Fact Sheet - Chronic Kidney Disease and Kidney Failure - some history

[okarol]

National Institutes of Health
 
Fact Sheet    
Chronic Kidney Disease and Kidney Failure
 
Thirty Years Ago
•    One third of diabetic patients were destined to
develop kidney failure.
•    Two lifesaving renal replacement therapies, dialysis
and renal transplantation, developed through
fundamental National Institutes of Health (NIH)
research in the 1960s, were increasingly available;
however, neither was ideal.
•    Dialysis left patients feeling washed out and unable
to work. Patients suffered from disabling bone
disease, dementia caused by aluminum intoxication,
and severe fatigue from uncontrollable anemia. High
cardiovascular disease death rates limited life
expectancy.
•    Some patients were lucky enough to get a kidney
transplant, which greatly improved their quality of
life and life expectancy. However, transplantation
was not common, and acute rejection resulted in
transplantation failure rates of 30 to 50 percent. 
•    No methods were available to screen diabetic
patients for early signs of kidney injury, so
preventive treatments were not possible. 
•    Few treatments for kidney disease were available,
and the importance of controlling of blood sugar and
blood pressure was not recognized.
•    Kidney failure was increasing at epidemic rates.
Through the 1980s and 1990s, the number of
patients developing end-stage kidney failure nearly
doubled each decade.

Today
•    With good care, fewer than 10 percent of diabetics
develop kidney failure.
•    Management of anemia and bone disease has
markedly improved the quality of life of dialysis 
patients. Dialysis dementia due to aluminum toxicity
no longer occurs.
•    High cardiovascular death rates in dialysis patients
remain a problem.
•    Transplantation is widely available, although limited
organ availability has resulted in longer waiting
times.
•    Transplant failure due to acute rejection is much less
common, with one year success rates exceeding 90
percent.
•    Kidney disease can be detected earlier by
standardized blood tests to estimate renal function
and monitoring of urine protein excretion. New
drugs better control blood pressure and slow the rate
of kidney damage by about 50 percent. An NIH
education campaign informs patients and their
doctors about the importance of early detection of
kidney disease.
•    As a result of improved treatment, the number of
new dialysis patients has stabilized, and indeed has
begun to fall.
•    The savings to Medicare for each patient who does
not progress to dialysis is estimated to be $250,000
per patient. Overall estimated Federal savings from
recent improvements in preventing kidney disease is
approximately $1 billion per year. 
•    Currently the NIH spends $425 million on kidney
disease research. The Medicare program spends
approximately $19 billion for care of the 450,000
U.S. patients with end-stage kidney failure. This
represents 6 percent of Medicare expenditures.

Tomorrow
•    The continued development and testing of new
detection strategies, therapies, and community
education will result in fewer people developing
advanced kidney disease and kidney failure,
requiring less need for dialysis and transplantation.
The NIH is conducting research that will help us
realize these benefits for patients.
•    As additional advances become available, there will
be a decrease in the number of diabetics with kidney
disease. Because kidney disease often runs in
families, the NIH has launched two genetic studies
of diabetic kidney disease to identify genetic
markers that might predict who will get kidney
damage, identify key disease pathways, and new
drug treatment strategies. These genetic studies will
yield clues about how to intervene earlier in disease
progression and to intervene more precisely and
effectively.
•    We want to extend the success in people with
diabetes to other common causes of kidney injury
such as high blood pressure, glomerulonephritis and
cystic disease, and to learn how to control the
accelerated cardiovascular disease, the main cause of
death in kidney patients. Ongoing longitudinal
studies will determine new risk factors for
accelerated cardiovascular disease, and permit
individualized prevention strategies.
•    If caught sufficiently early, it may be possible to
restore lost kidney function using therapies that are
more precise. A more aggressive management of
diabetes, high blood pressure, and drugs that target
kidney fibrosis may give patients additional years of
life without dialysis.
•    For those patients who need dialysis, NIH is
studying whether more frequent dialysis allows them
to have a more normal life. The NIH is also studying
better drugs to prevent clotting and dysfunction of
the dialysis access that patients use to hook up to a
dialysis machine. 
•    Despite our best immunosuppressant therapies,
patients with kidney transplants still lose their
transplanted kidney due to chronic rejection. Better
strategies to maintain the function of transplanted
kidneys and prevent chronic scarring are likely to
emerge from on-going basic research and improved
imaging methods.
•    The best hope for reducing the human and economic
costs of end-stage renal disease lies in prevention.
The NIH’s kidney disease public education activities
are especially targeting minority populations — who
continue to be disproportionately affected by kidney
disease — and health care professionals, as we seek
to bridge the gap between scientific evidence and
clinical practice.

