NATHAN KIDNEY FOUNDATION

KIDNEY KNOWLEDGE SERIES - (16)

2011-02-16T09:16:00.000Z

LIVING WITH KIDNEY FAILURE

Q: What is the healthy eating plan?

· A healthy eating plan will influence how you feel and how well your treatment works.

· What’s important to know, is that there is no standard kidney eating plan. If you are undergoing treatment for early stage kidney failure, your doctor and nutritionist will work together to design a healthy eating plan that’s right for you. This eating plan will be based on the stage of your disease, the cause of your kidney failure and other treatments or medications that you are using.

· The eating plan will focus on balancing proteins, minerals and calories to maintain muscle tissue, blood pressure, bone strength and energy.

Q: What kind of sport and exercise can I engage in?

A: Physical activity will give you the strength, energy and motivation to participate in daily activities, helping to avoid the fatigue that can sometimes result from kidney failure. The benefits of exercise include:

1. Improved strength and fitness

2. Lower blood pressure

3. Better sleep

4. Lowered fat levels in the blood

5. Higher energy levels.

· Your doctor will let you know what is appropriate, particularly if you don’t already participate regularly in physical activity.

Q: What of kidney failure and intimacy?

· Kidney failure and subsequent treatments can adversely affect personal relationships and intimacy by changing how you feel about yourself and sex.

· Emotionally, chemical changes resulting from kidney failure can lower your libido, while stress from dialysis can cause tension in your relationships, creating barriers to intimacy and effective communication. While lowered libido is common among those who experience kidney failure, discussing these issues with your partner will help to maintain a healthy relationship.

Q: How will Kidney failure affect my lifestyle?

A: If you are living with kidney failure, you may need to make some changes to your lifestyle to reduce the risk of further kidney damage.

1. Quitting smoking

2. Limiting alcohol

3. Weight reduction if overweight

4. Strict control of Diabetes and High Blood Pressure if afflicted

5. Use of specific types of blood pressure pills to slow down progression of disease.

Q: How can I travel safely with Kidney Failure?

A: If you are living with kidney failure, travel for whatever purpose does not need to be ruled out. You can still enjoy domestic or international trips with a little extra planning.

o Some smart travel tips are listed below:

· Plan well ahead wherever possible and factor your treatments into your itinerary

· Take enough medication with you to last the whole trip, and some extra in case of a spill or unexpected delay

· Make sure you pack your medication in your own carry-on luggage in case you become separated from your suitcase or travelling companion/s

· Keep in touch with your friends and family and advice them of any changes to your travel plans.

o If you are travelling abroad you should also consider the following:

· Discuss your travel plans with your doctor at least six weeks before departure to determine any vaccines you may need and how these could affect your treatment

· Check that your medications are legal in the countries that you are visiting by contacting the country’s embassy or high commission

· Carry a letter from your doctor detailing what your medication is, how much you’ll be taking and stating that it is for your own personal use

· Keep all of your medication in their original packaging so they are clearly labeled with your name and dosage instructions.

Q: How can I stay informed about kidney failure?

· Being pro-active and keeping up-to-date with the latest information on kidney failure will help you to better understand your condition and treatment options.

· Visiting your doctor regularly and reading relevant information will keep you one step ahead in the health and wellbeing stakes and help prevent further kidney damage.

KIDNEY KNOWLEDGE SERIES - (15)

2011-02-10T10:45:00.000Z

Complications of Kidney Transplants (Contd)

Q: What are the common complications after kidney transplant? (contd)

1. Diabetes

Diabetes is an increased level of sugar in the blood and it may be caused by some of the anti-rejection medication. A patient should notify his transplant team or doctor if he experiences any of the following symptoms: increased thirst, increased frequency of urination, blurred vision, and confusion. Blood sugar can be reduced through weight loss, careful diet, and exercise. An oral diabetes drug or insulin injections may be necessary.

2. Cancer - Transplant patients have a slightly higher risk of cancer than the general population. Skin cancers are the most common, but can be decreased by wearing sunscreen. Also breast and cervical cancers in women. After transplant it is very important to have routine cancer screening because early detection greatly improves the chance of cure.

3. Imbalances in electrolytes including calcium and phosphate which can lead to bone problems amongst other things.

4. Other side effects of medications include:

a. Gastrointestinal inflammation and ulceration of the stomach and esophagus

b. Hirsutism (excessive hair growth in a male-pattern distribution)

c. Hair loss

d. Obesity

e. Acne

f. Hypercholesterolemia and others.

Q: Which patients are likely to have complications?

A: There is no way to predict accurately which patients will have problems. The transplant team will do their best to reduce the likelihood of complications and to treat them promptly if they occur. Following instructions carefully and keeping the transplant team informed of any difficulties will help a patient return quickly to a normal, active life.

Q: When should a patient notify the transplant team?

A: A patient should notify the transplant team if he:

· Has prolonged illness (nausea, vomiting and diarrhea).

· Is unable to take medicines by mouth due to illness.

· Thinks the directions on the label may be different from what he was told.

· Has a reason to take aspirin, paracetamol, other pain relievers, or cold remedies.

· Feels he is having a reaction to the medications.

· Has had a change in health or eating habits.

· Has a new prescription from his local doctor or a change in a current prescription.

· Is undergoing dental work of any kind.

Q: How does the recipient take care of the kidney after transplant?

A: The transplant team teaches the recipient the important things to know about taking care of the kidney. It is very important that the recipient take the immunosuppressive medications that are prescribed, and continue with follow-up appointments so that complications can be detected and corrected early.

Q: How much do anti-rejection medications cost?

A: Some of the immunosuppressive (anti-rejection) medications are expensive. For now, in Nigeria, recipients have to buy their own drugs which on average cost N150, 000 monthly, for the first year. This reduces subsequently as drug dosages are reduced.

KIDNEY KNOWLEDGE SERIES - (14)

2011-02-04T10:30:00.000Z

Complications of Kidney Transplants

Q: Why should one have a kidney transplant?

A: With improved surgical techniques and better anti-rejection drugs, renal transplantation has become the treatment of choice for end-stage renal disease (ESRD). It offers a much better quality and quantity of life, compared to dialysis.There is also substantial cost savings on treatment cost over a long time.

Q: What are the complications of kidney transplant?

· Although a transplant is an excellent treatment for most people with kidney failure, transplantation is not problem-free.

· Most of the complications are mainly due to three factors.

o First, many people having a transplant have health problems in addition to kidney failure. These can include diabetes, high blood pressure, heart disease, or other complications of kidney failure and dialysis.

o Secondly, the body recognizes a transplanted kidney as an invader or foreign body, in the same way it would recognize a germ. This means that the body will try to destroy the transplant, and this is what is called rejection.

o Thirdly,the long term use of anti-rejection drugs may result in some side effects and increase susceptibility to some infections. The incidence of certain types of Cancers is also higher after prolonged use, compared to the general population.

Q: What are the common complications after kidney transplant?

A: Several complications can occur after transplant. The most common complications are:

1. Rejection -This happens when your body's immune system thinks your new organ is "foreign" and attempts to destroy it. The patient requires anti-rejection medications for life, to prevent rejection.

