Dialysis of COVID-19

Dialysis of COVID-19

As COVID-19 has engulfed the whole world, a pandemic situation has come into existence. Here is a set of questions to intimate you about the dialysis process of COVID-19 patients.

How dialysis of COVID-19 takes place?

The Government has taken initiatives to set up different dialysis centers, especially for COVID-19 patients throughout the country. All the dialysis technicians have to abide by the guidelines formulated by the higher authorities. Each center has three separate units for the tests. They are the outside area, the screening area, and the internal Dialysis Unit.

What are the duties of the Administration for dialysis units?

According to the Government’s general guidelines, the administration authorities of every dialysis center should follow these rules;-

  • The hospital should specify at least one hemodialysis facility with an adequate number of dialysis machines and trained staff
  • District Administration should ensure that dialysis consumables are delivered to both hospitals.

When should a patient visit a Dialysis center for COVID-19?

Before visiting the dialysis unit, the patient should recognize the symptoms first. The usual signs of COVID-19 are fever, sore throat, cough, shortness of breath, body ache, fatigue, etc. There should be appropriate arrangements for all the arrivals in the screening area. The patients stable on maintenance hemodialysis can come to the unit alone without the support of any attendant.

Can dialysis patients recover post COVID-19 infection?

According to the recent reports, around 80% of the COVID patients undergoing dialysis have mild or moderate symptoms. However, 15-20% of the cases show that the patients are suffering from severe conditions. As per experts, after proper dialysis, the COVID-19 patients can fully recover within six weeks on an average. But, the duration can extend to a few months in some severe cases.

After a successful recovery from ventilation, the patients can go through a post-traumatic stress disorder. But, those who lack desirable response in ventilation can suffer from an acute lung disorder. This can also be fatal.

What is the dialysis process for patients with acute kidney injury?

The symptoms are generally mild but AKI patients requiring renal replacement therapy can develop serious complications. For such patients with AKI, bed-side dialysis will be more preferable than shifting to the central dialysis unit.

About Chronic Kidney Disease

About CKD

What is chronic kidney disease?

What are symptoms of kidney failure?

There are less or no symptoms in mild to moderate kidney failure. Thus, early or even late kidney failure is usually detected on a preventive health check-up.
Swelling over body sometimes it is first noticed over feet (around ankles) or over face (around eyes).
Nausea, vomiting, hiccoughs.
Breathlessness on exertion or physical activity.
Low sugar levels (hypoglycaemia) in case of diabetic related kidney failure.
Generalized weakness, easy fatigability.

Life threatening presentation

a. Convulsions
b. Abnormal heart rate (due to high potassium)
c. Chest pain (pericarditis)
d. Altered sensorium (uremic encephalopathy)
e. Severe metabolic acidosis

How to delay chronic kidney disease progression?

Detection of kidney disease at an early stage.
Control of blood pressure (less than 135/85 mmHg, less than 130/80 mmHg in proteinuria cases)
Control of blood sugar (HbA1c less than 7%)
Avoid nephrotoxic agents (common painkillers, some antibiotics and indigenous agents) and many others
Proper treatment of infections.
Proper treatment of urine outflow obstruction.
Avoid tobacco consumption and smoking
Healthy lifestyle
Very high protein intake
Proper treatment of stones
Some kidney harmful or nephrotoxic medications

Diabetic kidney disease

Kidney disease is very common in diabetic patients. In present scenario life style related diseases like obesity, diabetes, and coronary heart disease related kidney disease are very common. Swelling over feet or face is generally a common symptom in diabetic kidney disease.
Blood sugar level should be:
• Between 70 and 130 before eating ;
• Less than 183 about 2 hours After eating ;
• Between 90 and 150 at bedtime.

How to monitor kidney related complications in a diabetic patients?

• Following to be monitored at least 3 to 6 monthly.
• Urine for proteinuria-urine for micro albuminuria, urine for albumin(dipstick)
• Serum creatinine level.

Whether my both kidneys are affected?

