Kidney disease not death sentence

Being diagnosed with kidney failure does not mean your life is over. Reverend Tsoane Thole, who is living with the condition and continuing with his life as normal, is a
good example.

Even though you will not find a Valentine’s Day card with a kidney on the cover, it has been proven that kidneys are every bit as important as hearts.

Kidneys can be described as extremely sophisticated waste disposal machines, which remove non-recyclable waste from the blood, 24 hours a day, seven days a week. Much of this waste is produced by the body as it processes what we eat and drink.

But not everyone realises how hard kidneys work until it is too late, says Reverend Tsaone Thole (45), an animal health officer at the Department of Agriculture and a reverend of the United Congregational Church of South Africa.
Thole was diagnosed with kidney failure in January this year.

“I was diagnosed with Type 2 diabetes in 1999, which did not come as a surprise. I knew what diabetes was since my father was a diabetic. As a diabetic, my lifestyle changed completely. I had to be aware of what to eat and drink, when to take my medication, and how to take care of my body. But when I was diagnosed with kidney failure, I could not conceive any possibility of staying alive and healthy. I was certain that I was going to die. I thought of my wife and children and what it would mean for them to continue life without a father. It was terrifying.”

Thole’s body began displaying symptoms of kidney failure in October 2011. His feet started swelling to such an extent that he could not wear shoes or walk properly.

“I had no idea what was going on and everyone who saw me told me that it was witchcraft, which is a common answer to serious health conditions in the black community.”

When the symptoms worsened, Thole made an appointment with his doctor, who he could only see on January 31.

“When I think back on it now, I realise that my father displayed similar symptoms before he passed away, but we thought it was his diabetes. We did not realise it had progressed to kidney failure.

“Because of the constant focus on HIV/Aids, other life-threatening diseases such as kidney failure have not been given the necessary regard and sufficient information is not given to the poor. To the uninformed, kidney failure means a short and painful life. It means urinating in a bag and walking around with it.”

Chronic kidney disease is a growing health problem in South Africa. According to the National Kidney Foundation, 10 000 South Africans die of kidney disease or kidney failure every year.

“The kidneys are remarkable in their ability to compensate for problems in their functions. That is why chronic kidney disease may progress without symptoms for a long time until only very minimal kidney function is left,” said the unit manager at the National Renal Care (NRC) unit at Universitas Private Hospital, Sister Lynnette Roberts.

“When your kidneys begin to fail, the symptoms are often mild and ignored. It is likely to take a long period of time for the problem to be detected and treatment started. The body can adapt itself until 90 percent of the kidney is damaged. That is why most patients do not display any symptoms. The detection is done by laboratory testing of the urine and blood.”

The National Renal Care unit specialises in renal replacement therapy, which plays a vital role in the treatment of severe acute kidney injury and the end stage of chronic renal failure. Patients with kidney failure are referred to this unit for treatment after diagnosis.

Roberts, who has been with the National Renal Care unit for almost 15 years, said even though the disease has existed for many years, the ignorance around it astonishes her.

“It is sad to see someone come in, diagnosed with kidney failure, then go into a complete depression because they have come to believe that there is no hope for them past this point of diagnosis. Yes, there is no cure for the disease, but treatment has proven to be most beneficial and people can still live a full and healthy life.”

According to Roberts, kidney failure can occur from an acute situation or from chronic problems. Acute kidney failure is curable within six weeks and occurs when a person is dehydrated from exercise or illness. But chronic kidney failure develops over months and years and a person should get immediate help when they display the symptoms.

“Although chronic kidney disease sometimes results from primary diseases of the kidneys themselves, the major causes are diabetes and high blood pressure. If you have any of these conditions, you are at higher-than-normal risk of developing kidney disease. Your kidney functions may need to be monitored regularly.

“With kidney failure, you must make choices regarding dialysis treatment. Dialysis can replace part of the function of your kidneys.”

According to Thole, the myth around dialysis is that it is a death sentence, but he prefers to think of dialysis as a life sentence.

“Dialysis allows individuals to live productive and useful lives, even though their kidneys no longer work adequately.”

Treatment options include haemodialysis, which requires a machine to filter blood outside the body; peritoneal dialysis which uses the lining of the belly to filter the blood inside the body, and a kidney transplant, which entails a new kidney being placed in the body.

Thole said the choice of treatment depends on the patient’s lifestyle.

“I chose peritoneal dialysis because it fits my lifestyle. When you go to a National Renal Care unit, they will explain your options in detail to you. Having as much information as possible is a good way to learn about your options so you can make an informed choice. And if you find that your choice is not a good fit for your life, you can change treatments. With the help of your health care team, family, and friends, you can lead a full active life.”

Heamodialysis is usually done three times a week. Each treatment lasts four hours at a dialysis centre such as the National Renal Care unit at Universitas Private Hospital. They use a special filter called a dialyser that functions as an artificial kidney.

The machine temporarily rids the body of harmful waste, extra salts, and water. It also controls blood pressure and helps the body keep a proper balance of important minerals such as potassium, sodium, calcium, and bicarbonate.

“The disadvantage of this treatment option is that patients have to travel to the hospital three times a week. Your work and family need to be considered when you make this decision,” said Roberts.

With peritoneal dialysis, a mixture of minerals and sugar dissolved in water travels through a catheter into your belly. The sugar (dextrose) draws wastes, chemicals, and extra water from the tiny blood vessels in the peritoneal membrane into the dialysis solution. After several hours, the used solution is drained from the abdomen.

“The advantage for patients who decide on peritoneal dialysis is that the individual is taught to perform the procedure at home or wherever they are. I can still travel and go on vacations with my family using peritoneal dialysis,” explained Thole.
Due to the scarcity of donors, the average waiting time for a new kidney varies and can be anywhere between six and 12 years.

Roberts added that strain can be taken off the kidneys by limiting salt intake.

“Too much salt is not only bad for your blood pressure, but it is also for your kidneys. Do not load up on high-protein foods because too much protein, such as pork and beef, can overwork your kidneys.”
Blood pressure should also be kept at 130/80 or lower.

“If your blood pressure is above 140 over 90, this can cause kidney damage within five years. Blood sugar should be kept below 120 mg/dl.”

Diabetes and high blood pressure are the two leading causes of kidney failure. Diabetes affects almost all organs of the body. A person with uncontrolled diabetes for five to 10 years may develop significant kidney damage.

It is also recommended that you drink enough water. Doctors usually advise people to take in eight glasses of water a day, but this depends on your age and condition. If you sweat a lot and work outdoors, you may need to drink more than eight glasses a day. However, if you are above 65 years of age, you may do well with just six glasses a day.

Drinking enough water also prevents the formation of kidney stones, a painful condition which, if left untreated, can also lead to kidney failure.

She also cautioned against taking pain medication for a prolonged period of time as it may cause kidney damage.

“Because of this, we should limit taking these medicines to only a week, or just take them as needed. After taking these pain relievers, we need to let our kidneys rest first before taking the medicines again.”