KIDNEY KNOWLEDGE SERIES - (16)

LIVING WITH KIDNEY FAILURE

Q:     What is the healthy eating plan?

A:    

·        A healthy eating plan will influence how you feel and how well your treatment works.

·        What’s important to know, is that there is no standard kidney eating plan. If you are undergoing treatment for early stage kidney failure, your doctor and nutritionist will work together to design a healthy eating plan that’s right for you. This eating plan will be based on the stage of your disease, the cause of your kidney failure and other treatments or medications that you are using.

·        The eating plan will focus on balancing proteins, minerals and calories to maintain muscle tissue, blood pressure, bone strength and energy.

Q:     What kind of sport and exercise can I engage in?

A:     Physical activity will give you the strength, energy and motivation to participate in daily activities, helping to avoid the fatigue that can sometimes result from kidney failure. The benefits of exercise include:

1.     Improved strength and fitness

2.     Lower blood pressure

3.     Better sleep

4.     Lowered fat levels in the blood

5.     Higher energy levels.

·        Your doctor will let you know what is appropriate, particularly if you don’t already participate regularly in physical activity.

Q:     What of kidney failure and intimacy?

A:

·        Kidney failure and subsequent treatments can adversely affect personal relationships and intimacy by changing how you feel about yourself and sex.

·        Emotionally, chemical changes resulting from kidney failure can lower your libido, while stress from dialysis can cause tension in your relationships, creating barriers to intimacy and effective communication. While lowered libido is common among those who experience kidney failure, discussing these issues with your partner will help to maintain a healthy relationship.

Q:     How will Kidney failure affect my lifestyle?

A:     If you are living with kidney failure, you may need to make some changes to your lifestyle to reduce the risk of further kidney damage.

1.     Quitting smoking

2.     Limiting alcohol

3.     Weight reduction if overweight

4.     Strict control of Diabetes and High Blood Pressure if afflicted

5.     Use of specific types of blood pressure pills to slow down progression of disease.

Q:     How can I travel safely with Kidney Failure?

A:      If you are living with kidney failure, travel for whatever purpose does not need to be ruled out. You can still enjoy domestic or international trips with a little extra planning.

o   Some smart travel tips are listed below:

·        Plan well ahead wherever possible and factor your treatments into your itinerary

·        Take enough medication with you to last the whole trip, and some extra in case of a spill or unexpected delay

·        Make sure you pack your medication in your own carry-on luggage in case you become separated from your suitcase or travelling companion/s

·        Keep in touch with your friends and family and advice them of any changes to your travel plans.

o   If you are travelling abroad you should also consider the following:

·        Discuss your travel plans with your doctor at least six weeks before departure to determine any vaccines you may need and how these could affect your treatment

·        Check that your medications are legal in the countries that you are visiting by contacting the country’s embassy or high commission

·        Carry a letter from your doctor detailing what your medication is, how much you’ll be taking and stating that it is for your own personal use

·        Keep all of your medication in their original packaging so they are clearly labeled with your name and dosage instructions.

Q:     How can I stay informed about kidney failure?

A:    

·        Being pro-active and keeping up-to-date with the latest information on kidney failure will help you to better understand your condition and treatment options.

·        Visiting your doctor regularly and reading relevant information will keep you one step ahead in the health and wellbeing stakes and help prevent further kidney damage. 

KIDNEY KNOWLEDGE SERIES - (15)

Complications of Kidney Transplants (Contd)

Q:     What are the common complications after kidney transplant? (contd)

1.   Diabetes

Diabetes is an increased level of sugar in the blood and it may be caused by some of the anti-rejection medication. A patient should notify his transplant team or doctor if he experiences any of the following symptoms: increased thirst, increased frequency of urination, blurred vision, and confusion. Blood sugar can be reduced through weight loss, careful diet, and exercise. An oral diabetes drug or insulin injections may be necessary.

2.     Cancer - Transplant patients have a slightly higher risk of cancer than the general population. Skin cancers are the most common, but can be decreased by wearing sunscreen. Also breast and cervical cancers in women. After transplant it is very important to have routine cancer screening because early detection greatly improves the chance of cure.

3.     Imbalances in electrolytes including calcium and phosphate which can lead to bone problems amongst other things.

4.     Other side effects of medications include:

a.    Gastrointestinal inflammation and ulceration of the stomach and esophagus

b.    Hirsutism (excessive hair growth in a male-pattern distribution)

c.    Hair loss

d.    Obesity

e.     Acne

f.       Hypercholesterolemia and others.

Q:     Which patients are likely to have complications?

A:     There is no way to predict accurately which patients will have problems. The transplant team will do their best to reduce the likelihood of complications and to treat them promptly if they occur. Following instructions carefully and keeping the transplant team informed of any difficulties will help a patient return quickly to a normal, active life.

Q:     When should a patient notify the transplant team?

A:     A patient should notify the transplant team if he:

·        Has prolonged illness (nausea, vomiting and diarrhea).

