Frequently Asked Questions

How can I prevent or avoid kidney disease?

The most important facet of prevention is knowledge. You should first know what your risk for kidney failure is, and you ought to see a kidney specialist for early detection and treatment, if you are at high risk.


What is the role of the kidneys?

The kidneys are 2 fist-sized organs situated under the posterior rib cage, and are designed to be a finely-tuned, low-maintenance waste disposal system for the entire body. It cleans the body regularly, processing 200 liters of blood daily, to form 1-2 liters of urine. In addition, the kidneys stimulate the bone marrow to make red blood cells. Kidneys also adjust calcium balance and activate bone vitamins to maintain strong healthy bones. Finally, the kidneys control blood pressure by modulating the secretion of some vascular hormones and blood volume.


What are the risk factors for kidney disease?

Anyone can develop kidney disease. However, it appears that the risk is even higher in the elderly, those with Black or Hispanic ancestry, family history of kidney disease or kidney failure, history of arterial hypertension, history of diabetes mellitus, history of high cholesterol levels, history of proteinuria (often indicated by frothy urine), presence of heart disease or heart failure, extended exposure to kidney-damaging medications (such as pain pills or certain antibiotics) and cigarette smoking.


What are the types of kidney disease?

There are 2 types of kidney disease. Acute kidney injury identifies a sudden reduction in kidney function, often occurring in the hospital setting or with other serious injury or illness. Chronic kidney disease is often insidious; it is silent, and sneaks up on unsuspecting folk like the proverbial thief in the night, and is thought to be much more common than acute kidney injury.
The severity of kidney disease is classified based on estimated kidney filtration function (GFR), which is a measure of the ability of both kidneys to excrete waste products. Therefore, 5 stages of kidney failure are identified: stage 1 (kidney damage with normal GFR), stage 2 (kidney damage with mild reduction in GFR above 60% of normal), stage 3 (GFR between 30 to 59%), stage 4 (GFR between 15 to 29%), stage 5 (GFR under 15%). Stage 5 kidney disease suggests the need for kidney replacement, either through transplantation or by dialysis treatment.


How common is chronic kidney disease?

Based on 2007 data, it is estimated by Josef Coresh and his colleagues that 13% of the adult population has chronic kidney disease. That translates to 26 million people. The majority of sufferers are unaware of the fact they have kidney disease. These numbers are expected to increase, in part because of improved detection, better cardiac care, an aging population, a diabetes epidemic, and environmental as well as therapeutic exposure to potential kidney toxins.


What causes kidney failure?

The 2 most common causes are diabetes mellitus and arterial hypertension. Those take years or decades to affect the kidneys. Prevention of kidney disease therefore lies in good daily control of blood pressure and blood sugar. Other causes of kidney disease include kidney inflammation (glomerulonephritis), kidney infection (pyelonephritis), kidney obstruction (from stones, an enlarged prostate gland or enlarged uterus), hereditary diseases (such as polycystic kidney disease or sickle cell anemia) and medications (especially pain medications, heavy metals and some antibiotics).


Is there a cure for kidney failure?

In one word, No! But medical science offers hope for improvement and replacement. When both kidneys have completely failed, the 2 viable treatment options are dialysis or kidney transplantation. In some situations, it might be best to do nothing. Of course, that is an individual decision, which can only be made by the patient, assisted by family and care-givers as may be appropriate.


How can I tell if I have kidney disease?

Kidney disease is typically silent. You might not experience any symptoms, and most likely will not have any obvious changes in either urine volume or urine character until the very end stages of kidney failure. True, some warning symptoms may alert the observant patient to impending kidney problems, such as bloody urine, sudden reduction in urinary output, flank pain, passage of kidney stones, frothy urine or dysuria (painful passage of urine). But that is usually not the case in the majority of patients. In advanced kidney failure, some patients may experience itchy skin, hand tremors, excessive urination at night, dry heaves, nose bleeds, metallic taste in the mouth, hiccups, ankle swelling, generalized weakness, sore tongue, anorexia (loss of appetite), nausea (especially after eating meat), insomnia (sleeplessness), difficult-to-control hypertension, and ironically enough, sudden improvement in sugar control for diabetics.


