DIABETES – A MAJOR RISK FACTOR FOR KIDNEY DISEASE
The kidneys are a pair of organs located on each side of your spine. The main function of the kidneys is to filter and remove toxins from the body. It then sends the toxins to the bladder which is then removed from the body through urination.
When the kidneys lose their ability to filter toxins it results in a condition called kidney failure. The body becomes overloaded with toxins if the kidney fails to do its function. This can even lead to the life-threatening situation if not treated.
There are a number of reasons that can affect the kidneys. In many cases, several other health conditions can apparently affect the kidneys and result in kidney failure. There are many factors that can affect your kidney health and condition. It includes:
- Exposure to toxic pollutants
- Acute and chronic diseases
- Kidney trauma
- Severe dehydration
People who are at high risk of kidney failure suffer from one of the following causes.
- ¨ Loss of blood flow to the kidneys:
- ¨ Urine elimination problems
Other causes that may lead to kidney failure are:
- Chemo drugs
- Blood clot in kidneys
- Alcohol consumption
- Certain antibiotics
- Dyes used for imaging purposes
DIABETES & KIDNEY FAILURE:
One such health condition that adversely affects the kidneys is diabetes. Diabetes mellitus, commonly called as diabetes is a condition wherein your body cannot make sufficient amounts of insulin or cannot use the normal amounts of insulin produced by the body. Insulin is the hormone that regulates the amount of sugar in the blood. A high or low level of sugar in the blood can cause serious problems in many parts of the body.
There are 2 types of diabetes that are more common among the people. They are:
- Type 1 diabetes
- Type 2 diabetes
Type 1 diabetes also called as insulin-dependent diabetes mellitus is more common among the children. For this reason, it is also called as juvenile onset diabetes mellitus. In this case, the pancreas fails to produce sufficient insulin. To compensate this action, you will need to take insulin injections throughout your lifetime.
Type 2 diabetes is also called as insulin-independent diabetes mellitus and is usually common in people above 40 years of age. For this reason, it is also called as adult onset diabetes mellitus. On contrary, in this type of diabetes, the pancreas produce sufficient amounts of insulin but the body fails to use it in the proper sense. This leads to high blood sugar level in the blood. This needs to be maintained by proper diet or taking medications.
WHAT DOES DIABETES DO TO THE KIDNEYS?
Those suffering from diabetes do have injured blood vessels in their body. When this happens to the blood vessels in the kidneys, your kidneys will not be able to clean the blood properly. Your body will start collecting excess water and salt that it should. This leads to increase in weight and swelling in the ankle.
Sometimes, diabetes can also affect the nerves in your body. When the nerves are affected it can cause difficulty in emptying the bladder. If your bladder isn’t emptied from time to time then the pressure resulting from full bladder can injure the kidneys. Proteins & other waste materials start building up. If the urine remains in the bladder for a long time then you are at high risk of kidney infection as the rapid growth of bacteria in the urine has high levels of blood sugar.
A survey was conducted to determine the impact of diabetes on the kidneys, and it was found that about 30% of the diabetic patients with type 1 diabetes & about 10-40 % of those with type 2 diabetes will eventually suffer from kidney disease.
How will you know if you have a kidney failure?
Many symptoms can be signs of kidney failure. Sometimes there might be no symptoms but still, result in kidney failure. Some of the early signs of kidney disease in patients with diabetes are listed below:
- Reduced amount of urine
- Swellings in legs, ankles, and feet
- Pressure or pain in chest
- Excessive dizziness or fatigue
- Persistent nausea
- Increased excretion of albumin in the urine
- Frequent urination at nights
- High blood pressure
Some of the late signs of kidney diseases are:
- Increase in the blood urea nitrogen
- Nausea & vomiting
- Loss of appetite
- General weakness
- Itching & muscle cramps especially in the legs
In the later stages of the kidney diseases, you will need only less amount of insulin because the diseased kidneys cause less breakdown of insulin.
How is it diagnosed?
A urine sample is tested to check for any abnormalities. It is used to measure the amount of red and white blood cells, high levels of bacteria and cellular casts.
- Blood samples:
Blood samples are taken to measure the substances filtered by kidneys such as blood urea nitrogen (BUN) and creatinine.
MRI & CT scans provide images of the kidneys which help to detect any abnormalities or blockages in the kidneys.
- Kidney tissue samples:
A kidney biopsy is used to collect the tissue sample. A local anesthesia is given to avoid any discomfort. Ultrasound imaging can be used to locate the kidneys and guide the insertion of the biopsy needle.
How is a kidney-friendly diet different?
When your kidneys aren’t functioning properly it will begin building up wastes and fluid in your body. Over time, these waste and fluids can cause heart, bone & other health problems. A kidney-friendly meal plan will help reduce the number of minerals and fluid intake. This will reduce the building up of waste and fluids in the body. When the kidney disease gets worse over time, your doctor will advise you to limit the use of potassium, phosphorus, and fluid in your diet.
