High K and nerve dammage

Discussions for Patients, Family, and Friends HD For Patients
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Kidney patients warned away from potassium
Medical Research News
Published: Tuesday, 2-May-2006
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Many kidney failure patients are increasing their chance of nerve damage in their legs and feet by simply having too much potassium in their diet, according to research carried out by the University of New South Wales (UNSW), the Prince of Wales Medical Research Institute (POWMRI) and the Prince of Wales Hospital.
The researchers found that high levels of potassium, which is found in foods such as bananas and peanuts, is responsible for causing nerve damage in these patients, which in extreme cases can lead to people being forced to use a wheelchair.

One in three Australian adults have an increased risk of developing kidney disease, which is commonly caused by diabetes. In end stage kidney disease, the kidneys function at less than ten percent of normal capacity and cannot sustain life of the patient without dialysis or a kidney transplant. 52,000 Australians have severe kidney function impairment or kidney failure (Kidney Health Australia).

“The majority of people with end-stage renal failure have nerve damage, in their legs and arms. This can mean they have difficulty walking or in feeling their feet,” said Dr Arun Krishnan, a Neurologist and PhD candidate in the Faculty of Medicine at UNSW. "Once nerve damage develops, it cannot be reversed unless the patient undergoes renal transplantation. But our research indicates that patients do have some control over their situation.

“We found that higher levels of potassium in renal failure patients cause that nerve damage,” said Dr Krishnan. “The clear health message is that anyone with kidney failure or chronic kidney problems should regulate their intake of potassium in an attempt to preserve nerve function.”

Potassium is found in foods such as bananas, peanuts, soybeans, apricots and sultanas.

The research Sensory nerve excitability and neuropathy in end stage kidney disease has just been published in the Journal of Neurology, Neurosurgery and Psychiatry.

“Scientists have known for a long time that potassium was an important substance in terms of regulating nerve function, but until now no-one has made the connection between kidney function and nerve function,” said co-author UNSW Associate Professor Matthew Kiernan, a neurologist based at the Prince of Wales Hospital.

“Until now, kidney specialists have been less concerned about higher levels of potassium amongst these patients, unless they were affecting the heart,” said Professor Kiernan. “The clear message is that potassium levels need to be monitored in terms of nerve function too.”

The other authors are R K S Phoon, B Pussell and J Charlesworth, all from the Department of Nephrology at the Prince of Wales Hospital.

The research was supported by the Australian Association of Neurologists Research Fellowship and the NHMRC. Grant support from the Brain Foundation, the Sylvia and Charles Viertel Charitable Foundation and the Ramaciotti Foundation.

http://www.unsw.edu.au

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Both times I have gone on dialysis I have developed nerve damage. I was told it is a result of all the waste build up in your blood. Most of my feet are numb. Its a weird feeling, I can feel certain things, and my feet get very painful and hot.
When I got a transplant, my feet went back to normal.

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How high was your K and where exactly do your feet feel painful?

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Patients on conventional three times a week HD are encouraged to limit their intake of potassium to 2 grams (2000 mg) of potassium per day. People on PD and on more frequent HD need to ask their dietitian how much potassium they have daily.

Here’s a lengthy article on uremic neuropathy that discusses what was known in 2005 about it. It does briefly discuss sodium and potassium interfering with the nerve function and provides a long list of possible uremic toxins that could interfere with nerve function. It also talks about how transplant can reverse or improve the neuropathy.

http://www.emedicine.com/neuro/topic389.htm

I think the bottom line of this is to do your best to keep your labs as close to normal (or the renal normal) as you can, to get as much dialysis as possible, and to consider transplant. Of course, with transplant you get a whole different set of problems. One long-term patient told me that she thought the best approach if you have kidney failure is to rotate back and forth between dialysis and transplant so that each could counter the ill effects of the other. She has had 4 transplants in her 40 years with kidney failure.

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The highest my potassium has been is 6.8. Which was high enough to give me twitching, weak muscles, and nausea.

Beth, what sort of problems are you referring to in regards to receiving a transplant?
I dont know about “rotating back and forth” between dialysis and a transplant. :shock: Its not exactly a “choice” you can make. Load of hogwash if you ask me. I have had one transplant, and I can tell you now I would rather that any day, 100%.

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Oddly enough, the actual concentration of serum potassium doesn’t change that much comparing short daily, daily nocturnal and conventional 3 times per week hemo. It’s only goes down to about the concentration in the dialysate, no more. And then it gradually moves up to around 5.0, more or less. So, in terms of the actual numbers, potassium is in the same range. The advantage of daily treatments is mainly that you can eat more since you know you don’t have 2 or 3 days to wait until the next time.
Pierre

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Beth, what sort of problems are you referring to in regards to receiving a transplant?

