Education
Being educated on kidney failure and selected treatment is of the utmost importance. Knowledge of what is happening inside your body, the reaction to dialysis, why medication is needed and why certain foods and fluids must be restricted is crucial to your overall understanding of what is happening. The feeling of helplessness and dependency of the medical staff can be reduced by knowing and understanding kidney failure and treatment. Putting this knowledge to use will help you to feel better and can give you a sense of being in control of your own life. Fears and anxieties can be the result of lack of information; the unknown, which we all fear, can become known through education.

Fitness
Physical fitness should be important to everyone, regardless of kidney function. Mild and regular exercise can help rebuild strength, help with insomnia and anemia and strengthen bones and muscles. A physical fitness and exercise program developed with the help of a physician can give you a feeling of accomplishment and overall well-being.

Communication
One important way to maintain important personal relationships is via communication. Talking things through with your partner, family members and friends is very important in maintaining relationships. Sharing feelings, concerns, fear and anger with others not only helps you feel better, but it will also help your family and friends to better understand and accept what is going on with you. Closing out those people who are important to you can hurt the relationship by making them feel no longer needed or wanted. Ongoing communication, like education, may help you to become aware of your feelings. Once you are aware of your own feelings, you can begin to accept kidney failure as an unfortunate, but challenging, part of life, and then you can go on living.

Motivation
Setting personal goals, completing projects and continuing to lead life as close as possible to the way you did before kidney failure is very important. Continuing enjoyable activities, being with loved ones and continuing to plan your life should not change with kidney failure. Most people’s feelings of self-esteem or self-worth depend on what they do and accomplish. Although kidney failure and treatment can change some external aspects of your life, your essential worth and value to yourself and others can and should remain unchanged.

Kidney Failure and Sex
Sometimes, your desire for sexual activity, or sexual appetite, changes with chronic illness. The ability to enjoy sex, on the part of the male or female, depends on you as an individual. Impotence, or the inability of a male to have an erection or to maintain an erection, can occur. Problems with ejaculation are also a possibility. However, your ability to participate in sexual activity and to enjoy sex is still possible. If you find your sex life changing, talk to your doctor or social worker, because these problems may be treatable. Very often, the stress and anxiety that is related to kidney failure and the subsequent treatment can affect your sexual appetite and ability to enjoy sex.

Counseling
A social worker has the necessary skills and training in counseling and family therapy. If you think that counseling for you or your family members is needed, you should talk with a social worker. This professional member of the medical team can help determine if counseling can benefit you or other members of your family.

“That was it for me,” Morgan explained. “Now I take my insulin every day. My blood sugar doesn’t get over 120.”

People that suffer from Type 2 diabetes (the most common type) are particularly at risk for kidney failure. This type of diabetes inhibits the body’s natural ability to properly produce insulin. Insulin is a vital hormone that is necessary to get glucose into cells so that it may be used as energy. If this process is obstructed, the glucose may build up in the bloodstream which may lead to eye, nerve, and kidney damage. If this problem is neglected, there may be serious consequences such as loss of limbs, stroke, or heart disease.

Along with frequent doctor visits, there are many ways for people with Type 2 diabetes to minimize their risk of experiencing kidney failure. For instance, eating fish twice a week is believed to significantly reduce the risk of kidney disease for diabetics. Poor diet is one of the biggest risk factors.

Tracy Morgan is expected to recover quickly, and will probably only have to be absent from a couple episodes of 30 Rock, his current hit television show. Upon returning, Morgan will be welcomed by his fellow cast members such as Alec Baldwin, Tina Fey, and fellow kidney transplant recipient Grizz Chapman.

These Medicare benefits consist of two types of insurance: Part A, or hospital insurance, and Part B, or medical insurance. Almost everyone who is eligible for Medicare is covered by hospital insurance without paying any monthly premium. Hospital insurance covers medically necessary inpatient hospital care and, under certain conditions, medically necessary post-hospital inpatient care in a skilled nursing facility, and home health care provided by a home health agency. The hospital insurance part of Medicare, for example, helps pay for an inpatient stay in an approved surgery. Hospital insurance has an annual deductible, and Medicare payments for services are made directly to the participating facility providing services.

