Post Transplant Watch: Bone Disease

Bone disease is something that kidney disease often brings with it. The reason for this is that our kidneys play a major role in building our bones and keeping them strong.

One other issue is steroids. Most kidney transplant centers have used steroids as part of their immunosuppression protocols. Over the years, great strides in the post kidney transplant medication management have allowed doctors to minimize the doses of steroids we have to take in order to keep our transplants. In fact, there a already a number of transplant centers that have moved to a steroid-free immunosuppression protocol with great success rates.

But for most of us, whose transplant centers regimens include steroids, and for those who require steroids otherwise experience rejection, the consequences of steroids is something we have to deal with.

Here are some steps that doctors will monitor closely in order to minimize the problems caused by steroids with respect to bone disease.

RISK FOR OSTEOPEROSIS

Osteopenia and osteoperosis are two situations that everyone looks to avoid. They are signs that our bones are weaker that should be and in many cases more brittle and thinner also. Having weaker bones makes us more susceptible to fractures and other bone injuries as well as unwanted changes in our stature that make it more difficult to function normally.

For patients at risk of osteoperosis, the following guidelines will help in preventing it from happening and keep a close watch so that more aggressive treatment can be made when there are possible signs of moving towards it.

Being in any of following situations may put you in greater risk of osteoperosis

• Women
• Menopause or above 45 years
• Personal or family history of low-trauma fractures
• Amenorrhoea (absence of menstrual bleeding)
• Slender build (BMI <>

STEP 1: Weight bearing exercises

I learned that weight bearing exercises are very important in keeping our bones strong. They also help build bone density. The logic sounds contrary to what we'd normally think. Common thinking would be, by not pushing or handling weight, we preserve our bones. But ironically, forcing our bones against heavier objects and making them 'work', actually improves their health, similar to how our muscles react to exercise. While being sedentary makes our bones deteriorate faster.

Not all exercises, however, are created equal. Some help in increasing bone mass and strength, while others don't. For example, exercises like lifting weights, brisk walking, climbing stairs strengthen bones, while swimming, rowing, cycling have been shown not to be as effective.

Also, different exercises affect different bones. Activities like climbing stairs, jumping and brisk walking help increase bone density in the hips and spine, whereas push-ups, for example, strengthen the bones in with wrist, arms and shoulders.

STEP 2: If you smoke, stop

Studies have shown that smoking is detrimental to bone health and bone healing.

The reason? Cigarettes and tobacco contain nicotine, which constricts blood vessels of their normal diameter. Because of the constriction of the vessels, the amount of nutrients that are supplied to the bones are less than they should be.

STEP 3:Calcium carbonate

Taking calcium carbonate is often needed in order to make sure that you get sufficient calcium that may otherwise be lacking from diet.

STEP 4:Vitamin D if or other activated forms of Vitamin D

Along with calcium, vitamin D is needed in order to build bones. With lessened function, the kidney isn't able to produce the same amount of vitamin D that it used to. Thus, supplementation with vitamin D is often required.

Depending on how well kidney function is, however, the type of vitamin D matters. If kidney function is good, meaning a GFR of 50ml/min or higher, then the vitamin D3 supplements are often given.

But in cases where there is decreased kidney function, like when creatinine is above 200 μmol/L or 2.3 mg/dL, your doctor may prescribe an activated form of vitamin D formulation like, alfacalcidol.

In doing this, it effectively side steps the need for the kidney to work in order to convert the vitamin D that comes in oral form or sunlight into the activated form which is what the body can use.

STEP 5: DEXA scan

A DEXA scan can be compared to other imaging machines like x-rays, and MRI machines. What they do is to scan through our bones and provide us an indication of how strong our bones are, in terms of bone mass density.

This is something that isn't always done by physicians but something I've learned to be quite important in gauging how well our bones have done over time (if they are improving or weakening) and if the current treatments being prescribed are working.

It is a good idea to get one before transplantation and yearly thereafter for comparison.

In an upcoming post, we will take a look at how the steps may differ when a diagnosis of osteopenia or osteoperosis has been determined.

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Kindess From A Stranger

When we look at the world we live in, we often see a lot of harsh and sad events that lead us to look at the world we live in with a negative perspective. The thing is, often enough, just when we're ready to give up on believing that man is still capable of great kindness and compassions, it never fails to pull out a surprise.

Here's a great inspirational story that reminds us of the wonders and generosity we are all capable of. In this instance, a cab driver offers to donate his kidney to a passenger whom he knows needs it.

PHOENIX — Rita Van Loenen had no idea that a trip in Thomas Chappell's taxi cab could end up being the ride that saves her life.

"There are better odds of getting struck by lightning," Van Loenen said. "A random taxi driver offering to give me his kidney and all these pieces match. There has to be something behind this. How can this be?"

Chappell, who has been driving Van Loenen to dialysis appointments, shocked the Gilbert, Ariz. woman a month ago by offering to donate his kidney. But even more shocking to her was that doctors found they had the same blood type, that they were compatible.

"He calls me all excited. If we were a closer match, we would've been siblings. I was ready to fall off the floor," Van Loenen said.

The Phoenix taxi driver said he was a man of faith and that a higher power wanted him to step in.

"By then, me and the good Lord already had a talk. He said 'Tom, you go give her one. It will work," Chappell said.

Last year, Van Loenen, an instructor in special education methods, began feeling ill and experiencing water retention in her legs. She went to see a doctor and was diagnosed with kidney disease. With kidney failure setting in, friends and family were tested but there was no match.

In February, she received her cousin's kidney but that transplant failed. One day, Van Loenen, 63, found herself telling Chappell, 56, about how her son was now going to get tested. Chappell decided to add his name to the list.

"I said 'Rita, your son's a whole lot younger than me. He's got a lot more years. I'm gonna go down and go through the process and see if it will work.' I don't think she really believed I was going to."

The gesture evoked tears of gratitude from Loenen but she was still skeptical.

"A little bit in my heart I didn't believe it. He said 'give me the number' and I have transplant number at Mayo (Clinic in Scottsdale) memorized."

The two first met more than three months ago. It wasn't an auspicious beginning.

Chappell was half an hour late picking Van Loenen up for a dialysis appointment.

"When I got there she was not happy," Chappell said. "And I can understand it now. She's sick and all these things she goes through ... The next day, it just so happens I got her again."

Since then he has — and he insists it is by happenstance — been her taxi driver three to four times a month. For the last month, Chappell has started undergoing the arduous process of donor screening, undergoing numerous tests and exams. But none of it has brought second thoughts.

"This has put a whole new kind of lift in my boots. I never knew what it felt like to give somebody life and that's what I'm doing," Chappell said.

Van Loenen said Chappell never asked for any compensation. She still can't quite believe his level of commitment.

