All posts by В. Пенчев

Potassium is a mineral and electrolyte that we need to maintain and regulate key processes in our body. It is one of the seven major macrominerals and plays an important role in kidney function. It is found in most of the foods we eat and is needed in our diet because it supports muscle movements, keeps the nervous system healthy and participates in the process of balancing the amount of water in the body. The amount of potassium in the blood is controlled by the kidneys. They remove excess potassium from the blood and excrete it in the urine, which process is reduced in patients with CKD.

Having too high or too low potassium levels can lead to complications that affect kidney function. In people with kidney disease, potassium levels can build up to higher levels. This is called hyperkalaemia and can be dangerous for the heart.

People with chronic kidney disease should limit the amount of potassium they consume, as their kidneys cannot process potassium properly and this leads to its accumulation in the blood. On the other hand, drugs used to treat CKD can also increase potassium levels.

It is recommended that healthy men and women over the age of 19 consume at least 3400 mg and 2600 mg of potassium per day, respectively. However, people with kidney disease who are on a potassium-restricted diet should usually keep their potassium intake below 2000 mg per day.

The optimal amount of potassium in the diet maintains and has a beneficial effect on the muscles that control heart rate and respiration.

Potassium restriction in the hemodialysis diet

Potassium-rich foods are limited for hemodialysis patients as potassium accumulates in the periods between dialysis treatments and can cause problems such as weakness, muscle cramps, fatigue, irregular heartbeat and heart problems.

Potassium is present mainly in fruits, vegetables and dairy products. Some fruits and vegetables are high in potassium and others are lower.

Foods that are low in potassium – meat, poultry, bread, pasta.

Potassium-free foods – butter, margarine and oils.

When the kidneys are healthy and functioning properly, filtering fluids, minerals and waste products from the blood, they usually do not allow large amounts of serum protein to be isolated in the urine. But when the kidneys do not filter properly, proteinuria can occur, which means that an unusual amount of protein is present in the urine.

The two main groups of serum proteins in the blood are albumin and globulins. Albumin is abundant in the blood, making up more than 50% of all serum proteins. Its functions include maintaining the right amount of water in the bloodstream, as well as binding and transporting substances that are poorly soluble in water – fat-soluble vitamins, calcium and some medicaments.

Transient proteinuria is a temporary release of protein and can be the result of strenuous exercise, fever, exposure to cold, stress and other conditions. Pregnant women can also excrete more protein in their urine. Transient proteinuria does not involve underlying kidney disease and does not require treatment.

Proteinuria might be also due to kidney disease, such as glomerulonephritis, primary focal segmental glomerulosclerosis (FSGS), or kidney damage due to systemic disease. Microalbuminuria means that low levels of albumin are found in the urine. Microalbuminuria may indicate that people with diabetes or hypertension develop an early stage of kidney disease.

Symptoms of proteinuria

In most cases, proteinuria has no symptoms and is detected during routine screening in people with high blood pressure or diabetes. If the protein loss is severe, swelling or edema may occur. Swelling may be present in:

• The face and around the eyes
• Hands and feet
• Ankles and feet
• Abdomen

There are three types of kidney damage (insufficiency) – prerenal, renal and postrenal. The mechanisms of occurrence are radically different, as in some cases the cause lies in the kidneys, and in others they are secondarily affected.

Prerenal acute impairment occurs when a sudden decrease in blood flow to the kidneys (renal hypoperfusion) causes loss of renal function. In these cases, the kidney structures are preserved and healthy but low blood pressure leads to a collapse of their function, stops the filtration of blood and urine production.

In renal damage, the renal glomeruli and especially the tubules (tubules) are affected by a real disease process. Treatment includes identifying and correcting the cause of the kidney damage. This often involves nephrotoxic drugs, glomerulonephritis, lupus, rhabdomyolysis and other specific kidney diseases. As a result of impaired blood supply through the renal arteries, secondary organic damage can occur, which can lead not only to a sudden loss of renal function, but also to remain even after the restoration of blood flow.

Postrenal renal failure is due to obstruction (blockage) of the urinary tract at various levels and causes the accumulation of waste in the kidneys. Obstruction of the urinary tract can lead to accumulation of urine in one or both kidneys. Over time, this accumulation of fluid can interfere with the normal flow of urine from the kidneys. This is usually a reversible process if the obstacle is removed. However, there are cases in which prolonged urinary tract infections can lead to permanent and severe damage to the renal parenchyma.

Chronic kidney disease (CKD) is a global health problem and is often associated with an increased risk of cardiovascular disease.

Cardiovascular disease is the leading cause of morbidity and premature mortality in people with chronic kidney disease. Also, patients with renal insufficiency have been found to be at higher risk of complications. The presence of cardiovascular disease can be a risk factor for CKD. The connection between them also contributes to their pathogenesis and progression in patients with any of the specific health problems. This risk often increases with the progression of CKD and is evidenced by a deterioration in urinary function, usually manifesting as a decrease in glomerular filtration rate and an increase in proteinuria.

Hypertension, one of the leading causes of renal failure, is a major culprit in this process, causing left ventricular hypertrophy, dilatation of the heart chamber and increased stress, ischemia, heart failure and arrhythmias. In addition to impaired coronary micro circulation, hypertension may contribute to the development of atherosclerotic coronary artery disease, especially in the presence of many lipid abnormalities observed in end-stage renal disease.

