What is a Nephrologist?
A nephrologist is a doctor who treats patients with kidney problems, hypertension (high blood pressure), who are on dialysis or who have a kidney transplant. Once you have been diagnosed with kidney disease, early referral to a nephrologist is important in preserving and protecting your kidney function.
What is CKD?
CKD stands for chronic kidney disease. CKD is defined as a decreased level of kidney function or the evidence of kidney damage for greater than three months. Individuals at risk for developing kidney disease are those with diabetes, high blood pressure or a family history of kidney disease.
What are the 5 stages of CKD?
Once CKD is diagnosed it is important to determine the level of kidney function. The National Kidney Foundation has identified 5 stages of chronic kidney disease. Each stage represents a level of kidney function as defined by a creatinine clearance.
The 5 stages are:
- Stage 1 CrCl > 90
- Stage 2 CrCl 60-89
- Stage 3 CrCl 30-59
- Stage 4 CrCl 15-29
- Stage 5 CrCl < 15 or dialysis
Why are the kidneys so important?
The kidneys perform numerous vital roles for your body. They filter and remove waste products from the blood, remove extra water from the body, and adjust levels of minerals, electrolytes, and chemicals in your body. Many medications you take are eliminated by the kidneys and may need to be dose adjusted for your degree of kidney function. Kidneys also produce hormones that help control your blood pressure and help your bone marrow make red blood cells.
What can I do to protect my kidneys?
There are a number of ways you can protect your kidneys and slow the progression of CKD. A low sodium diet (less than 2000mg/day) along with a diet low in saturated fats and rich in lean meats, fruits and vegetables is important. Maintaining adequate blood pressure control (less than 130/85 consistently), smoking cessation and moderation of alcohol intake are important. If you are also a diabetic, keeping your blood sugars well controlled will help delay progression of your kidney disease, and may even improve your kidney function. We encourage our diabetic patients to strive for a glycylated hemoglobin level (HbA1C) as close to 6 percent as possible.
Why may I need to take new blood pressure medications when my blood pressures have been well controlled?
High blood pressure may be controlled with a combination of weight loss, exercise, low soidium diet, and medications. Each type of blood pressure medication you take provides a different benefit for controlling your blood pressure. Some actually help to slow the progression of kidney disease! In addition, certain blood pressure mediciations such as ACE inhibitors and ARB's are often added to specifically to reduce the spillage of protiein in your urine.
Are there medications I should avoid with CKD?
Common medications to avoid are NSAIDS ( anti-inflammatory medications) such as ibuprofen, motrin, advil, and alleve. COX inhibitors such as celebrex, mobic, and bextra may need to be curtailed. Certain enemas (Fleet's) and phosphorous based laxatives should be avoided - unless ordered by the nephrologist. If you are going to have an imaging test that uses intravenous dye (such as cardiac catheterizations or CAT scans) please notify us, as they may pose harm to your kidneys. Some steps can be taken before the test to protect your kidneys from the dye load. It is also a good idea to check with your nephrologist prior to starting any new over the counter or prescription medications.
Why do I have anemia?
Anemia is a decrease in red blood cells or hemoglobin. Hemoglobin carries oxygen throughout the body and when low can result in fatigue, shortness of breath, depression, poor appetite and heart disease. The kidneys make a hormone called erythropoietin which helps your bone marrow produce reb blood cells. With CKD there is a decrease in the production of this hormone and thus a decrease in your hemoglobin. The treatment for anemia related to CKD is injections with the synthetic forms of the hormone erythropoietin and with iron pills or iron infusions. You may need to be referred to a hematologist (blood specialist) or an infusion center for these medications.
What are my treatment options if my kidneys fail?
Hemodialysis, peritoneal dialysis and kidney transplant are all treatment options. Kidney transplantation is the preferred method. It involves surgically placing a healthy kidney from another person into your body. The donated kidney does the work that your failed kidneys used to do. You will need to be referred to a local transplant center for such an evaluation (They are located in Tampa, Gainesville, and Orlando). For many people dialysis and transplantation extend and improve quality of life.
What is dialysis?
Dialysis is a process that cleans and filters your blood. There are two types of dialysis, hemodialysis and peritoneal dialysis.
Hemodialysis cleans your blood using a machine with a special filter called a dialyzer. During a hemodialysis treatment blood travels from your body through tubes to the dialyzer which filters out wastes and extra water. The cleaned blood flows through another set of tubes back into your body.
Peritoneal dialysis removes wastes and extra water from your body using the lining of your abdomen (peritoneum) to filter your blood. A special solution travels through a soft tube into your abdomen. The solution draws wastes and extra water from tiny blood vessels in your peritoneum back into the solution which is then drained from your abdomen through the soft tube.
Do you offer Home Dialysis?
Peritoneal dialysis is a form of home dialysis. Patients often infuse the solution in and out of their abdomen at night while they sleep using a machine called a cycler. This allows them to be 'free' from dialysis during the daytime. We have many patients who have been trained to perform home hemodialysis (HHD). This technique requires that a patient and caregiver be trained to perform the hemodialysis procedure which can be done in the evening 5-6 times a week. You will have you own machine and supplies - and it is covered by insurance. Like peritoneal dialysis, patients feel more independent as their day is not occupied by in center dialysis.
What is a vascular access?
For hemodialysis it is necessary to create a vascular access or 'shunt' to allow your your blood to be drawn, cleaned, and redelivered to your body. The access is usually created in your arm during a short surgery. One type of access is a fistula, another type of access is a graft (short gortex tube). In some cases an external catheter may be inserted into a vein in your chest or neck. A catheter is always a temporary solution as it easily gets infected and should be replaced by a fistula or graft as quickly as possible. Once your acces is placed, we will monitor and maintain the health of you vascular access - since this becomes your 'lifeline'.