"I've never known anybody so enthusiastic to get a body part removed," Van Loenen said.

After the transplant, which hasn't been scheduled yet, Chappell will need to tread carefully. He will have to rest between four and six weeks but his work has promised to cover his lost wages.

"I've had drivers do some pretty incredibly amazing things for no charge. But this is just over the top," said Jim Hickey, national sales and marketing director for the company that owns VIP Taxi. "We're just so proud of him."

Van Loenen said that, thanks to Chappell, she can actually make plans for the future.

"Whenever I tell my friends or my family, they just find it so incredible," Van Loenen said. "They do call him an angel. My friend says there's angels everywhere. That's the right way to capture it."

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Night Hemodialysis Just as Effective as Kidney Transplant

In the first study of its kind, it has been shown that night time home hemodialysis, which is done for 6 to 8 hours nightly, up to 7 days a week, is as effective as receiving a transplant. The long term study focused on comparing the survival rates and how this particular type of dialysis compares with both cadaver and living donor transplantation.

For the first time, it has been shown that patients who receive night home hemodialysis live just as long as those who receive kidney transplants from deceased donors.

[...]

a total of 1,239 patients were followed for up to 12 years. Night home hemodialysis patients were compared to patients who received either a deceased donor kidney transplant or a living donor kidney transplant. The study found that the survival between night home dialysis patients and those who received kidney transplants from deceased donors was comparable, while the survival of the patients who received a transplant from a living kidney donor was better than both the other groups.

These results are encouraging considering the shortage of organs. It provides a means for those waiting for a transplant to maintain good health and good quality of life. In certain situations, it may also be a good alternative to high risk patients that aren't approved for transplants and those who aren't able to get a kidney transplant.

The full article can be found here.
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Single Kidney Transplants from Young Donors Effective

In the August publication of The Clinical Journal of the American Society of Nephrology, researchers reported that transplanting a single kidney from a young deceased donor is sufficient in maintaining health in an adult with kidney failure.

In most transplant centers, the kidneys of very young deceased donors are transplanted together into one patient. According to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), a single kidney from a very young deceased donor maintains the health of an adult with kidney failure.

[...]

The researchers' study included all 79 adults who were transplanted at the Tulane Abdominal Transplant Institute with single pediatric kidneys from deceased donors aged 10 years or less between January 1996 and June 2007. Physicians transplanted a single pediatric kidney if it was healthy enough for splitting and the recipient consented. Half of the adults received single pediatric kidneys from donors less than five years of age. The other half received single kidneys from donors aged five to 10 years.

[...]

Patients in the two groups experienced similar rates of kidney rejection and delayed kidney function. In both groups, kidney function improved dramatically in the first year after transplant, and it continued to improve into the third year. Furthermore, patients in the two groups lived a similar length of time. The youngest donor in the study was a nine-month old female; both of her donated kidneys remain healthy more than six years post-transplantation into two different recipients.

The article is saying that based on their findings, using a single kidney from very young diseased donors are able to sustain good health in adults. Often, when the donor is of very young age, both kidneys are transplanted into adult recipients.

This report contradicts previous studies where it has been noticed that adults given single kidneys from very young donors produce more complications compared the those from adult donors.

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Wearable Artificial Kidney

The wearable artificial kidney that is being developed has been successful in preliminary trials. It looks promising with the ability to allow patients to strap on their 'portable dialysis' machines and receive dialysis 24 hours a day, 7 days a week.

While it is still going through tests, things look promising.

"Our vision of a technological breakthrough has materialized in the form of a Wearable Artificial Kidney, which provides continuous dialysis 24 hours a day, seven days a week,"

[...]

The device—essentially a miniaturized dialysis machine, worn as a belt—weighs about 10 pounds and is powered by two nine-volt batteries. Because patients don't need to be hooked up to a full-size dialysis machine, they are free to walk, work, or sleep while undergoing continuous, gentle dialysis that more closely approximates normal kidney function.

[...]

The Wearable Artificial Kidney is successful in preliminary tests, including two studies in dialysis patients. The new study provides important information on the technical details that made these promising results possible.

This will be a great innovation that will allow dialysis patients not only avoid having to sit around the dialysis machine during dialysis sessions, but also allow continuous filtering of the toxins from the body, resulting in better health and quality of life.
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Pros and Cons of Kidney Biopsies

Although the kidney biopsy is a very thorough test that is able to provide a good assessment of kidney function, it isn't always the first option doctors go to in diagnosing kidney issues. Other procedures such as blood tests, urine sampling, ultrasound and CT scans are often done first. Only when these have been exhausted and there are still some unanswered questions, or the need to get a more definitive answer to a lingering unknown does the biopsy come into play.

Knowing the pros and cons of having a kidney biopsy should help explain why physicians often take this route.

PROS

• Gives a clear cut picture of what is happening, what is affecting the kidney, how much is functioning, amount of renal mass that is still working and any infection or malignancy, if present.
• It can find the cause of the kidney problem and tell what the best treatment will be.
• Biopsies enable you to avoid being given unnecessary treatment which could have side effects.

CONS

• The procedure is invasive, because there is penetration of the skin more risk is involved. The most common complication is bleeding. Another complication is possible damage to the kidney or other parts near it, if the kidney biopsy is done incorrectly. Though complications especially the latter one are very rare.
• A kidney biopsy is expensive. The procedure itself which uses an imaging machine, like an x-ray or CT scan, along with the testing and doctors' fees cost significantly more than regular blood tests.
• In a biopsy, the doctor will take a part of the kidney, so the sample may not be a complete representation of the health of all the tissues in the kidney. For this reason, some doctors may get elect to take a number of samples from different areas of the kidney during the procedure.

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Warning Signs of Infection

A common side effect of immunosuppressive agents is increased susceptibility to infection. These drugs, such as kidney transplant medications, weaken the immune system to prevent rejection. Therefore, you must take precautions to avoid infection.

If you experience any of the following signs of infection and or rejection as mentioned here, you should notify your transplant coordinator immediately. They will be able to give you the proper instructions on what to do.

Here are common warning signs of infection.

1. Sore throat
2. Cough, cold or shortness of breath
3. Flu symptoms
4. Fever over 100°F or 37.8°C
5. Pain over transplant area
6. Gastrointestinal discomfort, diarrhea, nausea and vomiting
7. Skin irregularities like sores, redness, swelling, or wounds that don't heal

Looking after yourself and being careful often reduces the possiblity of getting infections. I remember my doc telling me what to watch out for. But the most important things that came out of his lips then was “use common sense.”

As transplantees, we should be wary of infections because when they occur, our body's immune system becomes active and sends out its soldiers to knock out that infection. During this process, our immune system goes into attack mode and is more vigilant to foreign substance, including our kidney, increasing the possibility of causing a rejection episode.