When a person becomes entitled to Medicare hospital insurance because of chronic kidney failure, they are also enrolled for medical insurance or Part B of Medicare. Although they do not have to take this part of Medicare, most of the services and supplies required by chronic kidney failure are covered only by the medical insurance and not by the hospital insurance. The monthly premium for medical insurance protection covers physicians’ services; outpatient hospital services; outpatient maintenance dialysis treatments in an approved dialysis facility; durable medical equipment for use in the home, such as dialysis machine; and almost all items necessary for home dialysis, as well as many other health services and supplies. In addition to monthly premium payments, medical insurance also carries a small annual deductible payment and a 20 percent co-insurance liability.

Note: There is no minimum age required to receive Medicare benefits under the kidney disease provisions, as long as all other eligibility requirements are met.

How to Find Out if You’re Eligible for Medicare Benefits

The law states that you must be a Social Security or Railroad Retirement beneficiary or be “fully or currently” insured in order to be eligible for the kidney disease provisions of Medicare. You are currently insured it you have at least six quarters of coverage during the full 13-quarter period ending with the calendar quarter in which dialysis or a transplant occurs. A patient is fully insured when they have one quarter of coverage under the Social Security program for each year elapsing after 1950 (or after the year the patient attains age 21, if later) to the year in which dialysis or transplant occurs. In no case is more than 40 quarters of coverage required. The spouse or dependent child of an insured individual is also eligible. For more information on eligibility, contact your local Social Security office. A social worker is best suited to assist you in determining whether or not you are eligible for Medicare benefits.

Can Medicare Help?

Yes. The Medicare kidney disease provisions cover 80-100% of medical and hospital charges, if the patient is qualified. For instance, one of the benefits of Medicare is the coverage of EPO when given in a dialysis facility. However, Medicare benefits are limited in the services are also covered by an employer group health plan.

Am I Eligible for the Kidney Disease Provisions?

Yes, you are eligible for benefits under the kidney disease provisions of Medicare if you have kidney failure and are receiving dialysis or have a transplant and meet one of the following qualifications:

• You are fully or currently insured under Social Security or are entitled to a monthly Social Security or Railroad Retirement benefit
• You are the spouse or dependent child of the aforementioned type of qualifying individual

If you are over age 65, you may also qualify under the regular Medicare provisions for older individuals. Eligibility is not based on age or whether or not a person is currently working or unable to work.

How Can I Apply for Medicare Benefits?

You should apply for Medicare benefits after the diagnosis of chronic kidney failure has been made and shortly after beginning treatment. Many people complete the application with the assistance of a social worker. Social Security area offices provide the necessary forms and will assist you in completing them.

• better understand the causes of kidney diseases and kidney failure
• develop new strategies for the treatment and prevention of kidney diseases and kidney failure
• improve dialysis therapies
• increase success rates for kidney transplantation
• find alternative treatment methods for kidney failure

Important Research Accomplishments

As a direct result of intensive research and technological advances, the treatment of kidney failure has changed and expanded. Many advances have made it possible for people with kidney failure to live longer and with fewer complications. Some of these research developments include:

• the use of recombinant erythropoietin to treat the anemia of chronic kidney failure. Erythropoietin has reduced the need for transfusions and has improved the exercise endurance and feeling of well-being of many people who suffer from kidney failure
• a better understanding of the immunology of transplantation that has led to the ongoing development of new medications and tissue typing techniques to prevent the rejection of transplanted kidneys
• the effective use of calitriol, the active form of Vitamin D, for the treatment of a common form of bone disease that occurs with kidney failure
  the identification of another form of bone disease in hemodialysis patients called amyloid bone disease and the development of methods to detect and diminish the accumulation of amyloid in bones and joints
• a major reduction in the occurrence of aluminum bone disease through the use of preventive interventions
  the continued improvement of continuous ambulatory peritoneal dialysis (CAPD) so that the risk of infection has been significantly mitigated

Recent Research Developments

There have been several recent research developments that have led to new ways of preventing kidney failure and treating people with kidney failure.

Recent research has demonstrated that the progression of diabetic kidney disease, a major cause of kidney failure, may be slowed by the use of blood pressure lowering medications called angiotensin-converting enzyme (ACE) inhibitors and by very good control of the blood sugar. In addition, the use of new tests for the early detection of kidney disease in diabetic patients permits earlier intervention with prevenentive measures.

