KIDNEY SPECIALIST SINGAPORE
Best Personalised Treatment & Renal Diet for Chronic Kidney Disease (CKD) | Renal Dialysis | Kidney Transplantation
Accredited nephrologist Dr Francisco offers unique, personalised treatment & holistic renal diet for chronic kidney disease (CKD) at Francisco Kidney & Medical Centre in Mount Elizabeth Novena Hospital (Singapore)
Dr Francisco Salcido-Ochoa is an accredited renal specialist in Singapore with extensive experience in kidney treatment procedures, such as kidney biopsies, haemodialysis and peritoneal dialysis treatments, kidney transplantation, as well as diabetes, high blood pressure, and weight loss.
Francisco Kidney & Medical Centre has been featured on…
An empathetic kidney doctor in Singapore who truly cares for you & goes the extra mile to help you regain your health with the best personalised chronic kidney disease (CKD) treatment & holistic renal diet
Dr. Francisco Salcido-Ochoa is a nephrologist (renal specialist) in Singapore [MD (Mex) & MRCP (UK)], a transplant immunologist [MSc (UK), Ph.D. (UK)], and an international health coach. In his 23 years of medical practice, he has helped thousands of people to live their best health and achieve their peak form with his medical expertise, scientist background, and holistic deep health coaching approach.
His kidney clinic Francisco Kidney & Medical Centre is located at Mount Elizabeth Novena Hospital, #07-32, 38 Irrawaddy Rd, Singapore 329563. Dr Francisco also offers telemedicine consultations worldwide, both in English & Spanish, through Francisco Kidney & Medical Centre and also through WhatsDoc, a professional online platform specialised in Telemedicine Worldwide.
Kidney Specialist Clinic in Singapore with Empathetic & Personalised Renal Disease Treatments
Chronic Kidney Disease & Glomerulonephritis
Management of different disorders of the kidney potentially causing acute kidney failure, chronic kidney disease or needing a kidney biopsy
Haemodialysis & Peritoneal Dialysis
Management of kidney failure through haemodialysis or peritoneal dialysis
Management of kidney transplant patients; advice for prospective transplantation in dialysis patients and potential donors; and kidney transplant biopsy
High blood pressure (hypertension), Type 2 Diabetes, High Cholesterol, Metabolic Syndrome & Gout
Screening and management of medical conditions causing or associated to kidney problems
Health Enhancement & Weight Management
Holistic and personalised health enhancement, sustainable and healthy weight loss and functional fitness
Accredited Renal Specialist In Singapore
Francisco Kidney & Medical Centre
We provide you approachable, flexible, empathetic and personalised specialist nephrology medical care in Singapore
We care about your physical and mental well-being and that of your family
We see you as an individual and we care about your peace of mind, which is crucial to aid in the process of healing
We are transforming the diet & lifestyle of many people to prevent diseases like type 2 diabetes or their complications
Frequently Asked Questions About Kidney Health, Chronic Kidney Disease (CKD), Dialysis, Kidney Transplant & Renal Diet
Why is it important for our kidneys to work well?
Our kidneys remove excess toxins and water from the body, regulate salt and water balance in the body, and produce the hormones necessary for red blood cell production and healthy bones.
What puts you at risk for kidney disease?
Kidney disease symptoms usually show up only when it is at a serious stage. That is why it is crucial to be aware of conditions that may predispose you to kidney disease. People who are at greater risk of getting chronic kidney disease or kidney failure are those with:
==> High blood pressure
==> Family history of kidney disease
==> Congestive or coronary heart disease
==> Prolonged use of non-prescription drugs such as Celebrex and Advil
What are the first symptoms of kidney disease?
Signs and symptoms of chronic kidney disease may include fluid retention, decreased urine output, leg swelling at the end of the day and breathlessness.
What are the causes of kidney failure?
There are a number of medical conditions that can cause kidney failure, whether it is over a period of time or suddenly. The sudden kidney failure (or acute kidney failure) may be due to certain drugs, infections or trauma. The kidney failure that happens over a period of time may be caused by diabetes, high blood pressure, and heart disease which are not controlled in the long run, thus causing end organ damage, and kidney failure is one of them.
What is the difference between chronic kidney disease and kidney failure?
Both chronic kidney disease and renal failure are the spectrum of the same disease process that affects the kidney function and the well-being of the kidneys.
That process goes through different progressive stages of chronic kidney disease, where the last stage is referred to by many as total kidney failure, when the kidneys stop working; although the preferred medical term for the last stage is end-stage kidney disease.
For clarity, I will use the term of total kidney failure.
Chronic kidney disease is the consequence of the damage caused by many different disorders and diseases in the kidneys.
These disorders result in the progressive damage to the kidneys, impairing all the functions of the kidneys.
There are five stages of chronic kidney disease, from stage 1 to 5; where stage 1 is the least advanced and stage 5 the most advanced, and which can lead to total kidney failure, when the kidneys completely stop working and this is typically irreversible.
When kidney function drops below 5-10%, patients can become very ill.
The situation can be life-threatening, and dialysis or a transplant needs to be performed to replace the lost kidney function or a patient might lose his or her life.
In Francisco Kidney & Medical Centre, we understand how confusing this can be. So, we give detailed explanations to our patients, with the aim of answering their queries and dissipating their concerns.
What are the stages of chronic kidney disease?
There are 5 stages of chronic kidney disease.
The 5 stages are classified according to the so-called glomerular filtration rate or GFR.