It is important to inform your transplant center when you notice these symptoms and not to just take any over-the-counter drug that other people take. Many over-the-counter drugs can harm our transplanted kidney.

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Post Transplant Watch: High Blood Pressure

After a kidney transplant, there are a number of health issues that doctors will ask you to watch out for. Often, most of the kidney related problems that appeared when you had kidney disease go away after having a kidney transplant. There are some, however, that will remain even after a successful kidney transplant.

This is a part of a series that I call Post Transplant Watch, where we will look at the different issues that may linger after kidney transplantation and steps doctors often take to treat them.

We begin with the most common problem and main cause of transplant (graft) loss-- cardiovascular disease or heart disease. Because there are many things that lead to cardiovascular disease, we will go through them one at a time, beginning with high blood pressure.

You will notice a number of levels listed below. Beginning with level 1, we start to solve the problem, in this case hypertension. If that doesn't work, we move on to the next level to see if that works better, and so on. These are the steps I've noticed doctors take in dealing with particular issues.

I hope this can be a guide for you so you will have an idea about what your doctor doing. Remember, this is meant to give you an idea of what to expect and is not a substitute to your doctor's advice. Only your doctor will be able to tell you what to do because they know your medical history.

Here goes.

Level 1: Target BP: less than 130/85

How? Weight loss if overweight, limit salt in diet or low sodium diet, reduce alcohol intake, increase exercise.

This is the best way to do it, without any drugs or medication. All natural. Your doc will probably want to have your BP at 120/80 or 110/70.

If these aren't able to control blood pressure, we proceed to level 2.

Level 2: Calcium channel blockers

What? Calcium channel blockers (CCBs) are blood pressure medications. Often the first line of defense used by doctors for high blood pressure in kidney transplant patients.

Research has shown that they help improve renal function by controlling blood pressure. The also protect you from the hypertensive effects of CNIs like cyclosporine and tacrolimus. Examples are amlodipine and lercanidipine.

Level 3: ACE Inhibitors and ARBs

What? These are 2 different classes of blood pressure medication. ACE inhibitors and ARBs work differently to achieve the same goal — lower blood pressure. Often you will be told to take one or the other with most doctors favoring the use of ACE inhibitors first before trying ARBs if the ACE inhibitors don't work well enough or produce side effects.

There are times that either ACE-I and ARBs aren't able to achieve the desired results on their own. In this case, the some doctors will use a combination of an ACE inhibitor and ARB.

The reason why CCBs are tried before ACE-I or ARBs is because the latter two have more side effects. One very known side effect is coughing. Increase in creatinine level and anemia in some patients also happen.

There is one instance though, where your doctor may opt to use an ACE inhibitor or ARB over a CCB. This is when there is protein in your urine. ACE-I and ARBs are known to have anti-proteinuric effects. And by lessening the amount of protein spilled in the urine, it protects the kidney.

Examples of ACE inhibitors are lisinopril and ramapril, while valsartan, losartan and candesartan are some known ARBs.

Level 4: Beta-Blockers

What? Beta blockers are yet another type of blood pressure drug. They work differently from those mentioned above and are known to be used for coronary heart disease.

They should be avoided for people with asthma. One example of a beta blocker is atenolol.

Level 5: Immunosuppressive medication adjustments

Why? Some doctors may actually try this before level 2. The reason I place this here is that adjusting medication is risky and often more troublesome. Having your kidney transplant medication adjusted may cause possible rejection if you become under suppressed. It also means that you'll probably be having labs done more often in the coming weeks to monitor if everything is okay with the change.

That said, lowering steroid doses helps in bringing down blood pressure. Another well known anti-rejection drug that causes hypertension are CNIs, like cyclosporine (Neoral) and tacrolimus (Prograf), so keeping it within therapeutic range will be helpful.

One thing to remember is that not everyone will have to deal with these issues. At times, these issues are caused by kidney transplant medications themselves. If you do happen to notice them make sure to inform your doctor so they can treat it accordingly. Read more...

Warning Signs of Transplant Rejection

After having a kidney transplant, or any other organ transplant, you will be required to take anti-rejection medicine for as long as your organ is functioning. The purpose of kidney transplant medications is to prevent our bodies from attacking our new kidney.

This is needed because our body's immune system cannot tell the difference between a new kidney and viruses or bacteria that might attempt to harm out body. In order to keep us healthy, our immune system destroys all foreign objects like viruses and bacteria, but in the process will also try to destroy our transplanted kidney.

The process where our immune system mounts an attack on your new kidney is called rejection. Rejection has a bigger chance of happening during the first year after transplantation and goes down over time, but it never goes away.

Here is a list of the warning signs of rejection.

1. Fever over 100°F or 37.8°C
2. Elevated Blood Pressure
3. Sudden and rapid fluid retention (rapid weight gain or swelling of the ankles)
4. Flu-like symptoms (dizziness, vomiting, headache, fatigue)
5. Discolored, bloody, or foul-smelling urine
6. Reduction of the amount of urine
7. Pain over the transplant site
8. Pain or burning during urination
9. Elevated serum creatinine level

Of all the warning signs, I have noticed that the most indicative is a rise in creatinine. Most of the time, you don't feel anything during a rejection episode except that the creatinine results have gone up. This is why it is important to have regular labs and doctor check ups.

As a guide, a sudden rise of 0.4 from your normal levels is a sign that something is happening. For example, your regular creatinine levels are 1.2, so a value of 1.7 or above will be a cause of concern.

Before you start to worry, I've learned that a sudden rise in creatinine does not always mean a rejection episode is happening. There are other possible reasons for a rise in creatinine which we'll talk about in a later post.

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The Issue of Generic Cellcept

Earlier this year, the generic version of Cellcept came into the market after Roche's patent on Cellcept expired in May of this year. This was and is still a much discussed topic. On the issue of kidney transplant medication or immunosuppressive medication as a whole, the issue of generics is a very touchy subject.

There are actually two main causes of this, on one side, is cost. Transplant medications are very expensive. Depending on what doses and which drugs you are on, costs may range from high to exorbitant. Not to mention that, more often than not, you have additional drugs and supplements aside from the anti-rejection pills.

At the other end, is drug efficacy. How well does the generic drug, in this case Cellcept, stack up against the branded one. Patients who have had their transplants have been on the Cellcept brand for a while and are now facing the choice between the cheaper generic and costlier but proven brand.

The sad fact of the matter is, as much talk as there is, transplant patients may not really have a choice. Most patients have their transplant medications covered by some sort of health insurance. In most cases, it has been the insurance agency that is prompting the move to generic. For those who pay out of their own pockets, depending on where you source your immunosuppressive drugs, the cost difference between Cellcept and its generic may vary from 10% to more than 50%.

