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20/Jul/2018

Why is Monitoring Phosphorus Important in Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD) and Dialysis?

10 Things ESRD CKD and Dialysis patients need to know about Phosphorus:

1.     Phosphorus is a very common and important mineral element in the body, symbol P.

2.     Phosphorus is found in meat, dairy products, dark cola (non translucent), beans, nuts, and in some food additives, especially in processed foods.

3.     Phosphorus is important in bone metabolism and in maintaining the proper pH (acidity) of the blood stream.

4.     When Phosphorus is combined with oxygen, it is called phosphate.

5.     Healthy kidneys maintain a proper level of blood Phosphorus by eliminating excessive Phosphorus in the urine.

6.     Patients with ESRD and CKD can retain too much phosphorus, called hyperphosphatemia.

7.     High levels of phosphorus combine (bind) with Calcium. Calcium can come out of the bones and lead to weak bones (renal osteodystrophy). The Phosphorus-Calcium complexes can also be deposited into organs and blood vessels, leading to hardening of these organs.

8.     CKD, ESRD, Dialysis and Hemodialysis patients are counseled to follow a diet that limits the amount of phosphorous-containing foods they eat.

9.     CKD, ESRD, Dialysis and Hemodialysis patients are often prescribed phosphorus-binding medications. Phosphorus-binding medications are usually taken before meals to help prevent phosphorus from being absorbed from the intestines.
Dialysis patients have their blood level of phosphorus measured every month to keep the phosphorus level in the appropriate range.

If you are a CKD, ESRD, Dialysis, and Hemodialysis, talk to your FKP Physicians.

 


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20/Jul/2018

Peritoneal Dialysis

What do I Need to Know?

Introduction

With peritoneal dialysis (PD), you have some choices in treating advanced and permanent kidney failure. Since the 1980s, when PD first became a practical and widespread treatment for kidney failure, much has been learned about how to make PD more effective and minimize side effects. Since you don’t have to schedule dialysis sessions at a center, PD gives you more control. You can give yourself treatments at home, at work, or on trips. But this independence makes it especially important that you work closely with your health care team: your nephrologist, dialysis nurse, dialysis technician, dietitian, and social worker. But the most important members of your health care team are you and your family. By learning about your treatment, you can work with your health care team to give yourself the best possible results, and you can lead a full, active life.

When Your Kidneys Fail
Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your bones strong and your blood healthy. When your kidneys fail, harmful wastes build up in your body, your blood pressure may rise, and your body may retain excess fluid and not make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys.
How PD Works

In PD, a soft tube called a catheter is used to fill your abdomen with a cleansing liquid called dialysis solution. The walls of your abdominal cavity are lined with a membrane called the peritoneum, which allows waste products and extra fluid to pass from your blood into the dialysis solution. The solution contains a sugar called dextrose that will pull wastes and extra fluid into the abdominal cavity. These wastes and fluid then leave your body when the dialysis solution is drained. The used solution, containing wastes and extra fluid, is then thrown away. The process of draining and filling is called an exchange and takes about 30 to 40 minutes. The period the dialysis solution is in your abdomen is called the dwell time. A typical schedule calls for four exchanges a day, each with a dwell time of 4 to 6 hours. Different types of PD have different schedules of daily exchanges.

One form of PD, continuous ambulatory peritoneal dialysis (CAPD), doesn’t require a machine. As the word ambulatory suggests, you can walk around with the dialysis solution in your abdomen. Another form of PD, continuous cycler-assisted peritoneal dialysis (CCPD), requires a machine called a cycler to fill and drain your abdomen, usually while you sleep. CCPD is also sometimes called automated peritoneal dialysis (APD).

Peritoneal dialysis.Getting Ready for PD

Whether you choose an ambulatory or automated form of PD, you’ll need to have a soft catheter placed in your abdomen. The catheter is the tube that carries the dialysis solution into and out of your abdomen. If your doctor uses open surgery to insert your catheter, you will be placed under general anesthesia. Another technique requires only local anesthetic. Your doctor will make a small cut, often below and a little to the side of your navel (belly button), and then guide the catheter through the slit into the peritoneal cavity. As soon as the catheter is in place, you can start to receive solution through it, although you probably won’t begin a full schedule of exchanges for 2 to 3 weeks. This break-in period lets you build up scar tissue that will hold the catheter in place.
The standard catheter for PD is made of soft tubing for comfort. It has cuffs made of a polyester material, called Dacron, that merge with your scar tissue to keep it in place. The end of the tubing that is inside your abdomen has many holes to allow the free flow of solution in and out.