There are several types of rejection:

Hyperacute rejection - happens when the body immediately destroys the new kidney, this is rare because of the crossmatch testing used before transplant.

Acute rejection - although this can happen at any time after the transplant, most often it happens during the first several months. This can be treated by giving the patient higher doses of medication by mouth or by intravenous infusion.

Chronic rejection - this may happen months or years after the transplant. This type of rejection is resistant to treatment with current medications. This will cause your new organ to slowly stop working.

2. Infection - The drugs taken to prevent rejection can decrease the ability to fight infections. Infections in a transplant patient can be serious and even life threatening and can be viral, bacterial or fungal. It is very important to seek help if symptoms of an infection develop.

3. Acute tubular necrosis (ATN, or delayed graft function) - The new kidney may not start to function immediately. Some kidney recipients need to continue to dialyze for a week or two. During the time the recipient remains on dialysis, a kidney biopsy may be performed to ascertain the exact cause of poor kidney function.

4. Hypertension (high blood pressure) - High blood pressure after transplant is very common. Most patients' blood pressures can be controlled with multiple anti-hypertensive medications. Controlling weight, limiting salt in the diet and exercising will also help.

KIDNEY KNOWLEDGE SERIES - (13)

2011-01-24T11:21:00.000Z

DECEASED DONORS (CONTD)

Q: How can one get permission from the donor family?

A: Abroad, permission is sought via:

1. The donor putting his/her name on the national organ donor register; then their wishes have priority after death.

2. If someone is not on the organ donor register, then the wishes of the family determine whether organs are donated.

This means that deceased donor kidney donation is a gift, even though it may come from tragic circumstances

Q: Is there a difference between living donors and deceased donors?

· Unlike living donation where the kidney comes directly from the donor to the recipient, kidneys from deceased donors are often injured by the death and preservation processes, so a delay in kidney function may occur.

· Occasionally, dialysis is continued until the deceased donor kidney begins to function. When dialysis is needed, deceased donor kidneys may take up to two weeks to begin functioning.

· With living donation, delay in kidney function is uncommon and function may be restored almost immediately.

Q: How good is deceased donation?

A: All kidneys from deceased donors are not the same. In fact, how well a kidney transplant works depends on both the donor and the recipient. Most deceased donors—of any kind—have less than perfect kidneys. This is what can affect the quality of kidneys from deceased donors:

1. The donor's age

2. Cause of death

3. Any event that happened when the kidney was removed, such as low blood pressure or clotting in the blood

4. Not knowing the exact condition of each deceased donor kidney; this is mainly because short-term problems can make the kidney work poorly for a while. However, after a few months, some kidneys from deceased donors are found to work better after the transplant.

5. How long the kidney has been kept out of a body in cold solution, after it has been removed from the deceased donor. This time is more of a risk when it is in the range of 18 or more hours. It happens more often when a kidney is sent from one region of the country to another because it is a good match.

Q: What are the risks involved in deceased donor kidneys?

· There are a number of risks in choosing a deceased donor kidney for transplant in today's world.

· Some kidneys that seem to work well may not, some that are not used for a transplant may have worked well. It may be hard to be sure of the quality of many deceased donor kidneys.

· Yet these kidneys cannot simply be thrown away just because questions arise. Many working kidneys would be lost.

Q: Can one be harmed by a kidney transplant from a deceased donor?

A: Deceased donors and their kidneys are tested carefully.

· First, doctors look at the condition that has caused brain death. Some deceased donors have other medical conditions or diseases. Family members are asked about the life style of the donor. Deceased donors are tested for syphilis, hepatitis B and C, HIV, AIDS, and other viral infections.

· Some good donors may have infections caused by bacteria. This does not rule out taking the kidneys. But the transplant patients must be treated for these infections at the time of transplant.

· Even with all the testing, there is always a risk that a disease from the kidney may be given to the transplant patient. This risk is much less than 1 in 100.

Q: What are the barriers to deceased donations?

A: Despite its vast potential, deceased donation in Nigeria may not be successful unless the following major barriers are removed:

1. Inadequate public awareness

2. Attitude of the medical community

3. Frequently held misconceptions about religious guidelines

4. Different conceptions of brain death

5. Absence of legislation on deceased donation

Q: What are the opportunities for deceased donation in Nigeria?

A: We need legislative, religious backing and nationwide education on deceased donation of organs. It will serve as another alternate source of organs for donation. This promotes the growth of transplantation activities in the country, reduces, and eventually eliminates commercialization of organ donation which is ethically and morally wrong.

KIDNEY KNOWLEDGE SERIES - (12)

2011-01-21T14:08:00.000Z

DECEASED DONORS

Q: Who is a deceased donor?

A: This is an individual whose tissues or organs are donated after his or her death.

Q: What types of diseased donors are there?

A: Donations come from two sources:

1. Patients who have suffered brain death. They are also known as heart beating donors or donor after brain death.

2. Patients whose hearts have irreversibly stopped beating i.e. cardiac death. They are also known as non heart beating donors or donor after cardiac death.

Q: Who are heart beating donors?

· These are donations from people who have suffered an injury such as a fall, motor vehicle accident or a stroke.

· The determination of irreversibility, as well as the determination that all brain function is not present, is only made after repeated, confirmatory testing over a prolonged period of time.

· Only then are the organs from a deceased donor retrieved by a surgical team.

Q: Who are non-heart beating donors?

· These are transplant kidneys from people whose hearts have stopped beating. These donors – called non-heart-beating donors – are people who have died very suddenly, usually from a heart attack.

· Their hearts have stopped beating and they are brain dead. They have not been put on a life-support machine.

· Kidneys from non-heart-beating donors often do not work immediately after transplantation and are not quite as good as those from heart-beating donors. However, advanced technology of organ perfusion and preservation has resulted in improved outcome.

Q: Can the kidneys or any other organs just be removed from the deceased?

A: No. Any organ for transplant has to be removed with the permission of the donor’s family.

Q: What are the events that lead to being a deceased donor?

1. The kidneys can only be removed after the patients have been diagnosed ‘brain dead’. This means that the part of the brain called the brainstem, which controls breathing, has stopped working permanently and patient is only being supported on a life support machine.

2. When the brainstem is dead, there is a permanent loss of consciousness and all feelings.

3. If the donor is on a ventilator (life support) machine, they are taken to theatre for donation while the ventilator is working and their heart is beating. For this reason, these donors are sometimes called heart-beating donors. Even though the heart is still beating, they would not breathe if they were not on a life support machine. Their brain is dead, and they have no chance of recovery, and indeed they have already been certified as legally dead by doctors from the intensive care unit.

4. Although brain-dead (or "heart-beating") donors are considered dead, the donor's heart continues to pump and maintain the circulation. This makes it possible for surgeons to start operating while the organs are still being perfused.

5. Treatment is discontinued (mechanical ventilation is shut off) then a time of death is pronounced. The patient is then rushed to the operating room where the organs are recovered. Storage solution is flushed through the organs. Since the blood is no longer being circulated, coagulation must be prevented with large amounts of anti-coagulation agents such as heparin.

6. Several ethical and procedural guidelines must be followed; most importantly, the organ recovery team should not participate in the patient's care in any manner until after death has been declared.