·        Is unable to take medicines by mouth due to illness.

·        Thinks the directions on the label may be different from what he was told.

·        Has a reason to take aspirin, paracetamol, other pain relievers, or cold remedies.

·        Feels he is having a reaction to the medications.

·        Has had a change in health or eating habits.

·        Has a new prescription from his local doctor or a change in a current prescription.

·        Is undergoing dental work of any kind.

Q:     How does the recipient take care of the kidney after transplant?

A:     The transplant team teaches the recipient the important things to know about taking care of the kidney. It is very important that the recipient take the immunosuppressive medications that are prescribed, and continue with follow-up appointments so that complications can be detected and corrected early.

Q:     How much do anti-rejection medications cost?

A:     Some of the immunosuppressive (anti-rejection) medications are expensive. For now, in Nigeria, recipients have to buy their own drugs which on average cost N150, 000 monthly, for the first year. This reduces subsequently as drug dosages are reduced.

KIDNEY KNOWLEDGE SERIES - (14)

Complications of Kidney Transplants

Q:     Why should one have a kidney transplant?

A:     With improved surgical techniques and better anti-rejection drugs, renal transplantation has become the treatment of choice for end-stage renal disease (ESRD). It offers a much better quality and quantity of life, compared to dialysis.There is also substantial cost savings on treatment cost over a long time.

Q:     What are the complications of kidney transplant?

A:    

·        Although a transplant is an excellent treatment for most people with kidney failure, transplantation is not problem-free.

·        Most of the complications are mainly due to three factors.

o   First, many people having a transplant have health problems in addition to kidney failure. These can include diabetes, high blood pressure, heart disease, or other complications of kidney failure and dialysis.

o   Secondly, the body recognizes a transplanted kidney as an invader or foreign body, in the same way it would recognize a germ. This means that the body will try to destroy the transplant, and this is what is called rejection.

o   Thirdly,the long term use of anti-rejection drugs may result in some side effects and increase susceptibility to some infections. The incidence of certain types of Cancers is also higher after prolonged use,  compared to the general population.

Q:     What are the common complications after kidney transplant?

A:     Several complications can occur after transplant. The most common complications are:

1.     Rejection -This happens when your body's immune system thinks your new organ is "foreign" and attempts to destroy it. The patient requires anti-rejection medications for life, to prevent rejection.

There are several types of rejection:

Hyperacute rejection - happens when the body immediately destroys the new kidney, this is rare because of the crossmatch testing used before transplant.

Acute rejection - although this can happen at any time after the transplant, most often it happens during the first several months. This can be treated by giving the patient higher doses of medication by mouth or by intravenous infusion.

Chronic rejection - this may happen months or years after the transplant. This type of rejection is resistant to treatment with current medications. This will cause your new organ to slowly stop working.

2.     Infection - The drugs taken to prevent rejection can decrease the ability to fight infections. Infections in a transplant patient can be serious and even life threatening and can be viral, bacterial or fungal. It is very important to seek help if symptoms of an infection develop.

3.     Acute tubular necrosis (ATN, or delayed graft function) - The new kidney may not start to function immediately. Some kidney recipients need to continue to dialyze for a week or two. During the time the recipient remains on dialysis, a kidney biopsy may be performed to ascertain the exact cause of poor kidney function.

4.     Hypertension (high blood pressure) - High blood pressure after transplant is very common. Most patients' blood pressures can be controlled with multiple anti-hypertensive medications. Controlling weight, limiting salt in the diet and exercising will also help.

KIDNEY KNOWLEDGE SERIES - (13)

DECEASED DONORS (CONTD)

Q:     How can one get permission from the donor family?

A:      Abroad, permission is sought via:

1.     The donor putting his/her name on the national organ donor register; then their wishes have priority after death.

2.     If someone is not on the organ donor register, then the wishes of the family determine whether organs are donated.

This means that deceased donor kidney donation is a gift, even though it may come from tragic circumstances

Q:     Is there a difference between living donors and deceased donors?

A:     

·        Unlike living donation where the kidney comes directly from the donor to the recipient, kidneys from deceased donors are often injured by the death and preservation processes, so a delay in kidney function may occur.

·        Occasionally, dialysis is continued until the deceased donor kidney begins to function. When dialysis is needed, deceased donor kidneys may take up to two weeks to begin functioning.

·         With living donation, delay in kidney function is uncommon and function may be restored almost immediately.

Q:     How good is deceased donation?

A:     All kidneys from deceased donors are not the same. In fact, how well a kidney transplant works depends on both the donor and the recipient. Most deceased donors—of any kind—have less than perfect kidneys. This is what can affect the quality of kidneys from deceased donors:

1.     The donor's age

2.     Cause of death

3.     Any event that happened when the kidney was removed, such as low blood pressure or clotting in the blood

4.     Not knowing the exact condition of each deceased donor kidney; this is mainly because short-term problems can make the kidney work poorly for a while. However, after a few months, some kidneys from deceased donors are found to work better after the transplant.