What tests can reveal if I have kidney disease?

A full physical examination by a competent MD is crucial, even before ordering any tests. Thereafter, several tests may be needed to clarify the situation, including blood and urine tests, as well as kidney imaging tests (usually with ultrasound). In some cases, we may advise a kidney biopsy.


What treatment will I be prescribed for kidney disease?

The scope of treatment for kidney failure has broadened over the last 10 years. Each year brings new advances. The initial strategies include at least 1 of the following: control of arterial hypertension (which is both a cause as well as an effect of kidney disease), reduction of proteinuria (using either an ACE inhibitor or ARB-type drug), normalization of elevated cholesterol levels, cessation of smoking, stabilization of glycemic control (in diabetics), aldosterone inhibition, dietary salt restriction, iron supplementation for anemia, vitamin supplementation, modulation of inflammatory cytokines in the blood, immunosuppression, weight loss and treatment of urinary tract infection.


How can I tell if the treatment is working?

By having your doctor check your current kidney function before starting any specific treatment, and at regular intervals thereafter. Do not simply rely on your sense of well being!


What happens if I am out of town?

Thanks to the miracle of telecommunications, we can stay in touch by phone or through the internet! In emergencies, we can usually locate a competent kidney specialist in most parts of the world to give assistance, when needed.


How does diabetes affect my kidneys?

With long-standing diabetes mellitus, gradual damage to minute blood vessels begin in the kidneys, nerves and eyes. With time, patients may notice a worsening of their vision, a decrease in ability to feel (sensory loss), and slow kidney damage. The ability of the kidneys to filter out waste products is eventually impaired. Therefore, toxic waste builds up in the blood instead of being passed out in the urine. In extreme cases, this leads to kidney failure.


Can diabetes cause other problems besides kidney failure?

Sadly, it can. The good news is that those problems can generally be avoided or corrected, if detected early, and if blood sugar levels are properly controlled. Diabetes can affect all body parts, leading to chronic foot ulcers (wounds that do not heal), nerve damage, gum disease, erectile dysfunction (impotence), heart disease and lazy stomach (GERD).


How can I take care of my feet in diabetes?

First, ensure your doctor inspects your feet at every opportunity you have! Look carefully for any cuts or bruises or calluses or corns on your feet each day. If they do not heal within 2 or 3 days, let your doctor know. Find a good podiatrist; if you have none, ask your doctor for a referral. Carefully cut your nails weekly, after taking a shower. Do not cut too short, and do not pare down too hard! Moisturize your feet to prevent cracks and sores, but do not apply lotion between the toe webs. Never go barefoot. Avoid extremes of cold or heat. Do not sit for longer than 1 hour without wiggling your toes and flexing your calf muscles. Wear comfortable shoes with thick socks. Stop smoking and keep walking!


What will my life be with kidney disease?

It absolutely depends on you. We often are obliged to remind our patients that they should strive to live with kidney disease, and not for kidney disease! Your life might be complicated by the demands of treatment as well as the spectrum of symptoms possible with kidney failure. Yet, many patients have done quite well, continued to enjoy the pleasures of a full life, and work in collaboration with their doctors to treat other medical issues that are all too common with age. You can certainly live a long, happy, good life either with dialysis or kidney transplantation.


Why do I feel tired all the time?

Fatigue is a common complaint in kidney disease. The reasons are often multiple, but include insomnia (inability to sleep restfully at night), anemia, malnutrition, heart failure, thyroid problems, low blood pressure and clinical depression. Depending on the cause, your doctor will find the appropriate treatment for you.


Should I continue working with kidney disease?