Doctors, on the other hand, are more hesitant. Given the option, they prefer that patients take the branded product. As a whole, they seem to agree that the difference in efficacy matters. Some say there is a 10% variance, others say the effects may be +15% or -15% the effect of the branded product depending on the person taking it.

Another thing they seem to agree is that though they prefer that we use the brand name, and should you shift to generic, to make sure to inform them so that they may monitor your progress and the cellcept blood levels closely during the initial conversion period.

So what has happened since?

Some transplant patients have avoided the generic because their doctors and clinics forbid it. Their doctors have provided branded scripts that explicitly state “no substitutions”, “use branded name”, “no substitutes,” “original as written” and the like.

Others have opted to add to their co-pays or pay for the extra cost it takes to have the branded name.

One creative method I've heard from few was they were asked to switch to Myfortic because the insurance didn't want the branded Cellcept.

There are also quite a number of transplants who have moved and are now using the generic. Some clinics have given it the go signal for their patients.

Generally, the generic seems to be working okay. Some have said they have no problems with it, others say it is less troublesome for their stomachs. Then again, I've also heard a few problems like stomach issues and skin problems, proving once again that everyone reacts differently to medication.

Luckily, my being on Myfortic allowed me to sidestep this issue. But whichever way you look at it, this is a learning lesson for all of us. It has happened before, with cyclosporine (Gengraf) and now Cellcept, and it will happen again.

Soon, Prograf will have a generic then all our other drugs will go past their patent. At least next time, we'll be better prepared.

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When to see a Nephrologist

A doctor who specializes in the kidney and kidney diseases is called nephrologist. Nephrologists are experts in handling different medical issues involving the kidney.

In general, a nephrologist is helpful at the very first sign of kidney problems. Even when your kidney function is still very good (above 60%) , once there are findings that point to possible trouble, a nephrologist can help do the following.

1. Select the proper course of action and diagnose the type of kidney disease. Many times, kidney disease that is caught early and properly treated can be stopped or reversed.

2. Slow the rate or completely stop the decline of your kidney function.

3. Treat the kidney disease related complications like high blood pressure and anemia.

Once your kidney function reaches 30% or below, going to a nephrologist becomes a must. During this latter stage, a nephrologist is needed as the effects of the diminished kidney functions, whether direct or indirect, will be very present.
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FDA warning on Cellcept and Anemia

The Wall Street Journal has reported that the U.S. Food and Drug Administration (FDA) is is warning doctors that organ transplant drug Cellcept, may cause a type of severe anemia. Recently, the FDA has asked Roche, the maker of Cellcept, to make stricter warning labels regarding the risks involved in using Cellcept.

The U.S. Food and Drug Administration on Friday warned doctors about a certain type of anemia in patients being treated with the Roche (ROG.VX) kidney-transplant drug Cellcept.

[...]

Last month, the FDA said it was requiring Roche and other manufacturers of certain drugs used to prevent the rejection of transplanted kidneys to warn of certain serious infections.

The drugs, including Cellcept, Myfortic by Novartis AG (NVS) and Wyeth's (WYE) Rapamune, already carry the agency's toughest boxed warning discussing their various risks.

The FDA said the drug labels must discuss an increased risk of "opportunistic infections," including activation of latent viral infections such as one caused by the BK virus.

The anemia the FDA is speaking of is PRCA or Pure Red Cell Aplasia. It is a severe form of anemia wherein the bone marrow ceases produce red blood cells because PRCA affects the production process of red blood cells within the bone marrow.

Like many other transplant medications, Cellcept carries a number of risks and produces a number of side effects. It is a very good drug in warding off rejection and is being used by close to 90% of transplant centers in the U.S.

As in many instances, with kidney transplants or organ transplants as a whole, the need for weighing the good against the bad and hopefully coming up with a harmonious balance is the key.

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Living Kidney Donation FAQ

Living kidney donation is a great gift where an individual offers a part of themselves in order to save someone else's life. It is a big decision and although many have thought of being possible organ donors, there are many questions involved in living kidney donation that sometimes keeps people from donating.

Here are answers to some frequently asked questions (FAQ) about living kidney donation.

Who can donate?

Anyone who is in good general health and has a genuine interest in donating.

Donors are often restricted to between the ages of 18 to 70, though there have kidney donations made by people younger than 18. Much of it depends on the protocol of the kidney transplant centers.

To be able to donate there are a few qualifications, like having a blood type compatible with the recipient. Donors who have high blood pressure, cancer, diabetes, kidney disease, heart disease, liver disease, sickle cell disease, HIV or hepatitis often do not qualify.

How will I know if I am suitable a suitable donor?

The kidney transplant center will provide you a thorough medical and psychological assessment to establish that you are fit and healthy to make a kidney donation. The results of the test will allow the healthcare team to make an informed decision whether you are suitable to make the kidney donation.

What are the health risks associated with donating?

Your surgeon and nurse coordinator will discuss all health risks with you. The risks of kidney donation stem from the transplant surgery, where bleeding and infection are possible. Death resulting from kidney donation is extremely rare.

Should I be worried about possible risks in the long-term?

Studies have shown that kidney donation has no long-term effect on the health or your remaining kidney. There is a small possibility of a slight rise in blood pressure and excess protein in your urine.

You will be at no greater risk of developing kidney failure after donating than anyone in the general population.
Studies have shown that donors live longer than the average population. This is because donors are selected on the basis of good health and are thoroughly screened prior to donation.

Will kidney donation affect my lifestyle?

A person can lead an active, normal life with only one kidney. Studies have shown that one kidney is sufficient to keep the body healthy. After recovering from transplant surgery a donor can return to the same lifestyle they used to have.

What should I expect after the transplant surgery?

Upon discharge, you may feel a bit of pain or swelling from the wound. This takes a bit of time to heal. You will be asked not to lift anything that weighs more that 20 lbs for the first four weeks after kidney donation. You may feel tired for the first week or two after the surgery and may need extra rest.

Donors often return to work 2-3 weeks after the transplant surgery, depending on the type of work. Some donors require a longer recovery period if their work requires heavy lifting or other physical demands.

Who pays for the transplant costs?

The donor does not incur medical costs in the kidney donation process. The expenses related to the living kidney donation evaluation as well as the hospitalization costs, transplant surgery and physician services provided during the kidney donation process and related transplant costs are covered by the recipient, often by their health insurance.

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Fruits & Vegetables Prevent Kidney Stones

A recent study has shown that eating a healthy diet consisting of high intake of fruits, vegetables, nuts and legumes, low-fat dairy products, and whole grains coupled with low intake of salt, sweetened beverages, and red and processed meats not only prevents metabolic problems like high blood pressure and diabetes but it also prevents the formation of kidney stones.

