Kidney Health and Treatment Information

While acute kidney failure occurs suddenly and is usually the result of an external insult such as accidental trauma, drug overdose, illness and/or severe blood loss, CKD happens slowly over a long period of time.

Chronic Kidney Disease (CKD) is characterized by the gradual loss of kidney function over an extended period. The leading causes of CKD are diabetes and hypertension. It is often a silent disease, as you may not have symptoms until its later stages. As the condition advances, you may progress to a stage where kidney function is severely compromised, leading to irreversible kidney failure. If this is the case, you cannot live long without some form of kidney replacement therapy—either dialysis or transplantation.

When you are in the early stages of kidney disease, you usually do not feel sick at all. As kidney disease progresses you may feel one or more of the following symptoms.

Symptoms of Kidney Disease

Kidney disease may affect individuals differently depending on the cause and the stage of your kidney disease. You may not experience all of the symptoms on this list, but you may experience any combination of these symptoms:

• Frequent thirst
• Urinating more or less often
• Passing very small amounts of urine
• Swelling in the hands, feet and face
• Puffiness around the eyes
• Unpleasant taste in the mouth and urine-like odor to the breath
• Feeling tired
• Trouble breathing or short of breath
• Loss of appetite
• High blood pressure
• Pale skin
• Dry, itchy skin
• Nausea and vomiting
• Headache
• Drowsiness or confusion
• Darker color to skin
• Muscle cramps
• Trouble Sleeping
• Inability to concentrate

When coping with kidney disease, it is natural to experience a period of grief as your life changes. You may wonder if your feelings are “normal,” and it is important to understand that most people do go through an adjustment process.

You may or may not experience all the emotions described below, or to the extent described. If at any time you do experience these emotions, know that they are common, and you are not alone. Discuss your feelings with your doctor or social worker and find answers to common questions at our FAQ page.

• Denial
• Anger
• Bargaining
• Depression
• Anxiety
• Despair
• Isolation
• Acceptance

Learn more about maintaining your physical and mental health on dialysis here.

Physical Changes to Expect

The physical changes you will experience with advanced kidney disease are primarily related to the symptoms associated with the disease. Additionally, if you already on dialysis and struggling to meet the diet and fluid restrictions necessary, or you skip scheduled dialysis treatments, you could experience a variety of symptoms.

Learn more about maintaining your physical and mental health on dialysis here.

You will also experience physical changes related to the access required for your dialysis modality of choice. If you have chosen hemodialysis, an AV fistula or graft is the best option for vascular access. Following the surgical procedure to place the access, usually in one of your arms, you may have visible scar tissue and marks, but these are usually minimal. When you are evaluated by the vascular access surgeon, you will have vein mapping to determine the best location for your access. You will notice changes occurring naturally as the access matures. With a fistula, the vein wall thickens and increases in diameter. It may look like you have “bulging veins” at the access site. With a graft, the artificial tube will be noticeable under the skin. If you wear short-sleeved shirts, it will be noticeable on your arm. If you have a temporary catheter inserted in the neck or chest area, you will have a small scar from the incision and there will two tubes sticking out of your neck or chest. With a catheter, you will not be able to shower or swim and will have a dressing over the site that should remain intact at all times.

If you have chosen peritoneal dialysis, you will have a soft, flexible tube inserted into your lower abdomen. It is about the size of a straw and there are usually a few inches of tubing left outside of the body, though it usually isn’t noticeable under your clothing. The site typically takes a couple of weeks to heal. Once healed, it is very important that you keep the site clean, and your home dialysis nurse will teach you how to do this. You may also need to keep the catheter secured with tape to minimize the chance of movement or trauma to the insertion site.

If you have concerns about these or any other physical changes that you experience, please discuss them with your doctor and care team.

Each patient’s treatment plan depends on their unique set of needs and preferences. DCI is proud to offer a variety of dialysis options and modalities, including in-center hemodialysis, peritoneal dialysis, at-home hemodialysis and help facilitating referrals for transplant services.

We deliver each treatment option with an emphasis on empowering patients to take an active role and ensuring that they have a voice, as well as equipping them with the tools and resources needed to live with kidney disease on their own terms.

Peritoneal Dialysis

Home Hemodialysis

Unfortunately, chronic kidney disease often progresses to end stage despite early diagnosis and aggressive treatment. If you are in early stages of kidney disease, you are still able to live without dialysis. Even though the kidneys are damaged, they are still able to filter some wastes and excess fluid from the blood. The primary focus for chronic kidney disease (CKD) patients is keeping your body well nourished, reducing protein waste build-up in the blood, and managing other conditions you may have by taking your prescribed medications and keeping your regularly scheduled doctor appointments. You will need to visit your doctor about every three months. It is important that your blood is checked at regular intervals so they can monitor your kidney function and make adjustments in your diet and medications as needed. There are steps you can take to help your kidneys and slow progression of the disease. If you have CKD stage 4 or 5 and are not yet seeing a kidney specialist, you should be referred to one as soon as possible so that you can be assessed regularly for kidney function changes.

