Kidney patients adjust lives to cope

Three times a week, 72-year-old Myrna Conley makes the trip from her suburban home in Richmond, Ontario to The Ottawa Hospital for her turn on the machine that keeps her alive.

For four hours each visit, blood flows from a tube in her arm into filters that remove waste products and excess water before returning the blood to her body.

The retired secretary and bookkeeper needs a machine to clean her blood for one simple reason: her kidneys can’t do it for her.

Statistics are rising
Conley is one of more than 22,000 Canadians with kidney failure. Every day, an average of 10 Canadians learn their kidneys have failed. And the problem is on the rise.

Statistics released in last year by the Canadian Institute for Health Information (CIHI) show the number of newly diagnosed cases per million shot up by 73 per cent between 1990 and 1999.

Among people 65 and older, it more than doubled, increasing by 132 per cent. Seniors now make up half of all new kidney patients.

“It’s devastating to learn you have it,” says Conley, although treatments can greatly increase life expectancy.

“It completely changes your lifestyle.t’s very hard to accept in the beginning but you finally realize you have no choice.”

A silent disease
Kidneys are two bean-shaped organs located on either side of the spine under the lower ribs. They remove waste and excess water from the blood by running it through tiny filtering units called nephrons.

Normal kidneys filter a fifth of your blood, about one litre, every minute and send the waste to your bladder. They’re so efficient that one kidney can take over the whole workload if the other one is damaged or removed.

While kidneys can stop working because of physical injury or damage from drug abuse, the problem is usually a gradual decline in function.

“It’s a silent disease,” says Dr. Kevin Burns, the head of the Department of Nephrology at The Ottawa Hospital.

“It doesn’t really show its face until kidney function is about 10 per cent of normal.”

Next page: Causes of decline

Causes of decline
Burns says kidneys decline with age, losing about a tenth of their efficiency each decade after the age of 40 or 50.

But older people are more at risk because the two biggest causes of kidney disease are on the rise among older Canadians: diabetes and cardiovascular disease, especially high blood pressure.

Diabetes accounts for about a third of all new cases of kidney failure. High blood sugar levels damage the delicate blood vessels in the kidneys’ filters.

High blood pressure, or hypertension, accounts for about 20 per cent of new cases. And it makes kidney disease worse, whatever the original cause.

“Hypertension is the most common and most potent aggravating factor for kidney disease,” says Dr. Andrew Steele, the chair of the Toronto Regional Dialysis Committee.

Older people are also more likely to get hardening of the kidneys’ blood vessels; similar to the buildup of plaque that leads to heart disease.

Preventing kidney disease
Preventing kidney disease means preventing diabetes, hypertension and cardiovascular problems. And that means eating a balanced diet with lots of fruits and vegetables, controlling your weight and getting regular exercise.

In the early stages of kidney disease, the right diet, medication and blood pressure control can slow the damage, but catching it early is not easy.

You may be at risk if you have swelling in the hands and feet, blood in the urine or trouble urinating. Most often, though, it shows up in a urine or blood test. If kidneys are functioning at less than 20 per cent, the only treatments are dialysis or transplant.

Types of treatment
Myrna Conley, like most Canadians on dialysis, uses a method called hemodialysis. A machine filters the blood and returns it to the body.

About 27 per cent of patients opt for another system called peritoneal dialysis. This filters the blood via a permanent catheter inserted into the membrane lining the abdominal cavity.

Patients can do this type of dialysis themselves, at home. But there is a risk of infection.

Next page: Control through diet

Control through diet
Treatment is only part of the story. Healthy kidneys eliminate waste and regulate important chemicals. When they fail, it’s important to control those substances through diet. Among the things to watch:

  • Protein:

Highest in meat, fish and poultry, protein creates a by-product called urea, which can further damage kidneys if it builds up in the bloodstream. However, patients who go on dialysis must often increase protein to compensate for losses caused by the process.

  • Phosphorous:

  • This is damaging to kidneys in higher concentrations. Found in proteins and cola drinks.

  • Potassium:
    It’s important to control levels, especially in the later stages of kidney failure. Found in bananas, oranges, melons, dried fruit, potatoes (especially baked), all tomato products, all legumes such as beans, whole wheat bread and cereal. Also found in strong coffee, molasses and chocolate.

  • Fluids:
    It’s important to regulate in the later stages of kidney failure.

  • It can be a tough diet to follow.

    “The main impact depends on what people were used to eating before they got sick,” says Nichole Currie, a registered dietitian with the Durham Region Dialysis Program in Ontario.

    “We try to make it as liveable and realistic as possible.”

    Transplant option
    While dialysis keeps patients alive, transplantation is best because it gives them back a normal life.

     “I feel more than 100 per cent better. For me, it has been a miracle,” says Vancouver resident Marcia Bell, a former national president of the Kidney Foundation of Canada, who got a transplant more than 14 years ago.

    After transplants, patients have wider food choices and more energy.

    But there’s a lack of donors. As of late 1999, almost 2,800 people were on the waiting list for a kidney. And Canada still has a low rate of organ donation compared to many other countries.

    About 65 per cent of transplanted kidneys come from donors who have died. The rest are from living donors, either family members or someone with a close connection.

    New surgery technique
    Live donations have the highest success rate because they’re usually a closer genetic match. But it’s far more painful for the donor than the recipient. While the kidney is transplanted low in the abdomen, requiring a relatively minor incision, retrieving the organ requires a large cut through muscle and ribs.

    It can take twelve weeks to fully recover. Now there’s a new approach: keyhole surgery.

    Dr. Joseph Mamazza of St. Michael’s Hospital in Toronto was one of the surgeons who pioneered the method in Canada two years ago. It uses only three tiny holes to accommodate a camera, and instruments to do most of the work of freeing the kidney.

    Then the surgeon makes a small incision low in the abdomen, slips in a hand and removes the organ.

    Since starting keyhole surgery, “we’ve doubled our living donor program in about a year,” Mamazza says. But so far, only a handful of hospitals are using the procedure. 

    While treatments advance, the most important key to living with kidney disease is the patient’s attitude, says Beryl Ferguson, national program director with the Kidney Foundation of Canada. The key is knowledge.

    “Better knowledge equals better emotional adjustment,” she says. “Become informed, learn all you can and face it head on.”