Researchers have found another reason to eat well: a healthy diet helps prevent kidney stones. Loading up on fruits, vegetables, nuts, low-fat dairy products, and whole grains, while limiting salt, red and processed meats, and sweetened beverages is an effective way to ward off kidney stones

The article also says that such a diet contained higher levels of calcium, potassium, magnesium, oxalate, and vitamin C while having a lower amount of sodium, things that are beneficial to overall health.

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Living Kidney Donation vs. Cadaver Donors

Kidney transplants are the most effective kidney disease treatments. With kidney transplants, patients who are suffering from kidney failure regain good health.

There are 2 major types of kidney transplants, namely through a living kidney donation (live donor), and from a cadaver donor (deceased donor).

Whenever possible, doctors recommend that patients receive a live kidney donation. Today, we examine why a living kidney donation is considered better.

1. The survival of kidney transplants from live kidney donation has been shown to be better than from cadaver donors.

2. A living kidney donation from close relatives, like brothers, sisters, or parents can yield excellent tissue-type match for the recipient. A good tissue-type match reduces the risk of the kidney being rejected by the recipient

3. Recipients who had their kidney transplants prior to dialysis have been shown to have better long-term transplant survival

4. A living kidney donation gives the patient, donor and their families the flexibility to plan the kidney transplant surgery when it is convenient for them

Read more...

EPO: Erythropoietin for Anemia

EPO, or erythropoietin, is a drug many kidney patients are familiar with. Just about everyone on dialysis has used one form or another of erythropoietin.

So what is it? And why is it important?

Erythropoietin is pronounced as e-ryth-row-po-e-tin. I actually had difficulty pronouncing it correctly in the when I first started using it. I spelled it out as it should be pronounced so you won't end up like me mumbling some funny word that made the doc scratch his head whenever I tried to say it.

Anyways, going back to our topic of discussion... let's rewind back to the functions of our kidneys, remember how the kidney produces erythropoietin in order to stimulate our bone marrow to produce red blood cells or blood? The problem with kidney disease is it causes the levels of erythropoietin produced by our kidney to go down, resulting in us becoming anemic.

One way medical science has learned to treat this is through the use of a synthetic (man-made) version of erythropoietin. And By injecting the synthetic erythropoietin, we supplement or replace that which isn't being made by our kidneys.

You will see doctors adjust your dosage on a weekly basis until they get the proper level that will allow you to maintain a healthy red blood level. So in case you were thinking, yes, this isn't a one-shot thing. It will likely be continuous until your kidneys can reproduce enough erythropoietin, which does happen for some after a kidney transplant.

The thing about erythropoietin is that it isn't fast acting. Often, it takes a around 2 weeks before you see improvement. Though I have seen cases where the docs pumped in a good amount of it that the hemoglobin values shot up within 3 days and kept going up.

So if it is slow acting, why not opt for blood transfusions instead, where the effects are immediate?

Whenever possible, you will notice that doctors will defer blood transfusions and opt to use EPO to boost red blood levels. This is because the risks that transfusions bring with them, which we mentioned here, are far heavier than those of EPO.

The exception to this rule is when your hemoglobin levels drop below 7, necessitating an immediate need to increase it.

Just for your information, there are three major types of erythropoietin currently available.

- epoetin alpha brand names Eprex®, Epogen® and Procrit®
- epoetin beta, under NeoRecormon® and Mircera®
- darbepoetin, branded as Aranesp®

We'll go through their differences in a later post so you can get a better grasp on the available options.

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Kidney Transplantation Intro

In starting this blog, I had a few goals, one of which was to shed light on transplantation and organ donation. Hopefully to share my experiences and learn from others. So here's a bit of info on kidney transplantation.

A kidney transplant is a life saving procedure that enables a person who has lost majority of their kidney function to return to good health. It is one of those things that you can call a medical miracle where doctors and researchers have been able to find a way to replace a person's (the recipient) diseased part with one from another person (the donor).

The process involves major surgery wherein doctors remove a healthy kidney from the donor and place it into the recipient's body to let it function in the place of the diseased kidneys. The donated organ is often placed in the front around the lower abdomen area, either to the right or left side of the belly button, while the native kidneys are often left as is.

Kidney transplants are made possible because though we are born with two kidneys, and like our lungs, we only need one in order to live well.

Doctors often categorize their kidney transplant patients based on the relationship between the donor and the recipient. The kidney may come from either a living person (living donor) or someone who is deceased, in this case called a cadaver donor. Another classification is whether the donor is a relative or not, the donor may be a living-related or living-unrelated donor.

The reason for such classifications is that statistically, it has been observed that in general, live organ donations perform better and last longer than kidneys from cadaver donors. Similarly, living related donors are preferred over non-related donors, because the genetic makeup is closer between the two individuals.

For majority of the cases, the data holds true. From my experience however, I've seen quite a number of kidney transplants who have passed the twenty-five year mark with cadaver donors. So for me, a living related donor gives you a good start, but there a lot of other factors involved before, during and after the transplant operation that doesn't always make this true.

Another thing my docs have always stressed is that transplant medicine has come such a long way to that point that to a certain degree, it is able to swing the odds to the kidney transplant recipient be it living or deceased, related or non-related donor.

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Choosing a Doctor That's Right For You

In the 9 years after being diagnosed with kidney failure, I've seen and been managed by a good number of doctors. From dietitians to hematologists, nephrologists to surgeons, infectious disease physicians, gastroenterologists, you name it.

One thing I've learned is it is very important to have a physician that is right for you. So today, we have the first part of Choosing a Doctor That's Right for You.

The first aspect in choosing a doctor for me is to figure out who are the best in your area of need and are they available.

Doing the Background Check

Expertise

The first step you want to do is make is a list of potential doctors who are knowledgeable the your area of need. A good place to start are friends, but only if they have some personal experience with the doctor or know someone personally who has been or is being handled by that doctor.

The next place to stake out would be the hospital where the doctor works. The people whom I found to be most helpful here were the patients who were being treated by the said doctor and the secretaries of other doctors in the hospital, yes, you read right, the secretaries. Why? Like anywhere, the medical workplace also has it share of gossip. After speaking to a few secretaries and assistants, I guarantee you'll know who to keep or cross out of your list.

Another resource where you can find good doctors are the organizations and support groups pertaining to your particular issue. As a group they know, and have dealt with a number of doctors. Experience has shown me that people who belong to such organizations and groups are often very open, accommodating and willing to share their experience and knowledge.

Location. Location. Location.

Where the doctor holds his clinic as well as his hospital affiliations are important. Try to have a hospital or clinic that is about 20 minutes or less away from your home. This may sound trivial, but when you have to go for checkups often or early morning blood tests, you will understand.

