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Kidney Failure: What to

Expect
How does kidney failure affect a word “renal” refers to the kidneys. Even
people who have dialysis treatments
person’s health? may experience some of the problems of

K
idney failure can affect a person’s uremia if they skip treatments or eat foods
health in several ways. Some not recommended for people on dialysis.
people experience fatigue, some
lose their appetite, and some have leg
cramps. These problems are caused by
Can uremia be avoided?
waste products that build up in the blood, People with kidney failure can avoid
a condition known as uremia. Healthy most of the problems of uremia by having
kidneys remove waste products from the regular dialysis treatments and limiting
blood. When the kidneys stop working, foods that contain sodium, potassium,
uremia occurs. and phosphorus. People who have CKD
should see a kidney specialist—called a
The kidneys also make hormones and nephrologist—regularly to track the pro-
balance the minerals in the blood. When gression of the disease so they can begin
the kidneys stop working, most people appropriate treatment before uremia
develop conditions that affect the blood, occurs.
bones, nerves, and skin. In addition to
fatigue, loss of appetite, and leg cramps, Even though health care providers can
some of the more common problems treat most of the complications of CKD
caused by kidney failure are itching, sleep and ESRD, people with these conditions
problems, restless legs, weak bones, joint should know what to expect when their
problems, and depression. kidneys fail.

When is uremia likely to occur? What problems can occur during


Uremia is likely to occur when a person hemodialysis?
reaches the final stages of chronic kidney During the first few weeks of
disease (CKD). People with CKD often hemodialysis—a type of dialysis that uses
feel no symptoms until the kidneys are a machine to circulate blood through a
severely damaged. Usually when people filter outside of the body—many people
develop symptoms, their kidney failure find that rapid changes in the body’s
has progressed to the point where they water and mineral balance can cause prob-
must have regular blood-filtering treat- lems. Muscle cramps and hypotension—a
ments called dialysis or receive a kidney sudden drop in blood pressure—are two
transplant to stay alive. Kidney failure common side effects. Hypotension can
treated by dialysis or transplant is called make people feel weak, dizzy, or sick to
end-stage renal disease (ESRD). The their stomach.

National Kidney and Urologic Diseases


Information Clearinghouse
Many people need a few months to adjust to How does kidney failure affect the
hemodialysis. Side effects can often be treated
quickly and easily, so people should always report appetite?
problems to their health care provider and dialysis People who have uremia often lose their appe-
staff. Many side effects of hemodialysis treatments tite. Some people find that food tastes different.
can be avoided by following a diet tailored for Some no longer like foods they once craved. In
hemodialysis patients, limiting liquid intake, and fact, many people feel sick to their stomach at the
taking medications as directed. thought of eating. But getting enough protein and
calories is important for staying healthy. People
with kidney failure should talk with the renal dieti-
How does kidney failure affect the tian at their dialysis clinic or transplant center to
blood? find foods that are appealing and provide needed
In addition to uremia, kidney failure can also cause nutrients.
anemia, a condition in which the red blood cells
are fewer or smaller than normal, which means How does kidney failure affect the skin?
less oxygen is carried to the body’s cells. Anemia
Many people treated with hemodialysis complain
can cause extreme fatigue and can worsen existing
of itchy skin, usually on the back, chest, head, or
heart problems.
limbs. The itching is often worse during or just
Anemia is common in people with CKD, as well after dialysis treatment due to the waste prod-
as those on dialysis, because the damaged kidneys ucts that are not removed from the blood during
slow the production of the hormone erythropoie- dialysis.
tin (EPO), which helps the bone marrow make red
The problem can also be due to the damaged kid-
blood cells. Less EPO means the body has fewer
neys’ inability to balance the levels of the minerals
red blood cells, resulting in anemia. A synthetic
calcium and phosphorus in the blood. The result-
form of EPO is commonly prescribed for people
ing low levels of blood calcium trigger four pea-
on dialysis.
sized glands in the neck, called the parathyroid
glands, to release parathyroid hormone, which
How does kidney failure affect the draws calcium from the bones back into the blood.
heart and blood vessels? The high levels of parathyroid hormone can cause
itching. Some people feel much better after having
People with kidney failure, particularly dialysis
most of their four parathyroid glands removed.
patients, have far higher rates of heart and blood
As long as one parathyroid gland remains, it can
vessel problems than people without kidney
regulate the calcium and phosphorus balance in
problems. Heart attacks are the leading cause of
the blood.
hospitalization and death among dialysis patients.
Kidney failure also raises the risk of other cardio- Damaged kidneys cause phosphorus to build up
vascular problems such as blockage of blood to the in the blood, which can also cause itching. Often,
heart and congestive heart failure. People who medications called phosphate binders—such
have kidney failure need to monitor their cardio- as calcium carbonate (Tums), calcium acetate
vascular health, take all prescribed medications, (PhosLo), sevelamer hydrochloride (Renagel), or
and follow their health care provider’s instructions lanthanum carbonate (Fosrenol)—are prescribed
for diet and exercise. with meals and snacks to bind phosphorus in the
bowel, decreasing its absorption into the blood.
The resulting lower blood phosphorus levels seem
to ease the itching for some people. Reducing the
dietary intake of phosphorus can also help.