[Nan]

Thank you....this information is enlightening......I LOVE that bright light at the end of the tunnel!

[stauffenberg]

That 'fact sheet' just proves how profoundly POLITICAL medicine is, always trying to put a falsely positive spin on things to make it seem as if doctors deserve all their power and money. The most glaring inaccuracy is the failure to admit that it is STILL the case that between 30 and 40% of type 1 diabetics develop renal failure, despite all efforts at proper care.  Two reasons can be offered for this.  First, the effort to keep blood sugar low enough not to damage the kidney can lead to immediate death or severe disability through severe hypoglycemia; or the constant effort of blood sugar testing, food measuring, and insulin injecting, with its resultant loss of productivity, spontaneity, and quality of life, can be nearly as bad as kidney disease itself.  The second problem is that there is an enormous spike of new cases of diabetic renal failure around 17.5 years after onset of diabetes, regardless of the level of blood sugar control, which tends to range over a gradual bell curve distribution and not show such a dramatic peak at any point as the new incidence of renal failure does.  This has caused many nephrologists to suggest that diabetic renal failure many well HAVE NOTHING TO DO WITH BLOOD SUGAR CONTROL, but rather, to be the result of a gene inherited along with the disposition to diabetes.  This is further proved by the fact that if diabetics do not develop renal failaure within 20 years of onset of their disease, they tend never to develop it, no matter how long they live or how much extra high blood sugar damage they do to themselves over the succeeding decades -- which could not possibly happen if the disease were caused by hyperglycemia.

The rest of the report tries to put a similarly sugar-coated spin on everything, which any nephrologist would immediately recognize as nonsense.  EPO does not adequately control anemia.  Death rates on dialysis have fallen, but the improvement in life expectancy has levelled off over the past decade and is not igetting any better.  Osteoporosis, nausea, vomiting, exhaustion, muscle wasting, and neurological disease remain severe problems for dialysis patients.  Because the dialysis population continues to grow rapidly, while the number of organs becoming available for transplant has stagnated worldwide, the amount of time patients spend on dialysis will lengthen, thus vastly increasing all the problems associated with dialysis.  Thus the situation is getting worse, not better, which is the opposite of what this 'social control' propaganda is trying to convey.

[Adam_W]

•    For those patients who need dialysis, NIH is
studying whether more frequent dialysis allows them
to have a more normal life.

This is the part that bothers me. We are seeing study after study after study about more frequent dialysis, and it's been very well proven that more frequent dialysis IS better. Yet we aren't really seeing efforts to break away from the "3X4" (3 days/week, 4 hours) "maintenance" dialysis (at least in North America) which leaves patients always feeling washed out, and causes frequent hypotension because so much fluid must be taken off each treatment. I mean, I'm no doctor, and I'm still a relatively new dialysis patient, but it didn't take me long to realize the more dialysis I could get, the better I would feel. When I was in-centre, when we would have water or bicarb problems and the machines would go into bypass, my four hours would be up, and I would fight to stay ON the machine so I could reach my clearance goal. I think one of the biggest problems is lack of education for patients (and adequate Medicare funding). Most dialysis patients go into the dialysis centre, have their treatment, and go home without having the slightest clue of what's really happening, and they have no idea that they COULD be feeling better than they do. When I would talk to other patients in my old centre (and even some of the techs) about wanting to do MORE FREQUENT home dialysis, most of them looked at me like I was crazy. In short, we need to stop doing all of these "studies", and start educating patients and professionals about ALL dialysis treatment options (a few of the techs at my old centre had never even heard of home hemo), and get away from the "standard" 3X4 treatments that are barely enough to keep us alive. OK, rant over.