It is also helpful to know their clinic hours, you may just find out that their schedules conflicts with yours.

Insurance

Financially, medical treatment is very expensive. Start by going through the list of doctors who accept the insurance you carry. More often than not, there is one good or even outstanding doctor under your HMO listing.

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Kidney Biopsy

Over the years, I have seen and gone through a lot of the different medical tests available. Not so much because I am a kidney transplant patient, nor because I had to go through dialysis. In fact, from what I've noticed, if things go smoothly as many dialysis and transplant patients I know do, the tests that and procedures you go through are not much different from those experienced by people who get annual check-ups. They just happen more frequently.

Most of my experience has come about because a lot of strange things happen to me. I can actually recall a few times when my doctor had to set up conferences with her colleagues in the hospital, then another with her mentors in another hospital before figuring out how to handle my situation. Needless to say, between those meetings, I went through batteries of tests.

The one thing I learned is that when it comes to assessing the health of the kidney, the kidney biopsy is the number one procedure for the job. Before you begin to argue, let me explain myself. By the words assessing the health of the kidney, I don't mean assessing how it is functioning or how well it is doing work. Instead, I am referring to how well the status of the organ is.

The reason I separate the two, which are often referred to as meaning the same, is that the kidney can current show good function but when you give it a closer look and analyze it's structure, it may not be as healthy as is seems.

Take for instance, an active person, say in his mid-20's to mid-30's, who is playing a pick-up game of basketball on a sunny Saturday afternoon. He's athletic, muscular, in good physical shape and could play with the best of them. All of a sudden, in the middle of the game, he drops. His heart stops beating...

As sad as this analogy is, it has actually happened, in fact, to a number of professional athletes nonetheless. The thing I am driving at is that if the health of the kidney, its internal makings and structure are damaged or weakening, the effects of it may not manifest itself yet, so from the blood tests, it may look as if everything is a okay, but only on the surface.

Here's where the biopsy comes in. By taking a sample of the kidney, and analyzing that tissue, the biopsy will show how the kidney structure is, whether it is normal or is there scarring, if there is infection, if the kidney is receiving enough blood, and if there are certain disease from other parts of the body that have reached the kidney, or if there are tumors present.

Good kidney function may only be temporary if the underlying health of the kidney is hurt or weakened. The effects may not be present initially in the creatinine, but in due time they will appear.

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What Your Should Know About Blood Transfusions

Blood transfusions have become common in many medical procedures. They are used to replace blood that has been lost due to surgery, injury or disease. While patients suffering from severe anemia have also been known to receive blood transfusions in order to shore up their blood supplies.

Despite their routine nature, it makes you wonder why are you asked by hospitals to sign a consent form before you are given a blood transfusion.

The reason, like many medical procedures, there are risks involved. Here are some.

Allergic Reactions

Allergic reactions are the most common type of reactions. When they happens, the you start feeling itchy and hives appear as your body reacts to the donated blood. To avoid this, antihistamines like benadryl is often injected before transfusions.

Febrile Reaction

When a febrile reaction to the donated blood occurs, you get a sudden fever that may be accompanied by chills, headache and body discomfort, usually within 24 hours of the transfusion.

Infections

There have been very rare cases of people being infected from blood transfusions. Some of these infections include bacteria, Hepatitis B and C, and HIV.

Antibodies

For transplant patients and those waiting for transplants, blood transfusions may be needed if red blood cell levels drop significantly. The downside of blood transfusions for these patients is that Because the blood being transfused into your body comes from other people, it carries a bunch of antibodies different from yours. The net effect of this is it increases your panel reactive antibody (PRA) score. The PRA score is a gauge of how well your body is willing to accept organs from other people. The higher the PRA score, the less likely your body will accept a donated organ. In these cases, doctors often order leukocyte depleted red blood cells to be transfused to try to reduce this side effect.

These risks are often very small as hospitals take the utmost precautions in order to keep reactions from happening. Often, they run more than 10 tests on each blood sample to limit the risks.

This is not to say that we should avoid transfusions, but to know that there are risks along with the benefits. So, like many things, having the good effects outweigh the bad will be important in making the final decision on whether to have a blood transfusion or not.

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No Injections! Please.

No. The title has nothing to do with me being afraid of needles. I must admit that I used to have a fear of them, but with the tons of blood tests I've had along with dialysis, I've gotten use to them. Now, on to more important matters

A few weeks ago, I went for a CT scan on my lungs. My doc wanted to check if the lung infection I contracted a few months ago had totally cleared up. A CT scan was needed to verify what the chest x-rays had shown, that there was no more infection.

One thing that she made sure to repeat more than once was, “no contrast.” What she meant was to have a plain CT scan and not one where they use a contrast. Just to make things clear, a contrast is a substance that is injected to the patient that enhances the visibility of the internal parts they are examining.

Being the curious person that I am, I had to ask why. Her answer was short and simple, “the contrast hurts the kidneys, especially when kidneys aren't 100% they can really cause damage.”

Knowing that I fall under the 'not 100% kidney' category, I made sure I told the CT scan technician not to use contrast.

I was reminded of this when i happened to bump into this article, saying how research has shown that contrast agents used in imaging tests harm our kidneys.

Medical imaging often uses contrast agents, substances such as iodine and barium that enhance the contrast of structures or fluids within the body.

[...]

Exposure to contrast agents can injure the kidneys, but patients are often told that this is only a temporary side effect. Recent research has suggested that such contrast-induced kidney damage may actually be more serious, although no thorough studies have looked into the hypothesis.

[...]

Individuals who developed contrast-induced kidney injuries had twice as many long-term negative health effects compared with patients whose kidneys were not damaged. In the absence of contrast-induced kidney injury, there was no difference in the incidence of long-term negative health effects between patients taking iopamidol or iodixanol.

The day after, I retrieved the CT scan results and my doc was happy to see that my lungs were in fact clear of the infection. Another day, another learning experience.
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FACT OR FICTION: Some More Organ Donation Myths

We have gathered another set of of popular organ donation myths to make up part 2 of our series. If you missed part 1, click here.

Myth #5:

Having "organ donor" noted on your driver's license or carrying a donor card is all that's needed in becoming a donor.

FICTION. To a certain degree this is true. However, during time of death, parents and guardians are often called in. There are occasions where parents, who happen to be against the donor's wishes, end up disallowing the donation.

Myth #6:

There is a black market in the U.S. for organs or tissues

FACT. As much as I don't like to admit it, the presence of a black market in the U.S. for organs and tissues as evidenced by the FBI's recent arrest of a rabbi in New York.