Q: Is diseased donation available in Nigeria?

A: No. In Nigeria, the main sources of donors are living and are genetically or emotionally related and altruistic in nature. Deceased donors are the main source of kidney donors in UK and America

KIDNEY KNOWLEDGE SERIES - (11)

2011-01-17T09:36:00.000Z

LIVE KIDNEY DONATION (Contd)

Q: Will I have a normal life after surgery?

A: We expect most patients to return to a normal life within two to three months after surgery, provided there are no serious complications.

Q: How long will it take to recover?

A: Recovery time will depend in part on whether your kidney is removed by an open incision, which involves a larger incision and longer recovery time of about eight weeks, or by laparoscope, which involves several small incisions and a shorter recovery of about four weeks.

Q: What should I expect during recovery at home?

A: When you return home, your activities will be limited. However, donors are encouraged to be active in between their periods of rest. Walking is considered excellent exercise during this time. You may also have some swelling around the incision area and should plan to wear loose, comfortable clothes.

Q: What are the health risks associated with being a donor?

· The risks of donation are similar to those involved with any major surgery, such as bleeding and infection.

· Death resulting from kidney donation is extremely rare.

· Current research indicates that kidney donation does not change life expectancy or increase a person’s risks of developing kidney disease or other health problems.

Q: Will giving a kidney 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 surgery, a donor can work, drive, exercise and participate in sports, though contact sports are not recommended.

· A donor can continue in all types of occupations, including military duty.

· Also, being a donor does not impact a person’s ability to have a child.

Q: What kind of follow-up is needed?

· You will have a post-operative appointment with your surgeon 1-2 weeks after the surgery.

· After donation, it is recommended that routine annual check-ups are completed with either your primary care physician or the transplant center.

Q: What emotions do donors feel after the surgery?

· Most living donors say they feel great satisfaction with the donation experience because they have helped to improve another person’s quality of life.

· Even in rare instances where the transplant is not successful, many donors say they feel positive about their decision because they did their very best to help a relative or friend.

· However, there is a small chance for donors to experience some negative or mixed feelings after the donation. These feelings have been more likely to occur in cases where the outcome of the surgery did not meet the expectations of the donor and/or recipient as well as in cases where the donor was unsure of his or her decision.

Q: When can I resume normal activities?

· The goal is to be back to normal health within two to three months.

· Walking is very important to your recovery. Each day, you should push yourself a little bit more. By walking as soon after your surgery as possible, you will help prevent such complications as blood clots, pneumonia and muscle wasting.

· If you are feeling well and not having complications, you may begin to return to your normal exercise activities. Begin slowly and build up your strength and stamina. You will need to avoid any heavy lifting for the first four weeks until your abdomen has completely healed.

Q: Who pays for the medical costs of the donor?

A: In Nigeria, this is usually borne by the family members of the recipient and usually includes testing required for the living donor evaluation as well as the hospitalization costs and physician services provided during the donation process.

Q: Is kidney transplant covered by the NHIS?

A: For now, the NHIS does not cover transplant or dialysis.

KIDNEY KNOWLEDGE SERIES - (10)

2011-01-13T08:28:00.000Z

LIVE KIDNEY DONATION (Contd)

Q: Do some donors have trouble making the decision to donate?

· The decision to donate can vary from person to person. Some people make the decision instantly with few worries or concerns.

· Other people go through some soul-searching and will talk with close friends or family before deciding whether or not to donate.

· It is normal for some people to be afraid of donating a kidney as well as to experience guilt about not wanting to be a donor.

· Individuals should not, under any circumstances, feel pressured to donate.

· The only “right” decision is the one that makes the donor feel comfortable.

· Potential donors are encouraged to speak with the transplant team if they have any questions or concerns about their decision.

· It is a safe procedure with minimal acceptable risk.

Q: What does the donor evaluation involve?

· The purpose of the evaluation is to make sure your kidneys are normal and that you don't have any medical or psychiatric illness that would make this procedure risky or difficult.

· It makes sure you don't have any medical conditions that could be transmitted to the recipient and to confirm that you're donating voluntarily, without pressure.

· Tests are comprehensive including blood, urine etc. chest x-ray and an angiogram to outline kidney blood supply.

· Once all results from the entire evaluation process are available, they will be reviewed by a multidisciplinary committee who decides whether you are able to safely proceed with the donation.

Q: When will I be told if I can be a donor?

A: Generally, you should know within two weeks of completing the evaluation. The decision to donate your kidney is not one to make lightly. Consider it carefully and discuss it with your family and significant others.

Q: If I am approved to be a donor, when will the transplant take place?

· This decision is made jointly by the transplant team, you and the recipient.

· The transplant team — particularly the doctors involved in the recipient's care — will determine the best time for the transplant, based on the recipient's medical condition.

· Unfortunately, a number of factors could affect the plans. For example, the recipient's condition might deteriorate so that he or she is too sick for a transplant. Or, the recipient or donor might develop an infection or other condition that must be treated before a transplant.

Q: How should I prepare for the surgery?

A: The medical evaluation of potential living donors is extremely thorough. Once your evaluation is complete and the transplant team decides to proceed, there is not much additional testing to be done.

Q: How is my kidney removed?

The kidney is removed one of two ways

1. An open incision on the side of the abdomen or

2. Several small incisions with the aid of a scope and camera, called a laparoscope.

The laparoscopic approach has advantages of; less pain, lower complication rate, shorter hospital stay, shorter recovery and return to normal activities. The small incision scars are also cosmetically more acceptable. However it requires additional surgical skills and expertise with appropriate high-tecnology tools.

Q: Will I require a blood transfusion?

A: Blood transfusion during this surgery is uncommon. As a precaution, you may be asked to "donate" one or two units of your own blood before the surgery, we use your own blood so you're not exposed to possible risks of a transfusion from someone else. Blood may also be obtained from the general blood bank if required.

Q: How long will I be in the hospital?

A: The average hospital stay for donors is five to seven days after surgery.

Q: Will I have a scar?

A: In most cases, the incision heals quickly; leaving a scar that fades over time but will always be visible.

Q: Will I have pain after the surgery?

A: Unfortunately, you may have significant pain after this surgery. Pain medication will be given but you will still be very uncomfortable for at least the first week. You will begin to have less pain as each day goes by, but most donors say they have significant discomfort for one to two weeks after surgery.

KIDNEY KNOWLEDGE SERIES - (9)

2011-01-10T09:14:00.000Z

LIVE KIDNEY DONATION

Q: Who can be a kidney donor?

A: Any individual:

· age 18 to 70 years

· Including parents, children, siblings, other relatives, and friends.

· With normal kidney function and anatomy, as determined in the evaluation process

· With a genuine interest in donating and a compatible blood type with the recipient.

Q: What are the requirements to become a living donor?

· Donors should be in good general health.

· Basically, you should not have any major medical or psychiatric illness.

· You must not be pregnant; you should not be overweight, although you may still be a potential donor if you lose weight.

· If you smoke, you must quit for six weeks prior to surgery

· You also must understand the risks of this surgery and comply with instructions for follow-up medical care.

