Kidney Function

Module 2 Chapter 7. This is the first chapter of the 2nd DVD about living with Kidney Disease. It is a Health awareness/education project designed to support anyone who has been told by their doctor that they have some level of kidney Disease. The 2nd module offers practical advice for those patients with advanced kidney disease.

Many people are not aware of the link between kidney disease and insomnia. This isn’t too surprising, given the two seem unrelated on the surface. Although lack of sleep is often associated with heart disease, it can also be a red flag of early kidney disease.

In the beginning stages of renal disease, it is not uncommon for patients to suffer from insomnia due to the body’s toxins invading the bloodstream and vital organs as the kidneys fail to properly process them.

As kidney disease progresses further, patients often experience high blood pressure as a subsequent result of failed kidney function. High blood pressure can put serious strain on the heart which in turn may cause chemicals in the brain to prevent proper rest.

For those patients that undergo dialysis treatments, they may experience trouble sleeping as a result of leg pain and cramps that tend to come at night. They may also feel the need to stretch or kick their legs at night which can disrupt their sleep (as well as the sleep of their partner).

Some kidney patients may be prescribed medication to treat their insomnia. It is critical that those suffering from kidney problems view insomnia as a potentially serious threat and not just an inconvenience.

Other alternatives to treat insomnia include natural sleep aids that can be acquired without a prescription. Consult your physician to determine which treatment option may be best for you.

Background: Patients with primary focal segmental glomerulosclerosis (FSGS) resistant to current treatment regimens are at high risk of progression to end-stage kidney disease. Antifibrotic agents, such as tumor necrosis factor α antagonists, are a promising strategy to slow or halt the decline in renal function, based on preclinical and clinical data.Study Design: Phase 1 clinical trial to assess the pharmacokinetics, tolerability, and safety of adalimumab, a human monoclonal antibody to tumor necrosis factor α.Setting & Participants: 10 patients (4 male and 6 female) aged 16.8 ± 9.0 years with an estimated glomerular filtration rate of 105 ± 50 mL/min/1.73 m2 were studied.Intervention: Adalimumab, 24 mg/m2, every 14 days for 16 weeks (total, 9 doses).Outcomes: Pharmacokinetic assessment, tolerability, and safety.Measurements: Estimated glomerular filtration rate, proteinuria, and pharmacokinetic assessment after initial dosing and steady state.Results: Pharmacokinetic evaluation indicated that the area under the curve was decreased by 54% (P < 0.001) and clearance was increased by 160% (P < 0.01) in patients with resistant FSGS compared with healthy controls and patients with rheumatoid arthritis. Adalimumab was well tolerated with no serious adverse events or infectious complications attributable to the drug. Proteinuria decreased by ≥ 50% in 4 of 10 treated patients.Limitations: Insufficient power to assess the safety or efficacy of adalimumab therapy for patients with resistant FSGS.Conclusions: Pharmacokinetic assessment showed increased clearance of adalimumab in patients with resistant primary FSGS and validated the need to evaluate the disposition of novel therapies for this disease to define appropriate dosing regimens. The study provides a rationale to evaluate the efficacy of adalimumab as an antifibrotic agent for resistant FSGS in phase 2/3 clinical trials.