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What Does Kidney Dialysis Entail


Kidney disease is one of the possible long-term complications of diabetes. In some cases, the kidneys fail. This is more common for people with type 1 diabetes than with type 2. It's important to know that for most people, the kidneys don't fail. Your doctor can check your kidney function regularly, and if the early signs of kidney disease develop, there are steps you can take to slow down the progression of the disease.

Kidneys are bean-shaped organs about the size of your fist. They're just below your rib cage, below the middle of your back.

Your kidneys are filters for your blood. When you eat food, your body takes the nutrients it needs. Whatever is not needed (called a "waste product") goes into your blood. Then, the kidneys remove the waste products and extra water from your blood. You remove these waste products and extra water from your body when you go to the bathroom.

This filtering process takes place in tiny units inside the kidneys. These units are called "nephrons." If the nephrons can't remove all of the waste products from the blood, these waste products build up in your blood and damage your body.

If you have diabetes and there is a lot of extra sugar in your blood, that makes your kidneys work harder as they perform their filtering task. The nephrons lose their ability to filter and eventually begin to leak. Nutrients that you need, such as protein, go into the urine.

This is when the early stages of kidney disease begin, when the protein begins to flow into the urine. This stage is called "microalbuminuria."

Early stages have no symptoms

Early kidney disease is just like high blood pressure in one way-you can't tell you have it by the way you feel. There are no symptoms.

Generally, symptoms of kidney disease don't appear until the kidneys are very close to losing nearly all of their function. A this point, symptoms are usually a buildup of fluid, often around the ankles; loss of sleep; little desire to eat; upset stomach; weakness and difficulty concentrating. But by the time kidney disease reaches this point, people generally need to start kidney dialysis or have a kidney transplant.

How dialysis works

Dialysis acts like an artificial kidney. During dialysis, your blood is removed from your body through a needle and it's circulated through a machine that cleans it. Then it's placed back into your body through a second needle.

The entire process takes about a minimum of four hours per day, three or four times per week. It's a difficult thing to think about. Who wants to be tied down to a schedule like that? But there are people who work full time and go to dialysis after work. People even travel regularly and set up dialysis appointments in the cities they're traveling to.

Dialysis and your diet

When you're on dialysis, your diet is extremely important, because in between dialysis appointments, you need to do your part to eat food that will limit the amount of toxins in your bloodstream. You need protein, and you'll need to limit potassium and phosphate, because they accumulate in your blood and are difficult to remove even through dialysis. French fries should be avoided completely, and ice cream and cheese should be strictly limited.

You'll have to limit the amount of fluid you drink as well. Fluid builds up in your bloodstream, which can cause swelling and weight gain. It can also cause your blood pressure to rise, and it makes your heart work harder.

Almost all dialysis clinics have a dietitian who will help you determine exactly what your food plan should be-what you're able to eat, what you should limit and what you really shouldn't have at all.

There's a lot you can do to prevent kidney failure

The main things you can do to reduce your risk of kidney failure include:

  • Control your blood sugar
  • Control your blood pressure
  • See your doctor regularly so that you can be tested for early signs of kidney disease

    Your doctor can detect early stages of kidney disease

    It's critical to see your doctor regularly. By checking your urine for protein and your blood for waste products, your doctor will be able to tell whether your kidneys are still functioning well. You will also have your blood pressure checked, which is also important because high blood pressure increases your risk of kidney failure as well.

    Controlling your risk factors

    The best thing you can do to decrease your risk of developing kidney disease is to control your blood sugar and blood pressure. In fact, even if you do have the early stages of kidney disease (microalbuminuria), controlling these things can dramatically slow the rate at which the disease progresses.

    If your blood pressure is high and you've been having trouble getting it under control, it's time to make some changes to see what you can do to lower those numbers. Talk to your doctor or other member of your healthcare team to see what you can do to in terms of increasing your activity level, changing your diet or taking medication. And if you smoke, see what you can do to quit.

    Keeping your blood sugar in your target range is also an important way to reduce your risk of kidney disease. Tight control of your sugar can reduce your risk of microalbuminuria by one third, and it can reduce by one half the chance that microalbuminuria will progress.

    To read more about tight control, read the article in our September/October 2003 issue titled "Managing Types 1 and 2 with Tight Control."

    The American Diabetes Association; The National Kidney Disease Education Program
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