Milwaukee Nephrologists remains open for business at the usual business hours (Mon-Fri, 8:30AM-4:30PM) during the coronavirus pandemic. We have, however, implemented extra precautions in our offices. We now offer both in-person visits to our doctors and telehealth options if you do not want to come into the office. We request that visitors wear a face covering and maintain compliance with the Wisconsin Shelter-In-Place order.
We utilize a software application called Updox for our telehealth visits. When you request a virtual visit, our office staff will send you a link via text message or email. Simply click on the link and you will be taken to a virtual exam room with the ability to see and speak with your physician. You do not need to download or install any special software or app to gain access and it works with any smartphone, laptop or tablet.
Your health is our top priority and COVID-19 will not affect our dedication to providing the top quality kidney health care you've come to expect from us. We are still here for you; we will get through this together.
For more information on our telehealth option or to schedule a consultation, get in touch with our office near you.
Kidney Disease Diet: The Best Diet for Kidney Failure and Diabetes
Kidney disease, aka renal failure, is a very serious condition that affects millions of Americans. The kidneys prevent harmful waste from entering the body, produce hormones and regulate water/hydration, so when the kidneys fail to do their job, it introduces a whole host of health concerns and, if left untreated, ultimately result in death.
While there are two main options for treatment -- dialysis and organ transplantation -- these alone won't fully restore kidney function. The patient needs to take a proactive role in their own health because it's imperative to make lifestyle changes; the most crucial of which includes dietary adjustments. Kidney patients often find that retaining kidney health has much in common with retaining overall health, with a few differences to keep in mind -- the differences between dialysis and transplantation dietary restrictions. Generally speaking, the doctor will recommend a renal dietitian to plan a long-term, personalized regimen, but here we'll go over the basics of what to expect.
Foods To Eat on Dialysis | Dialysis Dietary Recommendations
When a patient receives dialysis treatment for renal failure, it's important for them to avoid foods high in salt, potassium and phosphorus while eating more foods rich in high-quality protein.
What are Dietary Recommendations After Kidney Transplantation?
Post-transplant kidney diets have a few goals: to promote overall health and wellness, to maintain a healthy weight and to avoid interference with prescribed medicine. Generally speaking, patients spend quite some time on dialysis before they ever receive a kidney transplant, so by then the dialysis diet should be fairly routine. The doctor will inevitably prescribe immunosuppressant drugs after the surgery to make sure your body doesn't reject your new organ. This means that most of your new dietary restrictions will revolve around these medications.
For example, grapefruit is a big no-no for post-transplant patients because it renders immunosuppressants completely ineffective. While transplantation diets are typically planned for each individual patient, taking a variety of factors into account, there are a few generalities that apply to the vast majority of kidney transplant patients:
What is the DASH Diet?
The most commonly agreed upon and advocated diet when it comes to maintaining good health is the DASH (Dietary Approaches to Stop Hypertension) diet. It's been endorsed by the National Kidney Foundation, the American Heart Association, the National Heart, Lung and Blood Institute and the Dietary Guidelines for Americans. The diet is a renowned treatment because it slows the progression of heart disease, diabetes, kidney disease, cancer and hypertension. According to their website:
"The DASH diet eating plan is a diet rich in fruits, vegetables, low fat or nonfat dairy. It also includes mostly whole grains; lean meats, fish and poultry; nuts and beans. It is high fiber and low to moderate in fat. It is a plan that follows US guidelines for sodium content, along with vitamins and minerals."
When everything is said and done, diet and regular exercise play the largest roles in personal health at all times, not just during and after kidney disease treatment. Start getting used to checking the labels while shopping at the grocery store. Go for a walk or light jog every day. Maintaining a healthy weight, eating fruits and veggies, and getting regular exercise will go a long way to avoiding kidney failure in the first place. But if you feel that you or a loved one are at risk of kidney disease, schedule a consultation today to get help and take steps to living a healthy life.
