End Stage Renal Disease - Group 20


What is End Stage Renal Disease?

End Stage Renal Disease (ESRD) occurs when the kidneys do not function at a level that is necessary to support the body without the aid of dialysis or a kidney transplant. ESRD, unlike acute renal failure, is not reversible and is a permanent condition. Patients with ESRD must either undergo a kidney transplant or frequent dialysis in order to filter the impurities and toxins out of their blood. (1)

Who is at risk for developing End Stage Renal Disease?

ESRD can affect anyone, but patients at the highest risk have:
  • Diabetes Mellitus
  • Hypertension
  • Chronic Kidney Disease, or CKD
  • Suffered an injury to their kidney(s)
  • Experienced major blood loss
  • Urinary tract infections
  • Kidney stones
  • Cancer
  • Autoimmune diseases
  • Family history
    (2)

What are the symptoms of End Stage Renal Disease?

  • Fatigue
  • Dry skin
  • Headaches
  • Weight loss
  • Loss of appetite
  • Nausea
  • Confusion
  • Muscle cramps or twitching
  • Excessive thirst
  • Problems sleeping
  • Lack of menstruation
  • Edema in extremities
  • Numbness in hands or feet
    (3)

external image PolycysticKidneys.jpg

(picture of kidneys with ESRD from progression of Polycystic Kidney Disease)

What is the treatment for End Stage Renal Disease?

ESRD is a permanent condition. The kidneys will never be able to function normally.
The two options for treatment are a kidney transplant or dialysis treatment.

Kidney Transplant
A single healthy kidney (from a donor that matches with the patient) will carry the workload of the two failed kidneys. This is a surgical procedure and there is a wait list for receiving a new kidney. According to the University of Maryland School of Medicine, the monetary cost of a kidney transplant including costs during the first year and medications to prevent rejection is about $106,000. (5) For more information on kidney transplantation visit: (4)
transpland.jpg(7)


Dialysis
  • Dialysis removes extra waste and water from the body as a normal kidney would. There are two types of dialysis: Hemodialysis and Peritoneal Dialysis.
Hemodialysis
  • This is a process that is conducted several times per week to filter waste and extra water out of the blood. The machine used for dialysis has a filter in it that cleans the blood, much as a normal kidney would do. After the blood is cleaned, it flows back into the body. The process takes about 3 or 4 hours. During hemodialysis, two needles need to be inserted into the body: one for 'dirty' blood to go out and one for 'clean' blood to come back in. Dialysis can be performed at home or in a hospital or clinic. (6)
dialysis_machine.gif
Hemodialysis image courtesy of http://www.kidneydoctor.com/esrd.htm
Peritoneal Dialysis (PD)
  • This treatment option is usually done by the patient at home. A catheter is inserted through the abdominal cavity into the peritoneal cavity. A solution called dialysate travels through the tube and removes waste from the patient's blood. The dialysate is drained every 4-6 hours in order to remove the waste, and fresh dialysate is given. The replacement of old dialysate is called an exchange. There are three types of PD based on the exchange schedule used:
    1. Continuous Ambulatory Peritoneal Dialysis (CAPD) - No machines are required for this method. A bag containing two quarts of dialysate is raised above the shoulder and infused into the abdomen. The dialysate fluid cycles through the body for about four to six hours, before a fresh solution is required. This exchange takes about 30 minutes and must be repeated four to five times per day. The final exchange is left in overnight.
    2. Continuous Cycling Peritoneal Dialysis (CCPD) - This method of PD uses a machine called an automated cycler and is done at night while the patient rests. This machine cycles dialysate solution through the peritoneal cavity over an eight to ten hour time period. The patient is disconnected in the morning and does not use the cycler again until night.
    3. Intermittent Peritoneal Dialysis (IPD) - This method uses the same machine used for CCPD. IPD takes longer and is usually performed in a hospital setting. (6)
peritoneal_dialysis.gif
Peritoneal dialysis image courtesy of http://www.kidneydoctor.com/esrd.htm






Nutrition for ESRD

The following serves as a guide for nutrition recommendations for individuals receiving dialysis. It is recommended that individuals consult a Registered Dietitian for individualized nutritional needs. (5)

Nutrient
Hemodialysis
Peritoneal Dialysis
Increased Protein
1.2 g/kg body weight
1.2-1.5 g/kg body weight
Increased energy intake
35 kcal/kg
30-35 kcal/kg
Restrict potassium
2-3 g/day
3-5 g/day
Limit Sodium
2-3 g/day
2-4 g/day
Restrict Phosphorus
< 17mg/kg body wt
<17 mg/kg body wt
Increased Calcium
No more than 2 g /day
No more than 2 g/day
Restrict fluids
750-1000 + urine output
2000 + urine output

Tips to Manage Thirst from Fluid Restriction

  • Avoid caffeinated beverages and foods (coffee, tea, soft drinks, chocolate). Caffeine can actually dehydrate you more.
  • Avoid commercial mouthwash. The alcohol in these products might increase dry mouth.
  • Eat frozen fruit.
  • Avoid eating salty foods that will contribute to thirst.
  • Eat sour/tart candy.
  • Drink cold beverages instead of hot liquids.

How Can I Prevent ESRD?

  • Manage hypertension and diabetes.
  • Eat a diet low in fat.
  • Limit sodium intake.
  • Limit potassium intake.
  • Limit alcohol.
  • Avoid tobacco.
  • Stay active 5 days a week.
  • Visit the doctor regularly.(3)





Resources used:

1. http://www.kidneyfund.org/kidney-health/kidney-failure/end-stage-renal-disease.html
2. http://www.kidneyfund.org/kidney-health/kidney-problems/chronic-kidney-disease.htmlhttp://www.kidneyfund.org/kidney-health/kidney-problems/chronic-kidney-disease.html
3. http://www.nlm.nih.gov/medlineplus/ency/article/000500.htm
4. http://www.umm.edu/ency/article/003005.htm
5. http://www.nutritionmd.org/consumers/renal/renal_nutritition.html
6. http://www.kidneydoctor.com/esrd.htm
7. http://www.umm.edu/presentations/100087_4.htm
8. http://www.google.com/imgres?q=end+stage+renal+disease&um=1&hl=en&sa=X&biw=1755&bih=841&tbm=isch&tbnid=0V5llfqTXdMSiM:&imgrefurl=http://www.homeopathyworldcommunity.com/forum/topics/
//www.kidneydoctor.com/esrd.htm