Driving with Kidney Disease

Role of the Kidneys

Most people have 2 kidneys that are located at the back of your body below the ribs.

Their primary role is the filtering of your blood to make urine that enables your body to get rid of waste and water that it does not need and to regulate the salts and minerals in your blood.(1)

It also controls your blood pressure, keeps your boners healthy and involved in making red blood cells.

When kidneys are healthy they make the hormone erythropoietin (EPO).

This hormone plays a vital role to help bone marrow to produce the correct amount of red blood cells (RBC) that the body needs to carry oxygen to vital organs.

When kidneys are damaged they may not make enough EPO with the result that the bone marrow does not make sufficient red blood cells for the body’s needs. (2)

Symptoms of Chronic Kidney Disease

Often in the early stages of kidney disease there may be no symptoms.

However, as chronic kidney disease progresses a patient may develop some or all of the following symptoms at all of different times.

• Shortness of breath
• Itching
• Tiredness
• Swollen ankles
• Lack of appetite
• Cramps in your legs
• Sickness

Identifying Kidney Disease

Kidney disease is often identified by a routine blood test performed for another reason; detection of a very high blood pressure reading or a urine test done for an employer or for medical insurance.

Young healthy people often have a Glomerular Filtration Rate (eGFR) of 90% or more but once kidney function falls to 20-30% of normal the kidneys are failing and treatments such as dialysis, transplantation or conservative management are implemented.

How can we slow down kidney damage?

We can often slow down the progression of kidney disease by:

• Taking all medication prescribed by your doctor
• Eating a healthy diet
• Keeping active
• Maintaining good control of your blood pressure, often with the aid of drugs
• Cessation of smoking
• Keeping good control of sugar levels if you are a diabetic

Deaths Due to Motor Vehicle Accidents and Potential Role of Kidney Disease

R Lozano and colleagues (3) evaluated the global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010.

The authors established that there were 52.8 million deaths globally in 2010. Furthermore, they found that communicable, maternal, neonatal and nutritional causes of death were 24.9% of deaths worldwide in 2010.

This was a reduction of 15.9 million (34.1%) from the 1990 figure of 46.5 million.

However there was a 46% increase in deaths worldwide due to road traffic accidents resulting in 1.3 million deaths in 2010.

Santos PR and colleagues studied acute kidney injury in an intensive care unit of a general hospital with emergency rooms specializing in trauma. (4)

They observed that admission categories were proportionally divided into 51.6% of non-trauma diagnosis and 48.4% of trauma cases.

The trauma cases generally involved brain injury (79.5%).

Interestingly the overall incidence of acute kidney disease was 32.9% that was distributed among the 3 stages: 33.7%, stage 1, 29.4% stage 2 and 36.9% stage 3.

The authors concluded that there was a high incidence of acute kidney injury in this study that was strongly associated with mortality among trauma and non-trauma patients.

A key finding was that trauma cases, especially brain injury due to traffic accidents involving motorized 2 wheeled vehicles should be seen as an important preventable cause of acute kidney injury.

Kidney Disease Associated with Difficulty in Driving

901 residents of Mobile County Alabama aged 65 and older who had a driver’s license in 1996 were studied by JM Lyman et al (5).

They utilised 3 dependent variables that were difficulty with driving, defined as any reported difficulty in > or =3 driving situations (e.g. at night),low annual estimated mileage, defined as driving less than 3000 miles in 1996, and low number of days (< or =3) driven per week.

They established that a history of falls, kidney disease or stoke was associated with difficulty in driving.

Older drivers who had a history of kidney disease were more likely to report a low annual mileage than subjects without kidney disease.

Cognitive impairment was also associated with low annual mileage.

Older drivers who had a history of cataracts or high blood pressure were more likely to drive less than 4 days per week.

However those subjects who suffered from visual impairment were at an increased risk of experiencing difficulty driving as well as low numbers of days driven per week.