Q: Must the donor be related to the recipient?

A: The three groups of potential living donors include; genetical, emotional (e.g friend) and legal (e.g spouse). And in all cases the intent must be altruistic with no commercial activity. The cases that are not first degree relatives will be subjected to interviews by an independent body and also obtain court affidavit to defend altruistic motive.

Q: What risks are associated with kidney donation?

· Although some risks are associated with any major operation, donating one kidney does not pose a major risk to a healthy donor.

· Studies show that the remaining kidney will continue function normally and will compensate for the loss of the other kidney.

· Kidney donation should not restrict or interfere with your lifestyle after full recovery from the surgery.

· There is no routine need for any special diet or medication after donation.

Q: Am I at greater risk of developing kidney failure if I donate my kidney?

A: You are at no greater risk of developing kidney failure after donating than anyone in the general population.

Q: Will donating a kidney shorten my lifespan?

A: 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.

Q: Will I have to change my lifestyle after donating?

A: No. You should lead a normal healthy life as before.

Q: Will donating my kidney affect a future pregnancy or fathering a child?

A: The data available shows that, having donated one kidney, there is no evidence to suggest an increased risk of complications during pregnancy, but you should be under the care of an obstetrician. A man’s fertility will not be affected.

Q: Will the transplant be successful?

A: There is no guarantee that any kidney transplant will work. However, living kidney transplantation is overwhelmingly successful with 90-95% of live donated kidneys working well at one year.

Q: What is the first step to becoming a living donor?

A: Discuss the donation process with the transplant team; they will answer any questions so that you can make an informed decision about proceeding with donor evaluation.

Q: Will I be paid for donating my kidney?

A: The act of giving a kidney is altruistic and unconditional. There should be no payment for doing this. The satisfaction of saving the life of a loved one is the ultimate reward.

Q: What are the first steps of the donor evaluation?

· Know your blood type. You must be either the same blood type as the recipient or blood type "O."

· Your Rh factor — positive (+) or negative (-) — does not affect your ability to donate as it is not important in kidney matching.

KIDNEY KNOWLEDGE SERIES - (8)

2011-01-06T10:41:00.000Z

KIDNEY TRANSPLANT (Contd)

Q: How long is the recovery period for the recipient after transplant?

A: The initial recovery time after the surgery is four to eight weeks. However, receiving a transplant carries a long-term commitment to ensure that the kidney continues to function. The recipient must be diligent in following the transplant team’s plan of post-operative care or the transplanted kidney may be rejected or lost due to other complications.

Q: Why does the recipient need to be on medications after the transplant?

A: Anti-rejection medications are designed to suppress, or disable, a person’s immune system so that the transplanted organ will not be rejected

Q: Will I be on medications for a long time after the transplant?

A: Transplant patients generally start out with six to eight medications in addition to their anti-rejection medications.

· By six months, they generally take two to three per day.

· Eventually, patients are required to take their anti-rejection medication for the rest of their life.

Q: What are the side effects of the medications?

· Side effects vary from minimal and tolerable to more severe.

· Side effects are discussed with the recipient before and after transplant.

· Dosages and side effects are closely monitored by the transplant team and adjusted accordingly

Q: What kind of care and testing can the patient expect after being released from the hospital?

· A patient's blood test and other lab results are monitored very closely in the months immediately after transplant.

· Patients must return to the clinic for routine follow-up, this is very important.

· The frequency of the follow-up appointments decreases as a patient gets farther away from transplant.

Q: How long can patients live with a kidney transplant?

A: The donor kidney lasts up to 10 to 12 years on average for Deceased kidney source, but 18 to 22 years for live donor source. However, the longest surviving transplanted kidney is about 45 years and this was performed between identical twins.

Q: What happens if the new kidney is rejected?

A: If the transplant fails the patient can be put on dialysis again until a new donor kidney is found.

Q: What are Some Possible Post-transplant complications?

1. Infections

2. Delayed kidney function

3. High blood pressure

4. Weight gain

5. Rejection

6. Cancer

Q: What is Rejection?

· Rejection is one of the most important concerns for renal transplant recipients.

· Your body's immune system protects you from infection by recognizing certain foreign bodies, like bacteria and viruses, and destroying them.

· Unfortunately, the immune system sees your new kidney as a foreign substance also.

· It could be acute or chronic and despite efforts to prevent it, it may still occur.

· Generally, rejection is treatable with medication and usually does not lead to loss of the kidney. Occasionally it does not respond to first line medication and there is need for second line medication. And very rarely the second line treatment fails and the transplanted kidney becomes irreversibly damaged and has to be removed.

KIDNEY KNOWLEDGE SERIES - (7)

2011-01-04T08:18:00.000Z

KIDNEY TRANSPLANT (Contd)

Q: What are the risks of having a kidney transplant?

A: The risks and possible complications of transplant are similar to those associated with any surgical procedure plus other unique problems perculiar to transplantation. Some of the possible complications include ;

· Infection

· Side effects of antirejection drugs

· Acute rejection

· Lymphocoele ( collection of lymphatic fluid near the new kidney )

· Persistent hypertension

· Post transplant diabetes

· Post transplant cancer

These conditions can be identified by appropriate investigations and treated accordingly.

Q: Do I need to find my own donor?

A: Yes. Patients are encouraged to look for potential donors from among family usually first degree. If this is not possible, then friends can be considered but the donation must be altruistically motivated.

Q: Does my donor have to be a blood relative?

No. A living kidney donor may be a relative or a person who is not related to the recipient. In the case of a non-relative, it is best if the donor has an emotional relationship with the recipient.

Q: How long do I have to find a 'donor' kidney?

A: There is no time limit to finding a kidney transplant donor.

Q: How do you determine if someone's kidney will be a match?

A: Donors and recipients are matched based on their blood type and whether the recipient has antibodies that would react with and damage the donor's kidney.

Q: What Does "Tissue Typing" Mean?

A: For your new kidney to work properly, you and the donor's kidney must be "compatible." To determine compatibility, three tests are done:

· ABO (blood type) Compatibility

· Crossmatch Compatibility

· Human Leukocyte Antigens (HLA) Tissue Typing

Q: What Happens During the Transplant Evaluation?

· The transplant evaluation consists of a review of your medical records and a complete physical by the transplant team.

· You will have a chest X-ray and ECG.

· Blood work will be drawn for routine studies and infectious disease testing.

· You will be given information concerning the transplant process, and have an opportunity to ask questions.

· You are encouraged to learn as much as possible about transplantation before making a decision about having a kidney transplant.

· The members of the transplant team will explain the benefits and risks of transplantation.

· After your evaluation, members of the transplant team will meet to review your case.

· They will decide as a group if further testing is necessary before any decision regarding transplantation can be reached.

Q: How much does a transplant cost?

A: Again, this will vary from person to person but on average it costs between three million and five million Naira (N3, 000, 000 – N5, 000,000) in Nigeria

Q: Can I live normally with only one kidney?

A: Yes. Some people can be born with only one kidney and live a normal life.

Q: Is there anything I can do to better prepare my body for a kidney transplant?

A: To prepare yourself for a kidney transplant, you should try and be in the best possible general health. This includes an ideal body weight, watching your diet and exercising if possible.