The most common cause of end stage kidney disease is diabetes mellitus. If you have diabetes, watch your blood glucose (sugar) closely to keep it under control. Make sure you are taking your oral anti-diabetic agent or insulin as directed by your doctor.

Follow your diet. Consult your doctor for the latest in treatment.

High blood pressure is the second leading cause of chronic kidney disease. High blood pressure damages the small vessels in the kidneys. Blood pressure should be checked regularly. People with reduced kidney function should have their blood pressure controlled. Work with your doctor to find the anti-hypertension medicine that works best for you. Many people will require two or more types of medication to keep their blood pressure normal. Along with prescribing medication, your doctor may recommend lifestyle changes such as exercising regularly and reducing your salt intake to keep your blood pressure under control.

Anemia is a shortage of red blood cells. These cells are important because they carry oxygen throughout the body. If you are anemic, you will feel tired and will look pale. Anemia may also stress your heart. Heart disease is the leading cause of death in people with kidney disease. Healthy kidneys make a hormone erythropoietin (EPO), which stimulates the bone marrow to make red blood cells. Diseased kidneys may not make enough EPO. Ask your doctor about medications such as epoetin to treat anemia.

Adequate iron must be available in your body for epoetin therapy to work. Your doctor will check your lab work to evaluate your iron status. If you suffer from iron deficiency, he or she may prescribe an iron supplement for you to take to build your iron stores. Correction of anemia has been shown to lower the chances of heart failure in people with CKD.

Your doctor will check your lab work periodically to evaluate you for bone disease.

• Phosphorus: If your phosphorus level is high, your doctor may prescribe a medication to lower it. It is important to take this medication exactly as your doctor prescribes. (Usually, it is taken with your meals and snacks.)
• Calcium: Your lab work will tell the doctor if your calcium levels are within normal range. If your calcium levels are low, your doctor may prescribe a calcium supplement, or, if your calcium levels are high, you may need to limit your calcium.
• Vitamin D: Your doctor may check your vitamin D level. If it is low, he or she may prescribe a vitamin D supplement. Remember, only take vitamins and minerals prescribed by your doctor.

If you have been prescribed medications such as ibuprofen (Advil), naproxen sodium (Aleve), and celecoxib (Celebrex), take only your prescribed dose. If your doctor has NOT prescribed these medications, it is important to ask him or her before you take them. Be sure your doctor knows about all prescription medicines, over-the-counter medicines, and herbs that you are taking.

If you need to have an x-ray or a procedure that uses dye, be sure the doctor performing the procedure knows you have kidney disease so that either no dye or a special dye is used.

To stay as healthy as possible, you should talk to your doctor about getting immunized against influenza, pneumococcus, Covid and hepatitis B.

It is important to keep yourself as healthy as possible to help slow down the progression of your kidney disease. Making necessary lifestyle changes can help.

• Maintain a healthy weight by following the prescribed diet.
• Limit alcohol consumption.
• Maintain good control of your blood sugar if you have diabetes. Diabetes is the number one cause of kidney disease.
• It is important to manage your blood pressure if you have hypertension. It is the second leading cause of kidney disease.
• Make an effort to include some form of physical activity in your day. Regular exercise can improve your mood, lower bad cholesterol and triglycerides, and keep your muscles and bones healthy.
• You should try your best to stop smoking. Smoking not only increases the rate of kidney disease progression, but it also contributes to deaths from strokes and heart attacks in people with CKD. In addition, many transplant centers will not accept you on their waiting list if you are an active smoker.
• Reduce stress in your life. It may take time to adjust to a diagnosis of kidney disease. Be patient and set realistic goals. Continue to perform your normal activities and responsibilities of daily life and share your feelings with your close friends and family. Consider joining a support group.
• Visit your doctor regularly to monitor your health and adjust your diet and medications as needed. Remember to tell your doctor if you are having any problems with your medications.
• Make sure to keep your appointments with your kidney doctor. Discuss any problems you have had since your last visit and the results of your lab tests that could indicate that your kidney disease is progressing. More information about specific lab tests can be found here.

Lab work, urine samples, and other tests may be completed during the diagnosis and treatment of kidney failure. Get to know what these tests are and what they mean.

If blood and urine tests indicate reduced kidney function, your doctor may recommend additional tests to help identify the cause of the problem.

Renal Imaging
Methods of renal imaging (taking pictures of the kidneys) include ultrasound, computed tomography (CT scan), and magnetic resonance imaging (MRI). These tools are most helpful in finding unusual growths or blockages to the flow of urine.

Renal Biopsy
Your doctor may want to see a tiny piece of your kidney tissue under a microscope. To obtain this tissue sample, the doctor will perform a renal biopsy, a hospital procedure in which the doctor inserts a needle through your skin and into the kidney. The sample tissue, less than an inch long, then helps the doctor identify the cause and severity of your kidney disease.