Chronic kidney disease, or CKD, is a condition in which the kidneys are damaged and cannot filter blood as well as they should. Because of this, excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and stroke. This is a common condition in the United States. In fact, more than 1 in 7 US adults are estimated to have chronic kidney disease. Understanding the basics of kidney disease, the symptoms, treatments, and how you can play an active roles in maintaining kidney health is important for overall well-being.

The two main causes of CKD are diabetes and high blood pressure. About 1 in 3 adults with diabetes and 1 in 5 adults with high blood pressure have CKD. People may not feel sick or notice any symptoms until CKD is advanced. The only way people find out if they have CKD is through simple blood and urine tests

If you have a late-stage chronic kidney disease, you may be referred to a vascular surgeon for the evaluation of dialysis access.

At Vascular Care Specialists of Los Angeles, Dr. Mathew Cheung and Dr. Peter Lin discuss some important facts regarding kidney disease. In this discussion, you can get an insight regarding symptoms and treatment for patients with chronic kidney disease.

We have two kidneys which are responsible for filtering the blood and creating urine. They are essential in maintaining normal ion and fluid levels. Without working kidneys, the body cannot function efficiently. Someone who does not have efficient kidney function has kidney disease, also called CKD. CKD is termed in stages which ranks the severity (e.g. Stage 1, 2, 3, 4 or 5 CKD). Stage 5 CKD is defined as kidney failure and means the body’s kidneys have little to no function left. This means that the body needs another method to filter the blood to survive.

Early kidney disease usually doesn’t have many symptoms, and so it is more important to be aware of the risk factors. Some key risk factors which may make you more susceptible to developing kidney disease includes

• High blood pressure
• Diabetes
• Heart disease,
• Family history of kidney disease

Symptoms of late-stage CKD may include: 

• Low urine output
• Fatigue
• Elevated Creatinine and BUN lab levels
• Leg swelling
• Shortness of breath

Diabetes is the leading risk factor associated with the development of chronic kidney disease. High glucose levels in the blood cause blockage and damage at the filtration system of the kidneys, promoting a gradual breakdown over time. Often, this may cause protein to start being released through the kidney’s filtration system, perhaps causing the foaming of urine.

High blood pressure is the second leading cause of CKD. When the volume of blood passing through for filtration is in excess, it is often challenging for the kidneys to keep up and breakdown can occur as a result. It is similar to an excess amount of water attempting to flow through a hole in a damn, causing cracks to the remainder of the foundation.

Additionally, substance use and abuse, especially in relation to recreational drugs and alcohol, may cause chemicals to enter the bloodstream that is challenging for the kidneys to break down and filter out. Conditions such as renal artery disease, lupus, hemolytic uremic syndrome, and more may also cause an increase in risk.

Depending on the cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure.

Treatment usually consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. If your kidneys become severely damaged, you might need treatment for end-stage kidney disease.

1. Treating the cause

Your doctor will work to slow or control the cause of your kidney disease. Treatment options vary depending on the cause. But kidney damage can continue to worsen even when an underlying condition, such as diabetes mellitus or high blood pressure, has been controlled.

2. Treating complications

Kidney disease complications can be controlled to make you more comfortable. Treatments might include:

• High blood pressure medications. People with kidney disease can have worsening high blood pressure. Your doctor might recommend medications to lower your blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers — and to preserve kidney function. •High blood pressure medications can initially decrease kidney function and change electrolyte levels, so you might need frequent blood tests to monitor your condition. Your doctor may also recommend a water pill (diuretic) and a low-salt diet.
• Medications to relieve swelling. People with chronic kidney disease often retain fluids. This can lead to swelling in the legs as well as high blood pressure. Medications called diuretics can help maintain the balance of fluids in your body.
• Medications to treat anemia. Supplements of the hormone erythropoietin (uh-rith-roe-POI-uh-tin), sometimes with added iron, help produce more red blood cells. This might relieve fatigue and weakness associated with anemia.
• Medications to lower cholesterol levels. Your doctor might recommend medications called statins to lower your cholesterol. People with chronic kidney disease often have high levels of bad cholesterol, which can increase the risk of heart disease.
• Medications to protect your bones. Calcium and vitamin D supplements can help prevent weak bones and lower your risk of fracture. You might also take medication known as a phosphate binder to lower the amount of phosphate in your blood and protect your blood vessels from damage by calcium deposits (calcification).
• A lower protein diet to minimize waste products in your blood. As your body processes protein from foods, it creates waste products that your kidneys must filter from your blood. To reduce the amount of work your kidneys must do, your doctor might recommend eating less protein. A registered dietitian can suggest ways to lower your protein intake while still eating a healthy diet.

Your doctor might recommend regular follow-up testing to see whether your kidney disease remains stable or progresses.

3. Treatment for chronic kidney disease or end-stage renal disease

If your kidneys fail, your body needs another way to filter the blood. This can be done via dialysis or a kidney transplant. There are two different methods for dialysis. One is called hemodialysis and the other is called peritoneal dialysis.

Hemodialysis consists of a machine which pulls blood from your body and filters it through a dialyzer (artificial kidney) and then returns it back to the body. You can either be connected through a central venous catheter, also known as a permcath, or through an arteriovenous fistula or graft (AVF or AVG). Hemodialysis is the most common way to perform dialysis as it can be started quickly in an emergency and can also be performed for long term use through an AVF or AVG.

Peritoneal dialysis consists of filtering the blood through the lining of the abdomen, also called the peritoneum. There are pros to peritoneal dialysis as it can be done at home vs hemodialysis which must be performed at a dialysis center; usually 3 times per week in 3–4-hour sessions. However, not everyone is a candidate for peritoneal dialysis which is why only about 10% of kidney failure patients use this method.

If you have been diagnosed with kidney disease, you can help the progression of your kidney disease by maintaining a kidney healthy diet.

• Eat foods low in sodium, protein, phosphorus, and potassium.
• Cook meals from scratch instead of eating processed foods; this can cut out a lot of sodium.
• Eat more leafy greens.
• Eat smaller portions of protein and eat more plant protein sources such as beans, nuts and grains instead of animal-based proteins.
• Grill or bake proteins instead of frying.
• Cook with herbs and spices instead of salt.

If you have a late-stage kidney disease, you might be advised to see a vascular surgeon for dialysis access evaluation. This is a step to prepare you to begin dialysis. Most people who begin hemodialysis start their sessions through a central venous catheter and then transition to an AVF or AVG which is surgically created by a vascular surgeon.  If the process of having a dialysis access is initiated early enough, a catheter may be avoided altogether when it becomes time to begin dialysis. Although central venous catheters allow for quick emergent dialysis, they remain a constant opening to the body and pose a high risk for infection. This is why a swift transition to a fistula or graft creation is imperative. It is key to know that after a dialysis access is created, it may take several weeks for it to be deemed ready for use during dialysis. The progress of dialysis access maturation is monitored by regular ultrasounds to measure the size and depth of the blood vessel.

At Vascular Care Specialists of Los Angeles, we strive to provide the best service, care, and results possible. If you have end-stage renal disease with dialysis access related problems, give us a call at 626-275-9566 to schedule an appointment. You can also visit us at www.vcsla.com for more information.