ESRD and Kidney Failure Statistics Worldwide
Chronic kidney disease (CKD), while common in America (over 660,000 have kidney failure), is not unique to the US. It is a human condition and affects millions all over the world. While we tend to focus on issues that hit close to home, it's important to recognize the worldwide community that puts effort into fighting the battle against CKD with us. Here are some of the more notable international statistics about CKD.
The prevalence of ESRD and CKD worldwide is quite staggering. They occupy a large portion of government healthcare budgets and funds in many countries. The international community continues to research and develop treatment methods to try to quell this international health crisis.
If you or a loved one are affected by kidney disease, schedule a consultation with local experts for quality care.
The Link Between Kidney Disease and Diabetes
Although Chronic Kidney Disease (CKD) isn't commonly thought to be a massive health crisis, the fact still remains that 10% of American adults (~31 million) have it and about 96% of them are unaware of it. While there are many causes and variables that play into kidney disease's presence, there is one thing that will assuredly lead to CKD: diabetes. Anybody that knows anything about kidney disease has probably heard that there's a link between kidney disease and diabetes -- after all, diabetes is the most common cause of CKD. But what exactly is that connection? Here, we'll discuss the effects that diabetes has on kidney disease.
What is Diabetes?
Diabetes is a condition that causes the body to become unable to create insulin, which then results in elevated levels of glucose in blood and urine. Glucose is where your body derives its energy by cell absorption -- so if your cells are unable to accept glucose, it remains in your bloodstream, eventually causing numerous health issues, including kidney disease. For more information about diabetes and each type, see our in-depth article on the topic.
How Does Diabetes Affect the Kidneys?
Kidney disease caused by damage done by diabetes is referred to as diabetic nephropathy. It can be caused by either type 1 or type 2 diabetes, inhibiting your kidneys' ability to filter wastes from the bloodstream. However, an estimated 40% of people with type 2 diabetes will eventually experience diabetic nephropathy, whereas an estimated 30% of type 1 diabetics will suffer from it.
Here's how it works:
As our body harnesses nutrients gained from eating, the body needs to filter out the waste. The kidneys have capillaries with millions of tiny holes that act as a filter for waste to pass through. Since proteins and other nutrients are too large to pass through those capillaries, they remain in the bloodstream. The waste, on the other hand, gets dispelled as urine from the body.
Since diabetes causes the body to stop producing insulin, the element that keeps glucose levels in check, it comes naturally that therefore the body's glucose levels rise. When the body's glucose levels become too high, the excess glucose damages the capillaries, reducing their ability to filter waste from the blood and essentially widening the opening for other nutrients to pass through. This means that the proteins that SHOULD have remained in the bloodstream are now passing through the kidneys' filters along with waste products. Traces of protein in urine is called microalbuminuria and is a key indicator of the early stages of chronic kidney disease. In fact, one of the main ways doctors test for kidney failure is by testing albuminuria levels.
What To Do If Diabetes Causes Kidney Damage
Since symptoms of kidney damage don't usually surface until stage 3 of kidney disease, it's imperative to get regular testing done if you suffer from any type of diabetes, even before you show symptoms. If you find that your kidneys have sustained damage due to diabetes, there are a few steps you can take to mitigate it:
Complications from diabetes are serious and can be severe, if left untreated. If you have diabetes, it's important to get regular checkups for your kidney health. There's no one universal solution, since treatment plans are formulated on a patient-by-patient basis, so be sure to consult with your doctor or kidney specialist. If you feel that you are at risk for kidney disease, get in touch now to schedule an initial consultation.
The Connection Between Kidney Disease and Dementia
In the past few years, studies have been conducted that have suggested a link between Chronic Kidney Disease (CKD) and cognitive disorders such as dementia. The findings drew this correlation due to abnormalities in the capillaries, the smallest type of blood cell in the human body. Capillary abnormalities are found in the brain of every patient that dies from dementia; and recent findings have shown that significant, similar capillary damage is found in the kidneys of patients that suffer from albuminuria, a symptom of CKD that is classified by the presence of the protein albumin in urine. Albuminuria is most commonly caused by diabetes and hypertension, which in turn, cause issues with blood flow and blood cell health. This has led professionals to the conclusion that vascular damage in the brain and capillary abnormalities in the kidneys are connected.