Following a kidney-friendly diet plan with diabetes:
If you have diabetes, then you will have to control the blood sugar levels in order to prevent more damage to the kidneys. Your doctor or dietitian will help you create a diet plan that will limit the blood sugar levels. One should also limit sodium, potassium, phosphorus, and fluids in their diet in order balance the blood sugar levels.
Following a kidney-friendly diet plan will make it hard for you to get all the essential nutrients such as vitamins and minerals. To help you get the right amount of all nutrients your dietician will supply you special supplements that are made for people with kidney disease.
Very importantly, tell your doctor and dietician about the various medicines, vitamin supplements and over-the-counter medicines which you are taking. Regular multivitamins may not be healthy for you if you have kidney disease. They may have too much of some vitamins and not enough of others. Your dietician will help you find the right vitamins which are just right for you!
How is a kidney failure treated in diabetic patients?
Once the kidneys are severely damaged there are 3 kinds of treatments that may be opted. They are
- Kidney transplant
- Peritoneal dialysis
Let us learn more about these treatment options in the later section of this article.
A kidney transplant is a process that involves the transfer of a healthy kidney from the donor to a person (recipient) who has little or no kidney function at all. The main role of the kidneys is to filter waste products from the blood and send it out of the body. If the kidneys fail to do this function, then the waste products get piled up which can cause life-threatening situations.
This loss of kidney function known as end-chronic kidney disease or kidney failure is the main reason for a kidney transplantation. However, the function of the kidneys can be replaced by a procedure called dialysis but this might be inconvenient or time-consuming. So a better plan would be going in for kidney transplantation.
There are basically two types of donors;
- Living donors
- Deceased donors
Living donors: a living donor may be a family member, a friend or any person who is willing to do donate their kidney. A person needs only one healthy kidney to lead a healthy life.
Deceased donors: a deceased donor is someone who has died recently.
The recipient may have to undergo a series of tests to see how well the donor kidney matches with your tissue or blood type. A close match in tissue or blood type will reveal that your body is ready to accept the new kidney provided you don’t suffer from other chronic diseases such as heart or lung infections.
The kidney transplantation procedure:
It takes about 3 hours for the kidney transplant surgery. During the surgery, the donor kidney is placed in your lower abdomen and the blood vessel from the donor kidney is connected to the arteries and veins in your body. The ureter from the donor kidney is connected to the bladder. The new kidney then produces urine and begins to filter and remove waste from the body. In most cases, the diseased or damaged kidney is not removed unless it is highly infected or the person has kidney cancer.
A kidney transplant is a crucial surgery followed by a wide range of potential risks. The short-term risks include blood clots and other infections whereas the long-term risks include diabetes or increased risk of infection which can be controlled by medications. The person who had kidney transplant must undergo regular health check-ups.
Living with a kidney transplant;
Once the person has undergone a kidney transplant surgery, he or she has to maintain a healthy lifestyle in order to reduce the complications. Therefore it is advised that
- You don’t smoke
- You eat a healthy diet
- You lose weight if you are overweight or obese
- Make efforts to reduce your developing infections
How long does kidney transplants last?
The duration of a transplanted kidney depends on many factors. Some of which are:
- Whether or not, the kidney came from a living donor
- How well the donor kidney matched with the tissue or blood type of the recipient
- The age and overall health of the person
The average kidney survival timings are as follows;
- 1 year- about 95%
- 5 years- about 85%-90%
- 10 years-about 75%
If you have a kidney transplant failure then you may have to go in for a dialysis unless and until you undergo another kidney transplant surgery.
The possible risks of a kidney transplant surgery:
- Severe infection
- Rejection of donor kidney
- Failure of donor kidney
- Reaction to anesthesia used for the surgery
What to think about?
- Although a kidney transplant surgery is an expensive procedure, it will be a better option compared to long-term dialysis because the survival rates are better after the transplant.
- One will have to wait for a long time before they receive a donor Also, the complications may be severe if the patient is suffering from heart diseases or cancer that might limit their life expectancy.
- After the kidney transplant, one will have to continue long-term medications to suppress their immune system to help prevent the body from rejecting the donor
Dialysis is the treatment that filters and purifies the blood using a machine. When kidneys stop functioning efficiently, dialysis is the only option. This helps to keep the body in balance when the kidneys don’t do their job. Dialysis is a procedure to remove waste products and excess fluids from the blood when the kidneys stop working properly. There are 2 types of dialysis:
- Peritoneal dialysis
Hemodialysis: your blood is put through a filter outside the body, cleaned and then returned to you. This is done either at a dialysis facility or at home.
Who needs dialysis?
If you have chronic kidney disease then you will need dialysis or kidney transplant at some point. Some will choose dialysis even before they have the symptoms of kidney failure such as nausea, fatigue, swelling or throwing up.
When you should start dialysis depends on your age, energy level, overall health and how willing you are to commit to a treatment plan.
How long will you need dialysis?