2
Other people find relief after exposure to ultravio- How does kidney failure affect the
let light. Ultraviolet light can be absorbed simply
by spending time in sunlight or near a light box, joints?
a therapeutic device that uses several fluorescent Kidney failure can cause pain, stiffness, and fluid
lights. Still others improve with EPO shots. A few in the joints, the points where two or more bones
antihistamines, such as diphenhydramine (Benad- come together. These symptoms result from amy-
ryl) and hydroxyzine (Atarax, Vistaril), have been loidosis, a condition in which an abnormal protein
found to help. People should consult their health in the blood called amyloid is deposited in tissues
care provider before starting any therapy that and organs, including the joints and tendons—the
includes over-the-counter medications. tough bands of tissue that connect muscles to
bones. Healthy kidneys filter amyloid protein out
A cure for itching that works for everyone has of the blood, but dialysis filters are not as efficient
not been found. In some situations, a health care as the kidneys in removing amyloid. Dialysis-
provider may refer people to a dermatologist, a related amyloidosis is common in people who
doctor who treats people with skin problems. have been on dialysis for more than 5 years. No
treatment to reverse amyloidosis has been found,
How does kidney failure affect the although a successful kidney transplant may stop
the disease from progressing. Health care provid-
bones? ers can advise people on the best ways to relieve
Kidney failure weakens the bones due to a condi- their pain.
tion called chronic kidney disease-mineral and
bone disorder. As discussed in the previous sec-
tion, kidney failure can throw off the balance of How does kidney failure affect sleep?
calcium and phosphorus in the blood, causing the People who have kidney failure often have
parathyroid glands to produce too much para- insomnia—trouble getting to sleep and staying
thyroid hormone. The high level of parathyroid asleep. Insomnia and other sleep disorders can
hormone draws calcium from the bones into the worsen a person’s quality of life. People with
blood, leaving the bones without enough cal- kidney failure should discuss these problems with
cium. Chronic kidney disease-mineral and bone their health care provider.
disorder describes the imbalance of calcium and
Some people suffer from sleep apnea syndrome,
phosphorus and how this imbalance weakens the
which may be related to the effects of advanced
bones. The condition affects 90 percent of dialysis
kidney failure on breathing. Episodes of apnea are
patients, both children and adults, causing bones
breaks in breathing during sleep. Over time, these
to become thin, weak, or malformed. Symptoms
sleep disturbances can lead to day-night reversal—
can be seen in growing children with kidney dis-
insomnia at night, sleepiness during the day. This
ease even before they start dialysis. Older patients
condition can cause headaches, depression, and
and women who have gone through menopause
fatigue. Some treatments may work with people
are at greater risk for this disorder. Controlling
who have sleep apnea, whether they have kidney
parathyroid hormone levels prevents damage to
failure or not. These treatments include losing
bones. Usually, overactive parathyroid glands are
weight, changing sleeping position, and wearing
controllable with an adjustment in dialysis treat-
a mask connected to a small machine that gently
ment, medications, or changes in diet. In some
pumps air continuously through a hose into the
cases, removal of most of the parathyroid glands
nostrils—nasal continuous positive airway pres-
may be useful. Reducing dietary intake of phos-
sure, commonly known as CPAP.
phorus can also help prevent bone disease.

