BLOG Archives - NEPHROXENIA https://www.nephroxenia.com/category/blog/ your dialysis centers! Tue, 29 Nov 2022 15:06:22 +0000 en-US hourly 1 https://wordpress.org/?v=6.9 https://www.nephroxenia.com/wp-content/uploads/2023/04/cropped-337713018_889473832352803_7427670057725383742_n.jpg BLOG Archives - NEPHROXENIA https://www.nephroxenia.com/category/blog/ 32 32 MYTHS AND CKD https://www.nephroxenia.com/myths-and-ckd/ Mon, 19 Sep 2022 14:20:56 +0000 https://www.nephroxenia.com/?p=3459 Chronic Kidney Disease is a misunderstood clinical entity, whose importance has only emerged in recent years ...

The post MYTHS AND CKD appeared first on NEPHROXENIA.

]]>

Chronic Kidney Disease is a misunderstood clinical entity, whose importance has only emerged in recent years and whose great clinical value has not been properly recognized by the community of medical specialists involved in managing renal patients.

Characteristic is the case of a patient to whom the doctor announces that he suffers from high cholesterol while the creatinine levels are marginally elevated, with interest concentrating exclusively on how cholesterol can be reduced, how long it will take, which is the best diet, when should the patient start treatment, how often one should be tested and the side effects of the medication etc. As for creatinine, it is considered enough for the patient to increase the daily water intake and the problem may be solved without any other intervention! So, let’s look at some myths circulating around Chronic Kidney Disease and which often inhibit the treatment of the disease.

First myth: "if you drink some more water your creatinine levels will fall"

This is the most common myth among renal patients. It is a fact that an elevated creatinine value may be a transient finding in the context of some conditions that are not related to the kidney (e.g. antibiotic treatment or other drugs, nutritional factors, muscle mass, etc.), but on the other hand, this elevated value may be suggesting some degree of renal impairment, especially in high-risk patients for renal disease (e.g. diabetic, hypertensive, obese, etc.). In such cases, the physician's purpose is to carefully investigate the causes of creatinine elevation and to further examine the patient for potential renal damage, not just to frivolously advise additional daily water intake, which, obviously in no way heals the damage! There are even cases in which excessive water consumption can lead to the worsening of a kidney problem, as is the case for people with a solitary kidney (congenital or of acquired etiology). In such cases, consumption of additional water may further harm the patient, leading to ultrafiltration and hyperfunction of the kidney with damaging results (e.g., exacerbation of existing proteinuria). Increased water consumption (> 2 L) is recommended in very specific cases, such as for patients with recurrent nephrolithiasis or recurrent urinary tract infections and for elderly patients taking diuretics. Even in the latter case, because of the thirst mechanism, it is imperative that patients are closely monitored so that their daily intake of water is within recommended limits and diuretic action does not lead to dehydration.

Second myth: "your creatinine levels are within the normal range, so there is no problem with your kidneys"

What is normal or not when assessing laboratory parameter is in no way dependent only on the normal limits given by each laboratory. What is of particular value is the comparative study of the laboratory parameters over time as well as the consideration of the particular characteristics of the person under consideration. For example, a creatinine value of 1.3 mg / dl may be a perfectly normal value for a 40-year-old muscular man whereas the same value for a 70-year-old man may suggest a loss of renal function of up to 60-70%! Also, a creatinine value that ranged from 0.6 to 0.8 mg / dl years ago and is currently estimated at 1.2 and 1.3 mg / dl is an important pathological finding, which should be evaluated with due care, even if these values remain within the normal limits given by the laboratory. Finally, it is noted that the value of creatinine is only one of many indicators of kidney damage. There are a few cases where even though creatinine is considered within normal limits, the kidney has a significant degree of damage. It is therefore necessary to further evaluate several different indicators when diagnosing a patient's kidney health status.