How Does Kidney Disease Affect the Brain?
The human body is a network of functioning organs that all rely on each other to pull their equal weight. We don't often think everything is so intricately interconnected, but it really is. Think of the body as a piece of machinery -- every cog, gear, belt, and piston needs to be in working order for everything to function properly. If one part starts to deteriorate or loses function, other parts are affected or strained to make up for the weight that part used to pull.
Since the brain and kidneys are both organs that rely heavily on healthy cardiovascular systems, it comes as no surprise that diabetes and hypertension, causes of disrupted blood flow, can easily and significantly damage the kidneys and the brain. In the brain, untreated hypertension and/or diabetes can lead to white matter lesions that contribute to cognitive decline, while in the kidneys, they lead to strained and weakened blood cells from which it becomes harder to filter waste (you can read more about this in our article on renal hypertension.)
What Studies Have Been Done?
The Cardiovascular Health Cognition Study tested 2000 people over the age of 65. They took measurements of albumin levels and concluded that 15% of the group had cognitive impairment and 12% had dementia. Those tested that had albuminia were 50% more likely to have dementia than those that do not.
The Journal of the American Society of Nephrology published a study in 2015 that monitored 2,600 people in the Netherlands, which found that those with lower kidney function was strongly associated with low blood flow, risk of stroke and dementia.
"Given that kidney disease and (reduced blood flow to) the brain are both possibly reversible, there might be an opportunity to explore how improving these conditions can ultimately reduce one's risk of developing brain disease," Dr. M. Arfan Ikram, an assistant professor of neuroepidemiology at Erasmus University Medical Center in the Netherlands, said in a journal news release.
Adam Davey, associate professor of public health in Temple's College of Health Professions and Social Work, published a study in the journal Nephrology, Dialysis and Transplantation. It came to similar conclusions, he states,
"As we get older, our kidney function tends to decrease naturally, so if there's an extra issue involved in renal function like chronic kidney disease, we need to know about it as soon as possible. That is something that needs to be managed, just like you would manage hypertension. Patients are still going to be able to take their medicine on time and without assistance, as well as understand the information that their physician is sharing with them about their disease."
Over time, it's no debate that the human body will decrease in efficiency and functionality. But if some parts of our proverbial well-oiled machine start to give, so too do other areas. Having kidney disease will exacerbate other illnesses -- even mental ones. So if you feel that you or a loved one are at risk or are currently suffering from CKD, please see a specialist as soon as possible.
Eating Healthy During Holidays For Kidney Health
As the holidays quickly approach, it's important that those with kidney disease plan ahead a little bit more meticulously than most, especially if travel is involved. Chances are, your doctor or nutritionist has you on a meticulous diet and dialysis regimen that can't be thrown out of whack during the holiday season. While a "cheat day" here and there might be permissible for most, kidney patients don't really have that luxury, since it can set back treatment and reignite old habits -- and the holidays are no exception.
Find A Local Dialysis Center
If you're traveling during the holidays, remember that it's important to find a local dialysis center near your destination, far in advance. During the hustle and bustle of the holidays, you may find that appointments tend to get booked very quickly, so be sure to reserve your time. Call ahead to find out what type of documentation you'll need to bring with you. We've written extensively on the topic of dialysis during travel, so check out that article for more details.
How to Eat Healthy During The Holidays
Chances are that you'll be spending time during the holidays with family and/or friends eating, drinking and being merry -- all activities that make it easy to cheat on your nutritionist-prescribed dietary restrictions. But with these helpful tips, you'll be able to make it through the holidays without setting your health back.
