Essential Guide to Managing Kidney Failure in 2023

Kidney disease is a silent disease. A recent survey by three big kidney societies (ISN, ASN, ERA) revealed that 850 million people worldwide have kidney disease and most are unaware of its dangers. From my experience, I can attest to this and would add that most patients are uninformed of their disease severity or how to prevent it until seen by a specialist.  This article will cover important facts you should know about kidney failure in order to better understand your diagnosis and protect yourself from renal complications before they occur. 

Renal failure is a serious condition that does not have a cure, but it can be managed with medication and lifestyle changes. If you are caring for someone with kidney failure, then you should know the facts about this life-threatening illness.  In this article we will cover what renal failure is, how to diagnose it, what signs of renal failure to look out for in your loved one and how best to care for them. 

Why does Diabetes cause Kidney Failure?

Diabetes is one of the leading causes of kidney failure and requiring kidney replacement therapy (known as dialysis). There are a couple of ways that diabetes can lead to kidney failure. First, high blood sugar levels can damage the tiny filters in the kidneys, called nephrons. This damage can cause the kidneys to leak protein into the urine, which can eventually lead to kidney failure. 

Additionally, diabetes can also increase the risk of developing other diseases and conditions that can lead to kidney failure, such as high blood pressure or glomerulonephritis.

Why does High Blood Pressure cause Kidney Failure?

Almost half of all chronic kidney disease cases are due to high blood pressure. The kidneys contain millions of tiny filtration units called nephrons that help maintain the right balance of water, salts, and chemicals in your blood by removing extra fluid, wastes, and toxic substances from your body. 

When blood pressure damages this filtering system (nephropathy), the kidneys can’t do their job as well. Fluid and waste start to build up in your body, which can lead to serious health problems, including kidney failure.

Early Signs & Symptoms of Kidney Failure

The kidney is a complex organ with great capabilities to overcome and adapt to almost any situation. This makes it hard, in most cases, to detect early without lab work since signs and symptoms might arise when there is significant damage. This is why it is important to know how to take care of our kidneys so that they can last through our lifetime.

This is why the earliest sign of kidney disease would be a diagnosis that is associated with chronic kidney diseases such as diabetes, or hypertension. Also, a sedentary lifestyle and smoking can contribute to kidney disease. When they do fail, we can notice some changes in the lab work (Creatinine and BUN) done by your primary care physician. You can check this blog article about the early warning signs of kidney failure.

As kidneys start to fail we can notice subtle changes in our bodies that might indicate the kidneys are overcoming obstacles in their function. 

One main function is to regulate the amount of water in our bodies. So one sign of kidney disease would be accumulation of water with swelling of the extremities and in some cases the whole body. This can be accompanied by difficulty breathing from water accumulated in the lungs. 

The kidneys also eliminate excess minerals and toxins. Some toxins like urea can accumulate when the kidneys cannot eliminate them. This might cause Uremia (which just means urea in the blood). Symptoms from Uremia consist of fatigue, somnolence and altered mental status. 

Another important role is the stimulation of production of red blood cells. This is done by erythropoietin secreted from the kidney. When the kidneys are unable to do so, the patients present with fatigue and difficulty breathing from anemia or chronic kidney disease.

What are the Stages of Kidney Failure?

Kidney failure can be divided into five stages, with each stage representing a different level of kidney function which is determined by a number called eGFR. A eGFR that is decreasing represents a kidney function that is deteriorating. The five stages of kidney failure are:

Stage 1 & 2

These are the earliest stages of kidney disease. You might have some or no protein in your urine and a small or no accumulation of Cr. There should not be many symptoms during these stages and lifestyle changes and modification of risk factors are key to prevent progression. 

Stage 3

This stage is divided in 3a and 3b. When at stage 3, patients might feel some symptoms as described above or no symptoms at all. Monitoring lab work with your nephrologist is key to detect progression. Some specific prescriptions depending on your risk factors and severity will be added during this stage. Some patients might stay in this stage if they take good care of themselves and follow the recommendations of their nephrologist.

Stage 4

In stage 4, the kidneys have a harder time eliminating waste products and fulfilling the majority of its functions. There could be more protein leaking in the urine and this needs to be monitored. If you were not being seen by a nephrologist before you definitely need to follow with one now. The symptoms described above become more prominent and some diet and medication changes will come in order. Some symptoms are swelling of extremities, worsening of blood pressure, fatigue from anemia among others. 