The GFR is an approximate measure of the percentage of kidney function.
In stage 1, the GFR is normal. Therefore, the kidneys clean the blood efficiently, but there is already detectable damage to the kidneys either because of protein or blood leakage in the urine, known kidney disease, for example, scars, or structural problems of the kidneys like cysts or stones.
In this stage, patients have no symptoms related to kidney dysfunction, but they might have symptoms of the original disease.
When the kidney function starts dropping progressively, meaning also the GFR starts dropping, and the injury to the kidneys progresses in intensity, chronic kidney disease moves from stage 1 to stages 2, 3, 4 and then 5.
In stages 2 to 4, typically the patient has no symptoms or only minor symptoms. Thus, it’s common to be unaware that he or she is suffering from kidney problems, unless the original disease gives them symptoms, pushing them to get checked by a doctor. For example, joint pains in lupus patients.
But those are not symptoms of chronic kidney disease.
By stage 4, many patients might have still no symptoms of kidney dysfunction or no major symptoms. However, it is advisable that patients at this stage start planning for dialysis or for a kidney transplant.
Not to start dialysis yet, but to start the planning of it. As everything in life, it is better to be prepared, to be ready and top of everything when total renal failure occurs, rather than renal failure catching the patient unguarded by surprise.
Many patients, due to natural fear for dialysis, delay the planning and end up having more complications or needing to start dialysis as an emergency.
By stage 5, many patients start having some of the symptoms of kidney failure; which were mentioned above.
As stage 5 progresses, the symptoms might be imposing on patients’ activities and well-being or might become life-threatening. In these scenarios dialysis needs to be started or a kidney transplant needs to be performed.
What is important to emphasize is that detecting chronic kidney disease early is crucial, as opportune intervention (for instance, diet and lifestyle modifications, and medications) can halt disease’s progression if they started on time.
When should you see a kidney specialist or nephrologist?
Unfortunately, kidney disease comes with very few symptoms until the patient has late stage chronic kidney disease. The best time to see a kidney specialist varies based on your kidney functions, renal conditions, and other risk factors. Some people should see a kidney doctor much sooner to control and manage their kidney conditions, especially those with diabetes and high blood pressure. To be safe, you should go for regular health screening so your doctor can pick up signs like blood or protein in the urine and institute corrective measures for you early if any abnormalities are found.
How are other organs affected by kidney disease?
With chronic kidney disease, many other organs get also affected.
The heart, vascularised organs, the brain and the nervous system are common targets.
For instance, patients with advanced chronic kidney disease, and even more, with total kidney failure, are at increased risk of heart attacks, heart failure, or erratic rhythms of the heart, or arrhythmias, that can even end-up in the heart going into stillness.
The blood pressure can go very high and this damages many other organs.
Severely increased blood pressure can precipitate a heart attack or a stroke or a bleed in the eyes.
If the potassium levels go too high, it can even make the heart stop. This can also happen with abnormalities in other electrolytes.
The bones can become fragile, leading to pain, deformities and fractures.
The muscles can also become very weak, and suffer from painful and sustained cramps.
The blood vessel can become stiff, which can cause circulation problems to many organs, then their function can be impaired.
The circulation to the heart, to the brain, to the legs, to the genitals, etc can be affected.
The nerves of the body also get affected and the patient can have loss of sensation of the skin, abnormal movement and impaired function of some organs as all organs depend on a healthy nervous system.
The skin becomes dry, which exacerbates the itch accompanying kidney disease.
And scratching predisposes to skin infection.
Organs like the liver can also not work that well with high levels of toxins, and the liver is also an important detoxifier of the body.
As the kidney disease progresses, the patient becomes more and more malnourished, losing flesh and strength.
This, together with weaker muscles and some electrolyte abnormalities, can predispose to falls and all their consequences.
If the patient becomes weaker, he becomes susceptible to transmissible infections, or he or she becomes more ill if suffering any sort of infection. Or he or she becomes more ill if suffering any sort of infection.
The mood of patients also changes, going downhill.
This might be an effect caused by the toxins or the psychological effect of knowing you have kidney disease.
In Francisco Kidney & Medical Centre, we are very aware of all the complications that kidney patients can suffer and their implications.
We provide empathetic, approachable and flexible specialist renal and medical care; because we can imagine the struggles our patients and their relatives could face in these situations. Because taking care of both the physical and mental well-being of our patients and their families is my top priority.
Does chronic kidney disease affect one or two kidneys?
Unfortunately, most kidney diseases affect both kidneys, and they affect them in similar fashion, like diabetes, high blood pressure, different types of inflammation (the so called glomerulonephritis) or systemic inflammation like lupus, allergy in the kidneys (e.g. reactions to medications), urine flow obstruction that affects the urinary tubes in both sides or the bladder, polycystic kidney disease plus many other rare diseases that affect both kidneys.
But true there are diseases that can affect only one kidney like stones, tumours, accidental injuries, obstruction of the urine flow of one single kidney, a urine infection, etc. Although, true also these problems can affect the two kidneys.
The crucial matter is that many of these problems can progress to kidney failure, especially if not discovered on time or not managed adequately or by not following doctor’s recommendations. Thus, in many cases kidney failure and the need for dialysis can be prevented or at least their chances reduced if we detect them early and we treat them promptly and adequately.
Does necessarily kidney disease end in kidney failure and the need for dialysis or a kidney transplant?
Not all patients with chronic kidney disease eventually develop kidney failure. In other words, not all patients with kidney disease need to undergo dialysis or a kidney transplant.