Types of PD
The type of PD you choose will depend on the schedule of exchanges you would like to follow, as well as other factors. You may start with one type of PD and switch to another, or you may find that a combination of automated and nonautomated exchanges suits you best. Work with your health care team to find the best schedule and techniques to meet your lifestyle and health needs.
Continuous Ambulatory Peritoneal Dialysis (CAPD)

If you choose CAPD, you’ll drain a fresh bag of dialysis solution into your abdomen. After 4 to 6 or more hours of dwell time, you’ll drain the solution, which now contains wastes, into the bag. You then repeat the cycle with a fresh bag of solution. You don’t need a machine for CAPD; all you need is gravity to fill and empty your abdomen. Your doctor will prescribe the number of exchanges you’ll need, typically three or four exchanges during the day and one evening exchange with a long overnight dwell time while you sleep.
Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)
CCPD uses an automated cycler to perform three to five exchanges during the night while you sleep. In the morning, you begin one exchange with a dwell time that lasts the entire day.

Customizing Your PD
If you’ve chosen CAPD, you may have a problem with the long overnight dwell time. It’s normal for some of the dextrose in the solution to cross into your body and become glucose. The absorbed dextrose doesn’t create a problem during short dwell times. But overnight, some people absorb so much dextrose that it starts to draw fluid from the peritoneal cavity back into the body, reducing the efficiency of the exchange. If you have this problem, you may be able to use a minicycler (a small version of a machine that automatically fills and drains your abdomen) to exchange your solution once or several times overnight while you sleep. These additional, shorter exchanges will minimize solution absorption and give you added clearance of wastes and excess fluid.
If you’ve chosen CCPD, you may have a solution absorption problem with the daytime exchange, which has a long dwell time. You may find you need an additional exchange in the mid-afternoon to increase the amount of waste removed and to prevent excessive absorption of solution.

Preventing Problems
Infection is the most common problem for people on PD. Your health care team will show you how to keep your catheter bacteria-free to avoid peritonitis, which is an infection of the peritoneum. Improved catheter designs protect against the spread of bacteria, but peritonitis is still a common problem that sometimes makes continuing PD impossible. You should follow your health care team’s instructions carefully, but here are some general rules:
-Store supplies in a cool, clean, dry place.
-Inspect each bag of solution for signs of contamination before you use it.
-Find a clean, dry, well-lit space to perform your exchanges.
-Wash your hands every time you need to handle your catheter.
-Clean the exit site with antiseptic every day.
-Wear a surgical mask when performing exchanges.

Keep a close watch for any signs of infection and report them so they can be treated promptly. Here are some signs to watch for:
-Fever
-Nausea or vomiting
-Redness or pain around the catheter
-Unusual color or cloudiness in used dialysis solution

Equipment and Supplies for PD
Transfer Set
A transfer set is tubing that connects the bag of dialysis solution to the catheter. When your catheter is first placed, the exposed end of the tube will be securely capped to prevent infection. Under the cap is a universal connector.

When you start dialysis training, your dialysis nurse will provide a transfer set. The type of transfer set you receive depends on the company that supplies your dialysis solution. Different companies have different systems for connecting to your catheter.

Connecting the transfer set requires sterile technique. You and your nurse will wear surgical masks. Your nurse will soak the transfer set and the end of your catheter in an antiseptic solution for 5 minutes before making the connection. The nurse will wear rubber gloves while making the connection.

Depending on the company that supplies your solution, your transfer set may require a new cap each time you disconnect from the bag after an exchange. With a different system, the tubing that connects to the transfer set includes a piece that can be clamped at the end of an exchange and then broken off from the tubing so that it stays on the transfer set as a cap until it is removed for the next exchange. Your dialysis nurse will train you in the aseptic (germ-free) technique for connecting at the beginning of an exchange and disconnecting at the end. Follow instructions carefully to avoid infection.

Transfer set. Between exchanges, you can keep your catheter and transfer set hidden inside your clothing. At the beginning of an exchange, you will remove the disposable cap from the transfer set and connect it to a Y-tube. The branches of the Y-tube connect to the drain bag and the bag of fresh dialysis solution. Always wash your hands before handling your catheter and transfer set, and wear a surgical mask whenever you connect or disconnect.

During an exchange, you can read, talk, watch television, or sleep.

The first step of an exchange is to drain the used dialysis solution from the peritoneal cavity into the drain bag. Near the end of the drain, you may feel a mild “tugging” sensation that tells you most of your fluid is gone.

After the used solution is removed from your abdomen, you will close or clamp the transfer set and let some of the fresh solution flow directly into the drain bag. This flushing step removes air from the tubes.

The final step of the exchange is to refill the peritoneal cavity with fresh dialysis solution from the hanging bag.