It all depends on your circumstances and attitude. I encourage all my patients to stay employed for as long as they can. Sometimes, that is not practical or wise. In the United States, most patients are entitled to Disability Income following kidney failure. However, it is important to regain a full, encompassing purpose in life, outside the concerns of chronic ill-health. If you cannot be fully employed, it might be helpful to consider part-time employment, or even non-paid volunteerism.


What Are Treatment Options for Kidney Failure?

There are several options available, and no particular choice is consistently superior to the other choices for all patients, all the time. The choice for each individual depends on the specific circumstances relating to the patient, the environment of the clinical practice (what is easily available in the area, and what can be readily monitored), and the “know-how” of the treating physician(s)/care-giver(s).
The three main options are: dialysis (either through the blood-stream, referred to as hemodialysis; or through the abdomen, referred to as peritoneal dialysis), transplantation (the placement of another kidney into the patient, either from a relative, referred to as “living related” donation, or from a dead person, referred to as “cadaveric” donation) or death (in some cases, kidney treatment may not influence the ultimate outcome for the patient, such as in those with terminal diseases, including metastatic cancer; or where kidney treatment may not make any meaningful difference to the quality of life, as in those with advanced dementia). In those exceptional cases, the patient may reasonably elect to forgo any specific treatment including dialysis or kidney transplantation.


How Can I Have Kidney Failure When I Can Still Make Urine?

This is a common question. Indeed, you cannot make urine, which is water plus salts and waste matter, when your kidneys have failed. However, most patients mistake “passing water” for “passing urine”. With kidney failure, the ability to excrete water is retained until the very end, far after the ability to remove blood toxins and waste has been lost. I often remind my patients that urine has a (dark amber) color, (salty) taste, peculiar odor, and will typically not support the growth of plants or grass. The “water” passed by those with kidney failure will be just like water without the “noxious” quality of urine.


Is Hemodialysis Going To Hurt?

Not typically. Inserting the needles will take getting used to, but with time, it becomes less of a source of anxiety or distress. However, dialysis is an “invasive” treatment, therefore it is common for patients to experience cardiac symptoms, fluctuations in blood pressure or even blood loss. Your care-givers are trained to respond appropriately to any emergencies.


How Long Will Dialysis Take?

The duration of treatment governs the amount of poison/waste removed from the blood stream during dialysis. The amount of poison/waste that needs to be removed depends a lot on body size: the bigger you are, the more cleansing you will need.
Your doctor will adjust your time, depending on other factors, to achieve removal of 65% or more of a “standard toxin” in the bloodstream (we use a common chemical found in the blood, urea, as the surrogate toxin).


Will My Life Change With Dialysis?

Yes, it will. However, how much it does change will depend a lot on you, as well as your attitudes to ill health. It is important that you understand from the very beginning that dialysis is designed to help you live; you do not live in order to dialyze. Therefore, we encourage our patients to stay connected, remain employed, go on vacations, and travel whenever they can. Live, man, live….


How Long Do I Need To Continue Dialysis?

Generally, once dialysis is started, most patients stay on treatment for the rest of their lives or until they receive a kidney transplant. Rarely, some patients elect to stop dialysis on their own. If notified by a patient of their intention to stop dialysis treatment, we counsel the patient, screen him/her for possible underlying depression, and then do our best to respect his/her wishes.


What Is A Nephron?

The nephron is the functional unit of the kidney, consisting of a filtration apparatus otherwise known as the glomerulus (“bag of worms”) at one end, with a U-shaped hair-pin loop called the “loop of Henle” in the mid-portion (which helps alter the composition and concentration of the urine as it is being formed), and terminating at the urine collecting duct, before tracking its way out of the body. As blood filters into the nephron to make its way to the outside, the minor miracle of water transmutating into urine is effected.


What Are The Manifestations Of Kidney Failure?