The Importance of Kidney Donation
Chronic kidney disease (CKD) is a very overlooked and under-recognized affliction that affects approximately 30 million Americans -- the vast majority (96%) of whom don't even know it. In 2013, more than 47,000 Americans died of kidney disease. While this may seem grim, it's important to realize the disease's prevalence and how it works. CKD is an affliction that causes the kidneys to cease functioning. Since the kidneys are responsible for filtering waste out of the bloodstream, it goes without saying that when they stop working, other health complications will arise; and while it's true that if left untreated it will result in fatality, it is a perfectly treatable, not curable, ailment. There are two methods to treat CKD: dialysis or organ transplantation. Dialysis is the most timely, cost-effective way of treating CKD, but again, it's not a cure. Dialysis cleanses the blood via machines that, in effect, replace the kidneys. Even though it's an effective treatment, many people complain that it's time-consuming and inconvenient because the patient needs to visit a dialysis center or hospital an upwards of 3 or 4 times per week, each session lasting a few hours, for the rest of their life. A more permanent, yet complex, solution is transplantation.
Kidney transplantation is a one-time surgery that replaces dying or dead kidneys with healthy ones from a donor (living or deceased). With a few lifestyle changes and supplementary medication, the patient can return to normal life. "If it's so effective, why doesn't everybody receive it?", you may be thinking. Well, there are a few complications -- and they're not the easiest to overcome.
Healthy Kidney Demand
The number of CKD patients vastly outweighs the number of healthy, available kidneys. It's as simple as that. Patients can wait for years on the waiting list before a compatible donor is found. Currently, an estimated 93,000 patients are on the kidney donor list awaiting transplant. Patients' transplantation viability is measured on a number of factors, the main ones being:
Blood Type Matters
While it's not the biggest determining factor in locating a viable donor, it definitely matters in terms of quality of life after the transplant. It's possible to receive a donated kidney from the wrong blood type (aka ABO incompatible), but a lot of extra medical care will be required both before and after the procedure since organ rejection will be more likely.
However, tissue type also plays a role. When it's determined that a potential donor has compatible blood types, another test is done to compare genetic markers that indicate further compatibility. Because of this, the best way to find kidney donors is within your own family. Siblings have a 25% chance of being an exact match and a 50% chance of being a half match.
Live or Deceased Organ Donors -- Which is Better?
There are two types of kidney donors in this world: those that are alive and those that are deceased. The majority of live donors are family or friends of the patient, around 7,000 per year, in fact. Meanwhile, around 13,000 kidneys per year are donated from deceased donors. This fact skews the statistics regarding wait time for kidney transplant. Since many of the living donors are family or close friends to the patient, the average wait time for a live donor transplant is around 1 year. However, if the patient needs to receive a transplant from a deceased donor, the wait can take years, if a viable kidney is even found at all.
Organ donation is an uncomfortable topic for some people. It's natural that we don't like to face our own mortality, but the reality is that becoming a donor after death can save many innocent lives at no real cost to you.
If you or a loved one currently or are at risk of chronic kidney disease, schedule a consultation today. The sooner you visit, the greater the chances we can help you navigate the path to a healthy life.
The DASH Diet for Kidney Health
People who are worried that they are at risk of chronic kidney disease (CKD) often wonder what types of things they can do to take charge of their own health and reduce their risk of CKD progressing further. There are plenty of things one can do to improve kidney health (or at least prolong degradation). CKD is caused by other underlying conditions such as diabetes and hypertension, so addressing those issues will go a long way in preserving kidney health. Things such as quitting smoking, frequent exercise, staying hydrated, cutting down on alcohol and eating healthy are all major contributors to slowing the progression of kidney disease.
But one thing might be nagging you: you always hear about "eating healthy". But what exactly does that mean? And is there a way to eat healthier to reduce the risk of kidney disease? The answer to these questions is to integrate the DASH diet into your lifestyle.
Please note that those already on dialysis should not participate in the DASH diet. Dialysis patients consult with dieticians to receive custom-tailored regimens on a case-by-case basis.
What is the DASH Diet?
DASH, or Dietary Approaches to Stop Hypertension, is a way of eating that, well, puts a quash to hypertension. And since hypertension is a major source for CKD and the diet has so many additional health benefits, nutritionists recommend it for those that are at high risk of kidney disease. It encourages foods that are high in potassium -- fruits, vegetables, low-fat dairy -- high in fiber, low in fat, with plenty of magnesium, calcium, and phosphorus, all of which are beneficial to both heart and kidney health.
What Foods Can I Eat on the DASH Diet?