Q: How long will the recipient be in the hospital?

A: The average hospital stay for transplant recipients is about two weeks. However, this can vary considerably from 10 days to three weeks, depending on many factors.

KIDNEY KNOWLEDGE SERIES - (6)

2010-12-17T08:53:00.000Z

KIDNEY TRANSPLANT

Q: I have been diagnosed with end stage renal disease. Is there any other treatment besides a kidney transplant?

A: Dialysis and transplant are the only two treatments available for end stage renal disease (ESRD)

Q: What is the purpose of kidney transplantation?

Kidney transplantation surgically places a healthy kidney from another person into your body. The donated kidney does enough of the work that your two failed kidneys used to do to keep you healthy and symptom free.

Q: Who is a candidate for kidney transplantation?

A: It is the treatment of choice for people with kidney failure who have been evaluated by the renal transplant team and found to be eligible for the procedure

Q: What is a perfect match kidney?

· Usually, a perfect match is between identical twins, a brother or sister.

· The chance of getting a perfect match from a living-related brother or sister is higher than from other related or non-related living donors.

Q: Is a kidney transplant a good option?

A: Dialysis can be done for as long as it takes to find a kidney donor but the best long-term option is a successful transplant.

Q: Who donates kidneys for transplantation?

A: The sources for kidney transplants include;

1. A living donor

2. Non-living donor ( Deceased donor ) after brain death

3. Non-living donor ( Deceased donor ) after cardiac death

Patients who have had kidneys donated from living donors usually enjoy higher success rates than those who receive organs from non-living donors, since there is less chance for rejection.

Q: Are there age restrictions for kidney transplant recipients?

· There are no strict age restrictions for kidney transplantation

· However, patients over 65 years must be in relatively good health other than the kidney disease for which they are undergoing a transplant.

Q: How will a patient know if he is eligible for a transplant?

A: There are several considerations that determine if and when a patient is eligible for a kidney transplant.

· Typically they will be transplanted when their function is close to 10% of normal.

· Prospective transplant recipients undergo a medical evaluation, to determine whether they can successfully tolerate the surgery and the concomitant immunosuppression.

· Generally, transplantation will not be considered in a patient whose underlying medical condition includes an ongoing infection, uncontrolled malignancy or an expected survival of less than five years.

Q: How long after I am diagnosed with Kidney Failure should I have a transplant?

A: There is no time limit to having a kidney transplant, some people stay on haemodialysis till the end of their lives. But if you are going to have a transplant, the earlier it is done, the better your quality of life.

KIDNEY KNOWLEDGE SERIES - (5)

2010-12-13T08:53:00.001Z

DIALYSIS (Part 2)

Q: When and why is dialysis given?

A: When end-stage kidney failure occurs, treatment is necessary to replace the function of the kidneys. Dialysis is a life-saving option until a suitable organ donor is found, but it is not a cure for end-stage kidney failure.

Q: Who can I talk to in order to learn more about dialysis treatments?

A: There are a number of people you can talk to but the most important person is your doctor or a nephrologist (a Physician who is a Specialist in kidneys). Others are the renal care team and even other people with renal failure.

Q: Where is the closest dialysis centre?

A: There are a number dialysis centres across Nigeria, especially in the urban areas. Your doctor can advise you of the nearest centre and how to access it.

Q: Can I change to a different form of treatment once I’ve started dialysis?

A: Yes. It is quite common for people to change treatments as their health and lifestyle needs change. You may have several methods of dialysis treatment throughout your life.

Q: Should I change my diet when I start dialysis?

A: Yes. All forms of dialysis restrict diet to some extent.

· Some treatment options like Haemodialysis (HD) have more restrictions than others.

· Peritoneal dialysis (PD) lets you have more protein, fluids and potassium in your diet.

· Your renal care team will advise you on changes to your diet plans and eating habits while on dialysis. You should also discuss these changes with a dietician if you have access to one.

Q: What is the diet for patients on Haemodialysis?

A: Hemodialysis and a proper diet help reduce the wastes that build up in your blood. A dietitian is usually available at dialysis centers to help you plan meals according to your doctor’s orders.

Q: What is the diet for patients on peritoneal dialysis?

A: A peritoneal dialysis diet is slightly different from that of a haemodialysis diet but this form of dialysis is not readily available in Nigeria presently.

Q: Will I be able to continue my normal activities once I start dialysis?

A: Working, driving and normal housework activities are typically not restricted on dialysis. Your level of freedom and flexibility will depend on the treatment you chose, whether it is a fixed schedule of HD, or PD.

Q: Is it dangerous to skip dialysis?

A: Yes, this can lead to fluid overload and accumulation of waste products in the body. It can also lead to breathing problems due to a serious condition called pulmonary edema where fluid gets accumulated in the lungs.

Q: What is the cost of dialysis?

A: A session of haemodialysis costs on average N25,000 (Twenty Five Thousand Naira). For it to be effective, a patient should have 3 sessions per week.

Q: What are the possible complications of haemodialysis?

1. Infection

2. Poor blood flow

3. Muscle cramps and

4. Hypotension—a sudden drop in blood pressure

You can avoid many side effects if you follow a proper diet, limit your liquid intake, and take your medicines as directed.

Q: What are the possible complications of peritoneal dialysis?

· The most common problem with peritoneal dialysis is peritonitis, a serious abdominal infection. It requires antibiotic treatment by your doctor.

KIDNEY KNOWLEDGE SERIES - (4)

2010-12-09T09:33:00.000Z

DIALYSIS (Part 1)

Q: What is dialysis?

A: Dialysis is a method of removing waste products and excess fluids from your body after your kidneys have failed. Kidney dialysis is an artificial process that performs the two main functions of the kidneys:

1. Filtering waste from the blood; and

2. Balancing the body’s fluid levels.

Q: What are the types of dialysis available?

A: There are two types of dialysis:

1. Peritoneal dialysis (PD) and

2. Haemodialysis (HD)

Q: What is Haemodialysis (HD)?

A: Haemodialysis (HD) is a machine-assisted blood filtration method which removes waste and excess fluid from your blood in a dialyser (or artificial kidney) outside your body. It usually requires a doctor to surgically insert a short term tube into the femoral vein; or long term tube (dialysis catheter) into your blood stream via a vein in your neck or chest wall. A more permanent procedure involves a surgical procedure connecting the forearm vein to the artery. This is called a fistula and it takes about six weeks for it to mature and be ready for use. These access procedures allow blood to be diverted from your body, through the dialyser and back into your blood stream.

Q: What is peritoneal dialysis (PD)?

A: Peritoneal dialysis (PD) uses the peritoneum, a natural membrane lining the cavity of your abdomen. The membrane has tiny holes that allow waste products and fluid to filter from your blood. The process of waste removal, as in haemodialysis, is called diffusion. The removal of excess water, osmosis, is aided by another substance within the dialysis fluid, usually glucose.

Q: How many types of peritoneal dialysis are there?

A: There are two types of PD:

1. Continuous ambulatory peritoneal dialysis (CAPD)

2. Automated peritoneal dialysis (APD).

Intermittent peritoneal dialysis can be done in emergencies and for the short-term pending insertion of more permanent Tenchkoff catheters.