Dialysis Solution
Dialysis solution comes in 1.5-, 2-, 2.5-, or 3-liter bags. A liter is slightly more than 1 quart. The dialysis dose can be increased by using a larger bag, but only within the limit of the amount your abdomen can hold. The solution contains a sugar called dextrose, which pulls extra fluid from your blood. Your doctor will prescribe a formula that fits your needs.
You’ll need a clean space to store your bags of solution and other supplies. You may also need a special heating device to warm each bag of solution to body temperature before use. Most solution bags come in a protective outer wrapper that allows for microwave heating. Do not microwave a bag of solution after it has been removed from its wrapper because microwaving can change the chemical makeup of the solution.

Cycler
The cycler-which automatically fills and drains your abdomen, usually at night while you sleep-can be programmed to deliver specified volumes of dialysis solution on a specified schedule. Most systems include the following components:

-Solution storage. At the beginning of the session, you connect bags of dialysis solution to tubing that feeds the cycler. Most systems include a separate tube for the last bag because this solution may have a higher dextrose content so that it can work for a day-long dwell time.

-Pump. The pump sends the solution from the storage bags to the heater bag before it enters the body and then sends it to the disposal container or drain line after it’s been used. The pump doesn’t fill and drain your abdomen; gravity performs that job more safely.

-Heater bag. Before the solution enters your abdomen, a measured dose is warmed to body temperature. Once the solution is the right temperature and the previous exchange has been drained, a clamp is released to allow the warmed solution to flow into your abdomen.

-Fluid meter. The cycler’s timer releases a clamp to let the used dialysis solution drain from your abdomen into a disposal container or drain line. As the solution flows through the tube, a fluid meter in the cycler measures and records how much solution has been removed. Some systems compare the amount of solution inserted with the amount drained and display the net difference between the two volumes. This lets you know whether the treatment is removing enough fluid from your body.

-Disposal container or drain line. After the used solution is weighed, it’s pumped to a disposal container that you can throw away in the morning. With some systems, you can dispose of the used fluid directly by stringing a long drain line from the cycler to a toilet or bathtub.

-Alarms. Sensors will trigger an alarm and shut off the machine if there’s a problem with inflow or outflow.

Testing the Effectiveness of Your Dialysis
To see if the exchanges are removing enough waste products, such as urea, your health care team must perform several tests. These tests are especially important during the first weeks of dialysis to determine whether you’re receiving an adequate amount, or dose, of dialysis.
The peritoneal equilibration test (often called the PET) measures how much sugar has been absorbed from a bag of infused dialysis solution and how much urea and creatinine have entered into the solution during a 4-hour exchange. The peritoneal transport rate varies from person to person. If you have a high rate of transport, you absorb sugar from the dialysis solution quickly and should avoid exchanges with a very long dwell time because you’re likely to absorb too much solution from such exchanges.
In the clearance test, samples of used solution drained over a 24-hour period are collected, and a blood sample is obtained during the day when the used solution is collected. The amount of urea in the used solution is compared with the amount in the blood to see how effective the PD schedule is in removing urea from the blood. For the first months or even years of PD treatment, you may still produce small amounts of urine. If your urine output is more than several hundred milliliters per day, urine is also collected during this period to measure its urea concentration.
From the used solution, urine, and blood measurements, your health care team can compute a urea clearance, called Kt/V, and a creatinine clearance rate (adjusted to body surface area). The residual clearance of the kidneys is also considered. These measurements will show whether the PD prescription is adequate.
If the laboratory results show that the dialysis schedule is not removing enough urea and creatinine, the doctor may change the prescription by

-increasing the number of exchanges per day for patients treated with CAPD or per night for patients treated with CCPD
-increasing the volume of each exchange (amount of solution in the bag) in CAPD
-adding an extra, automated middle-of-the-night exchange to the CAPD schedule
-adding an extra middle-of-the-day exchange to the CCPD schedule

Compliance
One of the big problems with PD is that patients sometimes don’t perform all of the exchanges prescribed by their medical team. They either skip exchanges or sometimes skip entire treatment days when using CCPD. Skipping PD treatments has been shown to increase the risk of hospitalization and death.

Remaining Kidney Function
Normally the PD prescription factors in the amount of residual, or remaining, kidney function. Residual kidney function typically falls, although slowly, over months or even years of PD. This means that more often than not, the number of exchanges prescribed, or the volume of exchanges, needs to increase as residual kidney function falls.

The doctor should determine your PD dose on the basis of practice standards established by the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI). Work closely with your health care team to ensure that you get the proper dose, and follow instructions carefully to make sure you get the most out of your dialysis exchanges.

Conditions Related to Kidney Failure and Their Treatments
Your kidneys do much more than remove wastes and extra fluid. They also make hormones and balance chemicals in your system. When your kidneys stop working, you may have problems with anemia and conditions that affect your bones, nerves, and skin. Some of the more common conditions caused by kidney failure are fatigue, bone problems, joint problems, itching, and restless legs.

