On July 3, 2021, Seniors Today hosted well-known nephrologist Dr Rasika A Sirsat at its weekly Health Live @ Seniors Today Webinar series. Dr Noor Gill captures her presentation and the Q&A thereafter on Dialysis and Other Concerns of the Kidneys for Seniors.
Dr Rasika A Sirsat is a leading nephrologist and a Consultant Nephrologist working with the Hinduja Hospital for nearly three-and-a-half decades. She did her MBBS and MD from Mumbai University in 1976 and 1981 respectively.
She is Secretary of the Mumbai Nephrology Group for the year 1987 and currently, since 2020. She is a Member of the International Society of Nephrology. She has won many awards for papers presented at leading international conferences and publications.
– Functions of the kidney:
- It removes all the toxins and excess water.
- It also maintains the balance of the electrolytes, acid-base balance
- Helps in maintaining the blood pressure
- Helps in the formation of haemoglobin
- Maintains the bone health
- Eliminates drugs and its metabolites
– Common causes of kidney diseases:
- Diabetes mellitus
- Kidney/ renal stones
- Hereditary kidney diseases such as Polycystic kidney disease
- Toxins and medications can also cause damage to the kidneys
– Chronic kidney diseases, by and large, are asymptomatic. Sometimes symptoms such as burning and pain during micturition, change in the stream of the urine, frothing of the urine, blood in urine, pain in the abdomen, swelling around the eyes and feet, sexual dysfunction, changes in the menstrual cycles may sometimes be present.
These are vague symptoms and usually present very late in the course of the disease.
– On ultrasonography, in an acute kidney disease, the size of the kidney is either normal or large whereas in chronic kidney disease, the size of the kidneys is usually shrunken. This is not always the case, but it is so most of the time.
– In patients with chronic kidney disease, we try to take extra care that the individual does not catch any infection, since the infection can further worsen kidney function. We encourage such patients to take their vaccination for influenza, hepatitis and now for Covid as well. This is to avoid these infections and to see that even if they do catch the infection, the intensity and severity of the infection is mild.
– In patients with chronic kidney diseases, when the patients come, it is not always possible to improve their renal/ kidney function, says Dr Sirsat, their doctor can however advise them and manage them in a way such that the renal functions do not deteriorate any further and if they do, they do so at a slower rate.
Mostly chronic kidney disease patients progress to end stage kidney disease.
– One of the most common advice for such patients is to control their blood pressure. The control should be obtained not immediately rather over a period of 2-4 months time and then it should be maintained.
If you’re a diabetic, maintain your blood sugar levels.
Avoid drugs that are toxic to the kidneys
Sometimes, despite all measures, the patient may land in end stage kidney disease.
– End-stage kidney disease is when the kidney function is less than 10%. At this stage what can be done is- dialysis and renal transplantation- which is decided depending upon your condition and your age.
– If the patient is very frail and the prognosis looks grave, they can also go in for palliative treatment.
– There are two types of dialysis:-
- Peritoneal dialysis
– Haemodialysis involves removing the blood outside the body, cleaning it and then returning it. Each haemodialysis session lasts for 3-4 hours. The usual recommended frequency is three times per week.
In haemodialysis, we require good flow of the blood when we take it out, and so we make an arteriovenous fistula, usually in the arm. And on times when the fistula can’t be formed, we place a graft or a catheter.
– Patients who do not or for whatever reason cannot visit the hospital very often, it is these patients who go in for peritoneal dialysis.
A pipe/ catheter is placed into the peritoneal cavity (it is the space within the abdomen that contains the liver, stomach and the intestines) surgically. This procedure needs to be done at least 10-15 days before the date of the dialysis.
In this, there is a bag of special solution which is passed into the abdominal cavity through the previously surgically placed catheter. This solution stays in the abdominal cavity for a few hours and it removes the toxins and the excess water that might be present in the blood. The bag is then clamped and the fluid that is in the abdomen is drained out into the drainage bag.
– Coronavirus affects our kidneys by affecting the blood vessels and the oxygen levels in the blood and by that extension, it can damage the kidneys. Sometimes because of clotting of the blood vessels, it can cause damage to the kidneys. It can also cause collapse of the glomerulus (filter of the kidney) and thus directly affecting the kidneys.
In patients with Covid, we also need to give the patients drugs that might be nephrotoxic
– If your kidney function is normal and you are a healthy adult, it is okay if you consume 1-1.5 grams/kg, but if you take high protein for longer durations of period, you can tend to damage the kidney, because you will be making your kidneys work overtime by consuming a continuous high protein diet.
– If you have an increased frequency of urination, especially in the night time, it is important that you look for any swelling in your feet. If no swelling in the feet is present and the complaint is fairly new, keep your water intake to a minimum after 6 pm in the evening.
And if you have swelling in the feet, the swelling would mobilise and would go to the blood and is discarded by the kidney and will lead to increased frequency of urination in the night.
– As you grow older, the ability of the kidneys to concentrate the urine decreases and thus the frequency of urination increases. Since the urine is not concentrated but is formed, you have to wake up every 2-3 hours to pass the urine.
– For a patient who is on haemodialysis, kindly take the Covid vaccine at least a minimum of 12 hours after receiving dialysis.
– Ayurvedic medicines are known to damage the kidneys, since they are not controlled and regulated, and contain some amount of impurities and heavy metals because of which they can be harmful to the kidneys. Some of the Ayurvedic medicines are good, but since they are not regulated, it is best not to take the risk.
– A healthy diet goes a long way- fruits, vegetables, less of red meat, less salt and sugar
– You can take insulin on the day of your dialysis but it is advised that you do not take the full dose. You may need to take half the dose or none at all, depending on how your blood sugar levels are- your doctor should be able to advise you better on that.
– A few things to keep in mind before and after dialysis:
- Try not gaining too much weight between two dialysis sessions (more than 2-2.5kg), since the more water they remove from your body, the more weak you’ll feel after the session.
- If they give you something to eat during the dialysis, and you do not have any complaints of nausea or vomiting, you can have it.
- After dialysis it is a good idea to eat something, a snack or something sweet right after your session.
– Any patient who has any comorbidities that can affect the kidney such as diabetes, hypertension, the least you can do on a regular basis is get your urea, creatinine tested and also your urine for albumin, spot urine sample for albumin to creatinine ratio.
For diabetic and hypertensive patients these tests should be done once every year.