Treatment for Kidney Disease

6. TREATMENT FOR KIDNEY DISEASE
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Since another  medical ailment usually causes chronic kidney disease, the most  effective way to treat kidney disease is to treat and manage the disease  that originally caused your kidney damage, for instance diabetes and  hypertension.

In Malaysia, some  57% of kidney failure patients are diabetics and 6% hypertensive.  Hence, your doctor will use blood and urine tests to regularly monitor  your kidney’s condition. These tests will determine how your kidneys are  functioning and whether any changes to your treatment plan is required.

6.1. Chronic Kidney Disease (CKD)

CKD is often progressive, and if this happens, your symptoms may occur more frequently or become severe.

Depending on your stage of CKD, you may  need to make dietary changes to help slow its progression. You may be  asked to limit your use of salt or watch how much potassium or  phosphorus is in your diet.

In the early stages of this disease, only  a small part of the kidney is involved. Some people have destruction of  the glomerulus or renal tubules. Early kidney disease can cause  scarring, which interferes with the blood flow to a portion of the  kidney.

In many cases, early detection and treatment may keep CKD from getting worse.

Over time, if CKD is not treated, End  Stage Kidney Failure occurs, one will require immediate and ongoing  dialysis treatment or a kidney transplant.

In most patients, medication is used in  addition to dietary restrictions to prevent further damage to the  kidneys. This is done to try and delay the progression to End Stage  Kidney Failure.

6.2. Kidney Failure

The treatment of End Stage Kidney Failure  involves haemodialysis (using a kidney machine), peritoneal dialysis or  kidney transplantation.

The type of treatment chosen is  determined by the general health and medical condition of the person, by  its impact on the person's lifestyle and by the person's personal  preference.

Many people may receive each one of these  three forms of treatment at various times. What may be the best  treatment for one person at one time might not be the best for another  or for the same person at a different time.

6.3. Dialysis

Dialysis is a life-saving process that artificially replaces part of the functions of the kidney.

There are two types of dialysis: haemodialysis and peritoneal dialysis.

Haemodialysis involves removing blood from the body and filtering it in an artificial kidney. The  patient is connected by a tube to the dialysis machine, which  continuously draws  blood out, cleans it and removes excess fluid and  then returns the blood back to the patient. Haemodialysis must be  performed for 3 to 4 hours at least three times a week. It is usually  performed at a dialysis centre, though home dialysis is also possible.

 

Peritoneal Dialysis is  internal or in-body dialysis. Peritoneal dialysis entails use of a  blood-cleansing solution called "dialysate" that is introduced into the  peritoneal cavity, the region of the abdomen that is lined by the  peritoneum. While in the peritoneal cavity, the dialysate works to  extract toxins and excess fluids from the blood. After a period of time,  the solution is then drained from the body cavity.

Three types of peritoneal dialysis are available.


CAPD requires no machine and can be done in any clean,  well-lit place. With CAPD, your blood is always being cleaned. The  dialysis solution passes from a plastic bag through the catheter and  into your abdomen, where it stays for several hours with the catheter  sealed. The time period that dialysis solution is in your abdomen is  called the dwell time. Next, you drain the dialysis solution into an  empty bag for disposal. You then refill your abdomen with fresh dialysis  solution so the cleaning process can begin again. With CAPD, the  dialysis solution stays in your abdomen for a dwell time of 4 to 6  hours, or more. The process of draining the used dialysis solution and  replacing it with fresh solution takes about 30 to 40 minutes. Most  people change the dialysis solution at least four times a day and sleep  with solution in their abdomens at night. With CAPD, it’s not necessary  to wake up and perform dialysis tasks during the night.


2. Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)
CCPD uses a machine called a cycler to fill and empty your  abdomen three to five times during the night while you sleep. In the  morning, you begin one exchange with a dwell time that lasts the entire  day. You may do an additional exchange in the middle of the afternoon  without the cycler to increase the amount of waste removed and to reduce  the amount of fluid left behind in your body.3. Combination of CAPD and CCPDIf you weigh more than 175 pounds or if your peritoneum  filters wastes slowly, you may need a combination of CAPD and CCPD to  get the right dialysis dose. For example, some people use a cycler at  night but also perform one exchange during the day. Others do four  exchanges during the day and use a minicycler to perform one or more  exchanges during the night. You’ll work with your health care team to  determine the best schedule for you.

6.4. Kidney Transplantation

A kidney transplant involves the taking of a kidney from  the body of a healthy person or cadaver and implanting it surgically  into the body of someone who has lost kidney function. The transplanted  kidney can then perform the function of that person's own kidneys. A  successful kidney transplant will allow you to have a better quality of  life, improves lifestyle and will free you from dialysis treatments.
Whilst a transplant is not a cure for kidney failure,  it does allow patients to live a more "normal" life than that  experienced on dialysis. Patients with a well-functioning transplant  have a greater sense of well-being and are able to enjoy a lifestyle  free of dependence on dialysis treatments, although they must continue  with their transplant drug treatment.
A transplant can mean improvement in anaemia, bone  disease and in children, body growth. It also offers freedom from  previous dietary and/or fluid restrictions and from restrictions on time  and mobility.
It is the treatment of choice for chronic kidney  failure for those who are considered suitable candidates for a  transplant. To find out if you are a candidate, your health care team  will perform a series of tests as part of a complete medical assessment.
Many ESRD patients benefit greatly from a kidney  transplant. After successful transplantation, patients no longer require  dialysis. Today there are many patients on waiting list to receive a  kidney transplant. The development of effective anti-rejection drugs  means that the prognosis for five-year survival for most of these  patients is high.
To avoid rejection, the best possible source of kidney  donation is a close relative whose blood and tissue type match the  patient's. Donated organs from cadavers also have high success rates. A  growing source of kidneys for transplantation comes from living donors  who are not blood relatives, but with whom the patient has an emotional  tie, such as a spouse, friend or co-worker.