Positive Living With Kidney Failure

The world kidney day (WKD) this year is on 14th March, and the theme for this year is Kidney Health for Everyone Everywhere. It is worthwhile to understand the global burden of this disease.Nearly 850million people worldwide are now estimated to have kidney diseases from various causes. Chronic kidney diseases (CKD) causes at least 2.4 million deaths per year and are now the 6th fastest growing cause of death.The social ,psychological and emotional effects of chronic kidney diseases (CKD)remain significant because of the challenges they pose on patients and their families.Here we briefly discuss the various areas associated with kidney failure and the best ways to cope with these.
 
What treatments are available for chronic kidney disease (CKD)?
In early stages from stage 1 to stage 4 patients are managed with diet and medication. For end stage kidney disease (CKD stage 5) , three main types of treatment are available for patients with kidney failure. They arehaemodialysis, peritoneal dialysis and kidney transplantation.Kidney Transplants can come from living donors, who are usually familymembers, spouses or friends of the patient.Transplants can also come frompeople who died recently (deceased donor).
 
How to choose one form of treatment over another?
The patient and family should explore each choicecarefully with their doctor, transplant surgeon and other health care team members. Atreatment choice is not always final. For example, a patient who has decided thathaemodialysis is the best choice may, at a later time, still consider peritoneal dialysis or akidney transplant after talking to the doctor and other members of the health care team.Haemodialysis may be done at a dialysis centre or at home, and treatments usually take place two to three times a week.Peritoneal Dialysis may be done at home, in office , in school or wherever a clean, private space is available for bag exchanges.
 
What are the common worries and fears at the  beginning of treatment?
Havingconcerns about your wellbeing, whether the treatment is painful,what the society will think of you, how close to normal you can feel and how long you can live with the disease is normal andexpected.Visiting the facility before you begin treatment can help make the dialysismachine and the treatment less frightening.Speaking to the doctor, staff, other patients and families who have been through the sameexperience can be very helpful.
 
How can a patient be guided to take responsible decisions ?
 Every patient should take part in decisions about type of treatment.The staff at the dialysis centre may be able to help by suggesting transportationsources for ambulatory patients and patients requiring wheel-chairtransportation.They should arrive on time for scheduled dialysis treatments.Learning that dialysis or a transplant will be needed can be very stressful at first, butnormal activities can be resumed slowly with understanding the disease process and associated responsibilities
 
When and how can dialysis patients return to their work ?
Absolutely they should return to their work once medically stable,and after discussing with the doctor. When patients and their families return to a more normal routine,they feel much more satisfied with their lives. There may be need of some modifications at work as some activities may no longer be tolerated andothers may need to be changed to another time. One should keep in mind their haemodialysis and PD timings to sync with their work timings. A kidney transplant patient can go back to his professional life after a brief period of rest in the post-operative period.
 
Can dialysis and transplant patients exercise?
With regular dialysis and use of erythropoietin patient’s well being ,most patients can start mild to moderate levels of exercise like brisk walking,light forms of aerobic exercises with the consultation of their of doctor . Successful kidney transplantsoften increase patients' exercise tolerance to normal levels.Before beginning an exercise program, it is important to consult your doctor andremember the difference between "doing" and"overdoing." Exercising with a family member providesincreased safety and companionship.
 
Can they have a normal sexual activity ?
As with other chronic illnesses, the desire for sexual activity may change with the onsetof kidney failure. Impotence, the inability for a man tohave or maintain an erection, is common in kidney failure. This may be due to medicalcauses or emotional reasons, such as depression, Couples who find that their sex lives are changing as a result of one partner's kidneyfailure should talk about the problem with the doctor or social worker because many ofthese problems can be treated.While some men and women with kidney failure continue to have sexual problems,many transplant recipients become more active sexually and have fewer sexualproblems as their new kidney continues to function.
Can a woman who is on dialysis have a baby?
Women with kidney failure, whether or not they have begun dialysis, are usually advisedagainst becoming pregnant. The rate of complications and the risk to both thendeveloping baby and the mother are high. It is important to consult a doctor for furtherinformation and advice and to consider birth control.
Can a woman who has a transplant have a baby?
Yes. A woman who has had a kidney transplant usually has more regular periods and
better general health. Therefore, it is easier for her to get pregnant and have a child.
However, pregnancy is not recommended for at least one year after the transplant, even
with stable kidney function. In some cases, pregnancy is not recommended because of
risk to the mother's life or possible loss of the transplant.
What can patients and their families do about feelings of depression andanxiety?
These feelings are very common causing in difficulty adapting to kidney failure if one holds the sadness and anxietyinside. Other patients can be a good source of support and inspiration.With the stress of kidney disease, it is important to maintain asense of warmth and closeness with family and friends.However, it isimportant not to make your family members feel guilty about your illness or to take outyour anger about your illness on them.Patients may feel they are a burden to their family. Sharing yourthoughts and feelings freely in an honest, respectful manner can help you and yourfamily.
How can patients and their families deal with the stress of chronic kidneydisease?
It is important to realize that kidney failure does not happen just to individuals - it happens to families. Family members may feel helpless because they cannot do anything about the illness. Kidney failure requires changes in lifestyle.Routine tasks and activities that require physical strength may be difficult to perform. Family members or friends may have to take on added responsibilities.The following steps can help to lessen the stress:Talk to the staff at the dialysis unit or transplant clinic.Write down questions ahead of time and inform family members about changesin treatment.Keep involved in the pleasures, activities and responsibilities of daily living.Share your feelings with family or close friends.Share your feelings with other patients.Seek help from the social worker at the dialysis unit or transplant clinic or froman outside counsellor , if family or personal problems need further attention.Find time to enjoy the outdoors.Be patient and set realistic goals in adjusting to all lifestyle changes
 
Senior Consultant Nephrologist and Kidney transplant physician
AMRI Hospitals Bhubaneswar
 


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