The kidneys are as important to your health as your heart or
lungs but far less understood. We normally have two kidneys the size of
clenched fists in the back of our abdomens, on each side of the spine,
processing about 50 gallons of blood each day. These vital organs
regulate water in the body and remove wastes, such as urea and
creatinine. They not only filter the blood but also produce important
hormones that balance the body's electrolyte levels, control blood
pressure and stimulate the production of red blood cells. In patients
with chronic kidney disease (CKD), the kidney's filtering ability has
been damaged over many years due to medical conditions such as diabetes
or hypertension. It is often called the "silent disease" because most
people have no symptoms before they are diagnosed.
The number of Canadians living with kidney failure has tripled over the past twenty years. Although some causes of kidney failure are sufficiently treatable to return the organ's normal function, other cases may be progressive and irreversible. Symptoms due to an eventual accumulation of waste products may cause weakness, shortness of breath, lethargy and confusion. Build-ups of potassium in the bloodstream may lead to abnormal heart rhythms and sudden death. Blood and urine tests are used in diagnosis but if the kidneys fail completely there may be no other treatment options but dialysis or transplant.
Dialysis is a treatment to clean the blood and filter toxins and excess water from the body. In hemodialysis, the blood is cleaned by being passed through an artificial kidney machine, usually taking three or four hours, three times a week. Peritoneal dialysis uses a similar filtration process but the blood is cleaned inside the body instead of a machine. Patients most often travel to an outpatient centre for these life-saving treatments but home dialysis is increasingly an option.
Hospitals with dialysis units use professionals with pharmacy technician training to document medication histories, manage the medicine inventory and pre-package dialysis-specific medications. CKD patients often need medications for conditions including:
- High blood pressure
- Fluid overload
- Diabetes
- Anaemia
- Bone disease
- Vitamin deficiency
- Constipation
- High potassium
- Stomach problems
Patients have the most contact with community pharmacists and technicians, whose careful therapeutic drug monitoring can prevent most adverse effects. Pharmacists need to ensure that CKD cleared drugs are adjusted as the kidneys fail and patients will need help understanding their many medications. For example:
- Since patients are often fluid restricted, they shouldn't take much water with their medications
- Oral iron supplements need to be taken on an empty stomach to optimize their absorption
- Calcium or aluminum products are prescribed as phosphate binding agents, not antacids, and must be taken with meals
- If they're on a diuretic they should avoid potassium-rich foods like oranges and bananas
- CKD patients should be identified by staff that have taken pharmacy technician courses so the proper counselling can be provided.
The number of Canadians living with kidney failure has tripled over the past twenty years. Although some causes of kidney failure are sufficiently treatable to return the organ's normal function, other cases may be progressive and irreversible. Symptoms due to an eventual accumulation of waste products may cause weakness, shortness of breath, lethargy and confusion. Build-ups of potassium in the bloodstream may lead to abnormal heart rhythms and sudden death. Blood and urine tests are used in diagnosis but if the kidneys fail completely there may be no other treatment options but dialysis or transplant.
Dialysis is a treatment to clean the blood and filter toxins and excess water from the body. In hemodialysis, the blood is cleaned by being passed through an artificial kidney machine, usually taking three or four hours, three times a week. Peritoneal dialysis uses a similar filtration process but the blood is cleaned inside the body instead of a machine. Patients most often travel to an outpatient centre for these life-saving treatments but home dialysis is increasingly an option.
Hospitals with dialysis units use professionals with pharmacy technician training to document medication histories, manage the medicine inventory and pre-package dialysis-specific medications. CKD patients often need medications for conditions including:
- High blood pressure
- Fluid overload
- Diabetes
- Anaemia
- Bone disease
- Vitamin deficiency
- Constipation
- High potassium
- Stomach problems
Patients have the most contact with community pharmacists and technicians, whose careful therapeutic drug monitoring can prevent most adverse effects. Pharmacists need to ensure that CKD cleared drugs are adjusted as the kidneys fail and patients will need help understanding their many medications. For example:
- Since patients are often fluid restricted, they shouldn't take much water with their medications
- Oral iron supplements need to be taken on an empty stomach to optimize their absorption
- Calcium or aluminum products are prescribed as phosphate binding agents, not antacids, and must be taken with meals
- If they're on a diuretic they should avoid potassium-rich foods like oranges and bananas
- CKD patients should be identified by staff that have taken pharmacy technician courses so the proper counselling can be provided.
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