Myth #7:

Patients determined to be brain dead can recover from their injuries

FICTION. Medicine defines brain death as “irreversible unconsciousness with complete loss of brain function,” although the heartbeat may continue. The heart will eventually stop working shortly after brain death.

In this case, there is no recovery and medically, the process cannot be reversed.

Myth #8:

I'm too old to be a donor.

FICTION. There is no age limit when donating an organ. What is important is the state of health that the organs to be donated are in.

Myth #9:

I have poor health. I’m not fit to be a donor.

FICTION. There are very few limitations in being an organ donor. Some of these include having particular infectious diseases. Physicians will make an assessment of your health status and be able to give you a decision as to whether you may be a donor.

Myth #10:

If you agree to donate your organs, your family will be charged for the costs.

FICTION. No expenses will be charged to any organ donor or their families.

There you have it. Hopefully, this will help dispell those misconceptions that are keeping people from saving others' lives. Go out and be a donor!

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Related Problems: Don't Let Them Surprise You

Our kidneys not only function to remove toxins from our bodies through our urine. They do many other things in the background such that when kidney disease strikes, a host of new health problems suddenly pop out of nowhere. Here's a list of related issues of accompanying kidney disease that I and other kidney patients I know experienced.

1. High Blood Pressure

Also known as hypertension, it is one of the most common effects of kidney disease. At times, hypertension may be the cause of the kidney damage. When you have kidney disease, blood pressure goes up as kidney isn't able to produce enough hormones to regulate it.

It is important to keep blood pressure under control because it can cause a host of other new problems like heart disease or stroke. Maintaining a BP of below 130/80 is good, 120/80 would be optimal.

2. Anemia

Anemia occurs when you lack of red blood cells in the body. Having anemia makes you tired all the time. Left untreated, it may harm other organs because there isn't enough blood that flows into these organs.

Anemia happens when the kidney isn't working well and does not release enough erythropoietin or EPO. EPO, along with iron, play significant roles in blood building. As a result, kidney patients often need to be supplemented with EPO injections regularly to prevent anemia.

A complete blood count (CBC) tells you if you suffer from anemia. See our post on the CBC test on how to interpret your CBC result

3. Acidosis

Our kidneys are also in charge of keeping a good acid-base balance in our bodies, partly by regulating the amount of water we retain. A problem that arises when the kidney isn't working properly is acidosis, where too much acid is present in the blood. When our body's pH becomes too acidic, we may experience joint pain, arthritis, weak bones and many other undesirable problems.

4. Bone Problems

We mentioned previously that our kidneys does two things related to bone strength.

a. produce calcitriol
b. balance the calcium and phosphorus levels in our blood

So when kidney function is diminished, calcitriol production decreases, resulting in a lack of the active vitamin D that is needed to keep bones strong. Less kidney function also lessens its ability to regulate the the calcium and phosphorus levels properly.

These 2 things leave bones weak and brittle, causing them to break more easily. So kidney patients are often told to exercise and are given calcium supplements and phosphate binders to help counter these problems.

Don't let these related effects of kidney disease surprise you. Prepare and prevent them.

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FACT OR FICTION: Popular Organ Donation Myths

A recent report by American Medical News mentioned that people willing to become organ donors continues to low because of existing misconceptions.

Only 38% of licensed drivers have joined their states' organ donor registries, with many deterred by long-held misconceptions about how the transplant system works, according to poll results released in April.

The survey of 5,100 American adults, conducted on behalf of the organ-donation advocacy group Donate Life America, found that:

- 50% think that registering as organ donors means physicians will not try as hard to save their lives.
- 44% say there is a black market in the U.S. for organs or tissue.
- 26% believe that patients determined to be brain dead can recover from their injuries.
- 23% who are undecided about donation wrongly worry that age or health conditions would make them unacceptable donors.

So here were are to see if these so called myths are FACT or FICTION.

Myth #1:

If I am an organ donor, my doctor or the emergency room staff won't work as hard to save my life, because they can use my organs to save somebody else.

FICTION. The focus of the medical team will always be on you and saving your life in case of emergency. Organ donation is only considered after brain death is declared. And the doctors who will be handling you will be those who know your medical history or who are in the area of expertise most closely matching your needs.

Myth #2:

People who are rich and famous are given priority. They are placed ahead when comes to receiving an organ.

FICTION. Due to the recent liver transplant by Steve Jobs, there has been speculation that people with money and influence get ahead on the waiting list. This is not the case, the waiting list places priority in the severity of a person's illness and how well the organs that are available match those who are on the list.

In Steve Jobs' case, he was able to find out out that the waiting list for a liver was faster in Tennessee than in other states.

If you want to know how long the the average wait list times for each state click here, then choose the type of report you want to create.

Myth #3:

I'm younger than 18. I'm too young and am not able to make this decision.

FACT. Being below 18 makes it legally true that you are too young to make decisions. In the past, individuals aged below 18, even infants have been donors. All it requires is that parents and/or guardians make the decision for the minor.

Myth #4:

My religion is against organ donation.

FICTION. Most religions agree to organ donation and transplantation. If you are unsure about what your religion's stance is on organ donation, ask an elder within your faith who can clear the issue.

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Anemia!

A couple of hours after I got back from my first dialysis session, a nurse entered the room and with a plastic bag filled with what seemed to be blood. She hooked it up to tall metal stand and proceeded to connect the plastic line from the end of the bag onto a small catheter that was inserted earlier on the top of my hand.

The nurse said that they were giving me a blood transfusion because I had low blood counts. I later learned that my hemoglobin levels, which is an indicator of how much blood was circulating in your body, was below 5.5. Normally it should be above 13.

Blood transfusions are the fastest way to increase your red blood cell count. Well, I'd have to qualify that a bit. By infusing blood into your body, a red blood cell transfusion quickly increments the the red blood cells that are circulating within the body. The result is instant and the RBC count, hemoglobin and hermatocrit levels go up.

The process itself takes a long time. This is because the transfusion is done via an I.V. drip. It generally takes about three to four hours to complete one bag, depending on how fast the drip is set. In most cases more than one bag will be ordered. I was given three.

Because the procedure began late in the afternoon, the transfusion went on throughout the night, and finished at around close to dawn the next morning. Between those times, the nurse would inspect the line at half hour intervals to see if everything was going well. And every three to four hours or so, she'd bring in a new pack filled with blood to replace the one which had been used up.

The good thing however, it isn't too bothersome, aside from tugging a line connected to a pole with wheels. I just dragged the pole where ever I wanted to go.
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Top 50 U.S. Hospitals

U.S. News recently released the list of Top 50 U.S. Hospitals for kidney disorders. Here are the the top 25, you can click on their links to see more on the hospital. You can see the the full list here.