Anemia and Erythropoietin (EPO)
Anemia is a condition in which the volume of red blood cells is low. Red blood cells carry oxygen to cells throughout the body. Without oxygen, cells can’t use the energy from food, so someone with anemia may tire easily and look pale. Anemia can also contribute to heart problems.
Anemia is common in people with kidney disease because the kidneys produce the hormone erythropoietin (EPO), which stimulates the bone marrow to produce red blood cells. Diseased kidneys often don’t make enough EPO, and so the bone marrow makes fewer red blood cells. EPO is available commercially and is commonly given to patients on dialysis.

Renal Osteodystrophy
The term “renal” describes things related to the kidneys. Renal osteodystrophy, or bone disease of kidney failure, affects up to 90 percent of dialysis patients. It causes bones to become thin and weak or malformed and affects both children and adults. Symptoms can be seen in growing children with kidney disease even before they start dialysis. Older patients and women who have gone through menopause are at greater risk for this disease.

Itching (Pruritus)
Many people treated with peritoneal dialysis complain of itchy skin. Itching is common even in people who don’t have kidney disease; with kidney failure, however, itching can be made worse by uremic toxins in the blood that dialysis doesn’t adequately remove. The problem can also be related to high levels of parathyroid hormone (PTH). Some people have found dramatic relief after having their parathyroid glands removed. But a cure that works for everyone has not been found. Phosphate binders seem to help some people; others find relief after exposure to ultraviolet light. Still others improve with EPO shots. A few antihistamines (Benadryl, Atarax, Vistaril) have been found to help; also, capsaicin cream applied to the skin may relieve itching by deadening nerve impulses. In any case, taking care of dry skin is important. Applying creams with lanolin or camphor may help.

Sleep Disorders
Patients on dialysis often have insomnia, and some people have a specific problem called sleep apnea syndrome. Episodes of apnea are breaks in breathing during sleep. Over time, these sleep disturbances can lead to “day-night reversal” (insomnia at night, sleepiness during the day), headache, depression, and decreased alertness. The apnea may be related to the effects of advanced kidney failure on the control of breathing. Treatments that work with people who have sleep apnea, whether they have kidney failure or not, include losing weight, changing sleeping position, and wearing a mask that gently pumps air continuously into the nose, called nasal continuous positive airway pressure (CPAP).
Many people on dialysis have trouble sleeping at night because of aching, uncomfortable, jittery, or restless legs. You may feel a strong impulse to kick or thrash your legs. Kicking may occur during sleep and disturb a bed partner throughout the night. Theories about the causes of this syndrome include nerve damage and chemical imbalances.
Moderate exercise during the day may help, but exercising a few hours before bedtime can make it worse. People with restless leg syndrome should reduce or avoid caffeine, alcohol, and tobacco; some people also find relief with massages or warm baths. A class of drugs called benzodiazepines, often used to treat insomnia or anxiety, may help as well. These prescription drugs include Klonopin, Librium, Valium, and Halcion. A newer and sometimes more effective therapy is levodopa (Sinemet), a drug used to treat Parkinson’s disease.
Sleep disorders may seem unimportant, but they can impair your quality of life. Don’t hesitate to raise these problems with your nurse, doctor, or social worker.

Amyloidosis
Dialysis-related amyloidosis (DRA) is common in people who have been on dialysis for more than 5 years. DRA develops when proteins in the blood deposit on joints and tendons, causing pain, stiffness, and fluid in the joints, as is the case with arthritis. Working kidneys filter out these proteins, but dialysis is not as effective [Top]

Adjusting to Changes
You can do your exchanges in any clean space, and you can take part in many activities with solution in your abdomen. Even though PD gives you more flexibility and freedom than hemodialysis, which requires being connected to a machine for 3 to 5 hours three times a week, you must still stick to a strict schedule of exchanges and keep track of supplies. You may have to cut back on some responsibilities at work or in your home life. Accepting this new reality can be very hard on you and your family. A counselor or social worker can help you cope.

Many patients feel depressed when starting dialysis, or after several months of treatment. Some people can’t get used to the fact that the solution makes their body look larger. If you feel depressed, you should talk with your social worker, nurse, or doctor because depression is a common problem that can often be treated effectively.

How Diet Can Help
Eating the right foods can help improve your dialysis and your health. You may have chosen PD over hemodialysis because the diet is less restrictive. With PD, you’re removing wastes from your body slowly but constantly, while in hemodialysis, wastes may build up for 2 or 3 days between treatments. You still need to be very careful about the foods you eat, however, because PD is much less efficient than working kidneys. Your clinic has a dietitian to help you plan meals. Follow the dietitian’s advice closely to get the most from your dialysis treatments. You can also ask your dietitian for recipes and titles of cookbooks for patients with kidney disease. Following the restrictions of a diet for kidney failure might be hard at first, but with a little creativity, you can make tasty and satisfying meals.


