New Hope for Patients With Kidney Disease

One promising breakthrough -- dialysis while you sleep

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By Dennis Thompson
HealthDay Reporter

FRIDAY, April 28, 2006 (HealthDay News) -- Technological breakthroughs are helping to make the lives of chronic kidney disease patients far more normal.

"There are lots of options," said Dr. Adeera Levin, a professor of medicine at the University of British Columbia and a physician at St. Paul's Hospital, both in Vancouver, Canada. "Care has really changed in the past decade. As a consequence, I think it's a more hopeful thing now."

For example, dialysis performed while you sleep has been found to profoundly improve quality of life for people with end-stage kidney disease.

However, millions of Americans have damaged kidneys but don't realize it. For them, the best care in the world won't matter if they don't realize their dilemma and seek help.

Chronic kidney disease is often called the "silent disease" because many sufferers have no idea their kidneys are being damaged -- or even that they're at risk.

"I view kidney disease as a public health problem," said Dr. Wendy Brown, chief of staff at the VA Tennessee Valley Health Care System and a professor of medicine at Vanderbilt University. "Chronic kidney disease is silent in many instances until you're pretty far along on the continuum."

Healthy kidneys balance the body's fluids by filtering and releasing wastes, controlling levels of water and important minerals, removing toxins and drugs from the bloodstream, and releasing hormones that control blood pressure, make red blood cells and keep bones strong.

Kidney disease occurs when those functions begin to break down.

An estimated 7.4 million adults -- about 4.5 percent of the American population -- have physiological evidence of kidney disease, according to the National Institute of Diabetes & Digestive & Kidney Diseases.

But researchers believe another 10 million or more people are suffering from decreased kidney function and other early warning signs of chronic kidney disease.

According to the National Kidney Foundation, symptoms can include fatigue, trouble thinking clearly, poor appetite, sleeplessness, dry and itchy skin, nighttime muscle cramps, swollen feet and ankles, puffiness around the eyes, the need to urinate frequently and unexpected weight loss or gain.

People who should worry most about chronic kidney disease are those with diabetes or high blood pressure.

Diabetes causes excess blood sugar, and the strain of processing this sugar can damage the kidney's filters. High blood pressure can scar the blood vessels surrounding the kidneys, choking blood flow to the vital organs.

Other people at high risk include those with a family history of kidney disease, people older than 60, and blacks, Hispanics, Asians or Pacific Islanders.

"If you're in any of those high-risk groups, it would be worthwhile to have your kidney function checked and have it followed up by an expert or others," Levin said.

A urinalysis is a common test for kidney disease, with doctors looking for blood and protein in the urine. Blood tests also are used to determine how well the kidneys are filtering and excreting wastes and excess fluids from the body.

Awareness of the disease has remained sketchy even as doctors have pursued technological breakthroughs that have made patients' lives much more easy and normal.

In a recent study, researchers found that dialysis performed while patients sleep at home does the job better than dialysis performed a few times a week during the day.

The findings by Canadian researcher Dr. Christopher Chan, medical director of home hemodialysis at Toronto General Hospital, have prompted two major follow-up studies involving hundreds of patients.

There are two big benefits to nocturnal dialysis, Brown said.

Since it is delivered more frequently than standard dialysis -- in which people come to a medical center three times a week -- nocturnal dialysis provides a more natural replacement for normal kidney function.

"You can keep their metabolism stable," Brown said. "There are less broad swings up and down."

As a result, patients report fewer symptoms of kidney disease in their day-to-day life.

The other benefit is purely practical. Patients no longer have to set aside large blocks of time during the day to receive dialysis treatment.

"They have better quality of life because they are free to do whatever people do during the day," Brown said.

Other breakthroughs have included new medications for regulating the symptoms of kidney disease, and improvements in transplantation technology, Levin said.

"Not everybody with kidney disease will go on to dialysis," she said. "Those that do, there are a lot of technological advances to help them cope better."

More information

To learn more, visit the National Kidney Foundation.

SOURCES: Adeera Levin, M.D., professor of medicine, the University of British Columbia, and a physician at St. Paul's Hospital, both in Vancouver, Canada; Wendy Brown, M.D., chief of staff, VA Tennessee Valley Health Care System and a professor of medicine at Vanderbilt University, Nashville; National Kidney Foundation; National Institute of Diabetes & Digestive & Kidney Diseases

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