Third myth: "Increased creatinine is not important. More important is your increased cholesterol value"

Renal disease is considered by many specialists to be equivalent to coronary heart disease. This means that a patient with impaired renal function and a patient with a history of myocardial infarction undertake theoretically the same risk of having a cardiovascular event in the future. This fact, combined with the empirical observation that chronic renal disease significantly increases the risk of cardiovascular disease (coronary artery disease, stroke, peripheral arterial disease, etc.) or even the risk of death of a patient, constitute proof that the elevated creatinine level is a serious disease indicator that needs to be assessed with due care and which is clearly more severe than an elevated cholesterol value, being after all just one of many risk factors to the onset of cardiovascular disease.

Fourth myth: "Chronic kidney disease is only dangerous at its last stages, just before the patient begins dialysis treatments"

It is a fact that chronic renal disease is an asymptomatic disease which in its final stages is accompanied by a remarkable symptomatology. However, its timely diagnosis is important for three reasons. Firstly, because of the previously mentioned increase in cardiovascular risk. Secondly, due to the significant therapeutic interventions that can be made in the early stages of the disease, either to induce cure (less often), or to slow down the progression of renal damage. And thirdly, because of the "silent" complications of the disease that start to appear during its third stage. These complications include among others, anemia of renal disease and bone renal disease, which if diagnosed relatively early, can be treated with the appropriate medication.

The demolition of these myths is imperative in adequately treating patients with CKD, thus substantially improving their level of health. Due to the high incidence of the disease both in the general population and in specific patient samples (diabetics, hypertensives etc.), the participation of the nephrologist in the patients’ medical team is mandatory. It is also important that other medical specialists involved in treating CKD patients are well educated as to the nature and peculiarities of renal disease. In the end, we can all agree that an increased creatinine value means much more than a simple recommendation of drinking a few more glasses of water daily. To paraphrase the old English proverb: “A glass of water a day cannot keep the nephrologist away”.

Bibliography

  1. William F. Clark, MD, Claude Kortas, MD MEd, Rita S. Suri, MD MSc, Louise M. Moist, MD MSc, Marina Salvadori, MD, Matt A. Weir, MD, Amit X. Garg, MD PhD, and for the WEL Investigators. “Excessive fluid intake as a novel cause of proteinuria”, CMAJ. 2008 Jan15;178(2):173-52.
  2. Thomas M. Hooton, MD1; Mariacristina Vecchio, PharmD2; Alison Iroz, PhD2; et al. “Effect of Increased Daily Water Intake in Premenopausal Women with Recurrent Urinary Tract Infections. A Randomized Clinical Trial”, JAMA Intern Med. 2018;178(11):1509-1515.
  3. Priyanka S. Sagar, Jennifer Zhang, Magda Luciuk, Carly Mannix, Annette T. Y. Wong, Gopala K. Rangan. “Increased water intake reduces long-term renal and cardiovascular disease progression in experimental polycystic kidney disease”, PLOS/ONE, Jan 2019
  4. Yerram P, Karuparthi PR, Hesemann L, Horst J, Whaley – Connell A. “Chronic kidney disease and cardiovascular risk”, J Am Soc Hypertens. 2007 May-Jun;1(3):178-84
Anastasios Ch. Fountoglou
Specialist Nephrologist, Nephroxenia Dialysis Center Corfu “NEPHROXENIA” Chalkidiki Dialysis Centre
NEPHROXENIA DIALYSIS CENTERS ARE DESIGNED SPECIFICALLY AROUND THE NEEDS OF A CONTEMPORARY RENAL PATIENT.
In Nephroxenia you can combine world class dialysis with amazing holidays.
FIND OUT MORE!

The post MYTHS AND CKD appeared first on NEPHROXENIA.

]]> AUTOLOGOUS ARTERIOVENOUS FISTULA https://www.nephroxenia.com/fistula/ Mon, 12 Sep 2022 13:35:27 +0000 https://www.nephroxenia.com/?p=2826 In patients undergoing chronic hemodialysis, the need for a vascular access (VA) that functions adequately for a long time ...

The post AUTOLOGOUS ARTERIOVENOUS FISTULA appeared first on NEPHROXENIA.

]]>
Autologous Arteriovenous Fistula

In patients undergoing chronic hemodialysis, the need for a vascular access (VA) that functions adequately for a long time and without significant complications, is a matter of critical importance for the quality of life and survival of these patients.