There are many factors responsible for this.
First of all, there is no single cause of kidney disease. And every disease behaves differently, some more aggressively than others. So, the progression and risk is different in every single patient; plus the fact that every patient is per se in general different.
Second, the current status of your kidney problem or the status of your kidney disease when it was detected can also determine your chances to progress to kidney failure or not.
For example, if the disease is detected early and is amenable to modification of habits and/or the use of medications to protect the kidneys, the chances of disease progression tend to be lower.
But if detected late or your percentage of kidney function left is already quite low, you will have higher chances of developing kidney failure as the time passes by.
This illustrates the importance of early detection and screening, especially if the patient has personal or family risk factors like diabetes, high blood pressure, or inheritable diseases like polycystic kidney disease; among many other causes.
Third, not every patient takes the same good care of their health; or adhere to their treatment for his or her underlying conditions; or modifies accordingly his/her diet and lifestyle.
As a consequence, and it is totally my professional experience and observation, patients with chronic metabolic conditions and kidney disease, who live a more frugal and active lifestyle, attending their appointments (i.e. getting opportune advice) and following that medical advice tend to have less risk of disease progression and chances of kid-ney failure. The opposite is true for those not taking good care of themselves.
There are other important factors to determine your chances to develop kidney failure, and as I mentioned, they vary patient to patient, so…taking into account your health and wellbeing is at stake, I recommend you to address your concerns with and be evaluated by a specialist kidney doctor, who can individualise his or her opinion to your particular case.
It is not easy living with kidney problems, the worry of disease progression, or having developed kidney failure already.
So, aiming to prevent or retard kidney disease progression or its complications, and getting help to fully understand this process and managing properly is crucial. However, many times despite all the efforts, the kidneys still give up and go into failure…and we need to advise our patients to prepare or go for dialysis or a kidney transplant.
Before concluding, it is important to mention that there are cases of temporary kidney failure, what we doctors call acute kidney failure, where the patient can need dialysis for a variable period of time and later showing recovery and the dialysis can be stopped.
However, these patients need to continue on follow up as they have higher risk of developing progressive kidney disease than normal people.
How are your kidney functions assessed?
In the clinic, we use different methods to assess the degree of kidney function or kidney dysfunction, depending how you want to see it, and to confirm if your kidneys are working fine or not. Specifically, regarding how well they clean the blood.
We measure the creatinine and the urea in the blood, which indicate indirectly the levels of toxins in your body.
Higher levels of these parameters represent higher levels of toxins in the blood, indicating a lower kidney function, and that the kidneys are not cleaning the blood properly.
We also measure the glomerular filtration rate or GFR, that simplistically is an approximate measurement of the percentage of kidney function. Thus, the higher the GFR, the better the kidney function.
As part of the general assessment, we also order other tests.
An ultrasound of the kidneys, for instance.
On occasions, it helps finding the cause of the kidney problem or to detect a complication. For example, it can detect a blockage from a stone, a tumour, etc.
But the ultrasound does not measure directly the degree of kidney function, not help finding all causes of kidney problems. The fact that an ultrasound is reported as normal, it does not mean that everything is ok, still there could be an underlying problem of the kidneys, at the microscopic level, like glomerulonephritis.
But true, if the kidneys are small in the ultrasound (likely scarred), it tallies with a lower level of kidney function and usually indicates that the kidney has been injured progressively and the kidney function progressively declined through prolonged time.
In this respect, there is another useful but more invasive test, the kidney biopsy, which is a procedure using a long needle to take small pieces of the kidney for analysis under the microscope. It does not measure the capacity of cleaning of the blood, but it is in theory the best method to check the status and health of your kidneys – that is, their vitality – ; and also to find the cause of your kidney problem. However, it can be risky in patients with certain conditions and when the kidneys are too small. So, not everyone can undergo a kidney biopsy.
We also perform something we call nephritic or autoimmune screen, which consists of special blood tests, which are more detailed and expensive than routine ones. But they can be seen as an investment as they can give us peace of mind, to both doctor and patients, if they are negative; as usually point to a more severe disease. But if positive, at least a hidden process can be detected opportunely and treatment implemented promptly.
What is the purpose of a kidney biopsy?
A kidney biopsy is a medical procedure by which a small tissue sample of one of the kidneys is taken with a fine needle. The sample is then prepared in special ways, and examined under a microscope.
This allows for detailed examination of the micro-anatomy of the kidney, revealing in most instances the cause of the kidney injury, the cause of kidney dysfunction or the cause of protein or blood leakage in the urine.
A kidney biopsy, per se, does not measure the capacity of cleaning the blood, but it is in theory the best method to check the status and health of your kidneys, and the degree of scarring of the kidneys (tissue that cannot be repaired).
A kidney biopsy can also help guide the correct treatment for your kidney condition and can help determine the prognosis or outlook of your condition. That is, the chances of disease progression.
A kidney biopsy is crucial in the management of many patients with kidney disease, but it is not a simple procedure and it is bound to complications. They are not common but they can be significant…like internal bleeding.
Therefore, patients must be assessed thoroughly by a kidney specialist.
First, to understand if a biopsy is necessary and if it needs to be performed urgently.
Second, to ensure it is safe to perform it. As it can be risky in patients with certain conditions, taking blood thinners including aspirin, and when the kidneys are too small.
So, not all people are suitable for this investigation.
Most experts agree when the kidneys are small or the damage seems to be permanent, a kidney biopsy might not be helpful also.
