FAQS & Education

To better serve our patients and the community in general, we have dedicated this section to cover topics that will help you understand more about kidney disease and dialysis process. Here you will find a list of common questions and answers related to CKD.

Definition, causes and symptoms of chronic kidney disease:

What is chronic kidney disease (CKD)?
Healthy kidneys function to remove extra water and wastes, help control blood pressure, keep body chemicals in balance, keep bones strong, tell your body to make red blood cells and help children grow normally. Chronic kidney disease occurs when kidneys are no longer able to clean toxins and waste product from the blood and perform their functions to full capacity. This can happen all of a sudden or over time.

What is acute renal failure?
"Renal" means related to the kidneys. "Acute" means sudden. So acute renal failure means the kidneys have failed suddenly, often due to a toxin (a drug allergy or poison) or severe blood loss or trauma. Dialysis is used to clean the blood and give the kidneys a rest. If the cause is treated, the kidneys may be able to recover some or all of their function.

What are the main causes of kidney disease?
Diabetes is the number one cause of kidney disease, responsible for about 40% of all kidney failure. High blood pressure is the second cause, responsible for about 25%. Another form of kidney disease is glomerulonephritis, a general term for many types of kidney inflammation. Genetic diseases, autoimmune diseases, birth defects, and other problems can also cause kidney disease.

I have diabetes. Will my kidneys fail?
Diabetes is a risk factor for kidney disease, but this does not mean your kidneys will fail. You can care for your kidneys by controlling your blood sugar and getting regular microalbumin urine tests to see if you are spilling even tiny amounts of protein. Even if you develop diabetic kidney disease, you can work with your doctor to keep your kidneys working as long as possible.

Can I catch kidney disease from someone who has it?
No. Kidney disease is not contagious. You cannot catch it from someone. Most kidney disease is caused by diabetes and high blood pressure, conditions that can run in families. If you are a family member of someone who has diabetes, high blood pressure, or kidney disease, it is a good idea to ask your doctor to check your blood pressure and kidney function at your checkup.

What are kidney stones?
A kidney stone occurs when substances in the urine form crystals. Kidney stones can be large or small. Large ones can damage the kidneys; small ones may be able to pass in the urine. Because crystals have sharp edges, passing even small stones can be very painful. Treatment depends on what the stones are made of.

What is PTH?
Parathyroid hormone (PTH) is produced by several small, bean-like parathyroid glands in your neck. Its "job" is to tell your bones to release calcium into your bloodstream. Too much PTH can become a problem in people with kidney disease.
Healthy kidneys convert a hormone called calcitriol to its active form of vitamin D. Calcitriol lets your body absorb calcium from food you eat. When your kidneys are not working well, they start to make less calcitriol-so even if you eat calcium, your body can't absorb it. PTH kicks in to make sure you always have enough calcium in your blood. Over time, this can weaken your bones.
A blood test can show if your PTH levels are above normal. If they are, your doctor may prescribe a form of active vitamin D.

I have a family member with polycystic kidney disease (PKD). Should I be tested?
Since 60-70% of people with PKD have a family member with PKD, asking your doctor about being tested seems like a good idea. The first test used for PKD is an ultrasound to look at the kidneys and see if there are cysts. No contrast dye is needed, so this is a non-invasive test. Learning more about PKD may help you to take better care of your kidney health. The PKD Foundation has free information that can help you. You can reach them at: 1-800-PKD-CURE, or visit their website, pkdcure.org.

What are the symptoms of chronic kidney disease?
Knowing the symptoms of kidney disease can help people detect it early enough to get treatment. Symptoms can include:

• Changes in urination — making more or less urine than usual, feeling pressure when urinating, changes in the color of urine, foamy or bubbly urine, or having to get up at night to urinate.

• Swelling of the feet, ankles, hands, or face — fluid the kidneys can't remove may stay in the tissues.
• Fatigue or weakness — a build-up of wastes or a shortage of red blood cells (anemia) can cause these problems when the kidneys begin to fail.
• Shortness of breath — kidney failure is sometimes confused with asthma or heart failure, because fluid can build up in the lungs.
• Ammonia breath or an ammonia or metal taste in the mouth — waste build-up in the body can cause bad breath, changes in taste, or an aversion to protein foods like meat.
• Back or flank pain — the kidneys are located on either side of the spine in the back.
• Itching — waste build-up in the body can cause severe itching, especially of the legs.
• Loss of appetite
• Nausea and vomiting.
• More hypoglycemic episodes, if diabetic

If you believe you have any of these symptoms, talk to your doctor about your concerns. This is especially important if you have a close family member who has kidney disease, or if you have diabetes or high blood pressure, which are the main causes of kidney failure.

How can I find out if I have kidney disease?
Kidney disease can be found through lab tests or by symptoms. High blood levels of creatinine and urea nitrogen (BUN) or high levels of protein in your urine suggest kidney disease. Diabetics should have a yearly urine test for microalbumin, small amounts of protein that don't show up on standard urine protein test.