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20/Jul/2018

Do I have Autosomal Dominant Polycystic Kidney Disease if my father has it? You have a 50% chance of having Polycystic Kidney Disease.  Autosomal Dominant Polycystic Kidney Disease is a Genetic Disorder. The phrase “autosomal dominant” means that if one parent has the disease, there is a 50 percent chance that the disease gene will pass to a child. In some cases-perhaps 10 percent-autosomal dominant PKD occurs spontaneously in patients. In these cases, neither of the parents carries a copy of the disease gene. Polycystic kidney disease (PKD) is a genetic disorder characterized by the growth of numerous cysts in the kidneys. The kidneys are two organs, each about the size of a fist, located in the upper part of a person’s abdomen, toward the back. The kidneys filter wastes and extra fluid from the blood to form urine. They also regulate amounts of certain vital substances in the body. When cysts form in the kidneys, they are filled with fluid. PKD cysts can profoundly enlarge the kidneys while replacing much of the normal structure, resulting in reduced kidney function and leading to renal failure. When PKD causes kidneys to fail-which usually happens after many years-the patient requires dialysis or kidney transplantation. About one-half of people with the most common type of PKD progress to kidney failure, also called end-stage renal disease (ESRD). PKD can also cause cysts in the liver and problems in other organs, such as blood vessels in the brain and heart. The number of cysts as well as the complications they cause help doctors distinguish PKD from the usually harmless “simple” cysts that often form in the kidneys in later years of life. In the United States, about 600,0001 people have PKD, and cystic disease is the fourth leading cause of kidney failure. Two major inherited forms of PKD exist:
  • Autosomal dominant PKD is the most common inherited form. Symptoms usually develop between the ages of 30 and 40, but they can begin earlier, even in childhood. About 90 percent of all PKD cases are autosomal dominant PKD.
  • Autosomal recessive PKD is a rare inherited form. Symptoms of autosomal recessive PKD begin in the earliest months of life, even in the womb.

Autosomal Dominant PKD

What is autosomal dominant PKD? Autosomal dominant PKD is the most common inherited disorder of the kidneys. The phrase “autosomal dominant” means that if one parent has the disease, there is a 50 percent chance that the disease gene will pass to a child. In some cases-perhaps 10 percent-autosomal dominant PKD occurs spontaneously in patients. In these cases, neither of the parents carries a copy of the disease gene. Many people with autosomal dominant PKD live for several decades without developing symptoms. For this reason, autosomal dominant PKD is often called “adult polycystic kidney disease.” Yet, in some cases, cysts may form earlier in life and grow quickly, causing symptoms in childhood. The polycystic kidney roughly retains the same shape as the healthy kidney. The cysts grow out of nephrons, the tiny filtering units inside the kidneys. The cysts eventually separate from the nephrons and continue to enlarge. The kidneys enlarge along with the cysts-which can number in the thousands-while roughly retaining their kidney shape. In fully developed autosomal dominant PKD, a cyst-filled kidney can weigh as much as 20 to 30 pounds. High blood pressure is common and develops in most patients by age 20 or 30.

What are the symptoms of autosomal dominant PKD?

The most common symptoms are a pain in the back and the sides-between the ribs and hips-and headaches. The pain can be temporary or persistent, mild or severe. People with autosomal dominant PKD also can experience the following complications:
  • urinary tract infections-specifically, in the kidney cysts
  • hematuria-blood in the urine
  • liver and pancreatic cysts
  • abnormal heart valves
  • high blood pressure
  • kidney stones
  • aneurysms-bulges in the walls of blood vessels-in the brain
  • diverticulosis-small pouches bulge outward through the colon

How is autosomal dominant PKD diagnosed?