Many patients, in fact, refuse to have a kidney biopsy done. In many occasions, this is riskier than the biopsy itself, because the cause of the kidney problem might remain unfound, the underlying problem not treated, not monitored adequately and allowed to progress on its own, making the prognosis uncertain or not good at all.
On many occasions, with the results from the biopsy, and a proper assessment and treatment plan, kidney failure can be retarded or even avoided at all.
What can you do if you have been diagnosed with kidney disease?
In general, we advise patients to modify any risk factor (i.e. diet or lifestyle habits) that could enhance disease progression.
For instance, avoid smoking, aim for better control of your blood pressure, better control of diabetes, aim for a healthier weight, and so on.
This in fact works in some patients, and on occasions that alone can halt or at least retard disease progression to kid-ney failure, prolonging the life of the kidneys for as long as possible.
But if you have kidney problems or a specific disease of the kidneys, on top of managing the specific disease, you then need to ensure you manage well other conditions you might have or put efforts in not developing other conditions, by following a healthy diet and lifestyle.
For instance, you might have inflammation of the kidneys, but ideal for you to lose weight if you have excess weight to avoid first that your kidneys overwork, and second to avoid added insults, which can increase the rate of disease progression.
For some diseases, especially the ones related to inflammation or allergy in the kidneys, patients need to undergo special treatments with powerful anti-inflammatory drugs, which sometimes successfully can halt the disease.
But sometimes the disease is too aggressive; or, severe damage has been already caused to the kidneys, that the expectations of recovery and to avoid dialysis are low.
All this information can be puzzling, therefore it can cause you additional stress, which is not good for your overall health. In Francisco Kidney & Medical Centre, we provide empathetic, approachable and flexible specialist renal and medical care; because we can imagine the struggles our patients could face, and we care about the physical and mental wellbeing of our patients and their families. So, we are happy to spend extra time being sure our patients understand very well their diseases and the rationale of our management strategies.
What are the general recommendations to take care of your kidneys – especially if you have risk factors for kidney disease or the disease already?
1. Blood pressure control is very important to protect the kidneys. When high, it can cause what we call hydrostatic injury to the kidneys. You can imagine the higher the pressure, the more the damage. To achieve good blood pressure control, it is essential for you to monitor your blood pressure at home and consult your doctor if any issues, to take your blood pressure tab-lets as prescribed, and to reduce salt intake in your diet. Exercise and losing weight also help keeping a healthier blood pressure and sometimes to reduce it.
2. Quit smoking. Smoking is very toxic for many organs of your body including the kidneys. This will be good for your general wellbeing, but also to minimise insults to the kidneys.
3. We already commented a bit about the effect of losing weight for blood pressure control. But also controlling your weight can help protect the kidneys.
In a way, the larger your body size the more effort the kidneys tend to put to clean your body; and with time some consequences of that overwork (what we kidney doctors call over-filtration) can cause kidney damage (let’s call it fatigue of the kidneys).
You probably know what you need to do to lose weight: Diet improvements (for example, eat a more balanced and moderate diet with reduction of sugar and fatty food), and to have a more active lifestyle.
This will be simpler with the help of a dietician, or if you join a healthy weight loss programme, especially if you find it is too difficult to do it alone or you have tried and failed and about to or already given up.
In fact, I developed a weight loss programme with the same aim to improve health, prevent diseases like diabetes, to protect the kidneys (and the general health) for my patients and clients – The OLYMPIA Lifestyle Health Enhancement & Weight Loss Programme. If interested to know more, you know how to contact me.
4. Do exercise (as tolerable, but consult your doctor first) to maintain your weight and improve your health.
5. Control your blood cholesterol, and if high, consult your doctor for diet advice. On many occasions, medications are needed.
6. If you have pre-diabetes or diabetes, reduce sugary food and sugary drinks and aim for good blood sugar control. Plus follow all general advice for diabetic people. But, irrespective of this, even if you do not have these conditions, it is always advisable to minimise your sugar content to prevent them. In my weight loss programme, we focus also on better metabolic control of people with diabetes, pre-diabetes or at high risk of it.
7. If your doctor prescribed certain diet restrictions to protect your kidneys, the so-called renal diet, consult an experienced dietician. She or he will guide you.
It will be simpler and more effective than figuring out those diet recommendations and restrictions on your own. The dietitian can translate that into a tailored diet plan for your needs.
In general, patients with kidney problems benefit from a diet low in sodium, fat and sugar; and in many occasions low in potassium, phosphate, and protein content.
To control the phosphate some patients need phosphate lowering medications.
8. Protein restriction in the diet can benefit many patients, retarding some of the progression of kidney disease, but please check this with your doctor and your dietitian.
First, if it is necessary. Second, to what degree. This must be adjusted greatly to the degree of kidney dysfunction, your nutritional condition and if you have any other accompanying diseases. Third, how to make your diet more balanced, to avoid over-restriction and prevent consequent malnutrition. Especially, patients with kidney problems, in particular in more advanced stages, they are more susceptible to malnutrition.
9. Control of fluid intake; what we call fluid or water restriction. It is important to stress that it is fluid restriction not only water restriction.
The restriction includes any fluid including other beverages like coffee, soda and juices, any soups or watery dishes like porridge, or even fruits like watermelon and others.
Many patients claim to attach to water restriction and maybe they have, but they need to review their diet from these other sources of dietary water.