There are several symptoms found with kidney failure, including easy skin bruising, unexplained and excessive weakness, darkening skin color, impotence, bleeding at the gum margins, sore tongue, muscle aches, depression, “burning” feet at night, insomnia, restless legs, muscle twitches, sudden “improvement” in diabetes (less insulin may be needed), sudden worsening of hypertension control, headaches, high blood pressure, nocturia (passage of large amounts of urine at night), frothy urine, reduced quantity of urine, dull flank pain, seizures, shakiness, drowsiness, ankle swelling, poor memory, poor appetite, excessive thirst, nausea, vomiting, hiccups, loose stools, dry furry tongue, leg cramps, bone pain, altered (metallic) taste to tongue, dry itchy skin, shortness of breath and low-grade fever.


What Causes Enlarged Kidneys?

Usually, chronic kidney disease is associated with small or shrunken kidneys. However, there are certain conditions with enlarged kidneys despite poor function. Those include polycystic kidneys, kidney inflammation, hydronephrosis (obstruction of urine outflow), diabetes kidney and kidney failure due to HIV infection. There are other less common causes, which a kidney specialist can easily determine through appropriate testing.


How Can I Tell Which Foods Are Rich In Phosphorus?

It is very difficult to tell. However, we have a “cheat sheet” to help our patients decide on high vs. low phosphorus meals.

1. Low Phosphorus
(a) Meat & Poultry -150 mg limit
Beef, ground, extra lean, 137 mg
Beef, ground, regular, 144 mg
Duck, domestic, with skin, 133 mg
(b) Fish -150 mg limit
Clams, raw, 144 mg
Cod, Atlantic, 117 mg
Grouper, 121 mg
Oysters, Eastern, raw/canned, 118 mg
Oysters, Pacific, raw, 138 mg
Shrimp, moist heat, 116 mg
(c) Dairy & Eggs – 100mg limit
Butter, 1 tbsp., 3 mg
Cheese, brie, 1 ounce, 53 mg
Cheese, feta, 1 ounce, 96 mg
Cottage cheese, nonfat 1/2 cup, 76 mg
Cream cheese, 1 ounce, 30 mg
Cream, half & half, 1 tbsp., 14 mg
Egg white, 1 medium, 4 mg
Egg yolk, 1 medium, 86 mg
Ice cream 10% fat vanilla, 1/2 cup, 67 mg
Sherbert, 1/2 cup, 38 mg
Sour cream, 1/2 cup, 98 mg
(d) Legumes- 100 mg limit
Peas, split, 97 mg
Peanuts, boiled, 63 mg
Soy milk, 59 mg
(e) Grains & Cereals -65 mg limit
Bagel, plain, 3 1/2″ diameter, one, 46 mg
Barley, pearled, cooked, 1/2 cup, 43 mg
Bread, pita, 6 1/2″ diameter, one, 60 mg
Bread, white, 1 slice, 27 mg
Corn flakes, 1 cup, 14 mg
Couscous, cooked, 1/2 cup, 20 mg
Crispy rice cereal, 1 cup, 31 mg
Farina, cooked, 3/4 cup, 21 mg
Hominy grits, 1/2 cup, 15 mg
Rice, white, cooked, 1/2 cup, 37 mg
(f) Snacks & Sweets -65 mg limit
Chestnuts, Chinese, canned, 2ounces, 10 mg
Cookies, shortbread, 4 small, 39 mg
Gelatin, water base, 1/2 cup, 23 mg
Popcorn, air popped, 1 cup, 22 mg
Rice cake, one, 34 mg
Cool whip, 2 tbsp., 0 mg

