Renal failure

Number of patients

According to the Russian Dialysis Society for 2019, from 7 to 15% of the world's adult population suffer from chronic kidney disease (CKD), but no more than 4% are aware of this.

According to data for 2021, about 840 million people around the world live with this disease, of which 47 million are located in the EU countries. At the same time, many have not been diagnosed with the disease.

In Russia, the number of patients with CKD, as of 2019, is about 700 people per 1 million population. Despite the fact that there are relatively few patients with such a disease, studies show that in Russia the number of people with various kidney disorders is increasing. For example, signs of albuminuria (a renal disorder in which protein is released together with urine) are observed in 42% of the adult population^[1].

Location in body

Two kidneys are located on either side of the spine behind the abdominal cavity, which is enclosed in the peritoneum. To avoid injury, they are located under the lower ribs and surrounded by a fat layer. They are fist-sized bean-shaped organs that vary slightly in volume depending on body size as well as primary pathology. On average, they reach 10 cm in height, 5 cm in width and 4 cm in thickness. A healthy kidney weighs about 120-200 g.

Renal functions

The kidneys are vital organs and perform excretory (excretory) and secretory (active excretion) functions. They are responsible for removing waste products from the body, regulating the composition of body fluids and releasing some hormones.

Every day 1500-2000 liters of blood are filtered in the kidneys. In 5 minutes, the entire volume of blood contained in the body manages to pass through the kidneys (in an adult it is about 5 liters). And all blood fluid manages to filter approximately 300 times per day.

Unsurprisingly, the total length of capillaries in one kidney is 25 kilometers.

Thus, their functioning is critical for balanced metabolism in the body. As a result of the disease, the kidneys may partially or completely lose the ability to perform these tasks. Kidney disease occurs when the kidneys can no longer fully perform these functions. Persistently reduced kidney function is called chronic renal failure (CKD).

Renal Performance Indicators

Creatinine in the blood

Creatinine is formed in muscles and then released into the blood. Creatinine is involved in the energy exchange of muscle and other tissues. Creatinine is excreted from the body by the kidneys in the urine, so creatinine (its amount in the blood) is an important indicator of kidney activity.

Urea

Urea is a vital product of the body resulting from the normal breakdown of protein in the liver. Urea is removed from the blood by the kidneys. Urea accumulates in the body as a result of impaired kidney function - and indicates a level of decline in kidney function.

Causes of renal failure

Main article: Kidney diseases

Renal insufficiency may result from a gradual decline in renal performance (CKD) over a long time or may be a consequence of sudden renal failure (i.e. acute renal failure - CNI).

Chronic kidney disease is a gradual and progressive decrease in kidney function that lasts for several years and leads to irreversible renal failure. A variety of causes can lead to chronic kidney failure. The most famous include:

• diabetes mellitus,
• chronic kidney inflammation (pyelonephritis),
• autoimmune kidney damage (glomerulonephritis),
• increased blood pressure (hypertension) and other vascular injuries.

As chronic kidney disease progresses, kidney failure develops - a decrease in kidney function. At the last, fifth stage of chronic kidney disease, end-stage renal failure develops. People with end-stage renal failure need dialysis or kidney transplantation to replace the work of sick kidneys. Terminal chronic renal failure - means a decrease in kidney function to a critical level, that is, the kidneys function by less than 15-10%.

Acute renal failure - a sudden and temporary decrease in kidney function. Acute kidney failure can be caused by a deterioration in the supply of blood to the kidneys, difficulty leaving urine, or traumatic damage to the kidneys, for example, due to surgery or a car accident. Acute renal failure, unlike chronic, is curable. Treatment is done by intermittent or continuous methods of renal replacement therapy, which is usually performed in the hospital resuscitation unit.

Consequences: uremia and renal anemia

With a decrease in kidney function, the formation of urine is disturbed and its components, for example, water and waste products, accumulate in the body, which leads to uremia.

Renal (nephrogenic) anemia - a decrease in renal function in chronic renal failure leads to a lack of erythropoietin, resulting in an insufficient amount of red blood cells. As a result, there is a decrease in the ability of the blood to tolerate sufficient oxygen. Read more here.

Chronic kidney disease is characterized by an increased risk of developing cardiovascular disease (CVD), such as heart failure and premature death. In the development of end-stage renal disease (ESRD) - the most severe form of this disease - due to damage to the kidneys and deterioration of their function, dialysis or transplantation is required. Most CKD patients die from CVD before developing ESRD.

Therapy

Kidney transplantation

Main article: Kidney transplantation

A kidney transplant is an operation in which a healthy kidney from another person is transplanted into the body of a patient suffering from chronic renal failure. A kidney transplant may be obtained from a living donor, usually a relative, or from a deceased person. Read more here.

Dialysis - renal replacement

Main article: Dialysis

If you do not do extracorporeal blood purification, then renal failure leads to death. Hemodialysis and peritoneal dialysis are the main ways to replace kidney function.

Dialysis is a method of partial replacement of kidney function, during which blood is purified from waste products, excess salt and liquids are removed, and blood pressure and the balance of electrolytes such as potassium, sodium, chlorides, etc. are maintained.

For some patients, only a certain method of therapy is suitable. Not every dialysis center offers all kinds of treatments.

There are three main types of therapies:

• Hemodialysis (HD) is a treatment during which an arteriovenous fistula is formed with the help of a surgeon, through which blood moves to a dialysis machine, undergoes purification and safely returns back to the patient's body.
• Peritoneal dialysis (PD) is a process in which a catheter is permanently implanted into the abdominal cavity. Blood purification occurs using the peritoneum in the abdomen. A special solution is poured into the abdominal cavity through the installed catheter, into which toxic substances and excess fluid come from the blood, passing through its own filter - the peritoneal membrane. This process can be performed by the patient on his own.
• Kidney transplantation is the posture of a healthy kidney. A kidney transplant may be obtained from a living donor, usually a relative, or from a deceased person.

To decide which therapy option is more appropriate for the patient, various medical, social and psychological aspects need to be considered. The doctor will advise which treatment is most appropriate.

2023

A device has been created to delay dialysis treatment for patients with chronic kidney disease

On September 6, 2023, it was reported that a medical device developed by the Israeli company Curespec is able to delay dialysis treatment of patients with stage three and four chronic kidney disease (CKD) for up to 12 months and is already undergoing clinical trials in hospitals and medical centers in several countries of the world. Read more here.

A technology has been developed that is more effective than dialysis in renal failure. It reduces mortality in such patients by 23%

In June 2023, it became known about the creation of a new dialysis technology, which, according to the developers, is more effective than traditional dialysis for kidney failure. It reduces mortality in such patients by 23%. The find was shared by scientists at the University of Utrecht. Read more here.

See also

• Healthcare in Russia

Notes