The word "diet" tends to deter people because often, the first things that comes to mind are temporary fads that are ultimately unsustainable in order to benefit in the short-term but offer no crucial health benefits in the long run. But don't automatically rule DASH out. It's not a fad diet -- it's a lifestyle changer. Those that participate in DASH are still able to eat the dishes that they know and love; there are just a few restrictions and modifiers to take into account. Plenty of cookbooks have been published to provide creative, delicious meals for those on the DASH diet. They also modify existing popular recipes to cater to those on DASH. Here are just a few examples of foods that can be created while adhering to DASH:
There are hundreds of delicious recipes that will satisfy both your appetite and the need to retain a healthy heart and kidneys. As you become accustomed to the various types of foods that are permitted within DASH, you can even start experimenting on your own to figure out what you most love!
The DASH diet has many health benefits aside from maintaining heart and kidney health. It assists in weight loss and will help to energize you throughout the day. So even if you're not suffering from CKD or hypertension, adopting elements of DASH into your everyday life can go a long way in your overall health.
Type 2 Diabetes Treatment Options
Diabetes is a disease that affects the body's ability to produce or process glucose (you may have also heard glucose referred to as "blood sugar"). When blood sugar levels are too high, insulin distributes it to the cells, converting it to energy that keeps you going throughout the day. Diabetes effectively prevents the body from producing insulin, resulting in excess glucose within the blood and leading to very serious health complications over time. An estimated 29 million people in the United States have some form of diabetes -- type 2 accounts for about 90-95% of the diabetic population.
The reason it's so much more common is in large part due to the fact that that type 2 is developed in life, whereas type 1 is a genetic defect. This means that type 2 is usually possible to treat with some lifestyle changes. Every treatment regimen is dependent on the patient's situation, but here are some suggestions you can expect to hear from your doctor.
Ditch the Tobacco
One of the most important and immediately beneficial steps you can take (not just for diabetes, but for your overall health, too!) is to quit smoking. According to the Centers for Disease Control and Prevention (CDC), regular smokers are 30–40% more likely to develop type 2 diabetes than nonsmokers. And people who smoke a pack per day are twice as likely to develop diabetes than nonsmokers.
Smoking can also lead to insulin resistance. This compromises the effectiveness of several treatment options -- many of the medications designed to treat diabetes are centered around producing supplemental insulin. But if your body can't utilize it anyway, those treatments are unviable.
Get the Blood Pumping
Aerobic exercises are your best friends in your fight against type 2 diabetes. The CDC recommends aiming for 150 minutes of aerobics per week. Broken down, that's about 30 minutes a day for 5 days out of the week. It doesn't have to be super rigorous, although the more intense, the better. Weight loss plays a major factor in reversing the effects of diabetes. Combining aerobics, like walking or jogging for 30 minutes, with resistance training, like weight lifting, will help control glucose even more effectively.
Exercise lowers blood sugar levels so it's important to monitor yourself before and after you work out. Eating a snack beforehand may be necessary. Your doctor will discuss your training regimen with you.
Monitor Your Nutrient Intake
Unfortunately there is no "one size fits all" diet for diabetes. Successful diabetes treatment requires constant monitoring of blood sugar, vitamins, fat, fiber, carbs, fat and salt. Generally speaking, diets for diabetics will be low in carbs, fats and calories but high in fiber and nutrients. Be prepared to eat a lot of fruits, vegetables, whole grains and healthy proteins like fish. Portion sizes and a consistent daily meal schedule are also taken into consideration when customizing your diet. Your nephrologist and a dietician will help you plan out a coherent schedule, rich with healthy meals based on your personal tastes.
If diet and exercise aren't enough to control blood sugar, medication will be introduced into the mix. There are a number of possibilities, each with their own ways of working. Some medications train your liver to retain more glucose. Some tell your pancreas to produce more glucose. Some lower insulin resistance so your pancreas doesn't have to work as hard. You may also get insulin supplements by injection, inhaler or an insulin pump for continuous treatment. Your doctor will explain what each drug does and makes recommendations on a case-by-case basis.
