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Treatment of Kidney Failure
Treatment of Kidney Failure Complications
Besides dialysis, it is important to optimize care of other medical issues that may contribute to, or be complicated by, renal failure. These include:
Cardiac Issues - Careful management of blood pressure and lipid/triglyceride levels; monitoring of fluid status to avoid edema and "fluid overload" - daily weights may be recommended to help keep track of fluid accumulation; monitoring of potassium level since potassium can cause changes in the heart rhythm if too high or too low.
Fluid and Electrolyte Imbalance - Sevelamer (a phosphate binder) helps to reduce the level of phosphorus in the blood and reduces progression of coronary artery and aortic calcification. It is a pill that is usually taken three times daily.
Musculoskeletal Issues - Careful attention to diet (limiting intake of phosphorous), Calcium and Vitamin D supplements, Sevelamer (phosphate binder), exercise, and possibly surgery to remove some of the parathyroid glands.
Endocrine Issues - Careful management of diabetes and its potential complications, especially nephropathy (kidney damage). Patients are often treated with medications called ACE-inhibitors and Angiotensin II receptor blockers which not only lower blood pressure but have also been shown to protect the kidneys by blocking the renin-angiotension system which contributes to kidney damage in diabetes.
Hematologic Issues - Anemia may be treated by injections of erythropoietin; Darbepoetin Alfa (Aranesp); recombinant human erythropoietin; or iron supplementation. Guidelines recommend that the target hemoglobin level be at 12 g/dL. Treatment of anemia with erythropoietin in persons with kidney disease has been associated with dramatic improvements in quality of life.
Immunologic Issues - Careful monitoring for signs of infection such as fever is very important. In addition, ongoing cancer screening (mammogram, colonoscopy, etc.) is important to detect any early malignancy.
Skin Issues - Itching can be caused by uremic toxins not adequately removed during dialysis and can also be related to high levels of parathyroid hormone. Treatment options may include removal of the parathyroid glands; phosphate binders; ultraviolet light exposure; epoetin (Epogen; Procrit) injections; antihistamines (Benadryl, Atarax, Vistaril); or topical Capsaicin cream. Taking good care of dry skin with appropriate moisturizers is important.
