Frequently Asked Questions

Living with kidney disease

My Grandfather was suddenly admitted to hospital as his kidneys have stopped working. I have heard that he has something called a 'temporary access' for his dialysis while he waits for a 'permanent access' to be made. I am confused why will he need a temporary and then a permanent access? Why can't he have just the one?

Usually, when someone needs dialysis, enough time for preparations need to be made. This includes time for the preparation of a fistula which will help someone have their dialysis more conveniently. This is a direct connection between vein and artery, beneath the skin. A fistula can take up to 3 months before it is ready for use, although it usually ready in 6 to 8 weeks for permanent use.

The fistula

The fistula is formed by connecting a vein and artery to form a larger, more robust blood vessel. This surgery is done in theatre under local or general anaesthesia. In some cases, a special exercise is given that will help to build up the veins in the arm. This is started before surgery and carried on afterwards for about 3 months. Meanwhile the swelling goes down as the walls of the fistula thicken, blood flow increases and the fistula heals. Occasionally though, dialysis has to be given quickly, in order to save someones life.

Temporary Access

A catheter, known as a line is used for short term dialysis, perhaps while a fistula is being prepared. This is a soft, flexible tube which is placed in a large vein of the neck, chest or groin under local anaesthesia. This is stitched in place and as a dressing that is changed at dialysis session. Different types of catheter are suited to the different access sites and again, some catheters are designed for 48 hour use ranging through to those that can be used for several months. The longer term use catheters are designed to be comfortable and to reduce complications.

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I have Kidney problems and high blood pressure. I know this will make my kidney problems worse. How can I reduce my high blood pressure?

People with a long-term raised blood pressure are at risk of damage to heart and blood vessels. This means they will be more likely to have heart attacks and strokes.

Kidney problems are aggravated by high blood pressure. Treating blood pressure slows worsening in many kidney conditions and is the most important way of reducing progression towards kidney failure for many conditions. The following actions will help:

Avoid being overweight

Being too heavy increases your blood pressure. Try to eat a low fat, high fibre diet and aim to consume five portions each day of fresh fruit and vegetables if this is appropriate for your kidney diet. Your dietician will be able to guide you.

Keep alcohol consumption to a sensible level

Your alcohol consumption should be spread evenly over the week following the health recommendation of 21 units for men and 14 for women.

Reduce salt intake

Blood pressure is increased by a diet that is high in salt. Salt content is not always obvious and is contained within many processed foods. It is best not to add salt and to eat plenty of fresh, unprocessed foods.

Exercise regularly

Exercise can help you reduce your weight and your blood pressure. Try to aim for at least 3 sessions a week of 20-30 minutes each, that will make you a little breathless.

Stop smoking

Stopping smoking not only lowers your blood pressure, it reduces the risk of heart attack and stroke as there is less smoking related damage to the blood vessels.

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"I am a 30-year old on Haemodialysis who enjoys a night out with the girls every week. They are always saying: One pint won't hurt. Is that right? We always have a curry afterwards. I am supposed to eat boiled rice, but my friends tempt me with Chicken Tikka Massala, my favourite. They call me a wimp if I don't eat it. What can I do?".

One drink can often lead to another, then another. It will be you who will become breathless and needing emergency dialysis at your renal unit at 2am, not your friends. This is because haemodialysis patients will start to get overload if they go over their daily fluid allowance by very much. An alternative would be to drink shorts within reason!

As for the curry, sodium (salt), potassium and maybe phosphate content could be a problem, do check with your dietician. He or she will probably be able to suggest some alternatives for you to try.

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Going on holiday is possible and will be encouraged by your renal unit team. They will also help with your arrangements. However, it is essential to check with them before you make any plans or arrangements.

The limitations are not as great as you may imagine and it is possible to contact renal units, kidney health associations and charities worldwide through the internet, for your travel and health arrangements.

Their are several external websites which feature useful information:

Click here for Endeavour Safaris, a South African based company offering adventure travel for the physically challenge.

Click here for White Cottages, an online dialysis swap scheme for UK holidays.

Click here for Global Dialysis, a database of international and UK dialysis centres.

Click here for Walsgrave Kidney Patient's Hospital, follow the 'Holidays' link from their home page.

Last minute bookings unfortunately are not possible because of the arrangements that need to be made well in advance.