2. Medium Phosphorus
(a) Meat & Poultry -151 to 200 mg limit
Beef, chuck roast, 163 mg
Beef, eye round, 177 mg
Beef, sirloin steak, 186 mg
Chicken, white, 185 mg
Chicken, dark, 154 mg
Lamb, kabobs, domestic, 190 mg
Lamb, leg roast, domestic, 162 mg
Lamb, leg roast, New Zealand, 186 mg
Pork, fresh, loin ribs, 142 mg
Turkey, white, 188 mg
Turkey, dark, 157 mg
(b) Fish – 151 to 200 mg limit
Catfish, breaded, fried, 183
Crab, blue, moist heat, 175
Crab, dungeness, moist heat, 149
Cod, Pacific, 190
Lobster, moist heat, 157
Mussels, blue, raw, 168
Shrimp, breaded, fried, 185
Shrimp, canned, 198
Snapper, 171
Tuna, light, canned in water, 158
(c) Dairy & Eggs -101 to 200 mg limit
Cheese, blue, 1 ounce, 110 mg
Cheese, cheddar, 1 ounce, 145 mg
Cheese, mozzarella, 1 ounce, 105 mg
Cheese, provolone, 1 ounce, 141 mg
Cheese, Swiss, 1 ounce, 171 mg
Cottage cheese, 4% fat, 1/2 cup, 139 mg
Cottage cheese, 2% fat, 1/2 cup, 170 mg
Icemilk soft serve, vanilla, 1/2 cup, 106 mg
(d) Legumes -101 to 200 mg limit
Beans, black, 120 mg
Beans, black turtle, 140 mg
Beans, fava, 106 mg
Beans, kidney, 125 mg
Beans, lima, thick, 104 mg
Beans, lima, thin, 116 mg
Beans, navy, 143 mg
Beans, pinto, 136 mg
Black-eyed pease, 134 mg
Chickpeas, 137 mg
Peanut butter, 2 tbsp., 102 mg
Tofu, raw, regular, 120 mg
(e) Grains & Cereals -66 to 150 mg limit
Bread, pumpernickel, 1 slice, 71 mg
Bread, whole wheat, 1 slice, 66 mg
English muffin, plain, one, 67 mg
Oatmeal, cooked, 1 packet, 133 mg
Pasta, “al dente,” 1 cup, 81 mg
Raisin Bran, 1/2 cup, 124 mg
Rice, brown, cooked, 1/2 cup, 81 mg
Shredded wheat, 1 large biscuit, 86 mg
Wheat flakes, 1 cup, 100 mg
Wheat flour, white, 1 cup, 135 mg
(f) Snacks & Sweets -66 to 150 mg limit
Angel food cake, 1/12, 91 mg
Cocoa, dry, unsweetened, 2tbsp., 74 mg
Macademina nuts, oil roast, 2ounces, 114 mg

3. High Phosphorus
(a) Meat & Poultry -201 mg or higher
Beef, bottom round, 217 mg
Beefalo, 213 mg
Pork, fresh, boneless loin chop, 203 mg
Pork, fresh, leg roast, 224 mg
Pork, fresh, spareribs, 192 mg
Veal, cubes, stewed, 203 mg
Veal, rib roast, 211 mg
(b) Fish -201 mg or higher
Calamari, fried, 213 mg
Clams, moist heat, 287 mg
Crabs, alaskan, moist heat, 238 mg
Flounder, 246 mg
Haddock, 205 mg
Halibut, 242 mg
Oysters, Eastern, cooked, 236 mg
Mussels, blue, cooked, 242 mg
Salmon, canned, pink/red, 279 mg
Salmon, fresh, cooked, 234 mg
Scallops, breaded, fried, 203 mg
Sole, 246 mg
Swordfish, 287 mg
Tuna, white, canned in oil, 227 mg
Tuna, light, in oil, 265 mg
(c) Dairy & Eggs -201 mg or higher
Buttermilk, 1 cup, 219 mg
Cheese, parmesan, 1 ounce, 229 mg
Cheese ricotta part skim 1/2 cup, 226 mg
Milk, evaporated skim, 1/2 cup, 248 mg
Milk, nonfat, 1 cup, 247-275 mg
Milk, 1% lowfat, 1 cup, 235-273 mg
Milk, whole, 1 cup, 228 mg
Process American cheese 1 ounce, 211 mg
Yogurt, skim, 1 cup, 355 mg
Yogurt, lowfat, 1 cup, 326 mg
Yogurt, whole milk, 1 cup, 215 mg
(d) Legumes -151 mg or higher
Beans, small, white, 152 mg
Lentils, 178 mg
Peanuts, dry roasted, 2 ounces, 200 mg
Peanuts, oil roasted, 2 ounces, 290 mg
Soybeans, 211 mg
Tofu, raw, firm, 239 mg
(e) Grains & Cereals – 151 or higher.
Bran cereal, 100%, 1/2 cup, 402 mg
Corn flour, whole grain, 1 cup, 318 mg
Cornmeal, whole grain, 1 cup, 294 mg
Wheat flour, whole grain, 1 cup, 415 mg
Wheat germ, plain, toasted, 1/4 cup, 324 mg
(f) Snacks & Sweets- 151 or higher
Almonds, oil/dry roast, 2 ounces, 312 mg
Cashews, dry roast, 2 ounces, 278 mg
Cashews, oil roast, 2 ounces, 242 mg
Pecans, oil/dry roast, 2 ounces, 170 mg
Walnuts, black, 2 ounces, 264 mg
Walnuts, English, 2 ounces, 180 mg