In patients with more advanced stages of kidney disease, fluid restriction might be necessary as progressively it is more difficult for ill kidneys to handle the excess of water and you can develop fluid retention.
Water is vital, but when the kidneys do not work well, an excess of water can become toxic.
So, despite how difficult it can be; when the kidneys do not work well, fluid restriction becomes vital. So, if your doctor prescribed fluid restriction, try to attach to it, otherwise you can develop fluid overload with leg swelling, breathlessness, tiredness, potentially flooding the lungs and precipitating a heart failure episode, needing emergent hospital admission or worse.
In addition, not controlling the fluid intake through long periods of time imposes on the heart, making it overwork and with more chances to get fatigued (that is, developing chronic heart failure).
To prevent fluid overload, a low salt diet helps. Salty food triggers thirst; and salt is also a sort of sponge for water, increasing its retention (and remember, it also can increase the blood pressure).
Frequently, patients need to take water tablets (diuretics) to eliminate excess of fluids retained. But again, water tablets work better if fluid and salt restrictions are optimised.
10. Attending appointments and not missing them, even if you feel ok. If you miss it, you might think you are saving time, hassle and money; especially if the doctor tells you everything is fine or stable.
But that is crucial. You gain peace of mind. You know the current approach is working and you are doing the necessary. However, if missing appointments and there were to be an issue, you can miss it or at least delay its discovery.
On many occasions those details can harm your health, can allow a complication to develop or can allow an underlying condition to cause damage or scarring in some organs like the kidneys, which might not be reversible. Also, feeling well can be deceiving of what actually is going on inside your kidneys.
Kidney problems in early and moderate stages are typically asymptomatic (meaning you do not feel anything wrong), so that can give you false reassurance. By missing appointments, you can miss to discover things on time and miss the chance to intervene opportunely with the aim of delaying progress of your kidney dysfunction. This is a common issue.
11. Take all your medications as prescribed. Again, I cannot stress how important is not to miss medications and to take them as prescribed, avoiding under or overdosing.
In this latter issue, if you think you would need less or more medications, that might be true, but make aware your primary doctor, so he can adjust your management. Otherwise, if missing medications or not having the right doses, it is difficult for the treatment to work, it is difficult for your condition to improve, halt or reduce its deterioration speed and can precipitate side-effects.
Talking about prevention and renal protection. Some patients are prescribed anti-proteinuric medications, as they can protect your kidneys, in a way, by reducing the blood pressure inside the kidney at the microscopic level, making the filtering of the blood more gentle, and by minimising leakage of protein.
But not everyone should or can take them. Some patients might have contraindications for them and cannot use them. Check this with your doctor.
12. Many patients with high cardiac risk factors can benefit from taking aspirin or especial types of blood pressure tablets, so ask your doctor if they are suitable for you as not everyone can take aspirin, for example.
13. If you have anaemia, take your iron supplements and/or administer your erythropoietin injections as prescribed to improve your haemoglobin levels to the recommended range.
14. If your blood is acidic (low serum bicarbonate), take your bicarbonate supplements.
15. If your uric acid is high, take care of your diet and take anti-uric acid medications if prescribed by your doctor
16. Ask your doctor if you need some vitamin supplements.
17. If you have a stressful life, check what you can do to minimise your stress. Similarly, if you cannot sleep well, check what you can do to improve that. It could be from something like planning your life differently with the people around or involved in those situations, practicing meditations, mindfulness and other practices, or by asking help.
Sometimes is stress of busy modern lives with all their challenges. Sometimes there might be an underlying medical disorder.
18. Check with your doctor if your 25 vitamin levels must be checked, and if low, take supplements. In addition, some patients with advanced kidney disease might also need to take a more special active type of vitamin D or other medications to control the phosphorus and calcium in your body.
19. If you have high blood pressure and/or diabetes, you might need to see an eye doctor to examine the back of your eye.
20. Check what vaccinations are recommended for you. It varies patient to patient but typically vaccinations against influenza, pneumococcus and hepatitis B are advisable.
21. Follow all the necessary precautions recommended by international and local health advisory boards on COVID 19, for your own protection and the protection of the community in general. They can vary from country to country, so be attentive to that.
Overall, practice respiratory etiquette and wear a face mask when in public and especially if you are ill with flu-like symptoms; but if you are ill, better see a doctor and/or stay at home. Even if you are not ill, stay at home if you don’t need to commute or be outside, and avoid large crowds, keeping physical distance at your best capacity.
Eat healthy and maintain yourself active (eg do exercise outdoors -if allowed- or at home). If you smoke, stop smoking. Control your diabetes as best as possible and any other medical conditions that you might have. Lose weight if you have excess weight. And remember stay vigilant, stay safe and stay healthy.
22. If you have chronic kidney disease and renal cysts, you might need monitoring of the appearance and size of the cysts by ultrasound, performed at different intervals. Consult your doctor to see if this is necessary for you.
23. Inform your doctor immediately after becoming pregnant as you might need to discontinue medications like anti-cholesterol and anti-proteinuric medications or any other special medication given for certain kidney problems (diseases with inflammation in the kidneys) like some immunosuppressants
Go back to consult your doctor if you have queries or worries about your health or side effects of therapies, which can be more common in patients with kidney problems, or if you do not respond as both of you expected to the strategy proposed by your doctor.
Your doctor must be told about that, so he can advise you what will be the next step. Not all medications work for all patients or to the same degree in all patients.
Finally, I need to mention there is no magical answer, medication or strategy to make the kidneys recover or to never go into failure, especially if the process is ongoing, the kidney function deteriorating progressively or the kidney dysfunction quite advanced.