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My brother would like to donate his kidney to me but he lives in India. Could the transplant be done in the UK or should I go to India?

The best option would be for you to have the operation in the UK. Your brother will need to come to the UK for all the tests to make sure he is a suitable donor.

After the transplant, your brother would be able to travel home, once he is fit enough to travel. This is usually around a month later, although it depends how your brother recovers and how long or arduous the journey home will be. The transplant unit would send a letter advising an annual appointment in his own country. They will also advise on the checks and investigations needed for these. The advice and care will vary slightly at each transplant unit, so it is best to check with the unit your transplant is carried out at.

All the usual conditions for a living donor transplant will remain the same.

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Questions on kidney disease

These are done at the request of the renal physician.  Most investigations can be done in outpatients, but sometimes a short stay in hospital is needed.

The physician will bring in whatever expert help is necessary to ensure the best treatments, be it medical treatment, surgical treatment or a combination of both to delay the progress of renal failure.
 

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High blood pressure (hypertension) is both an important cause and consequence of kidney disease. Indeed, for some it can be difficult to determine which came first.  In those with kidney problems controlling high blood pressure is the most important measure that can be taken to reduce the risk of progressive kidney damage. Treatment of hypertension is therefore very important as it also reduces the risk of cardiovascular problems such as heart attacks and strokes.

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The role of the renal physician is to slow the progression of kidney disease and prevent complications of the disease.  Drugs for high blood pressure may be prescribed.  Other drugs may be necessary to correct deficiencies in the bones or blood.  Others may be needed to correct symptoms such as itching, nausea or shortness of breath.  Often dietary advice is necessary.

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Nephrology is the branch of medicine concerned with renal disease.  You are usually referred to a nephrologist or renal physicians via your GP or another hospital consultant so that the nature of the renal disease can be determined and best treatment started.  In a number of conditions the disease can be cured but for some there is no cure.  In such circumstances treatment is aimed at keeping you as well as possible and also providing advice and information regarding possible treatment by dialysis and/or transplantation.  How often you visit the nephrology clinic depends on the rate at which kidney function declines and how this responds to treatment.

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For the kidney to be able to work properly the following are required:

• A supply of blood that needs to be cleaned
• A cleaning or filtration system to clean the blood
• A way for the cleaned blood to return to the rest of the body
• A way of allowing excess water and waste to leave the kidney and then the body

Your kidneys need all four conditions to work properly. If this is not so, then urine is not produced by the kidneys and waste is not removed from the body properly. If the blood has not been cleaned when it returns to the body, waste products will accumulate and certain organs and tissues begin to be harmed. Eventually this results in illness which is generally known to as “kidney disease”. There are many different causes of kidney disease.

Examples where things can go wrong and cause kidney disease include:

• No blood supply to the kidney - the blood will not be filtered and cleaned. This can occur when the arteries supplying the blood to the kidneys become narrowed
• Blood is supplied to the kidneys but the filtration systems are not working - the blood will pass out of the kidney again, just as it went in, so no waste will have been removed. This can occur when the kidney is damaged by diseases such as “nephritis”
• When the blood has been filtered and urine made, but does not pass out – the waste products will remain in the body. This may occur as a result of a blockage (obstruction) to the tubes which drain urine from the kidney to the bladder or from the bladder to the outside. If the blockage is not relieved the kidneys will swell up and stop working

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Renal failure occurs when the kidneys fail to function properly. Normally, your kidneys work continuously to keep you alive and well. They act as filters and remove waste products from the blood and excess water from your body.

 

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There is no short answer here! For some, renal failure can develop over the course of months, even years – it is then called chronic kidney disease (CKD) for others it can occur very quickly, when it is called acute kidney injury (AKI). CKD cannot be reversed but progression of the disease can be delayed and its effects on the body treated. Some cases of AKI can be reversed although the individual may be left with permanent kidney damage (CKD).

However it develops, some form of treatment is needed possibly for life. The treatment received can be tailored to suit each person’s lifestyle.

What is ’Screening’?

The Kidney Early Evaluation Programme (KEEP) is a study designed to find out how many people may unknowingly have kidney disease or are at risk of developing the condition.

See the Department of Health’s Quality and Outcomes Framework document to see data on the prevalence of kidney disease in different parts of the country.

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Early detection and diagnosis is important, so treatments can begin sooner.