If I have signs of kidney disease, what should I do?
After you have basic screening tests done, if you have signs
of kidney disease, you should ask for a referral to a nephrologist, a specialist in treating kidney disease. A nephrologist will perform an evaluation then suggest medications or lifestyle changes to help slow the progression of kidney disease.

Dialysis:

If you have chronic kidney disease that progresses to end stage renal disease, you will want to know all of the dialysis choices that are available to you. Below are some frequently asked questions pertaining to dialysis, such as when it is necessary, how long you can be on it and how often you would need to dialyze.

If I have kidney disease, will I need dialysis?
In the early stages of chronic kidney disease, you do not need dialysis. These early stages can last for many years. But if your kidneys fail, you will need dialysis or a kidney transplant to keep you alive.

If I have kidney disease, how long will it be before I need to start dialysis?
Depending what stage your chronic kidney disease is and how quickly it progresses, you may never need dialysis — or you may need dialysis right away. Dialysis is usually recommended when your kidney function is about 10-15% of normal.

My doctor said I will need to go on dialysis in six months to a year. What does this mean?
It is time for you to learn about all the treatment options for kidney failure: peritoneal dialysis, hemodialysis and kidney transplant. You have some choices to make. If you plan to do peritoneal dialysis, which is a home dialysis option, you will need to have a tube surgically placed in your abdomen. If you plan to do hemodialysis, whether in center or at home, you will need to have surgery soon to create a vascular access and allow it to heal. If you want a kidney transplant, you will need to talk with your nephrologist about how to get on the transplant list or ask a friend or family member to donate a kidney.

How is dialysis paid for?
Private insurance generally covers treatment for kidney failure whenever your doctor says it is needed. If you don't have private insurance, you may be able to get coverage through federal or state funded healthcare programs, such as Medicare or Medicaid.
Most people (about 93% of those who apply) qualify for Medicare when they need dialysis or a transplant, even if they are under age 65. Medicare pays for 80% of treatment for kidney disease when kidney function has dropped to 10-15%, or when your doctor justifies it.
If you are not having symptoms, you may be able to wait a bit longer for dialysis. However, some doctors believe that starting dialysis as soon as Medicare or insurance covers it is wise, since it can take a long time to recover if you let yourself get very ill. Since chronic kidney disease often happens slowly, sometimes people do not even know how bad they feel until they start dialysis and begin to feel much better.
It is important to start getting ready for dialysis or a transplant well in advance — when your kidney disease reaches Stage 4 chronic kidney disease (with glomerular filtration rate (GFR), less than 30 mL/min). Any type of dialysis will require surgery — usually outpatient — to create an access for your treatments, and this should be done well in advance to allow time for healing.

I am in Stage 4 kidney disease and can't have a transplant. Can I do dialysis for the rest of my life?
The questions "How long can someone live?" and "How well can someone live?" are very common when you need to go on dialysis and you're scared. Yes, dialysis is something you can do for the rest of your life. And, most people on dialysis enjoy a good quality of life. Some people have been on dialysis for 30 years or more without getting a transplant. How long you can live on dialysis, and how well you do, will depend on a number of things, including:

• How healthy you are, other than kidney disease
• How positive your attitude is (optimists live longer, depression can be treated)
• Whether you receive good quality medical care and dialysis
• How much you learn about dialysis and take an active role in your care

Nobody lives for 30 years or more on dialysis by accident — it takes a lot of knowledge and effort. You are doing the right thing by visiting this website. Sign up for kidney classes. You may also want to check into joining a kidney patient organization, like a chapter of the National Kidney Foundation at: http://www.kidney.org, or the American Association of Kidney Patients at: http://www.aakp.org or learn more about kidney disease by visiting Kidney School at: http://www.kidneyschool.org.

If I start hemodialysis, how often will I have to get treatments?
The usual schedule for in-center hemodialysis treatments is three times a week, either Mon/Wed/Fri or Tues/Thurs/Sat. You will have the same morning or afternoon time for each treatment. The length of your treatment depends on what your doctor prescribes for you. Three to four hours is common, plus time to travel to and from the center, and often some waiting time when you arrive. If you don't like the treatment schedule you get, you can ask to be on a waiting list for a different time, or switch to a different center.

If I start PD, how often will I have to get treatments?
Peritoneal dialysis (PD) is most commonly done on a nightly basis using an automated cycler machine while a person sleeps. A patient will typically be connected to the cycler for 8 to 10 hours each night and be free of dialysis during the day. Some people will choose to do manual PD, which usually means doing four to five exchanges per day. Each exchange takes 20 to 30 minutes, and they need to be spread out over the whole day to clean the blood well. A common manual PD schedule might be to do one exchange upon waking, one at lunchtime, one at dinner, and one at bedtime. A cycler can be used together with a manual exchange. The cycler can be used at night with only one exchange during the day.