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I do not want dialysis: how long can I expect to live, and how would I feel?

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I often see patients in my office who refuse dialysis (should it become necessary) for their advancing kidney disease. I divide these patients in to two categories. The more common category is patients who refuse it because of the "fear of dialysis". They could have trouble understanding dialysis and what potential benefits they could derive from it. They would often make good dialysis candidates who have more to lose than gain by refusing dialysis therapies.

The other category is the patient who rightfully refuses dialysis because she or he would not make a good candidate for such treatment. There could be multiple reasons for that. It could be advanced age and frailty, presence of other severe disease conditions like heart failure or metastatic cancer, etc. In such cases, it is hard to always predict if dialysis would add anything to the quality/quantity of life. And often, patients are simply looking at the "big picture". So the questions that come up in this s…

Can certain herbal medications treat chronic kidney disease (CKD)? Is alternative medicine the cure for CKD?

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I set off to try and answer this question after one of my patients whom I saw at my Bradenton clinic brought along an article that claimed that "nettle leaf lowers creatinine level in the blood". This by extension would mean that it could perhaps cure CKD? I was quick to admit that not once during my typical "western medicine" training had I heard of that claim. To me, CKD had always been this inexorable malady that can be, at best, controlled or slowed down from progressing further. "Cure" is not a word that gets thrown around a lot when you talk about CKD. As I had discussed earlier, once kidney function declines chronically, it can typically not be regained.   
But I do try to have an open mind, the good old scientific temper and all that. So rather than dousing disdain over my patient's excitement, I tried to look for evidence to see if the article's claim was indeed true.

What is "Chronic Kidney Disease", or CKD?

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In my previous post, I had talked about how physicians check your kidney function, as well as the concept of glomerular filtration rate (a measure of your kidneys' function, or more accurately, its filtration capacity), or GFR. I want to talk today about an entity that you might have heard before: chronic kidney disease, or CKD. 
CKD is a generic, umbrella term. Nephrologists define it as "kidney damage or reduction in kidney function that persists for 3 or more months". The definition does not include the cause of kidney disease. In other words, whether you have reduction in kidney function from diabetes, or high blood pressure, or a genetic cause, you could still carry a common diagnosis of CKD. This diagnosis is then further subdivided in to stages 1 thru 5, depending on the disease severity. This is where the concept of GFR that I talked about before becomes useful. 

Take a look at the above picture (courtesy of The National Kidney Disease Education Program). Now th…

How does kidney disease affect your sexual health and reproductive function? What are your treatment options?

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Kidney disease has a profound effect on sexual health, fertility, the ability to conceive, etc. I will cover the issues related to chronic kidney disease (CKD) and pregnancy in my next post. For today, lets try and understand how and why a reduction in your kidney function could affect your sexual health. Sexual dysfunction does tend to worsen as kidney disease progresses, and is part of the constellation of various signs and symptoms of advanced kidney disease.

Managing pain in patients with kidney disease

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Pain, both acute and chronic, is commonly prevalent in patients with chronic kidney disease (CKD). This is due to the myriad diseases that often coexist in kidney disease patients (like arthritis, diabetes, obesity, etc). I had earlier written a post on how certain painkillers adversely affect the function of the kidneys. So we know that many pain medications are bad for your kidneys. We also know that even if some pain medications are not directly toxic to your kidneys, they can still accumulate in your body and affect other organs in patients who have kidney disease. It saddens me when patients with pain come to my office after being told that they can't take a particular pain medication because "their kidney numbers have worsened". Granted that could certainly happen; but not coming up with an alternative and leaving patients "marooned" is also a disservice to them. What then could be some viable options for patients with kidney disease to deal with their pa…

How do some over-the-counter pain medications cause/worsen kidney disease? How can patients with kidney disease treat their pain?

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The fact that a number of painkillers are available freely over-the-counter (OTC) often gives a lot of people a false sense of security about the safety of these medications. A statement that I here from some of my patients is, "it was available without a prescription, so I thought it wasn't too strong". So very often, patients assume that if a medicine is not too potent, it probably does not have serious side effects either. Sadly, a medication's potency is not necessarily proportional to its side effect profile.

HOW DO PAIN MEDICATIONS DAMAGE THE KIDNEYS: EFFECTS ON KIDNEY FUNCTION
Pain medications can have different renal effects. These can range from reversible, short term reductions in kidney function due to a decrease in the blood supply to the kidneys (called Acute Renal Failure, or Acute Kidney Injury), to a more chronic disease where the kidneys shrink in size, develop a rough and bumpy surface, and demonstrate tissue breakdown called "papillary necrosi…

Creating a human kidney in the lab to treat kidney failure: Reality or Star Trek?

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I look at the artificial kidney that I talked about in my last post as a sort-of futuristic automaton. It can work (in principle) on the body's internal power (the blood pressure) and does not require the frequent tweaks (again, in principle) that are required with conventional dialysis; thus giving patients more freedom with their lives.

However, the technology that really has the trans-humanist in me jumping up and down with excitement is the promise of regenerating a "natural" human kidney in the lab. In Greek mythology, Prometheus' liver would regenerate even after an eagle nibbled on it every day, all while the poor fellow lay chained to a rock (he was lucky the eagle didn't mess with his kidneys, which don't quite possess the same regenerative capacity!). My fantasy is not quite the same, but what I had always conceptualized is that with the advances in regenerative medicine, we might be able to just play God, and "make a kidney", a real huma…