Older drivers who had functional impairment were also more likely to drive less than 4 days per week.

Women with treated renal colic or kidney stones at higher risk of serious traffic accidents

E Lagarde and colleagues (6) evaluated a longitudinal study of 13,548 participants from a cohort of French workers.

The Follow-up period covered the 1989-2000 period.

The Adjusted hazards ratio (HR{adj}) for serious accidents were computed by Cox’s proportional hazards regression with time dependent covariates adjusted for age, occupation, alcohol consumption, annual mileage in 2001 and number of reported health problems.

They found that women who reported being treated for renal colic or kidney stones were much more likely to have a serious traffic accident.( HR{adj}=9.71,95% CI =2.40-39.3)

Men who were being treated for Dental or gingival problems (HR {adj) =8.57, 95% confidence interval CI=2.70-27.2) were also much more likely to have a serious traffic accident.

The authors also found that treated glaucoma, gastric ulcers, hiatal hernias, diabetes among women and treated cataracts among men were also associated with the risk of serious traffic accidents.

Special Precautions for Dialysis Patients when Driving

Patients who are on Haemodialysis describe loss or blurred vision, cramping, severe bleeding, cramping and fatigue while driving when they get off dialysis.

While in-centre patients are most at risk, these negative side effects may also occur for patients on home dialysis as well.

• Patients who feel faint and whose vision may become blurred perhaps due to low blood pressure should pull over.Low blood pressure can be a cause of dehydration so always have a bottle of water while driving a car after dialysis.(7)
• Wherever possible try to schedule appointment times when an in-centre patient to avoid peak traffic times so that you can get home earlier to recuperate.
• Sometimes “bleed-out” episodes occur. Appropriate bandages should be kept in the cars glove compartment in case there is an episode of profuse bleeding. The Health Care Team should be consulted as to the manner for the correct use of a tourniquet if it becomes necessary. If there is any sign of severe bleeding, you should pull over immediately to correct the issue.
• If you regularly find the sensation that you feel like you are “wiped out” after the dialysis treatment, it may be appropriate to discuss this with your nephrologist to adjust dialysis cleaning to make the process more manageable for your body.

Conclusion

Much more research needs to be done to evaluate the effects of mild, moderate and severe kidney disease on these patients ability to drive motor vehicles with safety.

Appropriate strategies must be identified and implemented to ensure that all these patients are able to have an optimum quality of life by being able to drive cars safely on the roads.

References:

(1) A guide to understanding your kidney disease. www.mykidney/org/KidneyDisease/ChronicKidneyDisease.aspx

(2) What You Need to Know about Anemia and Kidney Disease. The DPC Education Center 2013.https://dpcedcenter.org/what-you-need-know-about-anemia-and-kidney-disease

(3) Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I,Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD,Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L,Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD,Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D,Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N,Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L,March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA 3rd, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T,Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD,Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease study 2010.Lancet 2012 Dec 15;380(9859):2095-128.doi:10.1016/S0140-6736(12)61728-0

(4) Santos PR,  DL. Acute kidney injury in an intensive care unit of a general hospital with emergency room specializing in trauma: an observational prospective study. BMC Nephrol 2015 Mar 19; 16:30. doi: 10.1186/s12882-015-0026-4.

(5) Lyman JM, McGwin G Jr, Sims RV. Factors related to driving difficulty and habits in older drivers. Accid Anal Prev 2001 May;33 (3):413-21 

(6 ) Lagarde E, Chastang JF, Lafont S, Coeuret-Pellicer M, Chiron M. Pain and pain treatment were associated with traffic accident involvement in a cohort of middle-aged workers. J. Clin Epidemiol 2005 May;58(5):524-31

(7) KidneyBuzz https://www.kidneybuzz.com/the-unspoken-dangers-of-driving-on-dialysis-and-necessary-precautions/2014/1/2/the-unspoken-dangers-of-driving-on-dialysis-and-necessary-precautions.Jan 2 2014