The development of new and more effective antihypertensive medications now offers more treatment options for people with hypertension, which remains a major cause of kidney failure.

The continued development of high-flux dialysis membranes and new biocompatible membranes has improved the efficiency and safety of hemodialysis. The development of new CAPD systems has dramatically reduced the incidence of peritonitis the most common complication of CAPD.

Improvements in the use of immunosuppresive medications in preventing the rejection of transplantations and in tissue-type matching have increased the success rate of kidney transplantation.

Blood is made up of fluid (plasma or serum) and contains many different kinds of cells. Red cells, which are called erythrocytes, are the most common type. The average person has over thirty-five trillion erythrocytes. If a person has anemia, they have a reduced number of red blood cells. A doctor can tell how many red blood cells a person has by doing a blood test of the hematocrit or a red blood cell count. The hematocrit tells what percent of the blood is red cells. A normal hematocrit level is between 38% and 48%, but a level of 24 to 30 is still satisfactory for a dialysis patient. The doctor may also measure the hemoglobin level. Hemoglobin is the molecule that carries oxygen in red blood cells. A normal hemoglobin level is between 12 grams and 16 grams per deciliter. A normal red blood cell count is between 4.4-5.8 million per microliter.

Purpose of Red Blood Cells
Hemoglobin in the red blood cells carries oxygern to all parts of the body. The red cells are the oxygen transport system. The body uses oxygen as a fuel or source of energy. When a person is anemic, and does not ahve enough red blood cells, parts of the body do not get enough oxygen to work properly and the person may feel exhausted and out of breath. People with anemia may feel like they have no energy. The hemoglobin in red blood cells also serves to transport carbon dioxide, a waste product from the cells or tissues throughout the body to the lungs where carbon dioxide is excreted.

Symptoms of Anemia
Along with lack of energy, other symptoms of anemia include fatigue, depression, and inability to concentrate or exercise normally. Shortness of breath, palpitations (rapid or irregular heart beat), impotence (failure to achieve adequate penile erection), dizziness, light-headedness and constantly feeling cold are also symptoms of anemia.

Can Dialysis Help with Anemia?
Normally, the kidneys remove fluids and toxins from the blood stream. For people with kidney disease, dialysis does much of this work for the kidneys. However, dialysis cannot replace erythropoietin. Nevertheless, some dialysis patients are not anemic, even without being given erythropoietin.

How can Anemia be Treated?
Dialysis patients may receive blood transfusions if they are anemic. When patients are transfused, they receive red blood cells from a blood donor. They might also receive anabolic male-type (androgenic) hormones, such as decadurabolin. These substances may help raise the hematocrit to some degree.

Now there is an effective way to treat anemia in people with kidney failure. Scientists have found a way to produce erythropoietin in a laboratory using recombinant DNA technology. This erythropoietin is called recombinant human erythropoetin, or simply “EPO”.

Why is Fluid a Problem?

Properly functioning kidneys prevent the fluid in the body from building up by removing the excess body fluid as urine. When your kidneys are not functioning, fluid may accumulate in your bloodstream. A large amount of fluid in your blood can cause high blood pressure and it also places a strain on your heart. Although fluid can also collect in your lungs, making it difficult to breathe properly, this can be controlled by bringing the body to a dry weight or a weight at which the blood pressure is normal and no swelling is present. You should achieve proper fluid balance by watching your diet and fluid intake between dialysis treatments.

Will I Experience Muscle Cramps?

Muscle cramps are most likely to occur if you are overweight due to the excess fluid in your body. A major cause of muscle cramps is the removal of a large amount of fluid during treatment. The best way to avoid muscle cramps is to limit salt and fluid intake.

Will Itching be a Problem?

You may experience some itching as a result of kidney failure (uremia), the level of phosphorus in the body or allergies to medications you may be taking. If the itching symptoms are related to uremia, your doctor may increase dialysis or prescribe medications, and, in some cases, recommend ultraviolet light treatments. Your physician adjusts the intake of phosphorus through diet and medication if the itching is related to phosphorus. Your medications may be adjusted if the itching is a result of an allergic reaction to medications.