Stage 5 End Stage Kidney Failure:

In stage 5, the kidneys have completely failed and people will need dialysis or a kidney transplant to survive. Stage 5 is also known as renal failure or end-stage renal disease (ESRD).

While there is no cure for kidney failure, there are treatments available that can help people manage their condition. Treatment options vary depending on the stage of kidney failure, so it is important to talk to your doctor about the best options for you.

If you are concerned that you may be experiencing symptoms of kidney failure, it is important to see a doctor right away. Early diagnosis and treatment can help prevent the disease from progressing further.

What Types of Kidney Failure can be Reversed?

There is no one-size-fits-all answer to this question, as the answer may vary depending on the cause of kidney failure. If left untreated, however, kidney failure may become permanent. However, in some cases, kidney failure may be reversible if caught early enough. 

Treatment for reversible kidney failure typically includes medications and lifestyle changes that help improve renal function. 

• Acute renal failure

This type of kidney failure is typically caused by an injury or sudden illness, such as sepsis. Treatment for acute renal failure typically includes aggressive supportive care and stopping the offending cause. If the cause of the renal failure can be identified and treated, the kidneys may recover completely.

• Chronic renal failure

This type of kidney failure is typically caused by long-term (more than 3months) damage to the kidneys, such as from diabetes or high blood pressure or after acute kidney injury that didn’t recover completely.  Treatment to prevent progression of chronic kidney disease typically includes medications and lifestyle changes.. In some cases, a kidney replacement therapy or transplant may be necessary. 

You can find more information on how to take care of your kidneys in this video

When should you start Dialysis for Kidney Failure & is it Permanent?

Dialysis is a method used to artificially replace the function of the kidney. This treatment is usually started when the kidney reaches stage 5 ( see above regarding stages discussion) or if the patient has an acute injury that stunts the kidney in such a way that it poses a threat to your health. 

The question now comes whether it will be a permanent or temporary measure and this can be a harder question to answer since it depends on several factors and the kidney might take up to 3 months to recover from an acute injury severe enough to require dialysis. 

Usually chronic kidney disease that has progressed slowly through all the stages will not recover after reaching stage 5, at this point, dialysis will be permanent. 

Several factors involved in the need of dialysis include the type and severity of kidney disease, other medical problems that may exist, patient preference or wishes, financial impact, age, prior kidney injury and overall health.

What are the Types of Dialysis Available for Kidney Failure?

There are two main types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis (link for video on hemodialysis) involves filtering blood outside of the body using a machine, while peritoneal dialysis uses the patient’s own body tissues and organs to filter blood.  The best modality is the one the patient feels comfortable with and adapts to the patient’s lifestyle. Important things to consider when starting dialysis are the location of treatment. Treatment can be at home or in-center. 

In-center (or as inpatient) treatments are done with a hemodialysis machine and usually last 3-4 hours three times a week. Home treatments can include hemodialysis or peritoneal dialysis. Home treatments vary in frequency and intensity since they try to adapt to the patient’s lifestyle. 

Why should I consider dialysis?

When should you start dialysis for kidney failure depends in large part on how well your kidneys are working. In cases where kidney function has started to decline but hasn’t yet reached the point where dialysis is necessary to sustain life, it may be possible to delay treatment by making certain changes in your medications, diet (watch this video on potassium and dialysis) and lifestyle. This will not reverse kidney disease but can help slow the progression of the damage done to your kidneys over time.

Transplant for Kidney Failure

Since 2002 51% of transplants have been performed for people with end stage renal disease. In the US there are over 101,000 people currently on the waiting list for a kidney transplant. A kidney transplant is the best option for those with end stage kidney disease with less mortality rates than dialysis.

Kidney transplant is a surgery to remove a healthy kidney from someone else and implant it into the person with end stage kidney disease. The donor kidney may come from a living donor or from someone who has recently died, otherwise known as cadaveric organ donation.

The kidney is removed from the donor through an incision (cut) made along the side of the lower back. The recipient will have an incision made below the belly button where the kidney will be implanted and connected to big blood vessels. Usually only one kidney is transplanted.