5.     How long the kidney has been kept out of a body in cold solution, after it has been removed from the deceased donor. This time is more of a risk when it is in the range of 18 or more hours. It happens more often when a kidney is sent from one region of the country to another because it is a good match.

Q:     What are the risks involved in deceased donor kidneys?

A:     

·        There are a number of risks in choosing a deceased donor kidney for transplant in today's world.

·        Some kidneys that seem to work well may not, some that are not used for a transplant may have worked well. It may be hard to be sure of the quality of many deceased donor kidneys.

·        Yet these kidneys cannot simply be thrown away just because questions arise. Many working kidneys would be lost.

Q:    Can one be harmed by a kidney transplant from a deceased donor?

A:      Deceased donors and their kidneys are tested carefully.

·        First, doctors look at the condition that has caused brain death. Some deceased donors have other medical conditions or diseases. Family members are asked about the life style of the donor. Deceased donors are tested for syphilis, hepatitis B and C, HIV, AIDS, and other viral infections.

·        Some good donors may have infections caused by bacteria. This does not rule out taking the kidneys. But the transplant patients must be treated for these infections at the time of transplant.

·        Even with all the testing, there is always a risk that a disease from the kidney may be given to the transplant patient. This risk is much less than 1 in 100.

Q:     What are the barriers to deceased donations?

A:      Despite its vast potential, deceased donation in Nigeria may not be successful unless the following major barriers are removed:

1.     Inadequate public awareness

2.     Attitude of the medical community

3.     Frequently held misconceptions about religious guidelines

4.     Different conceptions of brain death

5.     Absence of legislation on deceased donation

Q:     What are the opportunities for deceased donation in Nigeria?

A:      We need legislative, religious backing and nationwide education on deceased donation of organs. It will serve as another alternate source of organs for donation. This promotes the growth of transplantation activities in the country, reduces, and eventually eliminates commercialization of organ donation which is ethically and morally wrong.

KIDNEY KNOWLEDGE SERIES - (12)

 DECEASED DONORS

Q:     Who is a deceased donor?

A:      This is an individual whose tissues or organs are donated after his or her death.

Q:     What types of diseased donors are there?

A:      Donations come from two sources:

1.     Patients who have suffered brain death. They are also known as heart beating donors or donor after brain death.

2.     Patients whose hearts have irreversibly stopped beating i.e. cardiac death. They are also known as non heart beating donors or donor after cardiac death.

Q:     Who are heart beating donors?

A:     

·        These are donations from people who have suffered an injury such as a fall, motor vehicle accident or a stroke.

·        The determination of irreversibility, as well as the determination that all brain function is not present, is only made after repeated, confirmatory testing over a prolonged period of time. 

·        Only then are the organs from a deceased donor retrieved by a surgical team.  

Q:     Who are non-heart beating donors?

A:     

·        These are transplant kidneys from people whose hearts have stopped beating. These donors – called non-heart-beating donors – are people who have died very suddenly, usually from a heart attack.

·        Their hearts have stopped beating and they are brain dead. They have not been put on a life-support machine.

·        Kidneys from non-heart-beating donors often do not work immediately after transplantation and are not quite as good as those from heart-beating donors. However, advanced technology of organ perfusion and preservation has resulted in improved outcome.

Q:    Can the kidneys or any other organs just be removed from the deceased?

A:      No. Any organ for transplant has to be removed with the permission of the donor’s family.

Q:     What are the events that lead to being a deceased donor?

A:     

1.     The kidneys can only be removed after the patients have been diagnosed ‘brain dead’. This means that the part of the brain called the brainstem, which controls breathing, has stopped working permanently and patient is only being supported on a life support machine.

2.     When the brainstem is dead, there is a permanent loss of consciousness and all feelings.

3.     If the donor is on a ventilator (life support) machine, they are taken to theatre for donation while the ventilator is working and their heart is beating. For this reason, these donors are sometimes called heart-beating donors. Even though the heart is still beating, they would not breathe if they were not on a life support machine. Their brain is dead, and they have no chance of recovery, and indeed they have already been certified as legally dead by doctors from the intensive care unit.

4.     Although brain-dead (or "heart-beating") donors are considered dead, the donor's heart continues to pump and maintain the circulation. This makes it possible for surgeons to start operating while the organs are still being perfused.

5.     Treatment is discontinued (mechanical ventilation is shut off) then a time of death is pronounced. The patient is then rushed to the operating room where the organs are recovered. Storage solution is flushed through the organs. Since the blood is no longer being circulated, coagulation must be prevented with large amounts of anti-coagulation agents such as heparin.

6.     Several ethical and procedural guidelines must be followed; most importantly, the organ recovery team should not participate in the patient's care in any manner until after death has been declared.

Q:     Is diseased donation available in Nigeria?

A:      No. In Nigeria, the main sources of donors are living and are genetically or emotionally related and altruistic in nature. Deceased donors are the main source of kidney donors in UK and America