Chronic kidney disease

rescribed for the prevention of vascular disease. You should also avoid ibuprofen if youre taking anti-rejection treatment following a kidney transplant. Coughs and colds Many of the products available for coughs and colds contain a mixture of ingredients	 so check the packaging carefully. Some products contain paracetamol	 which is safe	 but others contain high doses of aspirin	 which its best to avoid. Many cold remedies also contain decongestants 	 which you should avoid if you have high blood pressure. The best way to clear congestion is by steam inhalation with menthol or eucalyptus. For coughs	 try a simple linctus or glycerine honey and lemon to soothe your throat. Muscle and joint pains If you have muscle or joint pain	 its ideal to use topical preparations (applied to the skin)	 which are rubbed on to the painful area. Avoid tablets containing ibuprofen or similar drugs such as diclofenac if your kidney function is below 50%. Ibuprofen gel or spray is safer than ibuprofen tablets	 but it isnt completely risk-free as a small amount of the drug penetrates the skin into the bloodstream. Kidney failure About 1% of people with stage three CKD develop kidney failure	 also called established renal failure (ERF). Kidney failure has a major impact on your life and the lives of those close to you. People diagnosed with kidney failure usually go through shock	 grief and denial before they accept their condition. Choices if you have established renal failure If you have established renal failure (ERF)	 you will need to decide whether to have treatment with dialysis or a kidney transplant. You may decide to have neither treatment and to have supportive care. These choices should be made with your healthcare team. For people who want active treatment for their ERF	 a transplant would be the best option. However	 a transplant is only suitable for about half of all people with ERF. This is because they may have had recent cancer orare not physically fit. Many people who have slowly progressive kidney failure and other serious health problems	 and who are usually older	 may choose to avoid dialysis. Supportive care can still allow you to live for some time with a good quality of life. Transplant A kidney transplant	 when suitable	 is the best treatment for ERF. The transplanted kidney can be obtained from a deceased or living donor and survival rates are now extremely good. About 90% of transplants still function after five years and many transplants work usefully after 20 years. The main reason people have to wait for a transplant is the shortage of available donors. Over a third of kidney transplants are now from live donors. A live donor kidney can be transplanted before the need for dialysis	 rather than after a period of time on dialysis. One major risk after transplantation is rejection	 where the immune system attacks the donated kidney because it mistakes it for a foreign object. This is prevented with the use of strong drugs to suppress the immune system. These drugs need to be taken meticulously. They are usually well tolerated but may have side effects	 including an increased susceptibility to infections and some forms of cancer. For this reason	 transplant patients are given regular reviews in a specialist transplant clinic. Dialysis Dialysis can take place at home or in hospital. It involves filtering the blood of waste products and excess water. It is not as efficient as a human kidney	 so people with kidney failure usually need to restrict their intake of fluid and certain foods. They also require additional medicines such as iron supplements	 phosphate binders and antihypertensive medicine (to reduce blood pressure). There are 2 types of dialysis: peritoneal dialysis and haemodialysis. Peritoneal dialysis The abdomen (tummy) has a lining called the peritoneal membrane	 which can be used as a filter to remove excess waste and water. If you have opted for peritoneal dialysis	 a tube (catheter) will be inserted into your abdomen during an operation. This will allow you to drain dialysis fluid in and out of your tummy yourself. You will not need to go into hospital to be treated	 but you will have to spend an hour or two each day draining the fluid. The treatment involves either four exchanges spaced out during the day	 each taking half an hour	 or attaching yourself to a machine overnight that pumps the fluid in and out for you. Haemodialysis Haemodialysis removes waste products and excess fluid that build up in the body when the kidneys stop working. Blood is taken from the body to be cleaned in a filter known as a dialyser. It is effectively an artificial kidney. The whole process takes about four hours and usually has to be repeated three times a week. Most people go into hospital to have haemodialysis. However	 some people choose to have the treatment in their own home. Home haemodialysis will give you more flexibility	 but comes with greater responsibility. Youll need to have the space in your home for a dedicated machine and	 in most cases	 a lot of support from a close family member or friend. Some people choose to have their dialysis at night while they are asleep. Most people who choose home haemodialysis have it every day	 so their fluid intake is not as restricted. Quality vascular access During haemodialysis	 it is important that large volumes of blood are passed through the machine. This requires special measures to get into large enough blood vessels. For this reason	 haemodialysis patients need a minor operation to join one of the deep arteries to a superficial vein (called a fistula). This is carried out in day surgery and should be done at least 6 weeks before dialysis is required because it needs time to mature before it can be used. Occasionally	 there will be insufficient time for a fistula to be created before dialysis is required. In this case	 a temporary solution is found	 usually involving the use of an indwelling plastic dialysis catheter. A catheter is a surgical tube inserted into the body to allow for the transfer of fluid. All the issues will be discussed in detail with you by the dialysis team before any decisions are made.