Treatment Strategies

There are two primary treatment options for end stage renal disease, dialysis and transplant. There are two types of dialysis, hemodialysis and peritoneal dialysis.

Hemodialysis

Dialysis is an artificial system for cleansing the blood. The first type of dialysis is hemodialysis. This process uses a special filter to clean the blood. During treatment, blood is removed from the body, traveling through tubing to a filter. The purified blood returns to the body through another set of tubes. The average treatment lasts 2 ½ - 4 hours and is required 3 times a week.

Hemodialysis treatments are usually done in an outpatient dialysis center. Hemodialysis cannot be performed without a fistula, graft, or catheter. Therefore, a surgeon may operate on an arm or leg to connect an artery and vein (called arterio-venous fistula or graft). This access is necessary to remove and return blood during the treatment.

Peritoneal Dialysis

The second type of dialysis is Peritoneal Dialysis (PD). This is a process whereby the blood is artificially cleansed using a man-made solution, which is put into and removed from the abdominal cavity. Dialysis does not totally compensate for all normal kidney function. For example, it does not replace the hormones produced by the normal kidney.

In PD, the peritoneal cavity in the abdomen is used as a reservoir for the dialysis solution. The thin membrane lining this cavity provides the suitable barrier through which the blood can be filtered. A tube or catheter is surgically placed in the abdomen to create an access for peritoneal dialysis.

Nutritional Guidelines

A special diet can help to control the buildup of waste products and fluid in your body and therefore decrease the workload required of your kidneys. This diet may also help to slow down the loss of kidney function. The main goal of the diet is to keep you healthy. Your doctor may recommend a special diet, depending on the stage of your disease.

What is the diet like?

In general, the diet used for the early stages of kidney disease controls the amount of protein and phosphorus you eat. Usually, sodium is also controlled. Getting enough calories to maintain a healthy weight is very important at this time.

What about protein?

Your body needs protein every day for growth, building muscles and repairing tissue. After your body uses the protein in the foods you eat, a waste product called urea is made. If you have lost kidney function, your kidneys may not be able to get rid of this urea normally. You may need to reduce the amount of protein you eat to avoid buildup of urea in your body.

What about phosphorus?

Your kidneys may not be able to remove phosphorus from your blood. This causes the level of phosphorus in your blood to become too high. A high blood phosphorus level may cause you to lose calcium from your bones. This may weaken your bones and cause them to break easily.

To help control the phosphorus in your blood, you should eat fewer foods that are high in phosphorus. Phosphorus is found in many foods but is especially high in the following foods:

• dairy products such as milk, cheese, pudding, yogurt and ice cream
• dried beans and peas such as kidney beans, split peas and lentils
• nuts and peanut butter
• beverages such as cocoa, beer and cola soft drinks

What about sodium?

You may need to limit the amount of sodium in your diet. This is because high blood pressure, kidney disease and sodium are often related. Learning to read labels can help you make lower sodium choices. Sodium is found in many foods, but is especially high in the following:

• table salt and foods with added salt such as snack foods, soups and processed cheese
• some canned foods, prepared foods and "fast foods"
• foods pickled in brine such as pickles, olives and sauerkraut
• smoked and cured foods such as ham, bacon and luncheon meats

What about calories?

Calories give you energy. Because you are getting fewer calories from protein, you will need to get more calories from other foods. Your dietitian may recommend that you get these extra calories from sugar and vegetable fats to help you get the right amount of calories.

Avoid losing too much weight because it can cause malnutrition and lead to illness.

Some ways to increase calories are as follows:

• Increase unsaturated fats such as vegetable oils (made with corn, cottonseed, safflower, soybean or sunflower oils), olive oil and mayonnaise type salad dressings.
• Use sugar or sweets such as hard candy, gum drops, jelly beans, marshmallows, honey, jam and jelly.
• Use canned or frozen fruits in heavy syrup.

If you are diabetic or overweight, talk with your renal dietitian about the best way for you to get the right amount of calories for your needs.

What if I am diabetic?

In some cases, you may need to make only a few changes in your diabetic diet to fit your needs as a kidney patient. If your doctor suggests that you eat less protein, you must be sure to get enough calories from other sources.

Limit Your Fluid Intake

Your doctor may recommend that you limit your fluid intake to 2 quarts or 8 cups per day. Measure the fluids that you drink and record the amount so you do not exceed the recommended amount of fluids each day. Be sure to include all fluids including water, drinks, coffee, jello, ice cream, yogurt, puddings, juice, milk, ice, soups, etc.

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