Most transplanted kidneys start working right away and can filter toxins from the blood very well. As long as you take your anti-rejection medicines as prescribed and keep all of your follow-up appointments, your new kidney should continue to work for many years.

In the United States, there are over 101,000 people waiting for a kidney transplant. The average wait time for those on the national waiting list is 3 to 5 years; however, this varies by geographic area. Transplant surgery is the only means to recover kidney function after end stage renal disease.. It is also possible to have a peritoneal dialysis catheter placed.

People with kidney transplants need to take life long immunosuppressive medication for the rest of their lives to help stop their body from rejecting or attacking their new kidney.

The donor receives general anesthesia and does not feel any pain during surgery. They are able to get up and walk around on the day of surgery, but they will need help at home for several days after surgery. The recipient receives local anesthesia and IV (intravenous) sedation; this means that they stay awake but do not feel any pain during surgery. After surgery, most recipients go home within 1-2 days.

What are the Risks of Kidney Transplant Surgery?

All surgeries carry some risk, but a kidney transplant is fairly routine. The main risks are infection and rejection of the new kidney. Anti-rejection medications help to reduce the risk of rejection.

Can I live a Normal Life after Kidney Surgery?

Most people who have a kidney transplant can resume their normal activities within several weeks. You will need to take anti-rejection medications for the rest of your life, but these medications have made kidney transplants very successful.

How do I find a donor?

Your doctor may be able to recommend someone or you may want to ask family or friends if they would like to donate their kidney. There are also online registries you can join to find a donor. Donors do not need to be related or have the same blood type.

The National Kidney Registry is a non-profit organization in the US that facilitates kidney donations for people who need transplants but have not found matching donors. The NKR matches both donor kidneys and recipient patients across the country to increase the likelihood of finding compatible matches when previous matches did not occur.

Experimental Treatments for Kidney Failure

Kidney failure can be devastating for patients and their families. Patients require kidney dialysis or kidney transplantation to survive. Current dialysis machines are big and cumbersome. There are efforts made to have artificial kidneys either by creating pocket size dialysis machines or created with stem cells. It is hard to predict when this will be available. Another treatment trying to solve the issue of organ shortage is transplant from other species.

Artificial kidneys currently available on the market are mainly based on silicon/polymer membranes that filter blood plasma similar to natural kidney glomeruli. The high cost (>US$ 100,000) hinders the wide application of this technology in clinical practice.

An alternative approach is to use bioartificial kidney technology to combine kidney cells with biomaterials. The advantage of this system is that it can be used for kidney failure patients who are unlikely to undergo kidney transplantation surgery because they have other medical conditions, such as surgery contraindications, lack of compatible donor organs or religious reasons. Clinical trials using stem cells to treat kidney failure were taken in animal models.

The eligibility of stem cell transplantation for kidney failure is that kidney tubule stem cells can express kidney function in an injured kidney. In addition, the kidney damage was effectively repaired when bone marrow mesenchymal stem cells were injected into the kidney.

Artificial kidney technology using biomaterials and bioartificial kidney technology based on stem cells have entered clinical trials in patients with kidney failure. The results are promising enough to further develop treatments for patients who suffer from chronic kidney disease. However, more clinical studies will be needed before artificial kidneys become a treatment option for patients with chronic renal insufficiency.

Artificial kidney technology using biomaterials and bioartificial kidney technology based on stem cells have entered clinical trials in patients with kidney failure. The results are promising enough to further develop treatments for patients who suffer from chronic kidney disease. However, more clinical studies will be needed before artificial kidneys become a treatment option for patients with chronic renal insufficiency.

CONCLUSION

Kidney failure is a serious disease that affects at least 1% of the American population. Although there’s no cure and many patients are suffering with it, there are options for long-term care. It’s important to seek out expert nephrology consults early on to prevent complications so you can receive personalized guided treatments and help navigating your specialized kidney care options.

We hope you have gained a great deal of value from this in-depth healthcare content to help you make the right health choices for yourself or for your family. Click here to join our membership plan for exclusive consultations with your preferred specialist.

If you would like to have a professional counsel on the appropriate treatments that might be right for you, click here to speak to our resident nephrologist Dr. Juan Jaller Char, MD in The VIOS Clinic who will be happy to answer any questions you have about this condition or refer you if necessary.