The information on “How to Avoid Dialysis” in this book resulted from years of research at The Johns Hopkins University by Dr. Mackenzie Walser and his colleagues. Case histories are excerpted from the book (see them below) to show you that you can be helped by the information in this important book regardless of your type of kidney disease. You owe it to yourself or to the loved one in your life who has kidney disease to try this therapy. There are only beneficial effects from the diet and the supplements for the kidney patient – a longer life, more energy, fewer illnesses and a better nutritional status when you are transplanted.

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From the cover –

The treatment I describe alleviates symptoms markedly. Appropriate care for kidney failure includes a very- low-protein diet, with supplements, as well as blood pressure control and specific therapies to regulate the metabolism of sodium, potassium calcium, phosphorus, and acid, and to correct anemia, high blood cholesterol, and high blood uric acid (which causes gout). Certain drugs are helpful and others are contraindicated. Transplantation, which has become more successful but is limited by the number of donors, may become more widely available; this book discusses how. – Coping with Kidney Disease A 12-Step Treatment Program to Help You Avoid Dialysis – Mackenzie Walser, M.D.with Betsy Thorpe and contributions by Nga Hong Brereron, M.S., RD., J.B.C.L.C.

Contents

PART I: LOOKING AT THE DISEASE OF KIDNEY FAILURE

1 What Do Kidneys Do and What Happens When They Fail?
2 Are You at Risk for Kidney Failure?
3 Symptoms of Kidney Failure

PART II: HOW TO TREAT KIDNEY FAILURE

4 Treating Kidney Failure
5 Step 1: Assess Your Current Treatment Plan
6 Step 2: Make Lifestyle Changes
7 Step 3: Follow a Low-Protein Diet
8 Step 4: Treat Salt and Water Problems
9 Step 5: Regulate Your Blood Pressure
10 Step 6: Treat Acidosis
11 Step 7: Treat Anemia and Iron Deficiency
12 Step 8; Treat Potassium Problems
13 Step 9: Treat Calcium and Phosphate Problems
14 Step 10: Treat Gout and Uric Acid Problems 122
15 Step 11: Treat Your High Cholesterol
16 Step 12: Know the Medications That Slow the Progression of Renal Failure

PART III: TRACKING KIDNEY FAILURE, DIALYSIS, TRANSPLANTS, AND MORE
17 Keeping Close Watch on Your Kidney Failure
18 Dietary Treatment of the Nephrotic Syndrome
19 Safe and Unsafe Medications for Patients with Kidney Failure
20 Transplantation as an Alternative to Dialysis
21 When to Opt for Dialysis
22 Patients Who Have Avoided Dialysis

Appendix 1: Resources for Kidney Patients
Appendix 2: Government Support of Low-Protein Diets

Glossary

Excerpts –

Before putting any patient on dialysis, doctors have an obligation to tell the patient that there is an alternative available, namely dietary treatment and close follow-up to watch for the other conditions that could endanger the patient with kidney failure.

Nephrotic Syndrome

p.160 Arnold Sanderson ... was referred to Johns Hopkins one year ago with a history of hypertension for 40 years and high urinary protein for 9 years. ... He was placed on a very- low- protein diet supplemented by essential amino acids and has been checked every two months. Three years later, the lab data showed only moderate worsening ... Perhaps in response to this diet, Arnold*s nephrotic syndrome has stopped progressing although his kidney function has declined. Dialysis deferral: 3 years

p.160 Lavinia Leonardois a 50-year-old resource manager for the army. She was referred to us for treatment in 1995. She had been diabetic since her second pregnancy 28 years ago. ... A kidney biopsy showed focal segmental glomerulosclerosis and mild diabetic glomerulosclerosis. She had been intermittently hypertensive for years ... Lavinia was placed on a very-low-protein diet supplemented by a double dose of essential amino acids (20 g per day). Over the next few months, her kidney disease disappeared: Her serum albumin concentration rose to normal, urine protein disappeared, and GFR rose to normal. Dialysis deferral: permanent

p.161 Martha Blomberg is a 44-year-old office worker with the nephrotic syndrome caused by a form of glomerular disease called focal segmental glomerulosclerosis. When placed on a very-low-protein diet supplemented by essential amino acids, she responded slowly but profoundly: urine protein decreased over the next year to about 3 g per day, serum albumin rose to normal (3.7 g per dl), and GFR scarcely changed. ... Dialysis deferral: 12 years so far

p180 Marshall Wynngarden, a 34-year old physician, came to Johns Hopkins in 1986, with a history of insulin dependent diabetes since age 9 and renal failure since 1983. He was complaining of fatigue, arthritic pains, sexual dysfunction and muscle cramps. ... In 1988 he was started on a very-low-protein diet, supplemented by amino acids ... Symptoms improved, but he continued to have difficulty with control of his diabetes. Kidney function continued to decline slowly, and he finally decided to start dialysis in 1992, after four years. Dialysis deferral: 4 years

p.181 Ernie Ball is a computer systems analyst. When he was 38, he visited his doctor because he had pain in his flanks. ... At age 56. by which time his serum creatinine concentration was 6.4 mg per dl, indicating severe kidney failure, he started a supplemented very-low-protein diet. He succeeded in deferring dialysis for four more years by means of a very-low-protein, low-salt diet plus either amino acids or ketoacids, ... Dialysis deferral: 4 years