Autosomal dominant PKD is usually diagnosed by kidney imaging studies. The most common form of diagnostic kidney imaging is ultrasound, but more precise studies, such as computerized tomography (CT) scans or magnetic resonance imaging (MRI) are also widely used. In autosomal dominant PKD, the onset of kidney damage and how quickly the disease progresses can vary. Kidney imaging findings can also vary considerably, depending on a patient’s age. Younger patients usually have both fewer and smaller cysts. Doctors have therefore developed specific criteria for diagnosing the disease with kidney imaging findings, depending on patient age. For example, the presence of at least two cysts in each kidney by age 30 in a patient with a family history of the disease can confirm the diagnosis of autosomal dominant PKD. If there is any question about the diagnosis, a family history of autosomal dominant PKD and cysts found in other organs make the diagnosis more likely. In most cases of autosomal dominant PKD, patients have no symptoms and their physical condition appears normal for many years, so the disease can go unnoticed. Physical checkups and blood and urine tests may not lead to early diagnosis. Because of the slow, undetected progression of cyst growth, some people live for many years without knowing they have autosomal dominant PKD. Once cysts have grown to about one-half inch, however, diagnosis is possible with imaging technology. Ultrasound, which passes sound waves through the body to create a picture of the kidneys, is used most often. Ultrasound imaging does not use any injected dyes or radiation and is safe for all patients, including pregnant women. It can also detect cysts in the kidneys of a fetus, but large cyst growth this early in life is uncommon in autosomal dominant PKD. More powerful and expensive imaging procedures such as CT scans and MRI also can detect cysts. Recently, MRI has been used to measure kidney and cyst volume and monitor kidney and cyst growth, which may serve as a way to track the progression of the disease. An ultrasound imaging device passes harmless sound waves through the body to detect possible kidney cysts. Diagnosis can also be made with a genetic test that detects mutations in the autosomal dominant PKD genes, called PKD1 and PKD2. Although this test can detect the presence of the autosomal dominant PKD mutations before large cysts develop, its usefulness is limited by two factors: detection of a disease gene cannot predict the onset of symptoms or ultimate severity of the disease, and if a disease gene is detected, no specific prevention or cure for the disease exists. However, a young person who knows of a PKD gene mutation may be able to forestall the loss of kidney function through diet and blood pressure control. The genetic test may also be used to determine whether a young member of a PKD family can safely donate a kidney to a family member with the disease. Individuals with a family history of PKD who are of childbearing age might also want to know whether they have the potential of passing a PKD gene to a child. Anyone considering genetic testing should receive counseling to understand all the implications of the test.

How is autosomal dominant PKD treated?

Although a cure for autosomal dominant PKD is not available, treatment can ease symptoms and prolong life. Pain. Pain in the area of the kidneys can be caused by cyst infection, bleeding into cysts, kidney stone, or stretching of the fibrous tissue around the kidney with cyst growth. A doctor will first evaluate which of these causes are contributing to the pain to guide treatment. If it is determined to be chronic pain due to cyst expansion, the doctor may initially suggest over-the-counter pain medications, such as aspirin or acetaminophen (Tylenol). Consult your doctor before taking any over-the-counter medication because some may be harmful to the kidneys. For most but not all cases of severe pain due to cyst expansion, surgery to shrink cysts can relieve pain in the back and sides. However, surgery provides only temporary relief and does not slow the disease’s progression toward kidney failure. Headaches that are severe or that seem to feel different from other headaches might be caused by aneurysms-blood vessels that balloon out in spots in the brain. These aneurysms could rupture, which can have severe consequences. Headaches also can be caused by high blood pressure. People with autosomal dominant PKD should see a doctor if they have severe or recurring headaches-even before considering over-the-counter pain medications. Urinary tract infections. People with autosomal dominant PKD tend to have frequent urinary tract infections, which can be treated with antibiotics. People with the disease should seek treatment for urinary tract infections immediately because the infection can spread from the urinary tract to the cysts in the kidneys. Cyst infections are difficult to treat because many antibiotics do not penetrate the cysts. High blood pressure. Keeping blood pressure under control can slow the effects of autosomal dominant PKD. Lifestyle changes and various medications can lower high blood pressure. Patients should ask their doctors about such treatments. Sometimes proper diet and exercise are enough to keep blood pressure controlled. End-stage renal disease. After many years, PKD can cause the kidneys to fail. Because kidneys are essential for life, people with ESRD must seek one of two options for replacing kidney functions: dialysis or transplantation. In hemodialysis, blood is circulated into an external filter, where it is cleaned before re-entering the body; in peritoneal dialysis, a fluid is introduced into the abdomen, where it absorbs wastes and is then removed. Transplantation of healthy kidneys into ESRD patients has become a common and successful procedure. Healthy-non-PKD-kidneys transplanted into PKD patients do not develop cysts.

