Chronic Kidney Failure Health Article

Medications and dietary supplements

Kidney failure patients with hypertension typically take medication to control their high blood pressure. Epoetin alfa, or EPO (Epogen), a hormone therapy, and intravenous or oral iron supplements are used to manage anemia. A multivitamin may be prescribed to replace vitamins lost during dialysis treatments. Vitamin D, which promotes the absorption of calcium, along with calcium supplements, may also be prescribed.

Since 1973, Medicare has picked up 80% of ESRD treatment costs, including the costs of dialysis and transplantation and of some medications. To qualify for benefits, a patient must be insured or eligible for benefits under Social Security, or be a spouse or child of an eligible American. Private insurance and state Medicaid programs often cover the remaining 20% of treatment costs.

Prognosis

Early diagnosis and treatment of kidney failure is critical to improving length and quality of life in chronic kidney failure patients. Patient outcome varies by the cause of chronic kidney failure and the method chosen to treat it. Overall, patients with chronic kidney disease leading to ESRD have a shortened lifespan. According to the United States Renal Data System (USRDS), the lifespan of an ESRD patient is 18–47% of the lifespan of the age-sex-race matched general population. ESRD patients on dialysis have a lifespan that is 16–37% of the general population.

The demand for kidneys to transplant continues to exceed supply. In 1996, over 34,000 Americans were on the UNOS waiting list for a kidney transplant, but only 11,330 living donor and cadaver transplants were actually performed. Cadaver kidney transplants have a 50% chance of functioning nine years, and living donor kidneys that have two matching antigen pairs have a 50% chance of functioning for 24 years. However, some transplant grafts have functioned for over 30 years.

BOOKS

Bock, G. H., E. J. Ruley, and M. P. Moore. A Parent's Guide to Kidney Disorders. Minneapolis: University of Minnesota Press, 1993.

Brenner, Barry M., and Floyd C. Rector Jr., eds. The Kidney. Philadelphia: W. B. Saunders Co., 1991.

Cameron, J. S. Kidney Failure: The Facts. New York: Oxford Univ. Press, 1996.

Ross, Linda M., ed. Kidney and Urinary Tract Diseases and Disorders Sourcebook. Vol. 21. Health Reference Series. Detroit: Omnigraphics, 1997.

U.S. Renal Data System. USRDS 1997 Annual Data Report. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 1996.

PERIODICALS

Friedman, Elia A. "End-stage Renal Disease Therapy: An American Success Story." Journal of the American Medical Association 275 (Apr. 1996): 1118-22.

Taylor, Judy H. "End-stage Renal Disease in Children: Diagnosis, Management, and Interventions." Pediatric Nursing 22 (Nov./Dec. 1996): 481-92.

ORGANIZATIONS

American Association of Kidney Patients (AAKP). 100 S. Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-2257. <http://www.aakp.org>.

American Kidney Fund (AKF). Suite 1010, 6110 Executive Boulevard, Rockville, MD 20852. (800) 638-8299. <http://www.arbon.com/kidney>.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Building 31, Room 9A04, 31 Center Drive, MSC 2560, Bethesda, MD 208792-2560. (301) 496-3583. <http://www.niddk.nih.gov>.

National Kidney Foundation. 30 East 33rd St., New York, NY 10016. (800) 622-9010. <http://www.kidney.org>.

United States Renal Data System (USRDS). The University of Michigan, 315 W. Huron, Suite 240, Ann Arbor, MI 48103. (734) 998-6611. <http://www.med.umich.edu/usrds>.

Paula Anne Ford-Martin

KEY TERMS

End-stage renal disease (ESRD)—Total kidney failure; chronic kidney failure is diagnosed as ESRD when kidney function falls to 5–10% of capacity.

Nephrotic syndrome—Characterized by protein loss in the urine, low protein levels in the blood, and fluid retention.

Ureters—The two ducts that pass urine from each kidney to the bladder.