Living with Chronic Kidney Disease. Divya Jain Arwindekar, DO Transplant Nephrologist University of Illinois at Chicago

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1 Living with Chronic Kidney Disease Divya Jain Arwindekar, DO Transplant Nephrologist University of Illinois at Chicago

2 What is Chronic Kidney Disease? Chronic Kidney Disease (CKD) Gradual loss of Kidney Function over time Currently affects 26 million Americans Can lead to End Stage Kidney Disease which requires treatment to live Dialysis Transplant

3 What causes CKD? Diabetes High Blood Pressure (aka Hypertension) Glomerulonephritis inflammation of the filtering units of the kidney (nephrons) Inherited diseases (i.e. Polycystic Kidney Disease) Congenital defects malformations in the womb Some autoimmune diseases (i.e. Lupus)

4 What causes CKD? Gout Obstruction (i.e. enlarged prostate gland) Recurrent (repeated) urinary tract infections Kidney stones Liver disease (i.e. hepatitis) HIV Medications (i.e. NSAIDs Motrin, Advil, ibuprofen, Aleve, naproxen, naprosyn) Age

5 Effects of CKD High Blood Pressure Increased risk of cardiovascular disease Anemia (low hemoglobin) Weak bones Electrolyte imbalances weakness Waste build up Fluid build up

6 Symptoms of CKD Fatigue Swelling of legs Chest pain Shortness of breath Erectile dysfunction Mental slowing Poor appetite Taste changes Urinating frequently, more so at night

7 How do we measure kidney function? egfr estimated glomerular filtration rate Calculated number that uses multiple factors in determining it race, age, creatinine, etc.

8 Stages of CKD Stage 1 Kidney damage with normal or increased egfr (egfr is >/= 90) Stage 2 mild (egfr 60-89) Stage 3 moderate (egfr 30-59) Stage 4 severe (egfr 15-29) Stage 5 failure (egfr < 15) End Stage treated with dialysis or transplant

9 Diagnosing CKD Labs creatinine, urine tests including looking at urine for protein/albumin Kidney ultrasound any structural issues (cysts, stones, etc.) and assess size of kidneys Kidney biopsy tissue sample to give more precise diagnosis

10 Goals in treatment of CKD Early diagnosis Delaying progression Referring for Kidney Transplant Ideally well before dialysis is needed Can be listed for transplant when egfr is less than 20 Preparing for dialysis learning about the different modalities and obtaining the best dialysis access

11 Early Diagnosis Ask your doctor what is your egfr Know your numbers Ask if you have any protein in the urine or anything else that might tip your doctor off

12 Delaying Progression Blood Pressure control Goal less than 140/90 Check your blood pressure at home Write it down and bring it to ALL of your doctor s appointments Sugar (glucose) control Check your blood sugar if you re a diabetic Write it down and bring your log to your doctor s appointments

13 Delaying Progression Exercise!!! Keep weight under control Decreases risk of Cardiovascular Disease Cardiovascular exercise increases your good cholesterol (HDL) Optimize you in case you need a transplant Diet vegetarian?? Increase fruits and vegetables Decrease animal proteins Limit simple carbs (complex carbs better) Avoid NSAIDs, Fleets enemas (phosphate enemas) Caution with herbal supplements

14 Delaying Progression Avoid NSAIDs, Fleets enemas (phosphate enemas) Caution with herbal supplements Avoid licorice root, goldenrod, nettle, etc. Not controlled by FDA May contain other kidney irritants i.e. heavy metals

15 Treatment Options for End Stage Kidney Disease Kidney Transplant Dialysis No treatment

16 Kidney transplant Can be listed once egfr is below 20 Prepare yourself if approaching egfr 20 Make sure your age-appropriate cancer screenings are up to date Prostate, colonoscopy, mammogram, Pap smear Make sure to receive your vaccines prior to evaluation hepatitis A & B, Shingles, Flu, Pneumonia (Pneumovax and Prevnar-13) Know all of your Doctors names; when,where and why you ve been hospitalized Know your medications

17 Types of Transplant Living Donor Related or Unrelated Donor doesn t have to be a perfect match Preferred over Deceased Donor Deceased Donor Average wait time in Chicago is 5-7 years National average is 3-5 years Wait time starts once you re listed or once you start dialysis, whichever comes first

18 Dialysis Treatment that uses a machine to help clean your blood to remove waste and excess fluid from your body

19 Types of Dialysis Peritoneal done at home Hemodialysis Home In-center

20 Peritoneal dialysis Gentle dialysis that is done daily Done at home Usually done while sleeping Catheter inserted into abdomen, but not directly in blood stream

21 Hemodialysis Involves the bloodstream Can be done at home or in-center Usually three times a week, but can be less or more Can be done nocturnally (at night) At home, requires a support person Best access: Fistula, Graft Least desired access: catheter inserted directly into bloodstream

22 Fistula vs. Graft Fistula directly connects the artery to the vein to provide dialysis access Need to wait to use this as it requires maturation Graft connects the artery to the vein via a synthetic material (graft) to provide dialysis access No time to mature

23 No treatment Some people may not benefit from treatment Age Other illnesses/diseases Ultimately will lead to death

24 Summary CKD is the gradual loss of kidney function over time The 2 main causes are Diabetes and High Blood Pressure Symptoms usually don t appear until later stages of CKD Cardiovascular disease is the leading cause of death in patients with CKD Main goal in treatment of CKD is to delay progression to End Stage Kidney Disease Once End Stage Kidney Disease, there is No Cure Treatment for End Stage is Transplant and/or Dialysis No treatment of End Stage will lead to death

25 Questions??

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