Adam

[tweetykiss]

How does a dialysis patient get cardiovascular disease?

[AlasdairUK]

How does a dialysis patient get cardiovascular disease?

Someone might be able to go into more detail, but my understanding is with the increase and decrease of fluid between dialysis enlarges the heart and while we have the extra fluid on board before we take it off on dialysis it increases our blood pressure which puts further strain on the heart.

When you add the toxic state our bodies live in with the electrolyte imbalance. Over time this all adds up to cardiovascular disease.

[KT0930]

How does a dialysis patient get cardiovascular disease?

It also has to do with your phosphorous/calcium product. If these two numbers are each too high, they combine in some way (the mechanics are too detailed to get into here) and pull calcium from your bones and cause that calcium to deposit in blood vessels, joints, and your organs, including your heart. In essence, you get bone forming in your heart. I realize that's not "traditional" cardiovascular disease, but it definitely puts a strain on your heart.

[Joe Paul]

Thank you....this information is enlightening......I LOVE that bright light at the end of the tunnel!

So long as that bright light isn't a freight train 

[stauffenberg]

The cause of heart disease in dialysis patients is multi-factorial.  Abnormal potassium and calcium levels contribute to the problem, as does the stress of having to pump a greater volume of blood during periods of fluid overload.  The increasing poisoning of the nervous system by the toxins imperfectly cleared during dialysis, which only replaces 10 to 12% of normal kidney function, also damages the nerves connected to the heart muscle.  A further source of damage is elevated creatinine, which promotes arteriosclerosis.

[okarol]

How does a dialysis patient get cardiovascular disease?

 
Article: Heart disease is the most frequent cause of death in dialysis patients. Although heart disease has decreased in the United States over the past 30 years, patients with chronic renal failure have not enjoyed the same reduction in the chances of having a heart attack or developing heart failure.

Hardening of the arteries is the most frequent cause of heart disease in dialysis patients. This process starts with fat deposits in the arteries and may begin at a young age, even in people without advanced kidney disease. Over time, the fat deposits contain calcium and form plaques that can block small arteries, like those in the heart. Many factors contribute to hardening of the arteries. This article will consider some of the risk factors for the development of hardening of the arteries and heart disease in patients with chronic renal failure. In addition, specific strategies for prevention will be presented.

For complete article go to --> http://www.aakp.org/aakp-library/Lowering-Risk--Heart-Disease/

[DeLana]

Thanks for sharing this interesting article. 

DeLana

[stauffenberg]

With respect to more frequent and/or longer dialysis being more healthy for patients, this is of course true, but it raises the paradox common to most chronic diseases, which is that the effort to improve the patient's health can itself become so burdensome that it is more debilitating than the disease.  Many patients plead with their doctors to be allowed LESS time on dialysis, because they still want some time left in their lives actually to LIVE, but the doctors, with their biocentric prejudice, which comes with their education, tend to believe that 'success' means keeping the patient alive longer, even if life becomes worthless because of the intrusiveness of the treatment.  You have to avoid devoting so many resources of time and energy to keeping yourself alive that you have no time or energy to live with the extra time you buy yourself.

[Zach]

With respect to more frequent and/or longer dialysis being more healthy for patients, this is of course true, but it raises the paradox common to most chronic diseases, which is that the effort to improve the patient's health can itself become so burdensome that it is more debilitating than the disease.  Many patients plead with their doctors to be allowed LESS time on dialysis, because they still want some time left in their lives actually to LIVE, but the doctors, with their biocentric prejudice, which comes with their education, tend to believe that 'success' means keeping the patient alive longer, even if life becomes worthless because of the intrusiveness of the treatment.  You have to avoid devoting so many resources of time and energy to keeping yourself alive that you have no time or energy to live with the extra time you buy yourself.

Life is always full of compromises, whether one has a chronic illness or not.