Our kidneys function primarily for regulating fluid, electrolyte and mineral content of the body, filtering and removing the waste materials of the metabolism and foreign bodies and producing and secreting various enzymes and hormones.There are two kidneys in a human body under normal circumstances, but a healthy kidney can sufficiently meet all needs of the body.Kidney failure is a clinical condition that is characterized with inability to kidney to perform functions, partially or completely, due to numerous diseases.
What is end-stage kidney failure?
Chronic kidney failure leads to long-term, progressive and irreversible kidney damage.It is mostly secondary to diabetes mellitus, hypertension and nephritis – the immune system-related inflammatory diseases of the kidney – with no clear etiology in most cases. Kidney failure is called end-stage kidney failure in case of severe progression.In this stage, patients suffer from severe fatigue and loss of appetite as well as swollen hands, face and feet, severe hypertension, nausea and vomiting, shortness of breath and difficulty falling asleep.Treatments should be started immediately which replace the functions of kidney, when these symptoms occur.
There are 3 primary treatment options for the patients in this stage:
- Continuous, regular hemodialysis
- Continuous peritoneal dialysis
- Deceased- and living-donor kidney transplant
Hemodialysis Therapy
Hemodialysis therapy is carried out at hemodialysis centers 3 times per week with each session lasting 3 to 5 hours.Toxic waste and excessive water in the patient’s blood are filtered or necessary minerals are supplied back to the body.
Relatively short duration, effective removal of waste materials and the center serving as a social circle for patients are main advantages of the therapy.
Primary disadvantages include requirement for vascular access, use of anti-coagulant agents for treatment, fluctuations in blood pressure and strict compliance to diet and treatment.Potential dialysis-related problems include hypotension, cramps, nausea, vomiting, headache, chest pain, back ache, itching, fever and tremors.
Peritoneal Dialysis Therapy
A silicon tube, called catheter, is inserted through the abdominal skin.A part of the catheter is exposed outside of the body, while the mid-section remains beneath the abdominal skin and the last part with numerous small holes remains in the abdominal cavity.The treatment is started once the patient is able to perform the procedure safely without aid.Abdominal cavity is lined by a membrane, called peritoneum.The membrane allows drainage of the accumulated waste material, various toxins and excessive fluid to the dialysis solution.The abdominal cavity is filled with dialysis solution several times a day to achieve these goals; the solution is left in the abdominal cavity for a certain period of time and it is drained thereafter.The filling and drainage is called exchange and lasts approximately 30 to 40 minutes.In a daily routine of 4 exchanges per day, the solution remains in abdominal cavity for 4 to 6 hours in 3 cycles in day time and for 8 to 10 hours in one cycle at night, although the exact period of time may vary.Unlike hemodialysis, peritoneal dialysis is carried out every day.
Vascular access is not required in this non-invasive method, which is the major advantage.Waste material and fluids are continuously removed from the body in peritoneal dialysis, just like native kidneys.This allows a more flexible diet and hydration.Peritoneal dialysis poses less restriction in daily activities.Patients are relatively more independent.They don’t have to visit the center.
The major disadvantage is infections.The puncture site and tunnel infections, especially including peritonitis (infection of the peritoneum), are the major challenges.Dietary complications are another set of disadvantages.Protein and energy malnutritions are likely due to excretion of proteins along with wastes into the peritoneal fluid and decreased food intake secondary to increased intra-abdominal pressure.
Information for Kidney Donors:
Kidney transplant is the best treatment of the end stage renal failure.Waiting for 6 months to a year on dialysis means wasting time for the patients who absolutely need dialysis for the management.It is not a correct approach to place a patient on dialysis, if the patient has a chance of transplant.At first, relatives who can donate one kidney are caring and willing, when the patient requires to go on dialysis.However, they can drop the idea of donating a kidney when they see the patient survive after dialysis therapy is started.But, their loved ones age two – three years for every one year of dialysis therapy.Therefore, their loved ones will get 20 to 30 years older in each decade they spend with dialysis.Unfortunately, a transplant cannot compensate this period of time that is already lost.Accordingly, the treatment of choice is to receive a transplant before going on dialysis therapy -if possible- for patients who are suitable for transplantation.The donor is capable of providing relief for the patient and the family.