Even a single kidney is enough to perform all functions of kidney (remove all toxins, and other functions) from our body. If serum creatinine level is high then either both kidneys (if both kidneys are working) are affected or if there is a single functioning kidney and that only is affected.
Kidney disease run in family

There are few kidney diseases common in family members. Following kidney diseases are:

1 Diabetes related kidney disease.
2 Polycystic kidney disease (PKD) – autosomal dominant PKD or ADPKD is passed from parent to child by an autosomal dominant type of inheritance. Thus if one parent has the disease, each child has a 50-50 chance of developing the disease.
3 Fabry disease- it involves major organs.
4 Kidney stones
5 High Blood Pressure
6 Alport Syndrome- leading to CKD (hereditary nephritis), deafness and eye abnormalities.
7 Unknown family related kidney disease.

How to manage chronic kidney disease?

How to know how much my kidneys are working?

Glomerular-filtration Rate: It is a rate at which blood is filtered through glomeruli in a minute. It tells us that how much the kidneys are functioning. It can be measured or estimated. There are various formulas for measuring GFR:
1. Cockcroft gault formula (CGF)
2. The Modification of Diet in Renal Disease (MDRD) equation
3. Creatinine clearance (Urine)
4. Others
How to estimate GFR:
1. Inulin
Most commonly used are CGF and DTPA
Using this GFR we can differentiate chronic kidney disease (CKD) into different stages
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 5 ND (not on dialysis) Stage 5 D (on dialysis) Stage 5 T (post-transplant) Patient can himself calculate GFR easily by computed formulas which are easily available on mobile applications and internet.

How to prevent kidney diseases?

Kidney diseases are common in:-
A. Diabetic patients
B. Hypertensive patients
C. Coronary heart diseases patient
D. Cerebrovascular disease patient
E. Over weight and Obese patient
F. Persons who are on long term kidney harmful medicines like painkillers (NSAIDS, lithium), some anti-biotic, some indigenous medication.
G. Smokers and chronic tobacco users.
H. Patients having recurrent urine infections.
I. Patients having multiple kidney stones
J. Persons in whom family member is suffering from kidney disease
K. Some genetic related kidney disease.
L. Urine outflow obstructive diseases.
M. Hyperuricemia and gout.
N. Connective tissue diseases like sjogrens, rheumatoid, sarcoidosis and others.
O. Others

If there are above risk factors than routinely kidney function test (creatinine) and urine routine examination to be done.
If any modifiable risk factor is present than we need to modify them.

Medicines for chronic kidney disease (CKD)

In managing CKD there are lots of medicines are required. There is a major issue of pill burden (number of pills per day). Following medicines are used in treating CKD.
• Hypertension-anti-hypertension medicines.
• Anemia-oral or intravenous iron, injection erythropoietin, darbepoetin, mircera.
• Antacids, proton pump inhibitors
• Calcium Supplements.
• Phosphate binders
• Vitamin-D active or Cholecalciferol.
• Vaccination- To prevent hepatitis B, Pneumonia, flu.
• Multivitamins.
• To control acidosis.
• Medicine related to primary disease.
• And others.

Kidney Disease

Kidney Disease

Kidneys are an essential part of our body. There is a pair of fist sized organs located at the bottom of the rib cage. There is one kidney on each side of the spine.

Kidneys are basically responsible for filtering waste products, excess water and impurities out of the blood. They stored toxins in the bladder and then removed them through urination. They also regulate PH, salt and potassium level in the body. Kidney produces hormones which control blood pressure and control the production of red blood cells. They also activate a form of Vitamin D which helps the body to absorb calcium.

Kidney disease occurs when kidneys get damaged and can’t perform their function. This disease may leave kidneys unable to remove wastes. It can be damaged by diabetes, high blood pressure and various other chronic conditions. Kidney disease can cause other health problems such as weak bones, nerve damage and malnutrition.

If your kidneys get damaged then waste products and fluid can make up in your body. It can cause swelling in your ankles, nausea, weakness, poor sleep and shortness of breath.