Understandably many patients have great hopes on newer therapies or some unregistered approaches. We as doctors cannot destroy hope from patients, but we have the duty to be objective and frank, irrespective how doom the outlook or thin the hope is.
All these strategies above will help you to prolong the life of the kidneys to different degrees, but a more realistic expectation for many patients is to maintain the kidney function stable for as long as possible or if deteriorating, to deteriorate as slow as possible; that is, the aim is to prolong the life of the kidneys, hopefully for the rest of the lives of the patients.
Since the treatment is complex and diverse, it needs to be personalised to your condition and wishes, after carefully explained the rationale, pros and cons of all options, my practical recommendation is to visit your kidney doctor to explain all that to you, taking into account your personal priorities and preferences.
What is the treatment of chronic kidney disease?
The treatment or management of chronic kidney disease can be divided into:
a) specific treatment of the original cause of kidney disease
b) treatment of the accompanying diseases
c) general management
Specific treatment aims to control the original cause of the kidney problems and prevent further or continuous damage as a consequence of it.
Specific causes of chronic kidney disease include diabetes, high blood pressure, different types of inflammation of the kidneys like glomerulonephritis, allergies, urine flow problems, rare diseases, recurrent infections, side-effects of medications or other agents, etc. So, the specific treatment includes treating specifically these conditions.
I will not be able to mention all the specific treatments for distinct diseases or associated conditions, but the principle is simple: specific treatment is directed to the specific cause. For instance, if diabetes is the cause, aim for good sugar control and follow all general recommendations for diabetic patients.
Plus knowing there are many ways to achieve good diabetic control. If blood pressure is the cause or accompanying factor, aim for good blood pressure control and do the necessary diet and lifestyle modifications. If inflammation is the cause, the patient might need to receive powerful anti-inflammatory drugs like steroids or more targeted specialised (and expensive medications) to treat the original disease process more effectively.
And there are many options to achieve those targets, that is, many ways to achieve good diabetic control, for example, etc.
The treatment of any accompanying disease or diseases, irrespective of being the cause or not of the kidney problem, will prevent extra insults and injury to the kidneys, which are already under siege by the original disease.
That is if diabetes is the cause of the kidney problem but you have high blood pressure, blood pressure control is a crucial aspect of your management to prevent added and extra injuries to your kidneys, in other words, to aim to prolong the life of your kidneys.
On the other hand, general management consists of general and similar recommendations given to most patients suffering from the kidneys, irrespective of the original cause of the kidney problem, aiming to halt or retard the progression of the chronic kidney disease by minimising extra insults to the kidney coming from certain risk factors, medications, diet or lifestyle, in other words to prolong the life of the kidney; and to prevent developing new conditions that will make the kidneys suffer further.
What does dialysis mean?
Dialysis is a medical procedure to remove excess waste, salt and fluids from the blood when the kidneys are not working properly by diverting blood to a dialysis machine to be cleansed.
When our kidneys are functioning properly, excess fluids and waste products are filtered and removed by our kidneys via urine to be passed out of our body.
What is the difference between haemodialysis and peritoneal dialysis?
The main difference lies on how the filtering process is done.
Haemodialysis uses a kidney machine to clean the blood, while peritoneal dialysis uses the abdomen’s lining (the peritoneum) for the filtering process.
Choosing between the two types of dialysis treatments is based on the patient’s medical condition, lifestyle, and personal preference.
Can dialysis be done at home?
Is kidney transplantation better than dialysis?
Kidney transplantation can prolong and improve the lives of patients with kidney failure.
When compared to dialysis, either peritoneal dialysis or haemodialysis, the outlook of patients choosing a kidney transplant is much better. They tend to live longer.
Kidney transplantation can also give patients a better quality of life. Most patients refer higher levels of energy, because indeed dialysis can be tiring and draining. Patients who have gone through dialysis note that change.
Most patients also comment that kidney transplantation allows them to regain their freedom to do many of the things that they used to do or they used to enjoy before developing kidney failure and needing to go for dialysis.
Thus, kidney transplantation appears to offer patients the best chances for rehabilitation in many aspects of their lives, including the medical aspect, family life, work or student life, social life and any sort of leisure, including freedom for travelling.
Although true they need to take more precautions regarding catching an infection, because they are taking medications called immunosuppressants to prevent the rejection of the transplant.
Patients undergoing a kidney transplant are subjected to less dietary and fluid restrictions than dialysis patients, which increases their quality of life significantly. Kidney transplant patients have also greater fertility and many patients become pregnant after transplantation when they tried and failed while on dialysis.
Importantly, kidney transplantation increases the chances of greater sense of personal fulfilment with a fuller and more harmonious personal, family, and work life. Many patients are able to reinstate their profession or previous work life after transplantation, which in some cases was severely affected after starting dialysis.
This does not mean that these goals cannot be achieved by dialysis patients, especially when taking good care of themselves. But it is true that the bulk of patients with a kidney transplant tend to do better than the bulk of patients on dialysis.
But true, in both modalities, there are exceptional or extreme cases: I am talking about those patients who lose the transplant on the same day of the surgery or have a major surgical complication, or dialysis patients who live for many decades with a very active and productive life.
However, kidney transplantation is not a cure for kidney failure. It is not either going back to the health status before having kidney disease. Kidney transplantation has also some disadvantages and patients do experience some symptoms as side-effects of anti-rejection medications and some complications.