PD allows one to be relatively independent and manage your own care at home. For now, it is not widely available in Nigeria.

Q: How does dialysis filter waste from the blood?

· During dialysis, waste and excess water pass from the blood into a liquid called dialysate for removal from the body by a process called diffusion.

· A thin layer of natural tissue (in peritoneal dialysis) or of synthetic plastic (in haemodialysis), known as the dialysis membrane, keeps the blood separate from the dialysis fluid.

· Blood cells are too large to pass through the dialysis membrane, though waste and water can diffuse into the dialysis fluid.

· Wastes are then removed from the body by extracting the dialysis fluid.

Q: How does dialysis balance the body’s fluid levels?

· In both Haemodialysis and Peritoneal dialysis, a process called ultrafiltration removes excess fluid.

· In haemodialysis, the fluid is simply drawn from the blood by the dialysis machine. The amount of water to be removed can be varied by changing the dialyser’s settings.

· In peritoneal dialysis a substance (most commonly glucose) is added to the blood to draw water out in a process called osmosis.

· Peritoneal dialysis solution containing a lot of glucose will draw out more fluid than a weaker solution.

Q: Will dialysis cure me?

· Hemodialysis and peritoneal dialysis are treatments that help replace the work your kidneys did.

· These treatments help you feel better and live longer, but they don’t cure kidney failure.

Q: How long can I be on dialysis?

A: You can be on dialysis for as long as it takes to get a kidney transplant or for the rest of your life.

KIDNEY KNOWLEDGE SERIES - (3)

2010-12-06T09:51:00.000Z

KIDNEY FAILURE (Part 2)

Q: Can I die from kidney failure?

A: In the long run, if there is no treatment with either dialysis or a transplant, kidney failure is fatal. This is due to the buildup of waste products, accumulation of fluid in the body and affectation of its other functions.

Q: How is kidney failure treated?

A: When the kidney failure becomes severe (usually less than 10 to 15% of the normal kidney functions), it is called end-stage-renal disease (ESRD) and treatments that replace the work of healthy kidneys must be started; this includes Dialysis and Transplantation.

Q: What can I do to reduce damage to my kidney?

· Keep fit with regular exercise to help blood pressure and weight control.

· Eat healthy and maintain a good body weight – which reduces blood pressure stress of being overweight and diabetes mellitus.

· Keep regular control of your blood sugar level

· Monitor your blood pressure

· Moderate alcohol consumption

· Do not smoke

· Do not take over-the-counter-pills on a regular basis

· Do not use bleaching creams and/or soaps

· Avoid herbal preparations

· Drinking adequate quantities ( 2 to 3 Litres ) of water daily

· See your doctor immediately you notice anything unusual

Q: What is end-stage renal disease?

A: Also called end-stage renal failure, it is the point at which the kidneys cannot sustain life any more.

Q: What are the treatments for End-Stage-Renal Disease (ESRD)?

A: When the kidneys fail completely, 2 options are available to sustain life: dialysis or transplantation.

Q: Can kidney failure be cured?

A: Acute renal failure is a serious condition but it may resolve in time and sometimes within days with haemodialysis. Recovery also depends on the underlying cause and the treatment given.

Chronic renal failure cannot be cured. Renal replacement therapies of dialysis can only perform 5% of the kidney’s function, while transplantation has to be sustained by a lifetime of medication.

Q: What are the complications associated with kidney failure?

A: When kidney function drops below 20 per cent of normal function, toxic waste and excess fluid begin to accumulate in the blood. Kidney failure may be responsible for various complications including:

· Fluid retention in the body’s tissue causing swelling known as oedema

· Fluid in the lungs known as “pulmonary oedema”

· Anaemia i.e. a lowered count of red blood cells

· Calcium shortage leading to the bones becoming weak

· End-stage renal failure (ESRF) also known as end stage renal disease (ESRD)

Early detection and appropriate treatment may slow or stop the progression of kidney failure and its complications.

Q: What are the risk factors of kidney failure?

A: Those most at risk of chronic kidney failure include people who:

· have diabetes

· have high blood pressure

· are obese

· are over 50 years old

· use traditional medication frequently

· use bleaching creams/soaps

· smoke cigarettes

· have a family history of kidney disease

Q: Does kidney failure run in families?

A: Although it is unusual, some forms of chronic renal failure run in families. Inherited disease like polycystic kidney disease can lead to chronic renal failure.

Q: Will kidney failure affect my sexuality and fertility?

A: Decreased libido can occur and loss of fertility during renal failure and dialysis can be distressful to patients. It is often restored after a kidney transplant and many patients have successful pregnancies.

KIDNEY KNOWLEDGE SERIES - (2)

2010-12-02T08:27:00.000Z

KIDNEY FAILURE (Part 1)

Q: What are the kidneys?

A: Each person is normally born with two kidneys, located in the lower back. The kidneys are shaped like beans and are the size of the fist. Each kidney contains normally about one million little filters called nephrons.

Q: What do the kidneys do?

A: The kidneys have many functions. Their basic job is to clean the blood through the little filters in them by removing waste products and to regulate the body fluid. They perform this by producing urine where what is not needed in the body is eliminated. They also assist in the production of vitamin D and erythropoietin, a protein necessary to produce hemoglobin for red blood cells.

Q: What is Kidney Failure?

A: Kidney failure occurs when both kidneys are so damaged that they no longer can clean waste products from the blood. When only one kidney is lost, the other one is usually strong enough to do the job.

Q: What are the types of Kidney Failure?

A: There are 2 types of kidney failure:

1. Acute Kidney Failure and

2. Chronic Kidney Failure.

Q: What is Acute Kidney Failure?

A: Acute Kidney (Renal) Failure is a sudden decrease in kidney function. It can happen for example with severe infections, severe vomiting and diarrhea with dehydration, intoxications or allergic reactions. With treatment in the hospital, usually dialysis, there is almost always return to normal kidney function.

Q: What is Chronic Kidney Failure?

A: Chronic Kidney (Renal) Failure is the gradual loss of kidney function because of kidney damage. Often people are unaware that their kidneys are not functioning properly, as they are highly adaptable organs. Even when most of a kidney is not functioning, the remaining portion will increase its activity to compensate for the loss.

Q: What are the causes of kidney failure?

A: The leading causes of kidney failure in Nigeria are:

1. Hypertension (High blood pressure)

2. Chronic Glomerulonephritis

3. Diabetes Mellitus

Others include ;

1. Chronic pyelonephritis

2. Sickle cell disease

3. Analgesic abuse

4. Obstructive uropathy

5. Polycystic kidney disease

6. Congenital anomalies (In children )

7. HIV nephropathy

8. SLE (Systemic lupus erythematosus)

9. Kidney stone disease

10. Herbal medication use and abuse

11. Bleaching creams containing mercury

12. For some people, the cause is unknown

Q: How do I know I have kidney failure?

A: The symptoms of kidney failure tend to appear gradually over a long period of time. They are therefore often easily overlooked or considered a response to the stress of daily life. This may delay diagnosis and treatment, increasing damage to the kidneys.

