Bleeding and bruising may become more prominent. Patients are often prone to infection and develop fluid retention with ankle swelling and shortness of breath. As these symptoms may indicate quite dangerous underlying problems, the aim is to commence dialysis before these symptoms occur . Dialysis improves most of the symptoms of kidney failure with the exception of anaemia, some bone problems and sometimes itch, although itch is generally improved with good biochemistry control. The anaemia can now be improved by the use of a drug called erythropoietin which is exactly the same as the hormone produced by healthy kidneys.
Erythropoietin stimulates the bone marrow to produce red blood cells.
After around 10 years of dialysis some new symptoms may develop related to the inefficiency of dialysis in comparison to normal kidney function. Other observations 1 . The rate of progress from one stage to the next may be unpredictable and not all patients who lose some renal function will go on to develop total renal failure. Even in disorders where progression is usually inexorable, good blood pressure control, diet and biochemical control can delay the process for years, e.g. with polycystic kidney disease. Conversely, acute events such as severe infection, dehydration from vomiting, or very high blood pressure can accelerate the development of renal failure.