Dr. Emile Mohammed

Consultant Nephrologist, NWRHA

Medical Director, CKDI

MB ChB (Aberdeen), FRCP (UK), CCT

Nephrology and General Internal Medicine (UK)

Associate Lecturer in Medicine (UWI)

Once kidneys are functioning less than 15% of normal, known as stage 5 Chronic Kidney Disease, renal replacement therapy is needed and this can be dialysis or transplantation. When the kidneys can no longer adequately function, the following may happen:

• Symptoms of uraemia. This can range from subtle symptoms of poor appetite, funny taste of food, weight loss and nausea to severe symptoms at the most advanced stages of vomiting, chest pain, confusion, seizure, coma and even death.

• High Blood pressure

• Fluid overload. Excess fluid accumulation can lead to weight gain, high blood pressure and fluid buildup in the tissues (such as the legs, arms and around the eyes) which is called oedema. If there is fluid buildup on the lungs, coughing and shortness of breath can develop.

• Anaemia. The main symptoms of anaemia are weakness and fatigue.

• High potassium. The kidneys clear potassium and with advanced kidney disease potassium levels in the blood rise. If it becomes too elevated, then it is dangerous as it may cause as irregular heart beat and can even stop the heart.

• Bone Disease. The kidneys help regulate calcium, phosphorus and vitamin D levels. Therefore bone problems can develop when the kidney function is impaired.

• Nerve changes. Symptoms include restless legs, burning sensation, numbness and tingling.

• Skin changes. The commonest changes are itching, dry and scaly skin.

• Changes in Sexual function. Physical and emotional changes can alter sexual function and even result in infertility, especially in women.

Dialysis

Dialysis does not cure the kidneys or make kidneys well again. It only partly replaces some aspects of kidney function and almost always needs to be continued for life. There are two types of dialysis hemodialysis and peritoneal dialysis.

Hemodialysis

Hemodialysis means “cleaning the blood”. Blood is withdrawn from the body by a machine and passed through an artificial kidney known as a dialyzer. The dialyzer has two spaces, one for blood and one for a special liquid known as dialysis fluid. This fluid helps remove the waste products from the blood. In order for blood to exit and return to the body, a vascular access must be created of which there are three types: fistula, graft or catheter. This is created by a simple surgical procedure after which the vascular access must be cared for as guided by your Healthcare team (dialysis nurses, dialysis technicians and doctors).

Peritoneal dialysis

This is another form of dialysis where the blood is cleaned with fluid inside your body rather than in a machine. The abdomen has a cavity called the peritoneal cavity which is lined with a thin membrane called the peritoneum. In peritoneal dialysis, the peritoneal cavity is filled with a special dialysis fluid. This exposes blood vessels in the peritoneum to the fluid. The peritoneum functions as the dialyzer. Excess water and waste pass through the peritoneum into the dialysis fluid. The fluid is then drained from the cavity and the process is repeated. This form of dialysis is slower and gentler than haemodialysis and in general, must be done daily. There are different types of peritoneal dialysis regimens such as Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD). The type of dialysis is tailored according to each individual’s characteristics, social support and availability of resources locally.

It is important to understand that in Stage 5 Chronic kidney disease, dialysis is only part of the treatment required for well-being.

Several medications need to be used such as iron, vitamins, erythropoietin, phosphate binders and blood pressure medications.

Compliance with dialysis, medications, diet and fluid restriction in combination with regular blood investigations and kidney specialist reviews are paramount to keep well.