Dialysis, the Flu, and You

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 as few as 30 minutes. ² While most people don't take this step, you are in a high-risk group (two, if you are over 50). 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, see a doctor.

Your best defense is a good offense

A yearly flu shot is your best defense, ³ but only about half of people with kidney failure get one. ⁴ Flu season starts in November, so get a flu shot in September or October. It takes about 2 weeks for a flu shot to help you fight off the flu. ⁵ Medicare pays for flu shots.

FluMist©, the nasal spray vaccine, is not a good choice for people with kidney disease or for those who live with them. ⁶

Are you over age 65? If so, there is a new flu vaccine just for you. ⁷ Fluzone® is stronger than the usual flu shot; it has 4 times as many antigens to help you fight the flu. This also means it may be more likely to cause side effects, including redness, swelling, headache, muscle aches, or fever. (Most people do not have problems with it.) Ask your doctor or clinic about Fluzone.

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
• Get a Pneumovax® vaccine to help prevent pneumonia ⁸

Drugs to help 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. ⁹

The CDC warns doctors not to prescribe Symmetrel© (amantadine) or Flumadine© (rimantadine) this flu season, because they do not work against this year's virus. But ask your doctor about taking Tamiflu© (oseltamivir phosphate) or Relenza© (zanamivir) for about 6 weeks during the height of the flu season. ¹⁰

• Tamiflu is a pill or liquid. A 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. ¹¹ 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. ¹²

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)¹³—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 doctor 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 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.

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.

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 cause your blood pressure to drop. 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.

In either case, you may need antibiotics, and you 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:

1. Naqvi SB, Collins AJ. Infectious complications in chronic kidney disease. Adv Chronic Kidney Dis. 2006 Jul;13(3):199-204.
2. Influenza Symptoms and Laboratory Diagnostic Procedures
3. 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.
4. 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.
5. Key Facts About Seasonal Flu Vaccine
6. Live, Intranasal Flu Vaccine 2010-11
7. Fluzone High–Dose Seasonal Influenza Vaccine
8. Pneumococcal Vaccination
9. 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.
10. Primary Changes and Updates in the 2010 ACIP Recommendations
11. 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.
12. Relenza: Consumer Questions and Answers
13. Influenza Report: Treatment and Prophylaxis