1 Brigham and Women's Hospital, Boston

2 New York-Presbyterian University Hospital of Columbia and Cornell

3 Mayo Clinic, Rochester, Minn.

4 Massachusetts General Hospital, Boston

5 Cleveland Clinic

6 Johns Hopkins Hospital, Baltimore

7 Ronald Reagan UCLA Medical Center, Los Angeles

8 Barnes-Jewish Hospital/Washington University, St. Louis

9 Vanderbilt University Medical Center, Nashville

10 University of California, San Francisco Medical Center

11 Duke University Medical Center, Durham, N.C.

12 UPMC-University of Pittsburgh Medical Center

13 University of Alabama Hospital at Birmingham

14 Hospital of the University of Pennsylvania, Philadelphia

15 University of Colorado Hospital, Aurora

16 University of Washington Medical Center, Seattle

17 University of Chicago Medical Center

18 University of Michigan Hospitals and Health Centers, Ann Arbor

19 Yale-New Haven Hospital, New Haven, Conn.

20 Cedars-Sinai Medical Center, Los Angeles

21 Stanford Hospital and Clinics, Stanford, Calif.

22 University of Minnesota Medical Center-Fairview, Minneapolis

23 University of Texas Southwestern Medical Center, Dallas

24 Beth Israel Deaconess Medical Center, Boston

25 Emory University Hospital, Atlanta

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Kidney Diet: Adjusting to Your Labs

During dialysis, your doctors will be monitoring your blood levels regularly. This is done in order to closely follow any changes that are occurring and quickly make adjustments to your diet to keep you healthy.

I've made a table that lists down the regular tests that dialysis patients have along with what the results mean with regards to dietary adjustments.

click image to enlarge

Hope this will help you understand how to manage you diet better.

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Kidney Diet: What You Can Do

As we've discussed previously, the kidney performs many tasks that keep us in tip-top condition. When kidney disease strikes, the ability of out kidneys to do these functions diminishes. In order to lighten the load on the kidneys, we have to make adjustments to what we eat and how much we eat.

Here are some general steps I was told follow in order to help ease the burden on my kidney when I went on dialysis. I noticed that, though difficult to get used to in the beginning, you get used to it after a while. The one good thing about following these guidelines was they allowed me to feel better overall and enabled me to go about doing what I did before getting sick, like working, playing sports and going out without missing a step.

LIMIT SODIUM

1. Learn to READ LABELS; very important, even after transplant; you want to avoid sodium and monosodium glutamate (MSG) or limit the amount you have.

2. Avoid processed, brined, or cured products.

3. Don't add salt to food, be it in cooking or at the table. Use other means of seasoning like herbs and spices.

WHY? High amounts of sodium cause blood pressure which harms our hearts and kidneys.

LIMIT PROTEIN INTAKE

1. You will be referred to a dietitian or nutritionist to guide you on the different food groups and amount of each you are to have per meal.

2. Your dietary regimen will differ from other kidney patients because each person responds differently to kidney disease and its treatment; don't compare with others.

3. Your diet will probably adjusted to get a daily allowance of 0.6-0.75 grams of protein per kilogram of weight, at least until dialysis, when you'll probably be asked to eat more protein.

4. Learn about the different types of protein. I've always been reminded to prefer fish and chicken over pork, and try to limit red meat as much as possible.

WHY? Too much protein will overwork the kidney and increase its rate of deterioration.

LIMIT POTASSIUM

1. As a guide, keep daily potassium intake to between 1500-2500 mg. You may be
asked to follow a lower daily limit if your kidneys aren't able to clear potassium well.

2. Know which foods are high in potassium; certain fruits like oranges and bananas are high in potassium

3. Choose low potassium foods like cabbage, lettuce, apples and pears.

WHY? High levels of potassium can cause heart attack or irregular heart beat.

LIMIT PHOSPHORUS

1. Keep phosphorus intake to between 800-1200 mg daily.

2. Avoid colas, beer and soft drinks; drinks with high phosphate content.

3. Know how much dairy you are allowed. These products, like milk and cheese, are high in phosphorus.

4. Avoid nuts, seeds, beans, peas and bran.

WHY? Your kidneys cannot remove phosphorus well. High phosphorus levels cause bones to be weak by pulling calcium out of our bones.

LIMIT FLUID INTAKE

1. I was told to limit fluids to 1 liter a day. You may be asked to limit fluid intake to between a liter and 1.4 liters depending on your center and how much urine your are producing.

2. Remember, soups and foods that are liquid at room temperature, like ice cream and gelatin, count as part of total fluid intake.

WHY? Your kidneys aren't able to completely get rid of the excess fluids in your body. Too much fluids will cause swelling and bloating of different parts of your body, not to mention increase the risk of high blood pressure.

By now you've probably noticed that most of it has something to do with limiting intake. This, to a point is true, however, it is very important that there is balance and not to overdo things. For example, if you limit protein too much you get weak, lose weight which will likely lead to more serious problems like susceptibility to infection.

Make sure that you eat enough so that you won't lose weight and have enough energy, which is just as important as limiting the items we just mentioned.

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Kidney Diet: An Overview

Nutrition is very important especially when you are dealing with particular health issues. This is the case for a person with kidney disease. Often, when kidney dysfunction is detected, you will be asked to see a dietitian or nutritionist who will prescribe a kidney diet in order to help preserve the remaining kidney function as well as prevent further deterioration to the kidney's health.

One thing I noticed is that not all kidney diets are created equal. Depending on how much kidney function a person has, the kidney diet, also known as the renal diet, will be structured differently.

During the early stages of kidney disease, the goal will be to lessen the stress on damaged organ. The first items doctors will limit will be sodium (salt) and protein.

Protein consumption, which is mostly from meat, chicken, fish and pork, will be decrease to lessen the amount of work the kidney has to do. Lowering sodium intake, on the other hand, is often necessary to keep blood pressure levels at proper levels. For diabetics, sweets and carbohydrates will also have to be controlled.

If the kidney dysfunction is in the later stages, potassium, phosphorus, calcium and fluid intake will likely be monitored also, as the kidney, in its weakened state, isn't able to regulate these levels well anymore.

The diet changes once again when you begin dialysis. I remember this being one of the most difficult things I ever had to adjust to. Due to the numerous restrictions, I often had to refer to my diet cheat sheet that listed the nutritional values of different foods.

i did in-center hemodialysis three times a week, so my diet was a bit stricter than those who did home dialysis (which is done daily) since the artificial kidney was not at work during non-dialysis days. I remember protein was limited to 5 servings a day (a serving is about the size of a match box), while being told to limit fluids to 1 liter a day. One thing that took some getting used to was removing salt totally from what I ate.

Monitoring potassium and phosphorus intake were probably the hardest part of diet preparation.
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