How to cope with kidney challenges

I have been on dialysis for kidney failure for five years now but I am increasingly stressed with the thoughts of having to live with this for longer. How do I deal with this feeling of desperateness?"

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On the face of it yours is a simple question on how to cope with kidney disease that requires dialysis.

Before we can discuss the failure of the kidney, we must ask ourselves what the kidney does to keep us alive. In realty, the kidneys (we all have two) are the organs that clear the body of toxins that accumulate in the during life.

In any one day, the adult filters about 200 liters of blood in the process of removing by a method called filtration, byproducts of metabolism that could be harmful to the body.

That, however, is the simple explanation. In realty, kidneys not only filter but they also keep a carefully balanced fluid system that ensures that we do not drown in the fluids that we drink, but also that we do not become dehydrated form too much fluid loss.

Additionally, the kidneys ensure that we do not have too much (or too little) salt and other minerals in the body.

Too much can kill and too little can also lead to death. Just like we need a city department to ensure city cleansing, the process of metabolising all that we eat causes byproducts that have to be removed for us to live. The kidneys are our cleaning department.

They also help in regulation of blood pressure and also produce hormones essential for blood production. Kidney failure is therefore more than the failure to produce urine.

There are many reasons for kidneys to fail, and therefore people with kidney failure will have other medical conditions (comorbidities). Diabetes and high blood pressure are the commonest co-occurring disorders with kidney failure.

This fact alone may be significant in the answer that we give you today. Do you for example, have diabetes? Did you know that one third of patients with diabetes also have clinically recognised depression which often goes untreated?

Did you know that depression occur in up to 40 per cent of patients undergoing dialysis? Have you had a mental health specialist examine you for the possibility that you are depressed?

The good news is that effective treatment for depression during dialysis is available and can be by giving medication, but in some cases talking therapy is adequate. Sadly, left untreated, depression in persons on treatment for end stage renal disease is linked to early death.

If only that was the end of the story! Sadly, the fact that kidneys are not working well causes a major change in lifestyle. One has, for example to spend four hours attached to the dialysis machine three times a week. That alone is a major shift in lifestyle that can be frustrating and awfully expensive.

For some patients, there is what is called “Kidney brain” felt most acutely after each dialysis treatment in which the brain feels foggy, confused and fatigue sets in. When on dialysis, one’s social life changes because life has to exist around the availability of dialysis.

One cannot for example take off to a foreign land on holiday without planning for dialysis. Tragically, some people stigmatise those on dialysis, as though the condition is infectious (which it is not).

Physical changes in people with renal disease can be most unsettling and irritating and lead to much stress. Swelling of the body, flaky and itchy skin are some of the common symptoms.

It is, however, worth noting that many diseases (not just kidney) lead to psychological problems. For example, people who suffer from heart attacks and strokes are more likely to suffer from depression than those without.

On the other hand, people with depression are more likely to have heart attacks than those without. This is what is called two directional movement of disease.

One leading to the other and vice versa. In Kenya, as we have done well to contain many infectious diseases, the challenge now posed by non-communicable diseases has become more real.

Diabetes, hypertension, obesity, renal diseases and mental disorders are the real issues of today and tomorrow, on account of the cost to society as a whole, and in particular as important causes of early death and disability.

Coming back to you and the dialysis that you are now undergoing, and in view of the frequency of psychiatric complications from this treatment, I would suggest that you discuss your concerns with your doctor and suggest that a psychiatrist or any other mental health worker might be of some help.

In Kenya, in this day and age, most doctors would have no problems giving you advice on your request and might even feel relieved that you have considered this as a possibility.