If the kidney disease gets worse with the period of time then it may stop working completely. It means that dialysis is required to perform the function of the kidneys. Dialysis is a treatment for kidney disease which filters and purifies the blood using a machine. Dialysis can’t cure the disease but it can prolong your life.

What are the types of kidney disease?

Chronic disease is one of the most common kidney diseases. It is a long-term kidney condition which doesn’t improve within the period of time. It is mainly caused by high blood pressure. High BP is risky for kidney disease because it can enhance the pressure on the glomeruli. Glomeruli are the very small blood vessels in the kidneys where blood is cleaned. With the passage of time, the increased blood pressure damages these vessels and kidney function starts to decline. Diabetes also leads to chronic kidney disease. Diabetes is a bunch of diseases which can cause high blood pressure. The increased level of sugar in the blood deteriorates the blood vessels in the kidneys over time. It means the kidneys can’t do the function properly. It may result in kidney failure when your body becomes overloaded with toxins. Other causes are chronic glomerulonephritis, chronic pyelonephritis, kidney stones, polycystic diseases, reflux nephropathy and others.

Kidney stone is another type of kidney problem. It occurs when minerals and other substances in the blood crystallize in the kidneys, forming solid stones. Kidney stones evenly come out of the body during urination. Passing kidney stones can be very painful but they rarely lead to significant problems.

  • Glomerulonephritis

Glomerulonephritis is the inflammation of the glomeruli. Glomeruli are very small structures inside the kidneys which filter the blood. It can be caused by infections, drugs and congenital abnormalities. It generally gets better on its own.

  • Polycystic kidney disease

This disease is a genetic disorder which causes the number of cysts to grow in the kidneys. These cysts can interfere with kidney function and result in kidney failure.

  • Urinary tract infections

UTI are bacterial infections of any part of the urinary systems. Infections in the bladder and urethra are the most common. They are easily treatable and infrequently result in more health problems. Though, these infections can spread to the kidneys and result in kidney failure.

What are the main symptoms of kidney disease?

Kidney disease is a condition which can easily go unnoticed till the symptoms become worse. The below symptoms are early warning signs which might be developing kidney diseases:-

  • Fatigue
  • Trouble in sleeping
  • Poor appetite
  • Dry and scratchy skin
  • Frequent urination
  • Difficulty in concentration

Symptoms which show that your kidney disease is developing into kidney failure:-

  • Nausea
  • Vomiting
  • Loss of appetite
  • Changes in urine output
  • Anemia
  • Sudden rise in potassium levels
  • High blood pressure
  • Breathlessness
  • Swelling over body

How is kidney disease diagnosed?

  • Glomerular filtration rate (GFR): the test will analyze how well your kidneys are performing and determine the stage of kidney disease.
  • Ultrasound scan: it creates clear images of your kidneys and urinary tract. The image allows your doctor to see if your kidneys are very small or large. They can also show any tumors that may be present.
  • Kidney biopsy: during a kidney biopsy, your doctor will eliminate a small piece of tissue from your kidney while you are composed. The tissue sample can help your doctor analyze the type of kidney disease you have and how much damage has occurred.
  • Urine test: your doctor may suggest you urine test for albumin. Albumin is a protein which can be passed into your urine when your kidneys are damaged.
  • Blood creatinine test: creatinine is a waste product. It is recused into the blood when creatinine is broken down. The levels of creatine in your body will enhance if your kidneys are not working properly.

How is kidney disease treated?

Treatment of kidney disease mainly emphasizes controlling the underlying cause of the disease. It means that your doctor can help you better manage your blood pressure, blood sugar and cholesterol levels. They may use one of the following methods:-

  • Drugs and medication
  • Dietary and lifestyle changes

How can kidney diseases be prevented?

Some risk factors of kidney disease such as age, race and family history are not possible to control. Although, there are some measures you can take to help prevent kidney diseases:-

  • Drink lot of water
  • Decrease intake of salt
  • Control sugar if you are diabetes patient
  • Control blood pressure
  • Stop smoking, no tobacco intake