Immunosuppression is well-known for increasing the chances of developing infections, metabolic problems like diabetes or high cholesterol; and even having a heightened risk of developing cancers. This does not happen in most people and in many instances the cancers can be curable. But true many cancers can grow faster in patients under immunosuppression. So going thorough routine check ups is advisable.
But again, despite these are significant side-effects to consider, the vast majority of patients undergoing a kidney transplant live longer and fuller lives than if remaining on dialysis. Because dialysis brings by itself many hassles, struggles and medical complications, especially heart-related complications and infections, which together lead to a shortened lifespan and lesser quality of life for most dialysis patients, compared to most kidney transplant patients.
But remember this is more complex than this and the discussions and advice must be individualised to your particular medical situation and preferences.
What is the best type of kidney transplant? Is it the same if I receive a kidney transplant from a living donor than from a deceased donor?
The short answer is NO. The outlook, in terms of quantity and quality of life, plus the actual length of life of the transplant itself, is better in most patients undergoing a kidney transplant from a living donor than from those receiving a transplant from a deceased donor.
However, kidney transplantation is a very complex field.
What I just mentioned is true for the average standard patient. But many patients with kidney disease defer greatly in their health and medical problems.
Anyway. Let’s go into more details.
There are different types of kidney transplants depending on the types of donors; and the outcomes greatly depend on this as I just mentioned.
Life donation occurs when people who is alive donate one of his or her kidneys to a loved one, a closed one or to someone they do not know, but do it, ideally, altruistically. Family members are commonly the living donors, or life partners.
One of the reasons of this type of transplant providing more benefits for transplant survival is the fact that the degree of organ and genetic compatibility between the patient and the donor is greater when they are from the same family. And if they are not, doctors have the opportunity to search for a better compatible donor.
This means they have fewer chances for transplant rejection, which in turn means that they might need lower doses of the immunosuppressive medications to prevent the rejection of the transplant, and in turn lower chances to use rescue anti-rejection medications if they were to suffer a rejection episode. This antirejection medications bring up more toxicity and side-effects.
Many doctors say that with modern immunosupression, achieving the best possible immune compatibility is not that important. I don’t fully agree with that.
Yes, modern immunosuppression is powerful and can be tuned up to minimise risk of rejection or transplant loss; and many episodes of rejection can indeed be treated…but there is always some risk left behind…the immune system has already been primed… But a better compatibility will come with less need for higher doses of immunosuppression and less chances of using salvage immunosuppression and their accompanied toxicity.
Remember, one of my premises of care is prevention being better than cure, and I prefer to be preemptive over being reactive.
In living donation, also the quality of the donated kidney, that is the quality of the kidney tissue itself, is higher as it comes from a Iiving person, a healthy family member (or a close person).
This means that the kidney transplant has more chances to last for longer than kidneys from deceased donors.
Also, after someone dies and donate his or her kidneys, they need to be left on ice or a solution for a good length of time while finding a compatible recipient in sort of a rush. Organs left on ice or similar preservation solutions for few hours can suffer some decay as well.
In addition, in living donation, in contrast to donation from deceased donors, the kidney transplant can be performed promptly without the need to remain for years on a waiting list for a kidney from a deceased donor.
This is very important as during those years on a waiting list, undergoing dialysis, complications can occur, and many of them can lead to patient’s loss of health and loss of fitness to undergo a major surgery like kidney transplantation in the future.
These benefits can be even greater if kidney transplantation is performed before undergoing dialysis, what is called pre-emptive transplantation, or as soon as possible after starting dialysis; which avoids the side-effects of prolonging the kidney failure status and the side effects of ‘partially effective’ dialytic therapies, as they cannot clean the blood as well as the transplanted kidney, and the body is ‘living; for long periods of time in an environment with higher levels toxins even while being dialysed.
Because dialysis only can clean the blood to the level that patients are definitively alive and as free of symptoms and complications as possible, but the blood is never cleaned to normal or close to normal levels.
Furthermore, this is true because the kidney transplant, as it is a natural, normal, fully functional kidney, provides to the patient with all the other important functions the kidneys have, not only cleaning the blood, but controlling water and salt levels, production of hormones for bone health or anaemia protection, etc; which no dialysis machine or therapy can do.
Overall, the best potential option for replacement of kidney function is a kidney transplant, and the best potential type of kidney transplant, for patients who can choose between all these options, is a pre-emptive kidney transplant, where the kidney organ comes for a living family member or partner (ideally aged matched); offering the best potential outcomes, leaving deceased donor transplantation and dialysis as second or third options, respectively.
As commented before, not every patient is, unfortunately, suitable for kidney transplantation.
Also the kidney transplant surgery is bound to heart, surgical and anaesthetic risks as any other major surgery. In addition, patients with kidney failure tend to have several co-existing illnesses and some have many medical complications.
If doctors are worried that the risk for surgery is too high, they might advise against transplantation. For instance, patients having multiple or frequent complications or the consequent disabilities, especially if elderly and frail.
Likewise, patients with active or recent cancers or active or serious infections or having other medical contraindications might not be suitable for kidney transplantation. Thus, in some patients dialysis might be safer than kidney transplantation, and the only option. Therefore, all decisions must be individualised.
If you start dialysis, do you need to do it for life? If you start dialysis, will you become dependent on dialysis?
These are very common and important questions that I have been asked many times.
The facts are that progressive and severe injury to the kidneys can cause permanent and irreparable damage to them; which can end up in total kidney failure.
