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Friday, December 13, 2013
There are many causes of chronic kidney disease, with diabetes and hypertension (high blood pressure) being two of the most common. Some types of kidney disease can be treated and cured, while others eventually lead to loss of kidney function and the need for dialysis.
However, even if the actual cause of a kidney disorder - such as diabetes or hypertension - cannot be removed, there are things that can be done to minimize or slow the damage done by the kidney disease, and to postpone the need for dialysis for as long as possible.
Here are some things that can be done to help preserve remaining kidney function in patients with CKD:
Depending on the exact type of kidney disease, dietary restrictions may be needed.
Salt (sodium) - If there is high blood pressure, swelling of the legs, or a tendency to accumulate of water elsewhere (such as in the lungs), then salt and/or fluid restriction may be needed. Salt restriction includes: not adding salt to food at the table, not cooking with salt, avoiding most types of fast food, and minimizing the use of most canned foods.
Potassium - In some types and stages of kidney disease, high blood potassium levels may occur, and the intake of potassium-rich foods (such as potatoes, oranges, bananas, tomatoes, dried beans, and figs) may be restricted.
Protein - Protein restriction is not usually advised until the very late stages of kidney disease; however, in general, patients with CKD should not be in the habit of gorging on high-protein meals because very high protein intake may actually accelerate the rate of kidney damage.
Keeping blood pressure within a normal range (generally aiming for less than 130/90, sometimes lower) is very important in the management of kidney disease. High blood pressure can damage blood vessels all over the body, leading to hardening of the arteries and its complications, including:
Similarly, high blood pressure within the kidneys can damage the tiny blood vessels within the kidney, leading to scarring of both blood vessels and kidney tissue. High blood pressure can be managed by a combination of
The most common types of medications used in blood pressure treatment include the following:
Diabetes is one of the most common causes of CKD, and can produce damage in the:
Diabetes causes damage by exposing organs and tissues to high blood sugar levels over periods of months to years. Therefore, strict blood sugar control is vitally important in minimizing organ damage from diabetes. This is achieved by a combination of dietary restrictions and the use of oral medications and/or insulin. Constant monitoring of blood sugars is essential.
High levels of "bad cholesterol" (LDL cholesterol, triglycerides) and low levels of “good cholesterol” (HDL cholesterol) can hasten the development of atherosclerosis (hardening of the arteries) and may play a role in the progression of damage from CKD. Treatment of lipid levels is accomplished with diet (to some extent) and with medications (such as atorvastatin, simvastatin, gemfibrozil, ezetimibe).
Obesity, while it usually does not in itself cause kidney disease, may increase the tendency to kidney damage from diabetes, hypertension, and certain other types of kidney disease. Weight loss may make diabetes easier to control, reduce blood pressure, and reduce protein leakage from the kidneys in some types of CKD.
Smoking accelerates atherosclerosis, making people more susceptible to heart attacks, strokes, and kidney damage – to say nothing of increasing the risk of chronic pulmonary disease, emphysema, lung cancer, and several other types of cancer as well.
The kidneys normally make a hormone called erythropoietin, which helps the bone marrow to produce oxygen-carrying red blood cells. CKD often results in decreased epo production and may lead to anemia (low red blood cell count), resulting in fatigue and decreased ability to perform strenuous activity.
While anemia can be treated with transfusions, the process of administering blood is complicated and expensive. Transfusions carry with them the risk of an allergic reaction, and are not permitted by certain religions.
Epo injections (usually administered every 2-4 weeks) provide an effective means of replacing this deficient hormone, resulting in correction of anemia, and allowing the CKD patient to feel better and to have more energy.
Diuretics - ("water pills") help to remove excess fluid or swelling that is often seen in CKD. They can also help to reduce blood pressure.
Vitamin D - Synthetic vitamin D, given in pill form, replaces another hormone that a failing kidney is unable to make. Vitamin D deficiency may result in both bone and muscle problems in CKD patients.
Phosphate binders - these tablets are taken with meals and help to bind phosphate in food, preventing it from being absorbed from the GI tract and entering the circulation. High blood phosphate levels develop in the more advanced stages of CKD and, along with vitamin D deficiency, may contribute to bone and muscle problems.
Many research studies are underway to help us learn about chronic kidney disease. Would you like to find out more about being part of this exciting research? Please visit the following links:
This article is a NetWellness exclusive.
Last Reviewed: Sep 03, 2013
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University