In the early 1960s, external shunt or Scribner shunt was originally used to perform hemodialysis in patients with end stage renal disease (ESRD). Despite the modifications and improvements made, complications such as inflammation, thrombosis and bleeding continued to occur at a high frequency.
VA got its current form in 1966 by surgical construction of an internal arteriovenous fistula (AVF). Since then, various improvements and innovations have brought other types of VA into daily clinical practice, such as arteriovenous grafts AVG and various types of central venous catheters (CVC). Autologous arteriovenous fistula (AVF) is constructed by subcutaneous anastomosis of an artery with an adjacent vein, allowing blood to flow directly from the artery to the vein (bypassing the capillary circulation), resulting in a vein arterialisation due to the high flows and pressures of the arterial circulation. The most common types of AVF are:

1The radial-cephalic AVF, which is constructed by anastomosis of the radial artery with the cephalic vein in the wrist, resulting in the creation of a superficial arterialised vein of satisfactory length along the forearm, suitable for puncture.

2The brachial-cephalic AVF in the upper arm at the level of the elbow between the brachial artery and the cephalic vein, resulting in the creation of a vessel suitable for cannulation along the arm.

3The brachial-basilic AVF also in the upper arm, between the brachial artery and the basilic vein. Because of the formation of an arterialised vein that is not found as superficially as required for puncture (> 6 mm from the surface of the skin), the basilic vein is usually translocated to a more superficial position. This technique results in a large incision along almost the whole upper arm and is performed under local anesthesia (basilic vein transposition).

The AVF anastomosis may be either side-to-side (such as the original type described by Brescia and Cimino in radial-cephalic anastomosis) or end-to- side (side of the artery- end of the vein). In both cases, the peripheral blood flow is maintained through the artery. In the side-to-side method, the increased arterial pressure can be transmitted to the venous system of the hand with subsequent edema formation. With the end to side anastomosis, this complication is limited due to ligation of the distal part of the vein. The autologous AVFs have a primary failure rate of about 20% (varies from 10-50%) which depends on the experience of each center.

Once the anastomosis has matured, the long-term patency rates are excellent and range from about 85% in the first year to 75% at 2 years, and with a low incidence of infection. Stenosis is the major cause of thrombosis of an AVF, and in case of a radial-cephalic AVF it is often located around the anastomosis area, whereas in the AVF made in the arm, stenosis is usually located more distally.

After the surgical construction of the AVF, at least one month is required for cannulation, while according to the Kidney Dialysis Outcomes Quality Initiative (K/DOQI) guidelines, the first puncture should not be attempted earlier than 6-8 weeks.

Bibliography

  1. Quinton W, Dillard D, Scribner BH. Cannulation of blood vessels for prolonged hemodialysis. Trans Am Soc Artif Intern Organs 1960; 6: 114-113).
  2. Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966; 275: 10891092.
  3. Harland RC. Placement of permanent vascular access devices: Surgical consideration. Adv Renal Replace Ther 1994; 1: 99-106.
  4. Kinnaert P, Vereerstraeten P, Toussaint C, Van Geertruyden J et al. Nine years’ experience with internal arteriovenous fistulas for hemodialysis: A study of some factors influencing the results. Br J Surg 1977; 64: 242-246.
  5. Tordoir JH, Dammers R, De Brauw M. Video-assisted basilic vein transposition for hemodialysis vascular access: preliminary experience with a new technique. Nephrol Dial Transplant 2001; 16(2): 391-394.
  6. Palder SB, Kirkman RL, Whittemore AD, Hakim RM et al. Vascular access for hemodialysis. Patency rates and results of revision. Ann Surg 1985; 202(2): 235-239.
  7. Malovrh M. Native arteriovenous fistula: preoperative evaluation. Am J Kidney Dis 2002; 39 (6): 1218-1225.
  8. Schwab SJ, Harrington JT, Singh A et al. Vascular access for hemodialysis [clinical conference]. Kidney Int 1999; 55 (5): 2078-2090.
  9. Albers FJ. Causes of hemodialysis access failure. Adv Ren Replace Ther 1994; 1(2):107118.
  10. Turmel-Rodrigues L, Pengloan J, Baudin S et al. Treatment of stenosis and thrombosis in hemodialysis fistulas and grafts by interventional radiology. Nephrol Dial Transplant 2000; 15(12): 2029-2036.
  11. Saran R, Dykstra DM, Pisoni RL, et al. Timing of first cannulation and vascular access in hemodialysis: an analysis of practice patterns at dialysis facilities in the DOPPS. Nephrol Dial Transplant 2004; 19(9): 2334-2340.
  12. National Kidney Foundation: K/DOQI clinical practice guidelines in vascular access: 2006 update. Am J Kidney Dis 2006; 48 [Suppl 1]: S176-S306.
Leivaditis Konstantinos MD, PhD
Demirtzi Paraskevi MD

