of them will die waiting. By being an organ donor, you are giving the gift of life. To become a donor, please talk to your family and friends about your decision to donate. The decision to donate should be voluntary and free of feeling ‘pressured’.

1 donor can improve the lives for up to 10 people

Advantages of living donation:

• Reduces the time the patient spends on dialysis

• Transplant can be scheduled to suit donors and recipients

• A living organ can function immediately

• Donations are generally more well matched if it is done by related family members (it reduces the amount of immuno suppressive medication the recipient has to take)

Who can donate?

• Donations can be from related relatives or an unrelated person

• Donors can be of any gender

• Donors must be over 18 years of age

• Donors must be in good health

 After a successful transplant, most donors recover quickly and can resume normal activities within 4-6 weeks. Activities such as sport will take longer. It is recommended that donors have annual blood pressure, blood and urine testing.

Having one kidney does not –

• Affect the woman’s ability to have children

• Change life expectancy

• Increase the risk of having kidney disease

How successful are transplants?

As medicine continues to advance, the success rate of transplants continues to improve. However, there may be some complications that could occur such as rejection, surgical complication and the original disease that caused kidney disease in the first place.

• Donating after death

• Blood or bone marrow

• Financial donations

• Donation of time as a volunteer

Most people think that death occurs when the heart stops beating. This is called cardiac death. Death, however, can also occur when the brain stops functioning. This is called brain death. The way a person dies will depend on which organs and tissues can be donated.

People who pass away from cardiac death can donate tissues such as heart valves, bones, corneas and skin up to 24 hours after they die. To be able to donate organs such as heart, lungs, liver, kidneys and pancreas, a person must be brain dead, on a ventilator (artificial breathing machine) and in hospital. Without a supply of oxygen from the ventilator, these organs would not be suitable for transplantation.

DonateLife™ Campaign

The Australian Government launched the DonateLifeTM national awareness program to help educate Australian families about organ and tissue donation, and, their power to save lives.

Links and Resources

Below are useful organisations who specialise in kidney disease information.