‘Screening’ is an initiative that encourages people to come forward for a kidney health check. The sooner any problems are discovered, the better.

The management of kidney disease depends on the severity of kidney damage found. This is graded in stages one to five, depending on how impaired the kidneys are.

In the early stages (CKD 1-3) important issues are lifestyle adjustments, treatment of diabetes (if present) and good control of blood pressure

In more advanced CKD (stage 4-5) specific treatments for the effects of kidney disease are required and are frequently provided by “pre-dialysis” or “low clearance” programmes

When very advanced (end stage kidney failure) (stage 5) renal replacement with either dialysis or transplantation should be considered. However, not everyone will benefit from renal replacement and this decision needs careful discussion between each person and their kidney team

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Increasingly, the earlier stages (one to three) of renal failure are managed at the local doctor’s surgery by the GP team.

Go here for information on the Stages of Kidney Disease.

The treatments are simple – they focus on protecting renal function by the promotion of good health and lifestyle.

Treatments include the management of blood pressure and any diabetes (if it exists.) Attention is given to lifestyle – you will be encouraged to eat healthily, reduce your salt intake, become more active, excercise and stop smoking, if you haven’t already. Attention will be given to your general health also. See Healthy eating for kidney patients for more details.

Your doctors will measure your blood pressure and take urine and blood tests regularly to make sure your condition has stabilised.

If your renal failure looks as though it is going to progress beyond stage 3, your GP will refer you to a kidney specialist (nephrologist or renal physician) at your nearest renal unit.

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Renal Units have teams of specialist staff to help with all forms of treatment for kidney disease, including dialysis and transplantation.

The teams consist of doctors, surgeons, renal nurses, laboratory scientists, transplant co-ordinators, dieticians, social workers, counsellors, renal technicians and others as required.

They will all work together to provide treatment, advice, training and support, be it physical, psychological or financial - even arranging transport requirements to and from treatments

Their objective is to give kidney patients and their family the most up-to-date treatment and support available so they can return to as independent a lifestyle as possible

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The major changes in diet are a reduction in the foods high in potassium and sodium (salt). One thing that is very difficult for dialysis patients is the restriction of fluid intake.

Diet will have to carefully modified as appropriate for each individual, and certain foods will be restricted. Fluids will also be restricted according to the patient's individual requirements. A dietician specialising in renal nutrition will provide the patient and their family with all the information required on the kind of food and fluid recommended and how to prepare it.

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Hypertension is both an important cause and consequence of kidney disease. Indeed, in some patients it can be difficult to determine which came first. Furthermore in patients with kidney problems controlling high blood pressure is the most important measure that can be taken to reduce the risk of progressive kidney damage. Treatment of hypertension is therefore particularly important in kidney patients. It also reduces their risk of cardiovascular problems such as heart attacks and strokes.

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According to the type of employment, patients may find that they have to modify their employment to fit around dialysis requirements, and some may find they have to give up work altogether in the short term.

If necessary, the social worker and community dialysis sister will (with your permission) talk to your employer about your treatment to help alleviate any concerns you may have, as well as those of your employer. The dialysis unit will do all they can to arrange your treatment times so that they fit in with your work schedules.

Financial worries can be discussed and, where applicable, certain benefits applied for, such as mobility and disability living allowance. The renal social worker also has access to certain kidney patient organisations that can provide assistance or act as a support group for you and your family.

Dialysis places a considerable strain on personal relationships, often making communication between patients and partners difficult. This, in turn, may have a knock-on effect on those around you.

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Maybe not exactly the same, but very nearly. Because they require long-term treatment they will need to compromise a little. There are different forms of dialysis available, so in most cases the patient will be able to choose a treatment that suits their lifestyle rather than change their lifestyle to suit the treatment.

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When contemplating a pregnancy there are several things that a woman may consider:

    * Will my pregnancy be complicated?

    * Will kidney disease affect my baby?

    * Who will look after me in pregnancy?

    * Can I deliver my baby normally?

    * Will pregnancy make my kidney disease worse?

Such questions are best asked before pregnancy. Speak to your family doctor, an obstetrician, a kidney doctor or a specialist nurse. If your kidney disease is mild then the chance of a successful pregnancy is good. By knowing what to expect you can make an informed choice about pregnancy for yourself.

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