3
Many people on dialysis have trouble sleeping at Eating, Diet, and Nutrition
night because of aching, uncomfortable, jittery, or
For people who are on dialysis or approaching total
restless legs. They may feel a strong impulse to
kidney failure, adequate nutrition is important for
kick or thrash their legs. Kicking may disturb a
maintaining energy, strength, healthy sleep pat-
bed partner throughout the night. Theories about
terns, bone health, heart health, and good mental
the causes of this syndrome include nerve damage
health. A person’s treatment will dictate the type
and mineral imbalances.
of diet that should be followed:
Moderate exercise during the day may help, but
n People on hemodialysis must watch how much
exercising a few hours before bedtime can make
fluid they drink and avoid eating foods with too
restless legs worse. People with restless legs syn-
much sodium, potassium, and phosphorus.
drome should reduce or avoid caffeine, alcohol,
and tobacco. Some people also find relief through n In contrast, people on peritoneal dialysis—a type
massages or warm baths. Health care provid- of dialysis that uses the lining of the abdomen,
ers may prescribe medications called benzodiaz- or belly, to filter the blood inside the body—may
epines, often used to treat insomnia or anxiety, for be able to eat more potassium-rich foods because
relief of restless legs syndrome. Benzodiazepines peritoneal dialysis removes potassium from the
include clonazepam (Klonopin), chlordiazepox- body more efficiently than hemodialysis.
ide (Librium), diazepam (Valium), and triazolam
n Both hemodialysis and peritoneal dialysis can
(Halcion). A newer and sometimes more effective
remove proteins from the body, so anyone on
medication therapy is levodopa (Sinemet), which is
either form of dialysis should eat protein-rich
also used to treat Parkinson’s disease.
foods such as meat, fish, and eggs.

How does kidney failure affect mental All dialysis centers and transplant clinics have a
renal dietitian who specializes in helping people
health? with kidney failure. People who are on dialysis
Many people feel depressed when starting dialysis, or have a kidney transplant should talk with their
or after several months of treatment. Adjusting clinic’s renal dietitian to develop a meal plan that
to the effects of kidney failure and the time spent will enhance the effectiveness of their treatment.
on dialysis can be difficult. People on dialysis also
For more information about nutrition for people
have less energy. They need to make changes in
with advanced CKD or who are on dialysis,
their work or home life, giving up some activities
see Nutrition for Advanced Chronic Kidney
and responsibilities. Keeping to a schedule can
Disease in Adults or Eat Right to Feel Right on
be difficult when kidneys fail. Accepting this new
Hemodialysis from the National Kidney and
situation can be hard. A mental health counselor
Urologic Diseases Information Clearinghouse at
or renal social worker can help people who are
approaching total kidney failure and those start- www.kidney.niddk.nih.gov.
ing dialysis. People who have kidney failure and
depression should not keep their depression to Points to Remember
themselves or assume they can handle their prob- n Kidney failure can affect a person’s health in
lems on their own. They should tell their health several ways.
care provider because depression can often be
treated with adjustments to the diet and dialy- n When the kidneys stop working, waste products
sis dose, medications, and counseling. Scientists build up in the blood, a condition known as
are also studying the use of cognitive behavioral uremia.
therapy—a way of correcting harmful thought and n People with kidney failure can avoid most of the
behavior patterns—to treat depression in people problems of uremia by having regular dialysis
with total kidney failure. treatments and limiting foods that contain
sodium, potassium, and phosphorus.