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20/Jul/2018

New study suggests 59% of Americans will develop kidney disease in their lifetime Nearly six out of 10 Americans will develop kidney disease in their lifetime, according to a new analysis published in the American Journal of Kidney Diseases. In comparison, the lifetime risk of diabetes, heart attack and invasive cancer is approximately four in 10. As a result of this and previous studies, the National Kidney Foundation is calling on health care professionals to screen patients in specific high-risk groups for kidney disease – those age 60 or older and those with high blood pressure or diabetes – by adding a simple urine albumin test for kidney damage to annual physical examinations. “These new data show clearly that Americans are more likely than not to develop kidney disease, which – in its later stages – is physically devastating and financially overwhelming,” said Dr. Beth Piraino, president of the National Kidney Foundation. “Importantly, if caught early, the progression of kidney disease can be slowed with lifestyle changes and medications. This underscores the importance of annual screenings, especially within the at-risk population, to potentially prevent kidney disease and ensure every patient with kidney disease receives optimal care.” The study, by a team from Johns Hopkins University, combined nationally representative prevalence data on 37,475 individual with kidney disease associated mortality risk data from more than 2 million individuals to create a model detailing lifetime risk. The lifetime risk of moderate kidney disease was 59.1%, which translates into 135.8 million people currently alive who will eventually develop moderate kidney disease. For moderate-severe kidney disease, the risk was 33.6 %, and for severe (stage 4) kidney disease, the lifetime risk was 11.5%. Finally, end-stage kidney disease requiring dialysis or kidney transplantation has a lifetime risk of 3.6 % which is dramatically higher among African-Americans at 8%. African Americans had a greater risk of developing more advanced disease and developing kidney disease earlier. In contrast, the overall risk was highest in women due to their higher life expectancy and the dramatic rise of kidney disease risk with older age. The authors also noted that kidney disease risk appears to be increasing over the past decades, suggesting their results based on the average risk may be conservative. The rise in obesity and diabetes over the past decades may further increase the lifetime risk of kidney disease. To read more go to http://www.nephrologynews.com/articles/109664-new-study-suggests-59-of-americans-will-develop-kidney-disease-in-their-lifetime

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20/Jul/2018

Kidney Disease – an underestimated Killer – Get screened for Kidney Failure Today- Call Your FKP Kidney Doctor today! Kidney disease doesn’t get the attention, funding or concern associated with cancers of the breast or prostate. But it actually kills more Americans — 90,000 a year — than both malignancies combined. Even when it is not fatal, the cost of treating end-stage kidney disease through dialysis or a kidney transplant is astronomical, more than fivefold what Medicare pays annually for the average patient over age 65. The charges do not include the inestimable costs to quality of life among patients with advanced kidney disease. Much is known about who faces the greatest risks of developing chronic kidney disease and how it can be prevented, detected in its early stages, and treated to slow or halt its progression. But unless people at risk are tested, they are unlikely to know they have kidney disease; it produces no symptoms until it is quite advanced. Perhaps no one knows this better than Duane Sunwold, 55, a culinary arts instructor at Spokane Community College in Spokane, Wash., whose compromised kidney function was not uncovered until a blood pressure crisis landed him in the hospital. A physician assistant found that abnormal amounts of protein were spilling out in his urine. Mr. Sunwold, then only 43, was referred to a nephrologist, who diagnosed a condition called minimal-change disease: damage to the tiny blood vessels within the kidney that filter wastes from the blood to make urine. Protein is not supposed to be among those wastes. Although Mr. Sunwold’s personal physician was treating him for high blood pressure, a leading cause of kidney failure, the doctor never checked to see how well his vital organs were functioning. Such a lapse is hardly uncommon. Kidney disease often is not on the medical radar, and in as many as three-fourths of patients with risk factors for poor kidney function, physicians fail to use a simple, inexpensive test to check for urinary protein. This fact has turned Mr. Sunwold into a proselytizer with a potentially lifesaving message for 26 million Americans who have kidney disease (many of whom don’t yet know it) and an additional 76 million at high risk of developing it: Make sure your doctor checks the amount of protein in your urine at least once a year. After his diagnosis, Mr. Sunwold brought all his risk factors under control and succeeded in improving his kidney function. He offers tips online and recipes for good kidney health, which are also good for the heart, diabetes and weight control. To read NT times article go to : http://well.blogs.nytimes.com/2013/07/15/kidney-disease-an-underestimated-killer/?_r=0  

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20/Jul/2018

by Beth Greenstein, LCSW Social Worker extraordinaire North Star Center, Boca Raton, Fl 561-0500 ext. 40

Shawn Achor, the author of The Happiness Advantage notes we have three mental paths when we are faced with adversity:

1. We can keep circling around, have no change, and end up exactly the same as when we started out. 2. We can be worse off then we started. This results in us being more afraid of conflict and challenge or

3. We can pursue a path that results in us being stronger and more capable after the crisis.

Sounds great, but is it doable??? Absolutely.

Take Fred, not happy about being on dialysis. Who could be? He was only 60, retired due to a heart condition, widowed and because of his disability, living with his sister and his brother-in-law. Hard to tell which one of those two are the craziest!

