Guest Blogger – Colin Caywood
In honor of March’s official designation as National Kidney Month, fellow Food Safety News contributing writer Dave Babcock recently published an article, National Kidney Month Kicks Off. In his article, Babcock discusses the connection between long-term kidney health and food safety, a connection which most commonly flows from the development of hemolytic uremic syndrome (HUS) caused by toxins from foodborne bacteria like shiga toxin-producing Escherichia coli (E. coli).
As anyone who has been forced to suffer through ESRD can attest, the physical and mental effects it can cause are devastating.
While it is true that various treatment options presently exist, none of those options are especially desirable. The biggest and most obvious decision for a person diagnosed with ESRD to make is whether to sustain on dialysis for as long as possible, or seek out a kidney transplant, likely enduring dialysis anyway during the waiting period.
If given the choice, most people with ESRD will opt for a kidney transplant. There is evidence that a transplant can increase a person’s life expectancy up to three times longer than dialysis alone. It can also have a much less invasive effect on a person’s day-to-day life when compared with the requirements of dialysis. Unfortunately, the wait-time for a donor kidney is often a year minimum, but usually longer depending on a variety of factors.
One such wait time factor is blood type. For example, a person with a rare blood type O will have the longest wait period, usually three to four years. Because a patient with blood type O has antibodies against blood types A, B, and AB, it severely limits the donor pool from which a kidney may be harvested. If the patient is fortunate, perhaps a deceased or living close relative, such as a parent or sibling over the age of 18 and who is compatible with the patient, will be able to donate a kidney. Regardless, while awaiting a donor, an ESRD patient must undergo dialysis treatment just to survive until the transplant operation can be performed.
Assuming the patient survives the transplant procedure, they can then look forward to a lifetime of immunosuppressive medications, necessary to prevent their body from rejecting the transplanted kidney. The artificial suppression of the immune system is–as nearly anyone can surmise–fraught with considerable side effects.
Commonly used immunosuppresants include cyclosporine, tacrolimus, meclophenalate, imuran, and corticosteroids. Cyclosporine and tacrolimus have side effects that include increased hair growth and gum hypertrophy, as well as, ironically, damage to the kidney. Meclophenalate and imuran are known to cause low white blood cell count and increased susceptibility to infection. Corticosteroids can produce the undesirable Cushing’s syndrome (fatty deposits around the facial cheeks, as well as on the abdomen and back), weight gain, emotional instability, cataracts, decreased growth, softening of the bones and bone pain, hypertension, acne, and difficulty in controlling glucose levels.
Immunosuppressants, like those described above, are necessary for organ transplant recipients. They reduce the body’s immune response, thereby preserving the useful life of the transplanted kidney which the body would otherwise recognize as foreign and dangerous. If this occurs, it sets off a chain of events that culminate in the body’s rejection of the kidney. But because a healthy and timely immune system response is the body’s critical and natural defense against illness, immunosuppression therapy necessarily leads to a lifetime of heightened susceptibility to serious infection, accelerated hardening of the arteries, cancer, and chronic kidney rejection.
Assuming the transplanted kidney is received by the patient without complication, no transplant lasts forever. The patient’s transplanted kidney can be expected to last about 15 years if it comes from a living donor, or about 10 years if it comes from a cadaver. Of course, the younger the patient develops ESRD, the higher the probability that a second, or even third, kidney transplant will be required during their lifetime. As each transplant reaches the end of its useful life, the patient will fall back into the cycle of ESRD, dialysis, an increase in kidney-related medical problems and then–assuming another kidney transplant is possible–recovery from transplantation.
Either decision the patient makes–transplant or dialysis–will involve dialysis treatments regardless. As with a transplant, the patient’s quality of life is guaranteed to suffer markedly. There are generally two modes of dialysis an ESRD patient may undergo: peritoneal dialysis or hemodialysis.
Peritoneal dialysis has been a major physical therapeutic method of therapy for ESRD for several years. Continuous Ambulatory Peritoneal Dialysis (CAPD) and automated peritoneal dialysis, also called Continuous Cycling Peritoneal Dialysis (CCPD), are the most common form of dialysis therapy used in children. In this form of dialysis, a catheter is placed in the area around the stomach. Dialysate (a chemical bath that draws fluids and toxins out of the bloodstream) is placed into the abdomen and changed four to six times a day. While children must often go to a medical treatment facility, adults can usually perform CAPD/CCPD at home.
The known compilations of peritoneal dialysis include peritonitis (infection of the fluid), which can be a major risk. Symptoms of peritonitis include fever, excruciating abdominal pain with movement, nausea, and vomiting. If left untreated, it usually results in death.
The other common dialysis method to treat ESRD is hemodialysis. During hemodialysis, blood in taken out of the body by a catheter or fistula, and circulated in a machine that simulates the kidney’s natural cleansing process, removing harmful toxins and excess fluid from the blood. While the hemodialysis process itself does not physically hurt, patients usually experience nausea and abdominal cramps as excess fluid is pulled from the body, along with fluctuations in blood pressure and heart rate. Hemodialysis is generally performed three times a week, and takes a major time commitment–three to four hours per session is the average.
Beyond the transplant and dialysis complications, bone disease is nearly universal in patients with ESRD. As a result, patients will be prone to develop bone pain, skeletal deformities and abnormal shaped bones, and have a propensity for fractures with minor trauma. Treatment of the bone disease associated with ESRD includes careful control of the patient’s serum phosphorous and calcium levels with stringent dietary restrictions, calcium supplements, phosphorus binders, and various other bone disease-fighting medications.
The last major common complication of ESRD worth mentioning is anemia. Anemia can be treated with a shot of erythropoietin given under the skin one to three times a week, or once every few weeks with a longer acting dose. Erythropoietin is a hormone normally produced by the kidney that promotes the formation of red blood cells in the bone marrow. In patients suffering from ESRD, this hormone ceases to be produced, thus anemia results. Left untreated, anemia can cause severe fatigue, nerve damage, mental impairment, heart problems, and death.
Given the gloom and doom of this article, it is important to remember that a person’s diagnosis with ESRD is a not a death sentence. But just because a person is fortunate enough to survive a serious shiga toxin-producing E. coli infection and HUS–often the result of foodborne contamination–kidney damage sufficient to result in ESRD will continue to affect their life long after the E. coli infection has passed. The vast complications of ESRD are incredibly serious, often painful, and certain to drastically reduce a person’s overall quality of life.