If you experience any of the following symptoms, discuss them promptly with your doctor:

· Nocturia (getting up at night to pass urine)

· Tiredness / lethargy

· Loss of appetite & nausea

· Increased or decreased urine volume

· Discomfort over the bladder / lower abdomen area

· High blood pressure.

· Swelling in your hands, feet or face, particularly around your eyes

· A metallic or foreign taste in your mouth

· Shortness of breath

· Restlessness

· Leg cramps

Q: How do I know there is something wrong with my kidneys?

A: There are very few symptoms of kidney disease until the kidneys are severely affected. Usually kidney disease is picked up early, by urine tests (to detect protein) or screening blood (serum creatinine particularly).

Q: What happens when the kidneys fail?

A: Harmful waste products and excess fluid accumulate in the body. The individual will have a poor appetite, will get tired more easily, will look pale because of anemia (low number of red blood cells), and performance may be affected.

KIDNEY KNOWLEDGE SERIES - (1)

2010-11-30T13:18:00.000Z

THE KIDNEYS

Q: What are kidneys?

A: The kidneys are two bean-shaped organs the size of a human fist. They are located on either side of the backbone, just below the ribcage and they work around the clock to keep the body healthy. The kidneys are a sophisticated filtering system. They pump up to 200 litres (20 buckets) of blood through around a million functioning units known as “nephrons”.

Q: What are the roles of the kidneys?

A: By filtering the blood this way the kidneys perform a range of vital functions including:

1. Filtering waste from the blood

2. Balancing the body’s fluid levels

3. Helping to control blood pressure

4. Helping to produce red blood cells

5. Maintaining strong, healthy bones.

Q: How do the kidneys filter waste from the blood?

· The kidneys remove waste and excess fluids collected by the blood as they flow through the body.

· Approximately 200 litres (20 buckets) of blood enter the kidneys each day via the renal arteries. Here, its filters separate waste and excess fluid from the blood.

· The majority of this waste enters the body in food and drink. The kidneys remove salt and other minerals leaving only what the body needs.

· Once cleansed, the blood returns to the heart to be re-circulated through the body while the waste is stored in the bladder as urine.

· When the bladder is full, the urine exits the body via the urethra. An adult passes an average of 2L of urine each day.

Q: How do the kidneys balance the body’s fluid levels?

· By removing just the right amount of excess fluid, healthy kidneys maintain the body’s fluid balance.

· Fluid content accounts for approximately 55 per cent of a woman’s total weight and 60 per cent of a man’s.

· The kidneys maintain these proportions by balancing the amount of fluid that leaves the body as urine with the amount of fluid that enters (via liquid drinks and foods with a high fluid content).

Q: How do the kidneys help to control blood pressure?

A: High blood pressure, or hypertension, is common among those living with kidney failure. Healthy kidneys release hormones to help control blood pressure.

· An important way is by regulating how much sodium (salt) and fluid the body keeps. If there is too much water in the body (fluid overload), a person’s blood pressure will rise. However if the body is lacking water (dehydration), a person’s blood pressure will drop. By monitoring and adjusting salt and water levels in the blood, the kidneys can correct imbalances and increase or decrease blood pressure when necessary.

Q: How do the kidneys help to produce red blood cells?

· Healthy kidneys also produce the hormone “erythropoietin” (EPO), which is carried in the blood to the bone marrow where it stimulates the production of red blood cells.

· Red blood cells carry oxygen throughout the body. A depletion of these cells puts one at risk of developing anaemia, a condition that makes you feel weak, cold, tired and short of breath.

Q: How do the kidneys maintain strong, healthy bones?

· The kidneys help keep bones strong by activating “calcitriol” (vitamin D), which stimulates calcium and phosphate absorption in the blood and bones. The kidneys also monitor and adjust these levels when necessary.

· Kidney failure may cause a drop in the production of calcitriol, leading to abnormal levels of phosphate and calcium, resulting in renal bone disease.

Living Donation

2010-10-28T11:40:00.000+01:00

Source: National Kidney Foundation

You can consider being a living kidney donor. Living donation takes place when a living person donates an organ or part of an organ to someone in need of a transplant. The donor is most often a close family member, such as a parent, child, brother or sister. A donor can also be a more distant family member, spouse, friend or co-worker.

General Information on Living Donation

What is living donation?
Living donation takes place when a living person donates an organ (or part of an organ) for transplantation to another person. The living donor can be a family member, such as a parent, child, brother or sister (living related donation).

Living donation can also come from someone who is emotionally related to the recipient, such as a good friend, spouse or an in-law (living unrelated donation).

In some cases, living donation may even be from a stranger, which is called nondirected donation though that is not common in Nigeria

What organs can come from living donors?
The organ most commonly given by a living donor is the kidney. People usually have two kidneys, and one is all that is needed to live a normal life. Parts of other organs including the lung, liver and pancreas are now being transplanted from living donors.

What are the advantages of living donation over deceased donation?
Transplants performed from living donors have several advantages compared to transplants performed from deceased donors:

Some living donor transplants are done between family members who are genetically similar. A better genetic match lessens the risk of rejection.

A kidney from a living donor usually functions immediately, making it easier to monitor. Some deceased donor kidneys do not function immediately, and as a result, the patient may require dialysis until the kidney starts to function.

Potential donors can be tested ahead of time to find the donor who is most compatible with the recipient. The transplant can take place at a time convenient for both the donor and recipient.

Are transplants from living donors always successful?
Although transplantation is highly successful, and success rates continue to improve, problems may occur. Sometimes, the kidney is lost to rejection, surgical complications or the original disease that caused the recipient's kidney to fail. Talk to the transplant center staff about their success rates and the national success rates.

How can I be a living kidney donor to someone I know?
To donate a kidney, you must be in good health and have normal kidney function and anatomy.
If the donor meets the criteria for donation, additional testing will be required to check for further compatibility (cross matching and tissue typing) as well as physical examinations and psychological evaluation. More information on testing and surgery procedures can be found in this booklet.

The donor should make the decision voluntarily and free from internal or family pressure. The decision to donate needs to be made with all the information necessary to make an informed, educated choice.

Immunosuppressive medications, which keep the recipient's body from rejecting the donor kidney, have improved greatly over the last few years. Now, a genetic link between the donor and recipient does not appear to be necessary to ensure a successful transplant.

Before surgery, the donor will receive education and counseling to help prepare mentally and emotionally for the donation and recovery. If the donor has questions, the transplant team can help. The decision to donate will affect all members of the person's family and should not be taken lightly.

Your first step is to contact the potential recipient's transplant center. (Transplant centers are hospitals that perform transplant operations-and donor operations, if there is a living donor). You should ask to speak with the Kidney Transplant Coordinator, who can give you additional information about living donation, and help you get started. If you live far away from the transplant center, you'll be referred to a center in your area for initial testing.

I want to be a donor to a friend or family member, but they won't let me. What can I do?
Some individuals with kidney failure may decide they do not want the transplant or choose not to consider a living donor. The person with kidney failure can choose to accept or reject your offer to donate. He or she has the right to decide against a transplant (though you may feel it would help). The patient, who must live with the disease, has the right to decide what is to be done. That decision, as well as yours, must be respected.

