Dialysis, the flu, and you: 2007 update
The flu is no fun for anyone. But as an adult with kidney failure, you're in a high-risk group if you catch the flu. Kidney failure can weaken your immune system, so the flu is 3 to 4 times more likely to cause pneumonia and make other health problems worse than in healthy people.1
What is the flu?
Influenza (the flu) is a virus that attacks the breathing system—your nose, throat, and lungs. It causes:
- Fever and chills
- Severe muscle aches
- Headache
- Overwhelming fatigue
- Sore throat
- A dry cough
- A runny or stuffy nose
The flu can last for a week or two, or longer if there are complications.
The flu may sound like a cold—but it comes on faster. In just a few hours you can go from feeling fine to feeling very ill. And the flu can make you feel much sicker than even a bad cold.
The only way to tell for sure that you have the flu is to get a nose or throat swab test. The rapid flu test can give results in about 30 minutes.2 While most people don't take this step, with kidney disease you are in a high-risk group (two, if you are over 50). So, go to your doctor and get a test if you think you have the flu.
Tip: Many other severe health problems—like sepsis (blood poisoning)—also start out with "flu-like" symptoms. If you feel like you have the flu, you need to see a doctor.
Your best defense is a good offense
A yearly flu shot is your best defense3—but only about half of people with kidney failure get one.4 Flu season starts in November or December, so it's best to get a flu shot in October or November. For adults, flu shots work better than FluMist©, the nasal spray form of the vaccine.5 You only need one flu shot per year; booster shots don't help.6 Medicare pays for flu shots.
Flu shots can help keep you from getting the flu, but they're not perfect. Flu spreads by droplets that spray out for about 3 feet when an infected person breathes, coughs, or sneezes. You catch the flu when you breathe in the droplets or touch something that's been coughed or sneezed on, then touch your nose or mouth.
Besides having a flu shot, you can also help avoid the flu if you:
- Stay at least 3 feet away from anyone who coughs or sneezes
- Avoid crowds if you can in "flu season" (late fall to early spring)
- Wear a surgical mask if you must be around lots of people
- Wash your hands often or use an alcohol-based hand rub
- Don't touch your nose or mouth if you haven't washed your hands
Drugs to prevent the flu
Some drugs that treat the flu can also be used to prevent it. They work by stopping the virus from growing inside your body, and are 60-90% effective.7
The CDC warns doctors not to prescribe Symmetrel© (amantadine) or Flumadine© (rimantadine) in the 2007-2008 flu season, because they do not work against this year's virus.8 But you can ask your doctor about taking Tamiflu© (oseltamivir phosphate) or Relenza© (zanamivir) for about 6 weeks during the height of the flu season.
- Tamiflu is a pill or liquid. A new study has found that taking 30 mg once a week can help protect people on PD from the flu. People who do HD 3 times per week can take the 30 mg at every other treatment.10 No frequency was given for daily HD, but twice per week might make sense. Ask your doctor about it.
- Relenza is a drug you breathe in through an inhaler. If you have lung problems, like asthma, Relenza may not be a good choice for you.11
Tip: Print this article and bring it with you when you see your doctor. It can remind you of questions you want to ask, and the references at the end may help your doctor to help you.
What to do if the flu catches you
If you do get the flu, taking Tamiflu or Relenza for 5 days may ease the course and help stop complications. The drugs must be started within 48 hours of getting flu symptoms (the sooner you start them the better they work)12—so, you need to see your doctor quickly. Since both drugs are removed from the body by the kidneys, you may need a lower dose than a healthy person. (As with any drugs, these products can have side effects.)
Before you take any drug— prescription, over-the-counter, herbs, folk cures— talk to your nephrologist or pharmacist. Drugs that are safe for healthy people can build up to harmful levels in your body. Dialysis does not remove as much of most drugs as working kidneys do.
You can safely use a saline (salt-water) nasal spray to help a stuffy or dry nose. Using a humidifier can make it easier to breathe and can help a cough. Your doctor can suggest:
- Lozenges to soothe a sore throat
- Cough medicine
- Pain pills for headache and muscle aches
Ask for help when you need it
Ask someone to be on hand to help you for a few days. (It's best if this person has had a flu shot.) The flu can flatten you, and having a helper to cook and bring you meals, run errands, fetch tissues, and call the doctor for you can let you save your energy for healing.