Life After A Kidney Transplantation: Now What?
If you've gone through the agony of kidney failure and don't have the capacity to do dialysis, then the only other option is to have a kidney transplant. The process of going through the waiting list, finding a compatible donor, and undergoing a successful surgery can be grueling and take a very long time. But barring those obstacles, if you're one of the lucky 16,000 per year in the US to receive a kidney transplant, there are some things you should know about recovery and your life post-surgery.
Recovery After Kidney Transplantation
Immediately following a kidney transplant, you can expect to be monitored in the hospital for anywhere between 24 hours to a few days, depending on your situation. Doctors will need to ensure that your body doesn't reject the new organ and that you're able to properly produce urine. Beyond that, you can expect to be out of commission during at-home recovery for 5-10 days. Recovery times vary from person-to-person, however it's important to note that your doctor will inform you of all the steps you need to take to make the most efficient recovery -- follow those instructions to a T. You will be able to return to your normal routine after 3-8 weeks.
Adapt and Retain a Healthier Lifestyle
One of the hardest parts of retaining your health after a kidney transplant is avoiding reverting to old habits that may have led to kidney failure in the first place. Changing the way you live is no easy task, but it's necessary if you expect your transplant to increase your lifespan. After all, what good is a brand-new kidney if you're not going to take steps to keep it healthy? Much of maintaining kidney health is connected with maintaining overall health, so you can probably guess what's coming -- that's right, diet and exercise.
Introducing more exercise into your daily routine is an absolute must. Even a 30-minute walk each day goes a long way to your physical and mental health. Refrain from lifting weights until your doctor gives you permission.
Better nutrition will play a larger role in your life from now on, as well. Dialysis carries harsher dietary restrictions than post-transplant life. And since you probably will have experienced dialysis while waiting for a donor, you can easily manage your new dietary requirements. Your diet will also heavily depend on the types of medication prescribed. For instance, while it's important to eat plenty of fruits and veggies each day, your nutritionist may advise you to avoid grapefruit because it can negatively affect certain immunosuppression medications, which are normally prescribed after a kidney transplantation.
Medications for Kidney Disease Transplants
You will need to take medications for the rest of your life, mainly consisting of immunosuppressants. These help the body "accept" the donated organ into the body seamlessly. Every person is different and immunosuppressants help to level the playing field, making the body more receptive to transplanted organs. Now, you may be thinking, "immunosuppressant -- does that mean it suppresses the immune system? Why would I want that?" First off, yes, you're correct. Immunosuppressants are drugs that reduce the strength of your immune system. However, the reason you need them is fascinating: when you receive a transplant, your immune system immediately recognizes the new kidney as a hostile foreign entity and begins to attack it, as it would any other unidentified bacteria or object. Without immunosuppressants, your body's immune system is capable of damaging or destroying the new kidney, bringing you back to square one. This process is called "organ rejection."
Strictly following your medication regimen is crucial to maintaining kidney function, so get to know the names of your meds, the dosage and any other details outlined by your doctor. You will probably have many different meds to take, so don't be shy about calling your doctor to explain the regimen again. Skipping or forgetting a dose should NOT be taken lightly. If you do forget a dose, call your doctor immediately to inform them and ask what steps to take.
What are the Signs of Transplant Rejection?
After the procedure is complete and you're spending time in recovery (and beyond), it's important to keep tabs on your body to ensure proper acceptance of the new kidney. Even if you're properly taking your meds, the body can still reject transplanted organs. Here are the signs of rejection -- if you experience any of these following a transplant, immediately call your doctor:
Don't be alarmed -- organ rejection doesn't mean that you'll lose your kidney. It is often fixed by adjusting the type or dosage of medications. If you do experience rejection, you'll be hospitalized for a few days as doctors try alternative immunosuppressants and monitor your progress.
Despite having its share of potential complications, kidney transplant is the optimal way to cure kidney failure. Patients experience a much higher quality of life than those on dialysis and are able to go on living healthily for the rest of their lives. If you have any questions about kidney failure or feel that you may be at risk, feel free to get in touch with us. We'll be happy to schedule a consultation.