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
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