Renal Failure Due to Hyperten... Health Article

Treatment and management

Once physicians diagnose end stage renal disease, they must make a plan for dialysis. In addition, patients may be placed on restricted fluids. Anemia is treated and transfusions are given if anemia is severe. ACE inhibitor drugs may be prescribed at low doses to treat cardiac symptoms. Diuretics may be prescribed to reduce fluid retention. Multivitamins may be recommended because of food restrictions.

All patients with kidney failure, despite the cause of the failure, must receive kidney dialysis or kidney transplantation. Eventually, those on dialysis will require transplantation of a kidney, either from a recently deceased person or a live donor. (Each person has two kidneys and can live normally with only one kidney.) About 13,000 kidney transplants are performed in the United States each year and about 47,000 people wait for a donated kidney per year.

There are two types of dialysis. The most common type of treatment is "hemodialysis," a procedure that uses a machine called a dialyzer to clean and filter the blood, since the kidneys can no longer perform that function. A connection from the machine is made to the patient's bloodstream and the blood travels through the dialyzer where it is cleaned for 2–4 hours. This procedure is generally performed three times a week. Patients must also change their diets to carefully limit the amount of salt, potassium, and fluids that are consumed, among other dietary restrictions that are given.

Peritoneal dialysis is another option for patients with kidney failure. In this procedure, the patient's own abdominal lining (the peritoneal membrane) is used to help clean the blood. Rather than the patients own blood traveling to a machine, as with a dialyzer, a cleansing solution is transferred through a special tube (catheter) directly into the body. The catheter remains in the body. The number of treatments and time to perform the cleansing procedures vary.

Prognosis

Most patients will eventually need a transplanted kidney to continue to live. The survival rate for those on kidney dialysis after one year is about 80% and after two years, about 66%. However, the five year survival rate with dialysis is 29% and the 10 year survival rate is only 8%.

In contrast, the survival rate for those who receive a transplanted kidney from a deceased person is 94% after one year, 92% after two years and 80% after five years. The 10 year survival rate with a cadaver transplantation is 57%. The survival rates are higher when the kidney is from a live donor; for example, the survival rate after 5 years with a live donor kidney is 89% and about 77% after 10 years.

BOOKS

Beers, Mark H. MD, and Robert Berkow, MD, eds. The Merck Manual of Diagnosis and Therapy. 1999. Available at <http://www.merck.com/pubs/manual/>.

National Institutes of Health. "Chronic Kidney Disease." In Healthy People 2010. National Institutes of Health, 2000.

"Patient characteristics at the beginning of ESRD." 2000 Atlas of ESRD in the United States. U.S. Renal Data System, 2000

PERIODICALS

Cohn, Daniel H., et al. "A locus for an autosomal dominant form of progressive renal failure and hypertension at Chromosome 1q21." American Journal of Human Genetics 67 (2000): 647-651.

Hsueh, Wen-Chi, PhD, et al. "QTL influencing blood pressure maps to the region of PPH1 On Chromosome 2q31-34 in Old Order Amish." Circulation 101 (2000): 2810.

Watson Jr., Bracie, et al. "Genetic association of 11B-hydroxysteroid dehydrogenase type 2 (HSD11B2) flanking microsatellites with essential hypertension in blacks." Hypertension 28 (1996): 478-482.

ORGANIZATIONS

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

American Kidney Fund. Suite 1010, 6110 Executive Blvd., Rockville, MD 20852. (899) 638-8299.

National Kidney and Urologic Diseases Information Clearinghouse. 3 Information Way, Bethesda, MD 20892-3560.

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

WEBSITES

"Entry 161900: Renal Failure, Progressive, with Hypertension." OMIM—Online Mendelian Inheritance in Man. <http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?161900>.

Christine Adamec