The word dialysis often comes up in connection with chronic kidney disease. But who exactly needs dialysis? And in what ways can you influence your kidney function so that you can delay dialysis as long as possible? You will learn about this and much more in this blog article.
In Germany, about one in ten people have chronic kidney disease, but only about 80,000 people use dialysis to cleanse their blood. In terms of the population as a whole, that is only a very small proportion of people. Not all kidney problems are the same, and only a few people actually need dialysis.
But what does dialysis actually mean? As you probably already know, one of the main tasks of your kidneys is to clean your blood from waste products. These waste products are produced when your body generates energy from food. They are then transported from the blood to the kidneys, where they are excreted in the urine. If your kidneys no longer manage to get rid of the waste, another solution will have to be found at some point.
One option is for you to have a donated kidney implanted (=kidney transplant). Your "new" kidney can then replace the functions of your damaged kidneys and take over their tasks. However, since it often takes several years before a suitable kidney is available, dialysis is used as a therapy for those people who need it. The most common form of dialysis is hemodialysis. In hemodialysis, your blood is filtered and cleaned by a machine outside your body. You can find more information about the different ways to replace the tasks of your kidneys in other articles in the Mizu App.
Does everyone with chronic kidney disease need dialysis?
To find out how well your kidneys are working, your doctor can determine the estimated glomerular filtration rate (eGFR) in the laboratory. The eGFR indicates how much blood your kidneys clean per minute. The higher the eGFR, the better your kidneys function. With the eGFR, kidney insufficiency can be roughly divided into 5 stages. The function of your kidneys decreases from stage 1 to stage 5:
Stages 1 and 2 are not directly considered disease if there are no other indicators that there you have problems with your kidneys. Chronic kidney disease (=CKD) is diagnosed when your eGFR is less than 60 ml/min - that is, from stage 3. If your kidney function declines even further and you reach stage 5 of kidney disease, we speak of so-called kidney failure. This means that your kidneys no longer function, or hardly function at all, and that they are generally no longer able to clean your blood sufficiently. In this case, a replacement of your kidney function via dialysis or a kidney transplant is necessary.
Who needs dialysis?
As you already know, the main function of your kidneys is to cleanse the blood of waste products. If your kidneys are no longer able to do this, this excess remains in your blood. To prevent your body from being poisoned, you either need a new kidney (=kidney transplant) or dialysis must take over the cleaning of your blood.
In concrete terms, this means that if your eGFR is less than approx. 7 ml/min, your kidneys are no longer able to keep your blood sufficiently “clean”. At this stage, you have kidney failure (=stage 5 of renal insufficiency) and have to go on dialysis.
However, if the remaining pollutants in your blood (=uremia) cause you problems early on, you may also need dialysis at an early stage. Signs of uremia can include specific bad breath, skin spots, itching, fatigue, nausea, vomiting and seizures. To detect these symptoms associated with worsening kidney function early on, you should visit your treating physician regularly. In many cases, your team of doctors will be able to determine months in advance if and when dialysis will be necessary. This makes it much easier to plan the therapy together. In this case, you can be informed about the various dialysis options and important preparations - such as the creation of a blood vessel access (=shunt) - can be planned in advance.
In summary, you need dialysis when your kidneys are almost completely failing. If the waste products in your blood start causing you problems early on, you may also need to start dialysis sooner.
What affects the progression of my kidney disease?
We discussed the different stages of renal failure at the very beginning. However, just because your kidney failure was classified to a certain stage doesn't mean it will always be that way. Your kidney function can improve over time, but it can also get worse. In this context, your doctor may have talked about the progression of your kidney failure. Rapid progression means that your kidney function is declining fast. A slow progression means that your kidney values, and therefore the function of your kidneys, remain pretty much unchanged over the long term.
There are a few things that can further damage your kidneys and cause your kidney function to decline more quickly:
1. Blood pressure & diabetes
The primary negative influences on kidney function are high blood pressure (=hypertension) and diabetes (=diabetes mellitus). If you have either of these two conditions, you may reach the final stage of kidney disease earlier and have to undergo dialysis sooner than expected. In this case, this would be called rapid progression and the chance that you will eventually need dialysis would be increased.
2. Anemia
In addition, your kidney insufficiency can cause you to develop anemia. This means that there is too little red blood pigment (=hemoglobin) in your blood. Hemoglobin transports oxygen to your organs, which they need to have enough energy to work. Anemia can also cause the function of your kidneys to deteriorate. This makes it more likely that you will eventually need dialysis.
3. Age
Last but not least, your age also affects how likely you are to need dialysis at some point. This means that the older you are when you are diagnosed with kidney failure, the less likely you are to need dialysis at some point. If you are diagnosed with kidney failure at an early age, it has more time to worsen. It is then all the more important that you actively try to slow down the progression of the disease.
4. Obesity & smoking
To put it in a nutshell, your kidney function can be additionally worsened by high blood pressure (=hypertension), diabetes (=diabetes mellitus), but also obesity, smoking and anemia.
