Coping with Kidney Disease

A 12-Step Treatment Program to Help You Avoid Dialysis

Mackenzie Walser, M.D.

with Betsy Thorpe and contributions by Nga Hong Brereton, M.S., R.D., I.B.C.L.C.

WILEY

John Wiley & Sons, Inc.

Copyright ® 2004 by Mackenzie Walser, M.D., and Betsy Thorpe. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey Published simultaneously in Canada

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Library of Congress Cataloging-in-Publication Data:

Walser, Mackenzie.

Coping with kidney disease: a 12-step treatment program to help you avoid dialysis/ Mackenzie Walser, with Betsy Thorpe, and contributions by Nga Hong Brereton. p.cm.

Includes bibliographical references and index. ISBN 0-471-27423-2 (Paper)

1. Kidneys. 2. Kidneys—Diseases—Prevention. I. Thorpe, Betsy. II. Brereton, Nga Hong. III. Title. RC902 .W34 2004 616.6'1—dc22

2003021346

Printed in the United States of America 10 9 8 7 6 5 4 3 2 1

Contents

Acknowledgments ix Introduction 1

Terms, Measures, and Abbreviations 5

Part I: Looking at the Disease of Kidney Failure

1 What Do Kidneys Do and What Happens When They Fail? 9

2 Are You at Risk for Kidney Failure? 17

3 Symptoms of Kidney Failure 27

Part II: How to Treat Kidney Failure

4 Treating Kidney Failure 35

5 Step 1: Assess Your Current Treatment Plan 44

6 Step 2: Make Lifestyle Changes 52

7 Step 3: Follow a Low-Protein Diet 55

8 Step 4: Treat Salt and Water Problems 88

9 Step 5: Regulate Your Blood Pressure 96

10 Step 6: Treat Acidosis 106

11 Step 7: Treat Anemia and Iron Deficiency 109

12 Step 8: Treat Potassium Problems 112

13 Step 9: Treat Calcium and Phosphate Problems 117

14 Step 10: Treat Gout and Uric Acid Problems 122

15 Step 11: Treat Your High Cholesterol 126

16 Step 12: Know the Medications That Slow the Progression of Renal Failure 130

Part III: Tracking Kidney Failure, Dialysis, Transplants, and More

17 Keeping Close Watch on Your Kidney Failure 139

18 Dietary Treatment of the Nephrotic Syndrome 158

19 Safe and Unsafe Medications for Patients with Kidney Failure 163

20 Transplantation as an Alternative to Dialysis 167

21 When to Opt for Dialysis 172

22 Patients Who Have Avoided Dialysis 180

Appendix 1: Resources for Kidney Patients 197 Appendix 2: Government Support of Low-Protein Diets 201

Notes 205

Glossary 213

Index 223

Introduction

Kidney disease is a huge, underrecognized and undertreated problem in the United States. In Coping with Kidney Disease, I hope to raise awareness about this disease among patients and their families and caregivers, and strongly advocate the benefits of predialysis care. The cornerstone of this treatment is a very-low-protein diet, which, as I have shown through my work with patients at Johns Hopkins University, can effectively delay or indefinitely postpone the need for dialysis in those with kidney failure. This diet, and many other effective treatments, will be explained and illustrated with patient histories throughout the book, such as this one:

Horace Lysenko, a 54-year-old self-employed art consultant, was referred to me four years ago with the following history: One year before, he had developed severe kidney failure caused by obstruction from an enlarged prostate. The prostate gland, which surrounds the urethra, frequently becomes enlarged in older men, obstructing the flow of urine from the bladder. Following surgical relief of the obstruction, his kidney function was only partially restored: Two-thirds of his kidneys had been destroyed by the increased back pressure from his bladder. His kidney function was measured at one-quarter of normal. He was placed on a very-low-protein diet, supplemented by essential amino acids—the treatment outlined in this book. In the ensuing five years, his kidney function has actually improved somewhat. Despite severe damage to his kidneys, he remains free of symptoms and may never go on dialysis.

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