It depends. In some cases, kidney failure may be a temporary problem and dialysis can be stopped when your kidneys recover. But often, someone with kidney failure will need a kidney transplant. It’s not always possible to carry out a kidney transplant straight away, so dialysis may be needed until a suitable donor kidney becomes available. If a kidney transplant isn’t suitable for you, for example, because you’re not well enough to have a major operation, dialysis may be needed for the rest of your life.
What happens during dialysis process?
Haemodialysis: it is the most common type of dialysis and the most type of dialysis that people are aware of.
During the procedure, a tube is attached to a needle in the arm. Blood passes through the tube and through an external machine and filters it before it passes through the arm through another tube. This is usually carried out 3 times a week and each session lasts for about 4 hours.
Peritoneal dialysis: this uses the inside lining of your abdomen to filter rather than an external machine. Like the kidneys, the peritoneum contains a number of blood vessels making it a useful filtering device. Before the treatment starts, an incision is made near your belly button and a thin tube called catheter is inserted through it. This is left in place permanently.
The fluid is pumped into the peritoneal cavity through the catheter. As the blood passes through the cavity, wastes and other fluids are drawn out of the blood and into the dialysis fluid. Changing the fluids usually, takes about 30-40 minutes and needs to be repeated 4 times a day. If you prefer, it can be done overnight when you sleep.
Advantages & disadvantages of dialysis:
If dialysis is recommended to you, you will often be able to choose between the 2 types. Both methods of dialysis are equally effective for most people so it is usually a case of personal preference.
However, there will some situations where a particular type of dialysis will be the best. Peritoneal dialysis may be recommended for:
- Children below 2 years of age or younger than that
- People who have limited kidney function
- Adults who don’t have serious health issues like heart diseases or cancer
Haemodialysis may be recommended for:
- People who cannot carry out peritoneal dialysis
- Visually impaired
- People who have dementia
- People with poor state of health
The main advantage of hemodialysis is that you have 4 dialysis-free days a week. The procedure will involve using the dialysis machine 3 times a week with each session lasting for 4 hours. You will need to plan your treatment days well in advance.
The disadvantage with hemodialysis is that the amount of fluid you drink and the diet have to be restricted. Many people undergoing this treatment have to avoid certain foods and are advised not to drink more than few cups of fluid a day.
The obvious advantage of peritoneal dialysis is that regular visits to dialysis units are not required and it can be done at home without the use of any bulk types of equipment.
Also, there isn’t much restriction to on diet and fluid intake for people having peritoneal dialysis compared to those undergoing hemodialysis.
The greatest disadvantage of peritoneal dialysis is that it has to be carried out each day, which may seem to be disruptive. It may also feel uncomfortable to have a thin tube left in your abdomen all the while.
Another risk of this type of dialysis is that you are at high risk of developing peritonitis. In some cases, it may become thickened and scarred and you will have to shift dialysis to stop this happening.
When one gets mentally prepared for the dialysis procedure they should also be aware of the side effects of this procedure. There are usually many side effects accompanied with dialysis. This is because of the way dialysis is carried out and it only partially compensates for the loss of kidneys.
You feel tired or exhausted is the common side effect of people who have undergone either form of dialysis. It is caused by a combination of:
- Loss of normal kidney function
- Effects that dialysis can have on the body
- Dietary restrictions associated with dialysis
- Overall stress and anxiety that many people will have
Regular exercise may also help. If you are fatigued and on dialysis, starting a program of regular exercise can be difficult. But if you persevere, you will probably find that exercising becomes easier with time.
Possible side effects of hemodialysis:
- Low blood pressure
- Muscle cramps
- Itchy skin
- Difficulty in sleeping
- Erectile dysfunction
- Dry mouth
- Bones and joint pain
- Loss of sex drive
Possible side effects of peritoneal dialysis include:
- Peritonitis: This is the common side effect of this type of dialysis. It is a bacterial infection of the peritoneum and can occur if the dialysis equipment is not kept clean. If there are bacteria on the equipment it can enter into the thin lining of the abdomen and cause serious damages to the body.
Signs & symptoms of peritonitis include:
- Abdominal pain
- High temperature
- Feeling and being sick
- Dialysis fluid becomes cloudy
- A hernia: people undergoing peritoneal dialysis are at increased risk of developing hernia because holding the fluid inside the peritoneal cavity for a long time will put a strain on the muscles of the abdomen.
The main symptom is the appearance of a lump on the side of your abdomen. This lump may be painless and may be detected only during a checkup. Surgery may be needed to remove a hernia. During the surgery, the surgeon will place a protruding tissue back inside your abdominal wall.
- Weight gain : the fluid used for dialysis will contain sugar molecules which will be absorbed by your body. This will increase the calorie consumption to several hundred calories per day. Do a lot of physical exercises to help retain your weight.
What if I want to stop dialysis?
This treatment should probably maintain or improve the quality of your life. But if you wish to stop it, you can do it anytime. If you wish to stop then talk to your doctor about it and also get to know what other treatment options can help you survive better. Changes to your diet and lifestyle can help improve the quality of your life.
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