Can the risk for rapid progression of my kidney disease be calculated?
To better assess the risk of your disease progression, there are a number of accepted and valid formulas and calculations. Most work with information such as gender, age, protein in the urine (=proteinuria) or the albumin-creatinine ratio (=ACR). However, make sure that the calculator you use comes from a recognized professional society. This will ensure that the values/statements are based on medical expertise.
However, your treating nephrologist still has the best overview of your personal progression of kidney failure. That's why it's best to talk to him/her about it again at your own convenience.
How can you positively influence your kidney insufficiency?
You now know that there are some things that can make your kidney function worse. Are there also concrete ways to have a positive impact on your kidney function? Ultimately, you will want to delay kidney failure for as long as possible…
1. Keep up with your regular checkups
It is especially important that you go to your doctor regularly for follow-up examinations. In addition to your kidney function, they will also monitor all your most important risk factors that can additionally damage your kidneys. These include - as already discussed - diabetes, high blood pressure, obesity and smoking. Anemia can also be detected and treated at an early stage. In this way, your doctor can support you in getting your risk factors under control and thus positively influence your kidney function. This will keep not only your kidneys, but also yourself, fit and healthy for as long as possible!
2. Get your blood pressure under control
We have already discussed that high blood pressure can also damage your kidneys. This means that your blood pressure should not exceed 140/90 mmHg. To keep an eye on your blood pressure, it is worth checking it regularly at home. There are easy-to-use blood pressure monitors for this purpose. Here, too, it is best to ask your doctor for advice. Getting your blood pressure under control is one of the most important components in slowing the progression of your renal failure!
3. Get your diabetes under control
In diabetes mellitus, your body can no longer absorb sugar from the blood (=blood sugar) into the body cells on its own, or can barely do so. Too much sugar in the blood is bad for your blood vessels and can also damage your kidneys. If you are diabetic, you should make sure that your blood sugar levels are not too high. You probably do this every day anyway. Another check is the so-called HbA1c value, which can be determined in the laboratory. This is the long-term blood glucose value. It indicates how high your blood glucose level was on average over the last 3 months.
To prevent your blood glucose level from causing additional damage to your kidneys, the HbA1c value should always be below 7%. As always, you will get your personal target value from your treating medical team
4. Master diet and body weight
A healthy diet and regular exercise can lower your blood pressure and blood sugar levels and help you maintain or reach your ideal weight. In this sense, you can have a positive impact on three risk factors that can worsen your kidney function.
But what exactly is meant by a healthy diet and regular exercise? Ideally, you should avoid processed products and cook as much as possible yourself. Sugar is often hidden in ready-made products. In this context, the words "Mediterranean diet" and "Mediterranean food" are often mentioned. The idea is to avoid animal fats in the form of red meat and sausage as much as possible and to consume more plant-based fats. You can find plant-based fats, for example, in vegetable oil such as olive oil and in nuts. It is also recommended that you eat fish twice a week, preferably eat whole grains and include fresh fruits and vegetables in your diet. If you want to know more about this diet, check out the other articles on the Mizu app.
By regular exercise, we mean sports that make you sweat easily. You should do this sport five times a week for at least 30 minutes. Which sport you do is up to you, and of course it doesn't always have to be the same sport. How about jogging/walking, for example, or a game of badminton in the park or indoors during the cold season? If it's easier for you to do sports in company, you can also join a club or motivate friends to do sports together.
You may have already heard the saying “Motion is lotion” which basically means that no matter what, you should try to move as much as possible, because any movement is better than no movement.
5. Smoking
Even though you know that smoking is not healthy, it is often difficult to kick the habit. To help you quit, many countries and health systems have developed cessation programs. These programs come digitally, with aids, in person… nowadays they are available in almost any form. If you currently smoke, it's a good idea to do your due diligence and find out more about the various programs from organizations, providers, and even people you know. This way you can find the best program for you to live nicotine-free in the future.
Some of these programs even include psychological and medical support. For this, it is best to talk with your treating doctor.
6. Treat anemia
You have already learned that your kidney weaknesses can also cause anemia. Anemia, in turn, can worsen kidney function. To prevent this, anemia should be detected and treated early. That is why it is all the more important that you go to your doctor for regular check-ups. If you are diagnosed with anemia, there is no reason to panic. If your reduced kidney function is the reason, there are ways to get it under control. Your medical team can offer you advice on how to best manage this.
Keep track of your health with the Mizu app
You have learned quite a lot about what has a positive and a negative impact on your kidney function. In this context, different laboratory values or blood pressure values were discussed again and again. You can use the Mizu app to not only always have these values with you when you go to your progress checks but also to keep track of them yourself. In the app you can clearly enter many of your lab values and your blood pressure values and even have the progress displayed in the form of diagrams. The Mizu app also provides you with suggestions for healthy recipes and lots of additional information on the topic of kidney failure.
