Robert Toto, M.D. Answers Questions On: Kidney Failure

There are several common misconceptions, and they are mostly misunderstandings about how kidney failure develops. One is that alcohol is bad for the kidneys. Alcohol can cause liver failure, but it’s not a cause of kidney failure.

Many patients also think that drinking a lot of fluid is good for them because it flushes out their kidneys. Now in some patients, such as people with kidney stones or certain types of kidney disease, we do ask them to drink large amounts of fluid. But 75 percent of the cases of kidney failure occur in people with diabetes or high blood pressure, and in general, drinking a lot of extra fluid doesn’t improve kidney function in those people.

Two other misconceptions are about the symptoms of kidney disease. Many patients assume they would notice signs of kidney disease, especially pain or a change in their urine. For most people with diabetes and high blood pressure, kidney disease is a silent disease as it’s progressing—it’s not commonly associated with pain or with less urine flow, except in end-stage disease. Whether or not you make normal amounts of urine doesn’t determine whether or not you have normal kidney function.

Many of our most effective treatments have been around for a while now, but we are refining some of our treatment strategies. For example, one thing that seems to be beneficial to patients who are on dialysis is longer dialysis sessions, like overnight dialysis or more frequent dialysis—there’s some data suggesting that these techniques offer better quality of life, and perhaps longer survival.

There are also two new medications that are still being studied for controlling potassium – a concern in many patients with kidney failure. When patients develop high potassium, which is common because of the medications we use to treat kidney failure, it can be dangerous and also difficult to treat. If these drugs prove to be effective at lowering potassium levels, they could lower a person’s risk for complications and also make his or her life a lot easier; a lot of food contains potassium, so these patients have to limit their diet in order to keep their potassium from going too high.

Yes. Transplant patients do really well, especially the first year or two. We still struggle with the loss of kidney function in kidney transplant patients who are four, five, or six years out.

We’re starting to see that those kidneys are losing function over time, and we don’t understand completely why. Now that’s not everybody, but that’s still a major issue for kidney transplants. So a lot of the work that’s being done in terms of treatment after transplant is focusing on how to prevent this subsequent loss of kidney function.

I think anti-inflammatory drugs is the area today’s research will head toward. Patients with kidney damage due to diabetes have a lot of inflammation in the kidney. And so there are efforts now to identify drugs that can reduce inflammation and oxidative stress, and I think this is where we might have significant impact.