Sleep Disorders and Kidney Disease
The kidneys, the most important excretory organ of the body, help to clean the blood by removing extra water, minerals, and wastes. In addition, they also make hormones that keep your bones strong and blood clean.
When the kidneys stop working, problems can arise. Such problems include anemia and disorders that affect the skin, bones, and nerves.
Conditions that are commonly caused by kidney failure include:
- Extreme tiredness
- Bone problems
- Itching (pruritus)
- Joint problems
- Sleep disorders
In addition, totally damaged kidneys result in build up of harmful wastes in the body, rise in blood pressure, causes the body to retain excess fluid and not make enough red blood cells. Treatment is necessary to replace the work of the failed kidneys.
Having a low count of red blood cells (RBCs) in your blood is called anemia. RBCs are the primary cells that carry oxygen to the different tissues and organs of the body. Without oxygen, cells cannot use the energy from food. Because of this, someone with anemia may tire easily and look pale. Having a low RBC count may also contribute to heart problems.
Anemia is commonly experienced by people with kidney disease. Normally, healthy kidneys produce a hormone called erythropoietin, or EPO. This hormone stimulates the bone marrow to produce red blood cells. People with damaged kidneys, however, do not make enough EPO. This results in less production of red blood cells.
Anemia may begin to develop during the early stages of kidney disease. It tends to worsen as the disease progresses. Nearly all people with kidneys that totally stop working have anemia. Complete failure of the kidneys is sometimes known as end-stage renal disease.
Treatment of anemia in people with kidney disease may include injection with a man-made EPO.
Renal osteodystrophy was the term used in the past to describe the mineral and hormone disturbances caused by kidney disease. Now, the term renal osteodystrophy is used only to describe the bone problems that result from a condition called chronic kidney disease-mineral and bone disorder (CKD-MBD).
Itchy skin, medically termed as pruritus, is a common complaint among people treated with dialysis. However, itching is also common even in people who do not have kidney disease. In people with kidney failure, wastes in the bloodstream that are not completely removed through dialysis make the itching worse.
Kidney disease related itching might also be related to high levels of parathyroid hormone. Some people have experienced dramatic relief after having their parathyroid glands removed. However, a cure for itching that works for everyone has not been found. In some people, taking phosphate binders that bind phosphorus while in the stomach seem to help. Others find relief after exposure to ultraviolet light. Still others feel improvement with EPO shots. Certain antihistamines have also been found to help. In any case, taking care of dry skin is important. Applying creams with lanolin or camphor may help.
Your health care provider can provide you with informations about medications or creams that you can use to manage the itching.
Sleep Disorders and Kidney Disease
Patients on dialysis often have insomnia, and some people have a specific problem called the sleep apnea syndrome, which is often signaled by snoring and breaks in snoring. Episodes of apnea are actually breaks in breathing during sleep. Over time, these sleep disturbances can lead to “day-night reversal” (insomnia at night, sleepiness during the day), headache, depression, and decreased alertness. The apnea may be related to the effects of advanced kidney failure on the control of breathing. Treatments that work with people who have sleep apnea, whether they have kidney failure or not, include losing weight, changing sleeping position, and wearing a mask that gently pumps air continuously into the nose (nasal continuous positive airway pressure, or CPAP).
Many people on dialysis have trouble sleeping at night because of aching, uncomfortable, jittery, or “restless” legs. You may feel a strong impulse to kick or thrash your legs. Kicking may occur during sleep and disturb a bed partner throughout the night. The causes of restless legs may include nerve damage or chemical imbalances.
Moderate exercise during the day may help, but exercising a few hours before bedtime can make it worse. People with restless leg syndrome should reduce or avoid caffeine, alcohol, and tobacco; some people also find relief with massages or warm baths. Some prescription medications may also help as well.
Sleep disorders may seem unimportant, but they can impair your quality of life. Don’t hesitate to raise these problems with your nurse, doctor, or social worker.
Dialysis-related amyloidosis (DRA) is common in patients, especially older adults, who have been on dialysis for more than 5 years. DRA develops when proteins in the blood deposit in bones, joints, and tendons. This can cause pain, stiffness, and fluid build-up in joints. Amyloid is the term used for abnormal depositions of proteins in tissues, and the disease process is called amyloidosis. Amyloid deposits may cause abnormal tears in ligaments and tendons.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about half of people with DRA also develop a condition called carpal tunnel syndrome. It results from the unusual build-up of proteins in the wrists. Symptoms may include numbness or tingling sensation in the fingers and hands.
Unfortunately, there is no cure for DRA. Treating the complications, however, is beneficial, such as correcting the torn ligament or tendon and treating carpal tunnel syndrome. Successful kidney transplant may also stop dialysis-related amyloidosis from progressing.
National Kidney and Urologic Diseases Informations Clearinghouse. Amyloidosis and Kidney Disease. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD. NIH Publication No. 06–4694, May 2006
National Kidney and Urologic Diseases Informations Clearinghouse. Anemia in Kidney Disease and Dialysis. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD. NIH Publication No. 05–4619, January 2005
National Kidney and Urologic Diseases Informations Clearinghouse. Renal Osteodystrophy. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD. NIH Publication No. 06–4630, January 2005