4
n Anemia is common in people with chronic kid- Hope through Research
ney disease (CKD), as well as those on dialysis,
The National Institute of Diabetes and Digestive and
because the damaged kidneys slow the produc-
Kidney Diseases (NIDDK) is devoted to improving
tion of the hormone erythropoietin (EPO),
the lives of people with kidney disease. Its Division
which helps the bone marrow make red blood
of Kidney, Urologic, and Hematologic Diseases sup-
cells.
ports several kidney programs and studies. These
n People with kidney failure, particularly dialysis focus on improving treatment for patients with
patients, have far higher rates of heart and kidney disease. The End-Stage Renal Disease Pro-
blood vessel problems than people without gram promotes research for patients on dialysis or
kidney problems. with a kidney transplant. The research is designed
to reduce medical problems in kidney failure. These
n People who have uremia often lose their
include bone, blood, nervous system, intestinal,
appetite.
heart, and endocrine problems. The program is also
n Many people treated with hemodialysis com- designed to improve the effectiveness of dialysis and
plain of itchy skin. transplantation. Current efforts focus on home dial-
ysis options and alternative dialysis schedules. They
n Kidney failure weakens the bones due to a con- include short daily sessions or long nightly sessions.
dition called chronic kidney disease-mineral and
bone disorder. Participants in clinical trials can play a more active
role in their own health care, gain access to new
n Kidney failure can cause pain, stiffness, and research treatments before they are widely avail-
fluid in the joints. These symptoms result from able, and help others by contributing to medical
amyloidosis, a condition in which an abnormal research. For information about current studies,
protein in the blood called amyloid is deposited visit www.ClinicalTrials.gov.
in tissues and organs, including the joints and
tendons.
For More Information
n People on dialysis often have insomnia, sleep
American Association of Kidney Patients
apnea syndrome, and restless legs syndrome.
3505 East Frontage Road, Suite 315
n People who have kidney failure and depression Tampa, FL 33607
should tell their health care provider because Phone: 1–800–749–2257
depression can often be treated with adjust- Fax: 813–636–8122
ments to the diet and dialysis dose, medications, Email: info@aakp.org
counseling, and cognitive behavioral therapy. Internet: www.aakp.org
n For people who are on dialysis or approaching American Kidney Fund
total kidney failure, adequate nutrition is impor- 6110 Executive Boulevard, Suite 1010
tant for maintaining energy, strength, healthy Rockville, MD 20852
sleep patterns, bone health, heart health, and Phone: 1–800–638–8299
good mental health. Fax: 301–881–0898
Email: helpline@kidneyfund.org
n All dialysis centers and transplant clinics have a
Internet: www.kidneyfund.org
renal dietitian who specializes in helping people
with kidney failure. People who are on dialysis National Kidney Foundation
or have a kidney transplant should talk with 30 East 33rd Street
their clinic’s renal dietitian to develop a meal New York, NY 10016
plan that will enhance the effectiveness of their Phone: 1–800–622–9010 or
treatment. 212–889–2210
Fax: 212–689–9261
Internet: www.kidney.org

5
Renal Support Network National Kidney and Urologic
1311 North Maryland Avenue
Glendale, CA 91207 Diseases Information Clearinghouse
Phone: 1–866–903–1728 or 3 Information Way
818–543–0896 Bethesda, MD 20892–3580
Fax: 818–244–9540 Phone: 1–800–891–5390
Internet: www.rsnhope.org TTY: 1–866–569–1162
Fax: 703–738–4929
Email: nkudic@info.niddk.nih.gov
Acknowledgments Internet: www.kidney.niddk.nih.gov
Publications produced by the Clearing-
house are carefully reviewed by both The National Kidney and Urologic Diseases
NIDDK scientists and outside experts. Information Clearinghouse (NKUDIC) is a
This fact sheet was originally reviewed service of the National Institute of Diabetes
by Keith Norris, M.D., Charles R. Drew and Digestive and Kidney Diseases (NIDDK).
University of Medicine and Science, Los The NIDDK is part of the National Institutes
Angeles. of Health of the U.S. Department of Health
and Human Services. Established in 1987,
the Clearinghouse provides information
National Kidney Disease about diseases of the kidneys and urologic
Education Program system to people with kidney and urologic
disorders and to their families, health care
3 Kidney Information Way
professionals, and the public. The NKUDIC
Bethesda, MD 20892 answers inquiries, develops and distributes
Phone: 1–866–4–KIDNEY publications, and works closely with profes-
(1–866–454–3639) sional and patient organizations and Govern-
TTY: 1–866–569–1162 ment agencies to coordinate resources about
Fax: 301–402–8182 kidney and urologic diseases.
Email: nkdep@info.niddk.nih.gov
Internet: www.nkdep.nih.gov
The National Kidney Disease Educa- This publication is not copyrighted. The Clearing-
house encourages users of this publication to dupli-
tion Program (NKDEP) is an initiative cate and distribute as many copies as desired.
of the National Institute of Diabetes and This publication is available at
Digestive and Kidney Diseases, National www.kidney.niddk.nih.gov.
Institutes of Health, U.S. Department
of Health and Human Services. The
NKDEP aims to raise awareness of the
The U.S. Government does not endorse or favor any
seriousness of kidney disease, the impor- specific commercial product or company. Trade,
tance of testing those at high risk, and proprietary, or company names appearing in this
document are used only because they are considered
the availability of treatment to prevent or necessary in the context of the information provided.
slow kidney disease. If a product is not mentioned, the omission does not
mean or imply that the product is unsatisfactory.

You may also find additional information about this


topic by visiting MedlinePlus at www.medlineplus.gov.
This publication may contain information about
medications. When prepared, this publication
included the most current information available.
For updates or for questions about any medications,
contact the U.S. Food and Drug Administration
toll-free at 1–888–INFO–FDA (1–888–463–6332) or
visit www.fda.gov. Consult your health care provider
for more information.
NIH Publication No. 12–6059
December 2011

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