Nephrologists, “NEPHROXENIA” Chalkidiki Dialysis Centre

NEPHROXENIA DIALYSIS CENTERS ARE DESIGNED SPECIFICALLY AROUND THE NEEDS OF A CONTEMPORARY RENAL PATIENT.
IN NEPHROXENIA YOU CAN COMBINE WORLD CLASS DIALYSIS WITH AMAZING HOLIDAYS.
FIND OUT MORE!

The post AUTOLOGOUS ARTERIOVENOUS FISTULA appeared first on NEPHROXENIA.

]]> KIDNEY TRANSPLANTATION https://www.nephroxenia.com/kidney-transplantation/ Thu, 14 Jul 2022 18:03:17 +0000 https://www.nephroxenia.com/?p=2655 A kidney transplant is the transfer of a healthy kidney from one person into the body of a person who has little or no kidney function...

The post KIDNEY TRANSPLANTATION appeared first on NEPHROXENIA.

]]>
Kidney transplantation

A kidney transplant is the transfer of a healthy kidney from one person into the body of a person who has little or no kidney function.

The main role of the kidneys is to filter waste products from the blood and convert them to urine. If the kidneys lose this ability, waste products accumulate in the blood, which is potentially life-threatening.

This loss of kidney function, known as end-stage Chronic Kidney Disease or kidney failure

is the most common cause for needing a kidney transplant. It’s possible to partially replace the functions of the kidney using a blood purification procedure known as dialysis. However, this can be inconvenient and time-consuming, so a kidney transplant is the treatment of choice for kidney failure whenever possible.

Kidney patients of all ages — from children to seniors — can get a transplant. Every person being considered suitable for transplant will get a full medical and psychosocial evaluation to make sure they are a good candidate for transplant. The evaluation may reveal potential problems, that can be corrected before transplant. Medical professionals provide with a complete physical exam, review health records, and order a series of tests and X-rays in order to evaluate how well a candidate for a transplant can handle treatment and decide if a transplant is suitable for him. Every patient with Chronic Kidney Disease can get a transplant, as long as:

  • they are well enough to withstand the effects of surgery
  • the transplant has a relatively good chance of success
  • the person is willing to comply with the recommended treatments required after the transplant – such as taking immunosuppressant medication and attending regular follow-up appointments
Reasons why it may not be safe or effective to perform a transplant include having an ongoing infection (which has to be treated first), severe heart disease, obesity and cancer that has spread to several places in your body. If you have diabetes, you may also be able to have a pancreas transplant.Getting a transplant before you need to start dialysis is called a preemptive transplantation. It allows you to avoid dialysis altogether. Getting a transplant not long after kidneys fail (but with some time on dialysis) is referred to as an early transplant. Both have benefits. Evidence indicate that a pre-emptive or early transplant, with little or no time spent on dialysis, can lead to better long-term health outcomes. It may also allow you to keep working, save time and money, and have a better quality of life.

Kidney donations are possible from people who have recently died. This is known as deceased kidney donation. However, this type of kidney donation has a slightly lower chance of long-term success. Unlike many other types of organ donation, it's possible to donate a kidney while you're alive because you only need one kidney to survive. This is known as a living donation. A kidney from a living donor may last longer than one from a deceased donor. To get a deceased donor kidney, you will be placed on a waiting list once you have been cleared for a transplant.