Is it harmful to miss my dialysis?

Yes, skipping dialysis treatments can be very harmful to you, and can significantly reduce your lifespan. Hemodialysis as is presently given in the United States, usually 3 to 4 hours three times a week, is the barest minimum amount of treatment that keeps you alife. In short, there is no “fluff” or “margin of error” in that bare-bones prescription. As one of my favorite teachers would say, “You won’t grow fat on thrice weekly dialysis”. Therefore, just skipping 1 day means you lost 33% (a third) of your weekly treatment for that week. Next time you come in for treatment, there are more poisons, more fluid, more potassium and more “ash” to clean out of your blood. Missing 1 treatment a week adds up to 4 months of lost treatment a year. Missing just 1 treatment a month equals skipping 1 month of treatment each year. please, remember that.


What can I do when I develop cramps during treatment?

The exact cause(s) of cramps are unknown, but it tends to be more common amongst patients who are heavy-built or need to have a lot of fluid removed during dialysis. Simple remedies often work: stretch your muscles periodically; try not to gain a lot of fluid between treatments; take off fluids slowly during treatment by not “cutting” your treatment time; apply warm packs to sore muscles; some swear by a half-glass of Tonic Water (it works better if it contains Quinine!) or Apple Vinegar, but make sure you discuss those first with your doctor.


I often throw up during dialysis. What can I do?

Usually, patients throw up when there is reduced blood flow to the stomach. That usually means that the Blood Pressure has dropped. Consider reducing fluid intake between treatments, so that no more than 1 or 2 liters of fluid is removed during dialysis; do not eat for at least 1 hour before treatment; talk to your Doctor about holding (or only taking half of) your anti-hypertension pills before treatment. If all else fails, there are some medications that might help you control this symptom.


How do I reduce fluid gain between treatments?

First, be aware that there is a problem with gaining too much fluid- you tend to cramp during treatment, you feel bloated (and sickly), you often feel sick and nauseous at the end of dialysis, and your blood pressures might drop during treatment. Avoid salted foods. Drink no more than a quart of water (32 ounces) of fluid each day. Keep your lips moist with Lip Balm. Suck on a mint. Stay away from the heat (and hot outdoors). Use airconditioning at home.


Why does my skin itch?

There are many reasons for dry, itchy skin. Perhaps, the most common cause is loss of moisture: invest in a moisturizing lotion (Vaseline or Eucerin is OK). Check your blood phosphorus levels, and make sure you are using your Phosphate-Binders with each meal. Avoid skin irritants, including perfumes, if you have sensitive skin. Wear long-sleeved clothes when outdoors.