Another example of avoidance of dialysis for several years with the aid of a supplemented very-low-protein diet is Mory East, a 32 year old physician. At age 10, he developed recurrent fevers and was found to have defects in the ureters, which drain urine from each kidney into the bladder. ... Because some progressive loss of kidney function was detected, in January 1989 he was started on a very-low-protein diet (0.3 g per kg per day) supplemented (initially) by essential amino acids. ... Dialysis deferral: 4 years

p.184 Leigh Dell, age 73, has never been to Johns Hopkins, because be lives too far away. He has had protein in his urine for many years (perhaps as a result of raking Advil over a period of years following a leg fracture). ... His wife, after some reading, decided to start a low—protein diet and tried to assemble an essential amino acid mixture from individual amino acids sold at the health food store. A renal dietitian they saw told him to discard the amino acids and to eat 60 g per day of protein. His serum creatinine increased to 4.1 mg per dl. His wife located a complete mixture of essential amino acids (Nutramine) and also put him on a 23 g protein diet. His energy increased markedly, and he managed to lose weight. ... He has no symptoms, and plays tennis, gardens, and goes to the gym.—Dialysis deferral: 5 years so far Click Here to visit her Blog!

Tim Ahlstrom first came to Johns Hopkins... On arrival here his blood pressure was alarmingly high (215/100),kidney function was 15 percent of normal, and blood chemical values were moderately abnormal. ... on a very-low-protein diet (0.3 g per kg, or 33 g per day), to be supplemented with essential amino acids ... His blood pressure eventually carne down to normal and, after a year, his kidney function actually improved. —Dialysis deferral: 3 years

Polycystic Kidney Disease

p.186 Doris Balboni, a 67-year-old retired nurse with polycystic kidney disease, was found to have severe renal failure, with a glomerular filtration rate of 10.2 ml per minute and a serum creatinine concentration of 4.2 mg per dl. She was placed on a very-low-protein diet supplemented alternately by an essential amino acid mixture ... Doris managed to postpone dialysis for another year while on the same regimen, thus deferring dialysis for a total of 20 months. Clearly progression of her renal failure was very slow. —Dialysis deferral: 2 years

Ella Johnson, a 49-year-old school teacher, came to Johns Hopkins in 1994. Polycystic kidney disease had been diagnosed from an abdominal scan four years earlier, although it was not seen in an X ray of the kidneys at age 22. The X ray was performed because she had recurrent urinary tract infections ever since age 18 and had required urethral dilatations. High blood pressure had been present for nine years ... She had no symptoms of kidney failure. ... At her request, despite the absence of symptoms, she was placed on a very-low-protein diet supplemented by essential amino acids. ... At this rate she will be well into her 70s before she needs dialysis or transplantation. Dialysis deferral: 10 years

Patients with Hypertensive Kidney Disease

Chester Land, a black retired postal supervisor, was referred at age 61 with a 20-year history of hypertension. By age 59 his serum creatinine level was elevated, though he had no symptoms of kidney disease. Physical exam showed only hypertension, but kidney function was severely reduced. He was prescribed a very-low- protein diet supplemented by essential amino acids ...During eight years of dietary treatment, kidney function did not worsen ... In retrospect, dietary treatment probably deferred dialysis for about four years.

p.188 A striking example is Lynne Bright, a 39-year-old secretary at a clinical laboratory in Indiana, who came to Johns Hopkins in February 2000. Two years earlier she had learned that she had kidney failure, when a routine exam revealed an elevated serum creatinine. At that time she had already had high blood pressure for about a year. Urine protein was also abnormal (3 g per day) but serum albumin concentration was normal. She had felt tired for about seven months, but denied loss of appetite, nausea, vomiting, muscle cramps, or itching. By April 2000 serum creatinine level was 8.6 mg per dl. She had been advised to start dialysis but wanted to defer it because she “didn*t feel that badly.” ... She continues to work full time and has no symptoms. ... She has not progressed in two and a half years. She may continue this way for years to come. Dialysis deferral: 4 years

p.189 Norton Cox, a 77-year-old retired NASA engineer was referred in April 2000 with a five-year history of high blood pressure and chronic kidney failure. ... He was placed on a very-low-protein diet supplemented by essential amino acids. In the ensuing two years, his kidney function (measured every three months) has not changed. He remains essentially free of symptoms. He may never go on dialysis.—Dialysis deferral: 4 years so far

Patients with Diseases of the Glomeruli

p.190 Denton Farris, a former businessman, developed urinary protein and red cells at age 65. Blood tests showed that he had a kind of kidney disease called IgA nephropathy but only mild loss of kidney function. ... As his renal function declined, a very-low-protein diet was added, supplemented alternately by amino acids ... Dialysis deferral: 3 years

p.190 Cary Moulin, a 40-year-old laboratory technician, was referred for treatment of glomerulonephritis, known to be progressive for the previous 19 years. He was an avid jogger, running about 48 miles a week. Physical exam showed only high blood pressure. His serum creatinine level was quite high (5.5 mg per dl), as was his serum urea nitrogen level ... In response to a very low-protein diet supplemented by essential amino acids, serum urea nitrogen fell to 33 mg per dl. Dialysis deferral: 5 years

Charles Hollins, a 49-year-old hazardous waste engineer, gave a 18-year history of hypertension, with protein in the urine for at least eight years. Kidney function began to decline three years ago. A kidney biopsy showed IgA nephropathy. ... He was prescribed a very-low-protein diet, essential amino acids, ... Dialysis deferral: 2 years