In order to treat chronic kidney failure the underlying disease should be treated first, if possible. In addition, the treatment of CKD is aimed at slowing the progression of the disease through various measures:
1.- Normalization of blood pressure: exercise, a balanced diet with weight reduction and antihypertensive drugs could be part of a multi angle approach to keep the blood pressure under control.
2.- Blood sugar control in diabetes: change in diet, exercise and drugs to lower blood sugar.
3.- Nutritional diet: CKD patients should consult with a dietician specialist. A low-salt and low-phosphate diet without excessive protein is a fundamental component of the overall treatment of all CKD patients.
4.- Body weight: Maintaining a healthy weight is important for your overall health. If you are losing weight without even trying, you may not be getting the right nutrition to stay healthy. Your dietitian can suggest how to safely add extra calories to your diet if needed.
On the other hand, if you are slowly gaining too much weight, you may need to reduce calories and increase your activity level. A sudden weight gain can also be a problem. If it is accompanied by swelling, shortness of breath and a rise in blood pressure, it may be a sign of too much fluid in your body. Speak to your doctor if your weight changes noticeably.
5.- Quit smoking: talk to your doctor about the available support to help you stop smoking.
6.- Administration of cholesterol-lowering drugs in case of high cholesterol levels⁶.
7.- Avoidance of kidney-damaging drugs (e.g. some non-steroidal anti inflammatory drugs or contrast media)
It is important that patients with CKD are regularly examined and followed up by a kidney specialist (they are called nephrologists), especially when the disease is difficult to manage, doesn’t respond well to treatment or progresses despite treatment. CKD of hereditary cause should also be followed up by a kidney specialist.
The possible complications of CKD such as anemia and disorders of the bone or acid-base metabolism should also be treated.
Since patients with CKD have an increased risk of infections, they should have adequate vaccination protection against diseases like the flu and others. Consult with your doctor which vaccines they recommend in your case.
The late stage of CKD manifests itself in an important deterioration in the general condition of the patient, which is accompanied by symptoms like nausea and vomiting. At this stage, the kidneys have almost stopped working and it's necessary to artificially perform the filtering functions that they are no longer able to perform. This is what is called renal replacement therapy or dialysis. The patient must be connected to a series of machines and artificial filters that perform the detoxification of the blood and remove the toxic waste.
Dialysis - what is it?
Dialysis, also known as “renal replacement treatment”, is necessary when CKD has progressed to such an extent that the kidneys can no longer perform their normal tasks.
Dialysis then takes on the following important tasks of the kidneys:
Excretion of toxic substances
Excretion of water
Correction of electrolyte and pH balance
The following two dialysis methods can be used:
- Peritoneal dialysis
Hemodialysis uses a dialysis machine in a dialysis center to externally clean the blood of the patient. In peritoneal dialysis, blood is cleaned inside the abdomen in a space called the peritoneum and can be carried out at home.
The basic principle is similar for both dialysis methods. The blood flows along a semi-permeable membrane that works like a filter, dialysis fluid removes the waste substances, similar to what healthy kidneys do.
During dialysis, toxic substances are removed from the blood and substances that the body lacks are supplied.
The healthy kidney filters 24 hours a day. Dialysis has to do this workload in a much shorter time and sometimes not all toxic substances can be removed during this time. That's why diet and paying attention to the fluid intake is so important when a patient is on dialysis.
When does a CKD patient need dialysis?
Dialysis therapy must be started when patients with advanced CKD show symptoms of what is called “urinary poisoning” or “uremia”. These symptoms usually appear when a patient's GFR falls below 5-10 ml / min / 1.73 m² and can include nausea, vomiting, itching and confusion.
Dialysis is also necessary if high blood pressure, overhydration of the body or the electrolyte composition of the blood cannot be adequately treated.
For patients with terminal (i.e., permanent) renal failure, a kidney transplant is another option to regain the function of the kidneys.
Preparing for Hemodialysis - Vascular Access
Hemodialysis requires that blood is drawn from and returned to a patient very frequently. The blood goes through the dialysis machine which cleans it and the cleaned blood is returned to the patient. For this to be possible, a special vascular access is necessary. This access is called “shunt” and is a surgically created connection between a vein and an artery usually on the forearm.
How long does hemodialysis take?
As a general rule, hemodialysis is carried out in a specialized dialysis center 3 times a week. At each visit, the patient is connected to a dialysis machine for 4-5 hours.
But it is important to clarify that how often dialysis has to be performed and how long a dialysis session lasts varies and depends, among other things, on the remaining kidney function and the patient's height.
Some patients may be offered options of at home haemodialysis where patients and their carepartners are taught how to safely perform the treatments using a dialysis machine at home.
Peritoneal dialysis, which can be done at home, can be an alternative for suitable patients. Ask your doctor to clarify which form of dialysis would be best in your case.
Anemia is a condition in which a person lacks enough healthy red blood cells or hemoglobin. Red blood cells carry hemoglobin, a protein that binds oxygen and distributes oxygen throughout the body. If there are insufficient red blood cells in the body, this means that tissues and organs may not get sufficient oxygen to function well. Anemia can be diagnosed by a simple blood test.
Your doctor can diagnose and treat anemia. Please consult with your doctor if you are worried about suffering from anemia.
Anemia is common in patients suffering from chronic kidney disease (CKD), and the risk for anemia can increase as CKD progresses.
Many causes can lead to anemia in CKD:
- Healthy kidneys produce a hormone called erythropoietin (EPO). EPO signals to your bone marrow to produce red blood cells. Damaged kidneys produce less EPO, and this can result in fewer red blood cells being available and less oxygen being delivered to the body’s organs and tissues. Additionally, these fewer red cells tend to live shorter in people with CKD, contributing even further to the anemia condition.
- People with CKD may have low levels of nutrients, such as iron, vitamin B12 and folate, that are needed to make healthy red blood cells.
- Other causes include blood loss, especially in patients treated with dialysis for kidney failure, infections, inflammation, malnutrition.
Anemia can lead to multiple symptoms:
• fatigue or tiredness
• shortness of breath
• pale skin, weakness
• body aches
• chest pain
• fast or irregular heartbeat
• sleep problems
• trouble concentrating, among others
A doctor will first treat any underlying conditions that may be causing the anemia, e.g. an iron or vitamin deficiency. If the anemia is mild and the patient has only a few symptoms, no specific treatment may be needed at first. Treatments for anemia may ease some symptoms and improve quality of life.
In the case of iron and vitamin deficiency, there are a number of iron or vitamin supplements a treating doctor can offer. Additionally, erythropoiesis-stimulating agents (ESAs) are available to treat symptomatic anemia of CKD. ESAs send a signal to the bone marrow to make more red blood cells and thus substitute for the reduced EPO produced by the damaged kidney. These medicines are administered as intravenous or subcutaneous injection, and have to be prescribed by a doctor.
Patients should also consider speaking to their doctor and dietitian to develop a meal plan that will support their disease journey and manage their anemia.
1. Adapted from Findlay’s and Isles’ “Clinical Companion in Nephrology”, Springer Ed., 2015.
2. Adapted from “Comprehensive Clinical Nephrology”, 6th edition, Elsevier Ed., 2015.
5. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 1–150.
6. Kidney Disease: Improving Global Outcomes (KDIGO) Lipid Work Group. KDIGO Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 259–305.
7. “Diabetic Nephropathy”, American Diabetes Association, Diabetes Care 2002 Jan; 25 (suppl 1): s85-s89.
8. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study, 2017.
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