Living-donor transplant is a safe and successful treatment option.The chance of a dialysis-free healthy life is 95% at the end of the first year after a living-donor kidney transplant.
On the contrary to the popular belief, donation of kidney does not increase the risk of kidney failure.The most important principle of living donor transplant is to avoid a damage to kidney donor who has no health problem and makes an important voluntary sacrifice to give life to a loved one.After donation status is verified in an organ transplant center, donors can live without any modification in life style, after they donate one of their kidneys.
When you decide to donate kidney, detailed examinations will be conducted to prevent any harm to your health and organ donation will be approved only after those examinations.If these examinations point to even a small hesitation, you and your patient will be informed and a new donor will be searched.Remember that you can change your mind about surgery any time.
Preparation procedures of the recipient and the donor for living donor kidney transplant are completed within a week in our center.
For living donor kidney transplants, it is legally obligatory that the donor and the recipient are at least 4th degree relatives.
1stdegree relative:Mother, father, child
2nddegree relative:Sibling, grandfather, grandmother, grandson/granddaughter
3rddegree relative:Maternal and Paternal Uncle, Maternal and Paternal Aunt
4thdegree relative:Children of third degree relatives; Niece/nephew (children of siblings)
Relatives of spouses are classified in the same way.
Applications of people who are not at least 4thdegree relatives are evaluated in Ethics Committee of Provincial Health Directorate.Ethics committee meets once every two weeks and evaluates the patients.Surgeries are planned and notified to patients once their status is approved by the committee.
Unless your physician states a contraindication for your organ donation, you can safely donate one of your kidneys to your patient.This condition will not cause any change in your normal lifetime.
There is no upper age limit for kidney donation.Kidneys get old like all other organs after 65 years of age and partial dysfunctions are likely thereafter.Even though, kidneys of individuals above this age are mostly healthy and donation of kidney is allowed.
Patients with Hepatitis B or C can benefit from a kidney transplant, unless they have advanced liver diseases.
Even if the examinations clarify that your kidneys function well at that time, you are informed that you are not an appropriate donor if you have history of a serious kidney disease or if you are diabetic.
ABO blood type compatibility between the donor and the recipient is necessary for kidney transplant and the rules for compatibility are same as blood transfusion.Rh factor has no significance in organ transplant; this means a patient with Rh negative blood can receive kidney from a donor with Rh positive blood.
HLA system, also called tissue type, is the second criterion that requires compatibility of the donor and the recipient.The more the tissues of two individuals are similar to each other, the lower the risk of rejecting the kidney by the body.Rejection is not possible in organ transplants between identical twins.Generally, tissues of mother and father are partially compatible with their children.Full-match or moderate match can be observed between siblings while a complete incompatibility can also be seen.Today, a patient with a living donor can successfully benefit from a transplant, even if there is no tissue compability.Cross-match is among important tests that apply to both deceased- and living-donor transplants.
Bloods of recipient and donor are mixed to review the risk of organ rejection.
It is substantial to avoid “transfusion of blood and blood products” for patients for whom an organ transplant is planned, unless it is critically necessary.Our immune system faces tissues of other people in transfusion of blood and blood products and thus, the donor kidney can be immediately rejected due to potential hypersensitivity.Kidney transplant can follow a very turbulent course for these patients.
Transplantation will be performed if results of all these examinations and tests are deemed appropriate.
The major goal of an organ transplant is to make the patient healthy and all efforts are made to ensure risk-free operations for both the recipient and the donor.
Preoperative investigations, various blood and urine tests and detailed review of your health as well as cardiology, pulmonary medicine, psychiatry and gynecology and obstetrics (for female donors) consultations to avoid potential intraoperative problems, kidney scan and angiography are required for donors, before a donor organ is removed.