From the time you go on the list until a kidney is found, you may have to be on some form of dialysis. Ideally, a kidney transplant should be performed when tests show that the extent of damage to your kidneys is so extended that you’ll need dialysis within the next 6 months. However, because of the lack of available kidneys, it’s unlikely you’ll receive a kidney donation at this time with the exception of a living one. On average, the waiting time for a deceased donor kidney transplant is 2 and a half to 3 years.

During the surgical procedure, the native kidneys generally aren’t extracted when you get a transplant. The surgeon leaves them where they are unless there is a medical reason to remove them. Nephrectomy is recommended in case of polycystic kidney disease due to the large size of the kidney or due to chronic infection or bleeding of a cyst within the kidney. The donated kidney is placed into your lower abdomen, where it’s easiest to connect it to your important blood vessels and bladder. If the kidney came from a living donor, it should start to work very quickly. A kidney from a deceased donor can take longer to start working—two to four weeks or more. If that happens, you may need dialysis until the kidney begins to work. How soon you can return to work depends on your recovery, the kind of work you do, and your other medical conditions. People who have not had satisfactory sexual life due to kidney disease may notice an improvement as they begin to feel better. In addition, fertility (the ability to conceive children) tends to increase. All pregnancies must be planned. Certain medications that can harm the fetus must be stopped six weeks before trying to conceive.

After surgery, certain medicines are considered to be necessary, because they tend to keep the immune system less active (called anti-rejection medicines or immunosuppressant medicines), in order to stop your body from attacking or rejecting the donated kidney. Patients need to take them as long as the new kidney is working.  Without them, the immune system would recognize the donated kidney as “foreign,” and would attack and destroy it. Widely used immunosuppressants include tacrolimus, tacrolimus, ciclosporin, azathioprine, mycophenolate, prednisolone and everolimus. Additionally, vaccinations should be up to date, although any vaccines that contain live viruses, such as the measles, mumps and rubella (MMR) vaccine should be avoided. In addition, there are certain recommendations in order to avoid contact with people having recently being infected with chickenpox or flu. Moreover, living with a kidney transplant includes:
  • smoking if you smoke
  • follow a healthy diet
  • lose weight
  • comply with the special medication and inform for any side effects or new drugs you will need to take
There are also certain risks of a kidney transplant that include:
  • risks related to the procedure itself
  • risks related to the use of immunosuppressant medications (which reduce the activity of your immune system)
  • risks related to something going wrong with the transplanted kidney
Complications that occur in the first few months after surgery are known as short – term complications, such as infection, blood clots, narrowing of an artery, blocked ureter, urine leakage and acute rejection. Long – term complications usually develop after many years and are associated with the immunosuppressant medication. The most significant long – term complications are:
  • an increased risk of infections
  • an increased risk of diabetes
  • high blood pressure
  • weight gain
  • abdominal pain
  • diarrhea
  • extra hair growth or hair loss
  • swollen gums
  • bruising or bleeding more easily
  • decreased bone density
  • mood swings
  • an increased risk of certain types of cancer, particularly skin cancer
Chronic rejection develops within months to years after transplantation and is the major cause of long-term graft loss. It is the result of a gradual decrease of the kidney function. Hypertension, proteinuria and increase of serum creatinine levels are features of this progressive loss of kidney function and may lead to chronic allograft nephropathy. A rejection episode does not always have clear signs or symptoms and that is why regular physical examination by the transplant team and blood tests are so important.

Bibliography

  1. National Kidney Foundation, January 26, 2017
  2. Kasiske BL et al. “The evaluation of renal transplant candidates: Clinical practice guidelines”, J Am Transplant. 2001;1.
  3. “Evaluation, selection and preparation of the potential transplant recipient”, Neprology Dialysis Transplantation. 2000;15 (suppl 7):3-38.
  4. Malgorzata Kloc and Rafik M. Ghobrial. “Chronic allograft rejection: A significant hurdle to transplant success”, Burns Trauma. 2014; 2(1): 3–10
Leivaditis Konstantinos MD, PhD
Demirtzi Paraskevi MD

Nephrologists, “NEPHROXENIA” Chalkidiki Dialysis Centre

The post KIDNEY TRANSPLANTATION appeared first on NEPHROXENIA.

]]>