In addition to having to pay for very expensive medications as long as your transplant works, other complications of transplant include:
– Risk of infection
– Kidney damage from anti-rejection drugs
– High blood pressure
– Increased appetite
– Weight gain
– Tremors
– Diabetes
– Acne
– Mood swings
– Increased hair growth
– Gum overgrowth
– Cataracts
– Joint problems and need for joint replacement surgery
– Stomach irritation
– Rounder face
– Flushed feeling
– Cancer
– Death during surgery or post-transplant

I have known people with transplants who have had some or all of these complications. I’m not listing these to say that people shouldn’t get transplants because I think a transplant does allow someone to live a more “normal” life than having to do dialysis. However, transplants are not a cure, but just another treatment. I hope people considering transplants know that these are risks and are choosing a transplant in spite of them.

I dont know about “rotating back and forth” between dialysis and a transplant. Its not exactly a “choice” you can make. Load of hogwash if you ask me. I have had one transplant, and I can tell you now I would rather that any day, 100%.

So far as to going back and forth between transplants and dialysis, some people I know have had multiple living donors. I know several people who have had kidney disease for over 30 years both in my area and through my involvement in various organizations. Three people I know have had 4 transplants over 30-40 years of kidney failure, some from living donors and some from the transplant list. Other people I know have had transplants that have lasted decades. I don’t know a single transplant recipient who hasn’t had some of these complications. All are glad to have had a transplant in spite of them.

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Pierre, the reason why we can eat what we want is because the length and slowness of nocturnal decreases our sensitivity in a way that stops our potassium and other levels from shooting up on our days off.
The reason why I had potassium trouble before, was because of the short treatment times, I was getting rebound potassium.
This is how our nocturnal works anyway. We do 8-10 hours either every second night, or 4 nights a week. I am guessing if you do it daily, then you may still get the rebound potassium, but seen as you are dialysing the next day, it doesnt get a chance to go too high?

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Sorry jane I didnt answer your other question. Its a bit hard to explain my feet pain. They get very sore if Im walking around too much, mainly my toes and the front half of the sole. I also get shooting pains up my toes, and generally my entire foot is extremely sensitive. Just touching the tops of my foot feels horrible. Its a weird sort of feeling, not sure how to explain it.

Beth, I think its worth getting a transplant if its offered. I guess you dont know how its going to go until it happens. I never had to pay much for medications, its actually costing me more for meds on dialysis.
Some of those risks are the same as for dialysis. I had one infection in my wound, which I got when the nurses were doing my dressing (one of them rubbed her nose then proceeded to peel my dressing off!), mild hypertension, put on 10kgs, ate too much, got a bit of acne, hair growth, round face, stomach ulcers, and over 100 breast lumps. All this stuff isnt that great, but for the 7 good years I got, it was so worth it. It allowed me to live a completely normal life, and go to uni. I managed to get the weight off by developing my own diet, and going for daily walks. The increased appetite subsides when the prednisolone is reduced. I took doxycylin for acne, which worked very well. I had a bit of hair growth on my arms and side of my face, which was fixed with a bit of bleach, no problems. One good thing that came of that, was my hair was just lovely. It went soooo thick and glossy. Then 3/4 of it fell out :frowning: I think it was due to the stress of uni.

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The studies are there to prove that a transplanted patient lives longer than a dialysis patient. The only thing is, we don’t really know if that applies to daily hemo, because there haven’t been any good studies yet involved enough patients for enough time.

I’ve know some transplant patients have a pretty rough time the first 6 months or so, some a year, but even those settle down after that. It doesn’t make sense for a relatively young or middle aged person not to take advantage of the ability to get a transplant when they can.

Pierre

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Ah man,

I remember my transplant…its has its bad sides as well you know…its not real freedom BUT will do things dialysis alone can’t do.

For some people its a GODsend, sheer luck … :slight_smile: maybe you could be next? Never hurts to have hope and faith, so just go for it!

Once there’s more research just maybe daily dialysis and Nocturnal may prove to be somewhat or slightly better than a transplant. :smiley:

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amba_79 writes:

Sorry jane I didnt answer your other question. Its a bit hard to explain my feet pain. They get very sore if Im walking around too much, mainly my toes and the front half of the sole. I also get shooting pains up my toes, and generally my entire foot is extremely sensitive. Just touching the tops of my foot feels horrible. Its a weird sort of feeling, not sure how to explain
it.

Welcome to the board -love you Aussie ppl! How long have you been on dialysis, are you diabetic? Have wondered about foot problems as have read where others experience it, too. None of my nephs educate until we come up with something and ask what is going on -have to find out from other patients’ experiences. What does your neph say…have you had it looked at by a specialist?

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Been on dialysis for about 2.5 years…cant remember exactly how long :?
Im not diabetic, but the doctor I used to see said I will be if I dont lose weight.
I have got peripheral neuropathy, basically from being inadequately dialysed. I was on PD for 18 months, and 12 months of that I was extremely ill, but the doctors took so friggen long to put me on hemo. I actually had to beg for it just about. They thought something else was making me sick, but it was the PD, as well as my old transplant kidney.
Im on gabapentin for it now, and it is working quite good to keep the pain at bay, and the weird feelings arent as bad too. I actually forgot to take it today, which is why Im up so late now, feet feel awful.

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It is sad what patients suffer due to inattentive nephs. I envision a board where education is very specific in each area for kidney patients…sort of like Kidney School, but even more comprehensive, so patients have something to refer to for preventative, proactive info.