If total kidney failure is confirmed by your doctor, dialysis will be needed for life. Obviously, unless you have the option of a kidney transplant.
Dialysis will be then for life, because, unfortunately, permanent and severe damage cannot be repaired and the kidney function will not recover on its own- not because you become or have become dependent on dialysis – like becoming dependent on a drug.
It is simply that your kidney problem is too advanced or severe enough that the kidneys cannot clean the blood adequately anymore to sustain your life or to keep you well, and then, as a consequence, dialysis is necessary; or otherwise you will become very ill and your life could be in imminent danger.
All what I just mentioned applies when chronic kidney failure progresses to total kidney failure.
But it is important to discuss acute kidney failure, too.
Some patients develop acute kidney failure, which can be potentially reversible and they might need to be supported with some sort of dialysis for a certain period of time, while their kidneys or their general condition improves. Then, dialysis can be stopped. So, in these cases, dialysis will not be forever.
Similarly, some other patients develop an acute deterioration of a chronic kidney problem. For instance, they might have chronic kidney disease, let’s say due to diabetes, and they suddenly become acutely ill due to an infection or a heart attack, causing their general condition to deteriorate fast and making their kidney function to drop to the point of needing dialysis, but later the general condition of the patient improves and the kidney have sufficient recovery to be off dialysis.
So, in these scenarios, dialysis will not be forever.
However, many patients present with kidney function seemingly in the levels of kidney failure, without other previous tests or clues suggesting if indeed the disorder is chronic or acute problems. What I mean is, patients just discovered out of the blue in a health screen with poor kidney function or after seeing a doctor for some unexplained symptoms.
Then we, nephrologists, need to use our clinical experience and extra tests to help us differentiate these two situations, for example the size of the kidneys on ultrasound and many more. But occasionally, only time passing by gives us the answer. If through time there is no observable recovery, it is most likely that the damage is permanent.
In fact, some patients might need to start dialysis first. Although it is not an exact rule: if by three months the kidneys do not show signs of recovery, it is more likely that the kidney dysfunction is permanent and dialysis will be needed for the rest of the patient’s life. Or that they need to be transplanted.
On occasions, some patients start showing some signs of recovery; for instance, more urine volume or the creatinine levels are too good for a patient on dialysis, then maybe the kidneys have improved through the time to the point of not needing dialysis.
Every patient and every situation is different, so it is sometimes difficult to predict the chances of recovery for specific patients.
What are the side effects of dialysis?
While dialysis can help prolong your life, both haemodialysis and peritoneal dialysis will make you feel exhausted, and they come with certain risks and side effects.
Haemodialysis Side Effects
Some of the side effects of haemodialysis include muscle cramps, itching, sepsis (blood poisoning), sleeping difficulty, high blood potassium levels, anemia, irregular heartbeat and sudden cardiac arrest.
Peritoneal Dialysis Side Effects
Peritoneal dialysis can put you at risk of developing peritonitis, an infection of the thin membrane that surrounds your abdomen. Other side effects may include fever, stomach pain, weight gain, high blood sugar due to dextrose in the dialysis fluid (dialysate), or hernia.
Why is a renal diet important for people with kidney disease?
A renal diet is a kidney-friendly diet that helps prevent kidney disease from getting worse so you can stay healthier longer.
Our kidneys are important organs that perform many important functions, such as filtering waste products, removing toxins, balancing fluids in the body, and releasing hormones that regulate blood pressure.
There are a number of ways in which these vital organs can be damaged, the 2 main risk factors being diabetes and high blood pressure. Other risk factors for kidney disease includes genetics, smoking, and obesity.
When the kidneys are not functioning optimally, toxins and excess fluid build up in the blood, which may cause various health issues (such as muscle cramps, blood in the urine, shortness of breath, swollen feet (from water retention), erectile dysfunction, and more), and can even be fatal in the long run.
That is why people with kidney disease needs to follow a proper renal diet.
What are the foods to avoid (or restrict) for kidney health
For most people with chronic kidney disease (CKD), it’s critical to adopt a kidney-friendly renal diet that helps decrease the amount of waste products in the blood.
Those with kidney disease need to restrict foods that contains the following nutrients:
Phosphorus is found in chicken, turkey, seafood, dairy, nuts, and food preservatives found in most fast foods, canned foods, and processed foods. Because damaged kidneys are not able to clear out excess phosphorus.
Sodium is a major component of salt and is found in many foods such as salted or canned meat, fish or poultry (bacon, sausage, ham, sardines, anchovies, etc). Because kidneys that are not functioning optimally cannot remove excess sodium, and this will cause your blood level to rise.
Potassium is found in bananas, oranges, raisins, potatoes, etc. Those with kidney disease need to limit potassium to avoid high blood levels.
Fortunately, there are many healthy options are low in phosphorus, sodium, and potassium that you can include in your well-balanced renal diet.
To help protect your kidneys, you also need to watch your protein intake. Because when your body uses protein , it produces waste products, which is then removed by your kidneys. This means if you eat more protein, your kidneys need to work harder, and this is a problem for those with kidney disease.
But your body still needs enough protein for enzyme and hormone production, immune function, and would healing. So the solution is to eat the right amount of protein based on your height, weight, and health conditions.
Protein can be found from both animals (meat, fish, eggs, dairy) and plants (nuts, grains, beans). Be sure to speak to your kidney doctor or dietitian to get the right combination of protein foods.
Book An Appointment with Dr Francisco Now