So, he couldn’t help it. Told himself it was all unfair and boy, was he was pissed! Then to make matters worse, he now can’t have ice cream, couldn’t go on extended weekend trips whenever he wanted. Add to this the fun of being stuck by a needle. No, it gets better. He wakes up one morning, gets ready to come to that clinic and guess what, he has none of that vibration stuff going on in his arm. It happened not one month but the following month again! Now he gets to enjoy spending another few hours arranging to get the thing going again, rushing to one of those Access places and having to spend his usual day off doing back to dialysis!

How about Jose! He is only 26, should be going clubbing at night, maybe finished with college and ready to show the world his stuff. But, nooooo! He gets to spend nights tied up to that PD machine. Yea, he knows, at least he has his days free. Right! What about the never-ending doctor appointments, the constant work-up for transplant? Do those people ever answer their phone!!!

So, needless to say, its’ not easy! But doable, yes!! Because, there is a tool, mightier than the sword! Nope, not Superman. Not even the Green Lantern!

As Anchor goes on to say “Happiness is not about lying to ourselves or forgetting negative experience but adjusting our brain so that we see the ways to rise above the circumstances.”

So, there’s what is called the ABC approach, easy enough to remember! A-The adversity, we can’t change it B- The belief about it, whether we think the problem is solvable C- The consequence of our belief D- the disputation – telling ourselves our thought IS A BELIEF NOT A FACT!

For example, Fred tells himself, “I am helpless, I have to have dialysis if I want to live” Jose says,”It’s’ all my families fault, they gave me the genes and didn’t help me.” True? Not true? As your social worker extraordinaire, I can tell you one thing (and probably only one thing!) which is THOUGHTS ARE THINGS.

What do I mean? If you keep telling yourself negative, angry, stress thoughts, guess what! Will you win the lottery! Will you be happy! Will you find the hot date you want on Match dot.com??

Chances are slim. Because many, many people, much smarter than I (hard to believe, I know) will tell you there is a strong link between our mind, our body, and our actions.

So, what now? (Isn’t this where we started from?) Remember:

WE ALL HAVE CHOICES IN OUR THINKING AND thoughts are things. (Gee, didn’t I see that somewhere recently) Here are some changes and choices you can make today:

1) Decide to say “Thank you” when you wake up in the morning. Yea, I know its corny, do it anyway! Tons and tons of research show that those who have an ATTITUDE OF GRATITUDE are healthier and happier. Isn’t this the goal?

2) Get a mentor! Ask that Social Worker in your unit. She needs a break from all that paperwork and sitting in her office anyway! I have a mentor, a nice man or woman in every one of my units who is happy to help someone else. Believe it or not, it helps them!

3) Get active. That’s right. Get off your duff! If your MD says Ok, spend a part of every day, moving that body!!!! Use it or lose it.

4) Find something you enjoy, people, sometimes, yes, even family, a hobby; go to the beach (we are in Florida!)

5) And of course, HELP SOMEONE ELSE,( you knew that was coming!) we all have this ability, even if its just to smile at someone, tell a joke or heaven forbid, tell someone if you can do it, they can too!

6) Contact this social worker extraordinaire, I take Medicare, Humana, and other insurances and am nice, good and helpful. Just ask Fred and Jose!


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20/Jul/2018

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Dr Casaretto completes the fourth annual Tour DaVita in Tacoma Washington – a three-day, 240-mile bike ride to raise awareness and funds for the fight against kidney disease which took place from September 19-21 in Washington State. This bike ride through him through rural parts of Washington State with two days of almost constant rain.

Dr Casaretto attributes his successful completion of this grueling event to the support and encouragement of his family and Davita Team mates.

Kidney Doctor Alberto Casaretto

To participate in Tour DaVita, riders raised a minimum of $750 to $2,000 in donations each and paid their own travel expenses. Their individual fundraising combined with donations from DaVita and other corporate sponsorship is expected to contribute more than $700,000 to The Kidney TRUST, a 501(c)(3) nonprofit organization with the mission to reduce the human and economic cost of chronic kidney disease across the United States.

By the end of the 2010 ride, more than 1,200 DaVita teammates, physicians, family members and friends will have participated in the four Tours DaVita – riding more than 250,000 miles collectively and raising more than $2.3 million.

Since 2007 The Kidney TRUST has administered more than 13,000 kidney screenings as part of its CKD rapid-testing program and made more than 700 individual grants totaling $1.5 million to help people on dialysis manage medical costs.

“Chronic kidney disease is a largely unknown but unquestionably deadly epidemic in the United States,” said Annette Eros, president and CEO of The Kidney TRUST. “This ride creates a terrific opportunity for people to get involved and make a difference while showcasing a healthy lifestyle and simultaneously spotlighting the need for CKD education and testing.”

For more information about the fourth annual Tour DaVita, please visit www.tourdavita.org.

For more information about The Kidney TRUST, visit www.kidneytrust.org.


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