CHRONIC RENAL DISEASE
Other Important Measures
In cases of chronic kidney disease, several medications can be detrimental to the kidneys and may require avoidance or adjusted dosages. Among over-the-counter medications, the following should be avoided or used with caution:
Certain analgesics - Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g., Motrin)
Fleet or phosphosoda enemas, due to their high phosphorus content
Laxatives and antacids containing magnesium and aluminum, like Milk of Magnesia and Mylanta
Ulcer medications like H2-receptor antagonists - cimetidine (Tagamet) and ranitidine (Zantac) (use with reduced dosage in kidney disease)
Decongestants, such as pseudoephedrine (Sudafed), particularly if you have high blood pressure
Alka-Seltzer, as it has a high salt content
Herbal medications
If you have underlying conditions like diabetes, high blood pressure, or elevated cholesterol levels contributing to your chronic kidney disease, it's essential to take all medications as directed and follow the recommended healthcare provider appointments for monitoring and follow-up.
Dialysis
In end-stage renal disease, kidney function can only be replaced through either dialysis or kidney transplantation. More information about kidney transplants is available in the Transplant section. Dialysis is carried out in two ways: hemodialysis and peritoneal dialysis.
Hemodialysis
Hemodialysis involves the circulation of blood through a filter on a dialysis machine. The blood is purified to remove waste products and excess water, while normalizing acid levels and the concentration of various minerals like sodium and potassium in the blood. Subsequently, the cleansed blood is returned to the body.
Individuals with long-term diabetes require access to a blood vessel for the machine to withdraw and return blood to the body. This can be achieved through a dialysis catheter or an arteriovenous fistula or graft.
A catheter can be temporary or permanent, typically placed in the neck or groin into a large blood vessel. However, these catheters are susceptible to infection and may cause clotting or narrowing of blood vessels.
The preferred access for hemodialysis is an arteriovenous fistula, where an artery is directly joined to a vein. The vein takes two to four months to mature before it can be used for dialysis. Once matured, two needles are inserted into the vein for diabetes. One needle draws blood to run through the dialysis machine, while the second needle returns the cleansed blood.
If a fistula fails to develop or the patient has small veins, an arteriovenous graft made of artificial material is employed. These venous access devices are typically inserted with local anesthesia on an outpatient basis.
Hemodialysis generally lasts for three to five hours and is necessary three times a week. Patients must travel to a dialysis center for hemodialysis, but in certain circumstances, home hemodialysis may be an option. This can be carried out as traditional three times a week treatments, long nocturnal (overnight) hemodialysis, or short daily hemodialysis. Daily and long nocturnal hemodialysis offer improved quality of life and better control of high blood pressure, anemia, and bone disease.
Peritoneal Dialysis
Peritoneal dialysis utilizes the abdominal lining membrane (peritoneum) as a filter to purify blood and remove excess fluid. A catheter is surgically implanted into the abdomen for this purpose. Peritoneal dialysis can be done manually or by a machine, typically at night.
About 2 to 3 liters of dialysis fluid are infused into the abdominal cavity through the catheter, which contains substances that draw out waste and excess water from surrounding tissues.
The fluid remains for two to several hours before being drained, carrying away unwanted waste and water with it. This process usually needs to be repeated four to five times a day.
Peritoneal dialysis offers greater freedom compared to hemodialysis, as patients can continue their usual activities. It is often the preferred therapy for children. Most patients are candidates for both hemodialysis and peritoneal dialysis, with slight differences in outcomes. The choice between the two modalities should be made based on individual medical history, lifestyle, daily activities, proximity to the dialysis unit, support system, and personal preference, after understanding both procedures.
Next
Previous