What are the long-term risks of donation?
You will also have a scar from the donor operation- the size and location of the scar will depend on the type of operation you have.

Some donors have reported long-term problems with pain, nerve damage, hernia or intestinal obstruction.
There are not currently any national statistics on the frequency of these problems.

In addition, people with one kidney may be at a greater risk of:

High blood pressure
Proteinuria
Reduced kidney function

You should discuss these risks with your transplant team, and ask for the hospital for any statistics related to these problems.

What else can I do?
You may not be able to be a living donor- or you may decide that living donation isn't right for you. You can still help those awaiting life-saving organ transplants and cannot afford the huge expense it entails by donating money to Nathan Kidney Foundation.

To fund our programs, we depend on contributions from caring individuals and corporate organizations. By making a gift today, you can give people living with kidney failure the gift of life.

Your donation can help:
• Inform people about how to prevent this epidemic and reduce fatalities
• Set up prevention programs in accessible health care centres
• Fund renal replacement therapies for the poor

Please make your donations through the following:

By cheque payable to the Nathan Kidney Foundation
23B, Ribadu Road, (1st Floor)
S/W Ikoyi,
Lagos State
For further information, please call us 01 – 8102805 or send an e-mail to donations@nkidneyfoundation.org

By payment into the following bank account:
Bank: GTBank
Account name: Nathan Kidney Foundation
Account number: 224 - 883641 - 110

By setting up a Standing Order with your bank This is an easy and manageable way to set up regular donations to NKF. Download, print, fill in and submit this form to your bank to set up a Standing Order.

Know More About Dialysis

2010-10-18T13:06:00.000+01:00

Source: National Kidney Foundation

Dialysis
Dialysis is a treatment that does some of the things done by healthy kidneys. It is needed when your own kidneys can no longer take care of your body's needs.

When is dialysis needed?
You need dialysis when you develop end stage kidney failure --usually by the time you lose about 85 to 90 percent of your kidney function.

What does dialysis do?
Like healthy kidneys, dialysis keeps your body in balance. Dialysis does the following:

removes waste, salt and extra water to prevent them from building up in the body
keeps a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate
helps to control blood pressure

Is kidney failure permanent?
Not always. Some kinds of acute kidney failure get better after treatment. In some cases of acute kidney failure, dialysis may only be needed for a short time until the kidneys get better.
In chronic or end stage kidney failure, your kidneys do not get better and you will need dialysis for the rest of your life. If your doctor says you are a candidate, you may choose to be placed on a waiting list for a new kidney.

Where is dialysis done?
Dialysis can be done in a hospital, in a dialysis unit that is not part of a hospital, or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes.

Are there different types of dialysis?
Yes, there are two types of dialysis --hemodialysis and peritoneal dialysis.

What is hemodialysis?
In hemodialysis, an artificial kidney (hemodialyzer) is used to remove waste and extra chemicals and fluid from your blood. To get your blood into the artificial kidney, the doctor needs to make an access (entrance) into your blood vessels. This is done by minor surgery to your arm or leg.

Sometimes, an access is made by joining an artery to a vein under your skin to make a bigger blood vessel called a fistula.

However, if your blood vessels are not adequate for a fistula, the doctor may use a soft plastic tube to join an artery and a vein under your skin. This is called a graft.

Occasionally, an access is made by means of a narrow plastic tube, called a catheter, which is inserted into a large vein in your neck. This type of access may be temporary, but is sometimes used for long-term treatment.

How long do hemodialysis treatments last?
The time needed for your dialysis depends on:

how well your kidneys work
how much fluid weight you gain between treatments
how much waste you have in your body
how big you are
the type of artificial kidney used

Usually, each hemodialysis treatment lasts about four hours and is done three times per week.

A type of hemodialysis called high-flux dialysis may take less time. You can speak to your doctor to see if this is an appropriate treatment for you.

What is peritoneal dialysis and how does it work?
In this type of dialysis, your blood is cleaned inside your body. The doctor will do surgery to place a plastic tube called a catheter into your abdomen (belly) to make an access. During the treatment, your abdominal area (called the peritoneal cavity) is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line your peritoneal cavity. Extra fluid and waste products are drawn out of your blood and into the dialysate. There are two major kinds of peritoneal dialysis.

What are the different kinds of peritoneal dialysis and how do they work?
There are several kinds of peritoneal dialysis but two major ones are:
Continuous Ambulatory Peritoneal Dialysis (CAPD) and Continuous Cycling Peritoneal Dialysis (CCPD).

Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of peritoneal dialysis that is done without machines. You do this yourself, usually four or five times a day at home and/or at work. You put a bag of dialysate (about two quarts) into your peritoneal cavity through the catheter. The dialysate stays there for about four or five hours before it is drained back into the bag and thrown away. This is called an exchange. You use a new bag of dialysate each time you do an exchange. While the dialysate is in your peritoneal cavity, you can go about your usual activities at work, at school or at home.

Continuous Cycling Peritoneal Dialysis (CCPD) usually is done at home using a special machine called a cycler. This is similar to CAPD except that a number of cycles (exchanges) occur. Each cycle usually lasts 1-1/2 hours and exchanges are done throughout the night while you sleep.

Will dialysis help cure the kidney disease?
No. Dialysis does some of the work of healthy kidneys, but it does not cure your kidney disease. You will need to have dialysis treatments for your whole life unless you are able to get a kidney transplant.

Is dialysis uncomfortable?
You may have some discomfort when the needles are put into your fistula or graft, but most patients have no other problems. The dialysis treatment itself is painless. However, some patients may have a drop in their blood pressure. If this happens, you may feel sick to your stomach, vomit, have a headache or cramps. With frequent treatments, those problems usually go away.

How long has dialysis been available?
Hemodialysis and peritoneal dialysis have been done since the mid 1940's. Dialysis, as a regular treatment, was begun in 1960 and is now a standard treatment all around the world. CAPD began in 1976. Thousands of patients have been helped by these treatments.

How long can you live on dialysis?
We do not yet know how long patients on dialysis will live. We think that some dialysis patients may live as long as people without kidney failure.

Is dialysis expensive?
Yes. Dialysis costs a lot of money. However, the federal government pays 80 percent of all dialysis costs for most patients. Private health insurance or state medical aid also help with the costs.

Do dialysis patients feel normal?
Many patients live normal lives except for the time needed for treatments. Dialysis usually makes you feel better because it helps many of the problems caused by kidney failure. You and your family will need time to get used to dialysis.

Do dialysis patients have to control their diets?
Yes. You may be on a special diet. You may not be able to eat everything you like, and you may need to limit how much you drink. Your diet may vary according to the type of dialysis.

Can dialysis Patients travel?
Yes. Dialysis centers are located in every part of the United States and in many foreign countries. The treatment is standardized. You must make an appointment for dialysis treatments at another center before you go. The staff at your center may help you make the appointment.

Can dialysis patients continue to work?
Many dialysis patients can go back to work after they have gotten used to dialysis. If your job has a lot of physical labor (heavy lifting, digging, etc. ), you may need to get a different job.

For further information, go to Nathan Kidney Foundation.