Even if you do all or most of your home dialysis yourself, when you're sick you may need help with your treatments. You don't want to take shortcuts and risk infection if you don't feel well enough to go through all the steps. If you do HD, you might want to get a treatment or two in-center to have a break. (You'd need to wear a mask to avoid spreading the flu.)
You may lose your appetite with the flu, which can affect your potassium levels. It can be hard to sort out muscle pain from the flu from symptoms of too-high or too-low potassium. Be on the safe side: ask for your level to be checked if you think there is any chance that it's "off" due to your diet.
Keeping your fluids in balance
When you have a fever, lose your appetite, have a sore throat...it can throw a wrench into your fluid balance:
- On PD, if you drink extra fluids because of the flu, be sure to keep track of your weight and switch solutions if needed so you don't get overloaded. Extra water in your blood and cells may make it harder to breathe. If you can't drink as much as usual, watch out for dehydration, which can make you feel even worse.
- On short daily or nocturnal HD, you may be able to drink a bit more fluid, since you will remove it more often or take off more at each treatment. If you are doing standard, three-times-a-week HD, fluid overload can make it harder to breathe and can damage your heart.
- On any form of HD, getting dehydrated can drop your blood pressure. This can leave you feeling light-headed and put you at risk for access clotting. If you can't drink enough to keep your blood pressure normal, you may need IV fluids.
Flu complications
Even though the flu is a virus, it can lead to bacterial infections:
- If your teeth or cheekbones ache and your nasal mucus is green or yellow, you may have a sinus infection.
- If you cough up yellow or green mucus, are short of breath, and/or have stabbing chest pain when you breathe, you may have pneumonia.
Either way, you may need antibiotics, and you will need to see your doctor. Pneumonia can be very serious. If you have trouble breathing or you can't keep your fluids in balance, go to the hospital. Let them take care of you for a while until you feel better.
Tip: Keep a list of all drugs you take and their doses, and a copy of your health history. Bring it along if you need to go to the hospital to save time and help ensure that you get the right treatment.
References
- Naqvi SB, Collins AJ. Infectious complications in chronic kidney disease. Adv Chronic Kidney Dis. 2006 Jul;13(3):199-204.
- Clinical Signs and Symptoms of Influenza
- Vogtlander NP, Brown A, Valentijn RM, Rimmelzwaan GF, Osterhaus AD. Impaired response rates, but satisfying protection rates to influenza vaccination in dialysis patients. Vaccine. 2004 Jun 2;22(17-18):2199-201.
- Kausz AT, Guo H, Pereira BJ, Collins AJ, Gilbertson DT. General medical care among patients with chronic kidney disease: opportunities for improving outcomes. J Am Soc Nephrol. 2005 Oct;16(10):3092-101.
- Ohmit SE, Victor JC, Rottholf JR, Teich ER, Truscon RK, Baum LL, Rangarajan B, Newton DW, Boulton ML, Monto AS. Prevention of antigenically drifted influenza by inactivated and live attenuated vaccines. N Engl J Med. 2006;355(24):2513-22.
- Song JY, Cheong HJ, Ha SH, Kee SY, Jeong HW, Kim WJ. Active influenza immunization in hemodialysis patients: comparison between single-dose and booster vaccination. Am J Nephrol. 2006;26(2):206-1.
- Cooper NJ, Sutton AJ, Abrams KR, Wailoo A, Turner D, Nicholson KG. Effectiveness of neuraminidase inhibitors in treatment and prevention of influenza A and B: Systemic review and meta-analyses of randomized controlled trials. BMJ. 2003;326(7401):1235.
- Recommended Antiviral Agents for Seasonal Influenza for 2007-2008
- Primary Changes and Updates in the 2007 Recommendations
- Robson R, Buttimore A, Lynn K, Brewster M, Ward P. The pharmacokinetics and tolerability of oseltamivir suspension in patients on haemodialysis and continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant. 2006;Sep;21(9):2556-62.
- Relenza Consumer Information
- Influenza Report: Treatment and Prophylaxis