END-STAGE RENAL DISEASE Definition and Statistics Kidneys are important parts of the urinary system. They are found at each side of the spine, below the rib cage. The kidneys perform life-maintaining functions as monitors and regulators of body fluid. They excrete fluids when the body has an excess of them and retain the substances necessary for the body’s continuing function. They produce and release a variety of chemicals to keep the body healthy and filter the entire blood supply every two minutes, excreting waste materials through the urine. 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 kidney transplantation in order to survive for more than a few weeks. Kidney diseases, especially End Stage Renal Disease (ESRD), are already the 7th leading cause of death among the Filipinos. One Filipino develops chronic renal failure every hour or about 120 Filipinos per million populations per year. More than 5,000 Filipino patients are presently undergoing dialysis and approximately 1.1 million people worldwide are on renal replacement therapy. Reliable estimates reveal that the number of these patients will double in 2010. The Department of Health (DOH) said close to 23,000 Filipinos underwent dialysis due to kidney failure in 2013, nearly four times higher than the 4,000 cases recorded in 2004, or a 10 to 15 percent increase a year. In the past, chronic glomerulonephritis was the most common cause of chronic renal failure. Today, diabetes mellitus and hypertension have taken center stage as the main causes of ESRD, which together account for almost 60 percent of dialysis patients. Affecting 10 percent of the global population and responsible for more than a million deaths each year, chronic kidney disease (CKD) has become a major public health issue. In the U.S. alone 30 million people, or 15 percent of adults, are estimated to have chronic kidney disease. Around the world, the number of people with chronic kidney disease continues to rise. The impact is immense; patients with CKD face diminished quality of life, higher risk of other health problems, and significant financial costs or death.
Risk Factors & Symptoms
Risk factors include diabetes, hypertension, heart disease, smoking, obesity, high cholesterol, family history of kidney disease, and age 65 or older. The most common causes of kidney disease include diabetes and high blood pressure, but population growth and aging are other factors driving higher rates of CKD. CKD may result due to infections, inflammation, or urinary system blockages such as kidney stones. Painkillers, like analgesics or antibiotics, also may cause chronic kidney disease if taken over a long period of time. Kidney disease affects people of all ages and races. African- Americans, Hispanics, Native Americans, and people of South Asian origin have a higher risk of CKD. This risk is due in part to high rates of diabetes and high blood pressure in these communities. Chronic kidney disease can occur at any age, but becomes more common with increasing age and is more common in women. Regardless of age or sex – kidney disease is harmful. Many people die prematurely due to complications of the disease, such as heart attack or stroke. Chronic kidney disease (CKD) usually gets worse slowly, and symptoms may not appear until the kidneys are badly damaged. In the late stages of CKD, as it’s nearing kidney failure (ESRD), one may notice symptoms that are caused by waste and extra fluid building up in your body. The main symptom of kidney disorder is fluid retention or edema. Patients may have puffiness around the eyes, swelling in the feet and legs and water in the lungs leading to difficulty of breathing. Any change in urination may also indicate kidney problem. This may consist of pain or unusual sensation during voiding, increased or decreased frequency of urination, difficulty in initiating urination, frequent urination at night, change in color of urine, blood in the urine or bubbly appearance of the urine. Kidney failure results in the retention of various body wastes which cause anorexia, vomiting, difficulty in sleeping and generalized body weakness. This is often evaluated by measuring serum creatinine and blood urea nitrogen. The presence of protein and red blood cells in the urine is also an indication of kidney disorder. In glomerulonephritis, proteinuria and hematuria are commonly seen because the glomeruli have become inflamed. Proteinuria is also the earliest manifestation of diabetic nephropathy. Pallor and weakness are also among the indications of kidney failure due to anemia secondary to low erythropoietin production by the failing kidneys. Hypertension is also a major consequence of kidney disorder. Initial evaluation of all newly diagnosed hypertensive patients should include serum creatinine and electrolyte levels (sodium and potassium) particularly among young hypertensive subgroup. Repeated urinary tract infections, back pain or pain in the lower abdomen may indicate the presence of kidney stones and may also cause blood in the urine.
Diagnosis and Treatment
There is no cure for chronic kidney disease. However, if detected early, treatment can help slow or halt the progression of the disease and can help prevent other serious complications. Simple laboratory can detect chronic kidney disease. These include a blood test to measure creatinine content and estimate Glomerular Filtration Rate (GFR), or kidney function, and a urine test (ACR for Albumin to Creatinine Ratio), which measures albumin, a type of protein in the urine. Elevated albumin is one of the earliest signs of kidney disease. Early detection of failing kidney function is critical to allow treatment before irreversible damage or other complications occur. The best hope for reducing the human and economic costs of CKD lies in awareness, and prevention through management of risk factors and early detection. Because kidney failure is already irreversible at later stages, treatment focuses on controlling the symptoms, minimizing complications and slowing the progression of the disease. Associated diseases that cause or result from chronic renal failure must be controlled. Hypertension, diabetes, congestive heart failure, UTI, kidney stones, obstructions of the urinary tract, glomerulonephritis, and other disorders should be treated appropriately. Medications such as iron supplements and erythropoietin injections may be needed to control anemia. Blood transfusion may be given but they are less preferred. Fluid intake may be restricted, often to an amount equal to the volume of urine produced. Dietary protein restriction may slow the build-up of wastes in the bloodstream and control associated symptoms such as nausea and vomiting. Salt, potassium, phosphorus and other electrolytes may be restricted. However, Dialysis and kidney transplantation may be required eventually when end stage renal disease ensues or when 85-90 percent of kidney function is lost. Hemodialysis uses a special filter called a dialyzer that functions as an artificial kidney to clean the blood. During treatment, blood travels through the tubes into the dialyzer which filters out wastes and extra water. Then the cleaned blood flows through another set of tubes back into the body. The dialyzer is connected to the machine that monitors blood flow and removes wastes from the blood. Hemodialysis is usually performed 2 to 3 times a week. Each treatment last for 4 hours. Peritoneal dialysis is another procedure that removes extra water and wastes from the body. This type of dialysis uses the lining of the abdomen to filter the blood. This lining is called the peritoneal membrane and acts as the artificial kidney. A mixture of minerals and sugar dissolved in water called dialysis solution travels through a soft tube into the abdomen. The sugar, called dextrose, draws wastes, chemical and extra water from the tiny blood vessels in the peritoneal membrane into the dialysis solution. After several hours, the used solution is drained from the abdomen through the tube, taking the wastes from the blood with it. Then the patient fills his abdomen with fresh dialysis solution and the cycle is repeated usually 3 to 4 times a day. Each cycle is called an exchange. Kidney transplantation surgically places a healthy kidney from another person into the body of the patient with end stage renal disease. The donated kidney does the work that the 2 failed kidneys used to do. It is generally not necessary to remove the diseased kidneys. A donated kidney may come from an anonymous donor who has recently died or from a living person usually relative. The kidney that the patient receives must be a good match for his body. The more the new kidney is like his own, the less likely will his immune system reject it. The patient will be made to take special drugs called immunosuppressive to help trick his immune system so it would not reject the transplanted kidney.