Some of the causes of cardiovascular disease are:

• High blood pressure – high blood pressure (hypertension) is one of the most important risk factors for CVD.
• Smoking.
• High cholesterol.
• Diabetes.
• Overweight or obese.
• Family history of CVD.

Patients with end-stage renal disease (CRF) treated with hemodialysis (HD) are increasing annually worldwide. Their quality of life to a large extent depends on the quality of their hemodialysis treatment. One of the main factors for this is the type of the used vessel access.

In practice, three main types of vascular access are used – arterio-venous fistula, arterio-venous prosthesis and central venous catheter – which in turn is divided into temporary and tunneled.

Temporary hemodialysis catheters were introduced in the mid-1970s, while tunneled catheters entered relatively later. Temporary vascular access is a consequence of emergencies through catheterization of large venous vessels. It is applicable in acute renal failure and is undesirable for chroniodialysis. Temporary catheters should be replaced by Permanent Tunneled Catheters.

The implantation of permanent tunneled catheters is performed by highly specialized physicians under constant ultrasound, X-ray or angiographic control during or after the procedure. They are most often implanted in the right atrium and are a complex medical procedure.

Permanent tunneled catheters are recommended in adult patients, such as those with cardiovascular disease, diabetics, cancer patients or in cases where prolonged stay of hemodialysis treatment is not expected.

The diagnosis of CKD is associated with the need for dialysis, for which, accordingly, there must be vascular access. An option for such access is the AV fistula, which is considered as the best choice, as it usually lasts longer and creates fewer problems.

AV fistula is a surgical connection made between an artery and a vein created by a vascular specialist. It is usually located in the arm, but if this is not possible, it can be placed in the groin or in the legs. With an AV fistula, blood circulates from the artery directly into the vein, delivering the right amount of blood flow needed to provide adequate hemodialysis treatment. AV fistulas are the preferred vascular access for long-term dialysis because they have fewer complications than other access methods and are less prone to infections and thrombosis. The fistula will take several weeks to mature, with an average period of 4-6 weeks.

Some of the benefits of AV fistula is that it provides the necessary blood flow needed for effective dialysis, which can help reduce treatment time, lower the risk of infection, and reduce the likelihood of clotting.

How is an AV fistula created?

The first step in creating an AV fistula is to assess the condition of the blood vessels (veins and arteries). These manipulations and examinations are performed by a vascular specialist. If necessary, minimally invasive tests such as ultrasound and possibly an angiogram can be used to determine the size and depth of the arteries and veins. These tests will determine if the blood vessels are able to support the AV fistula. The procedure is performed on an outpatient basis using local anesthesia. Once the AV fistula is established, it will take several weeks, in some cases a month or more, for the fistula to mature to the point where it can be used for hemodialysis treatment.

Acute renal failure develops rapidly, usually in less than a few days. It is most common in people who are already hospitalized, especially in critically ill condition, who need intensive treatment. Acute renal failure can be fatal and requires prompt and timely action. Often this process is reversible. Good physical health is essential to restore normal or near-normal kidney function.

Acute renal failure is very severe and is a dramatic condition in which the kidneys suddenly stop producing urine and the patient stops urinating. This can be a consequence of various diseases and injuries – severe acute kidney disease, major blood loss, severe shock injuries, dehydration (incessant vomiting and diarrhea), severe infections and more. An acute renal failure that lasts more than three months turns into a chronic one.

With the chronic renal failure there is a gradual and irreversible failure of the kidney function. Many are the diseases that may cause herein including: a hypertension disease, a diabetes, chronic diseases of glmerulus and kidney infections, gout, renal-stone disease, tissue and congenital malformations in the kidney  structure. There are medicines that may also cause irreversible kidney damage.

Unlike acute renal failure, chronic renal failure sometimes occurs covertly and unnoticed. To control these processes, a urine test should be performed 1-2 times a year, even if there are no complaints. A signal to suspect kidney disease is the presence of albumin in the urine and possible blood cells (leukocytes). In these situations, timely consultation with a specialist is mandatory.

Most dialysis patients are able to maintain a normal rhythm of life associated with work, travel and social commitments. Especially now, during the summer season, a lot of people take vacations to desired destinations and organize their stay according to the possibility of dialysis treatment in the region.

We at Dialysis Center NephroLife guarantee to all visiting patients in our city and the region the opportunity for quality and reliable dialysis treatment during the coming summer months.

The Bulgarian Black Sea coast is a wonderful place for a summer vacation and offers various opportunities for entertainment and accommodation, from luxury 4- or 5-star hotels to small romantic family hotels, all of which meet world standards.

The financing in Nephrolife Dialysis Center is covered by National Health Insurance Fund. No additional payment is required from patients for their treatment, nor for any of the accompanying services related to comfort or medication.

For your safety and convenience, we offer free transport services in brand new and comfortable cars. Our drivers will pick you up from the place where you are staying and will drive you to the center according to the schedule that you have specified in advance.

During your dialysis treatment session a doctor is always available in the treatment room. Our doctors and nurses will assist you at any time you may need help. You can ask the team any questions about your medical condition and convenience.

We will do our best to make you feel as comfortable as at home.