Chronic Kidney Disease Treatment and Follow-up focuses on medication, diet, and, if needed, surgery. LIV Hospital offers complete pediatric recovery programs.
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Controlling blood pressure is the single most effective intervention for slowing the progression of kidney disease. The target is typically to keep blood pressure below 130/80 mmHg. Lowering pressure reduces the physical stress on the glomerular filters, preserving their structure.
Two specific classes of blood pressure medications are preferred: Angiotensin Converting Enzyme (ACE) inhibitors and Angiotensin II Receptor Blockers (ARBs). These drugs do more than lower systemic pressure; they specifically dilate the blood vessels leaving the kidney, reducing the internal pressure within the filters.
These medications also have an anti-proteinuric effect, meaning they reduce the amount of protein leaking into the urine. This reduction in protein leakage correlates directly with slower disease progression. Regular potassium monitoring is required when taking these drugs.
Diuretics, or water pills, are often added to help remove excess fluid and lower blood pressure further. Combining medications is common to achieve the necessary control.
For patients with diabetic kidney disease, maintaining tight blood sugar control is paramount. High glucose levels perpetuate the damage to the microvasculature. The target HbA1c is usually around 7 percent, though this may be individualized based on the patient’s age and risk of hypoglycemia.
Newer classes of diabetes medications, specifically SGLT2 inhibitors (like dapagliflozin) and GLP-1 agonists, have shown remarkable benefits for kidney health. SGLT2 inhibitors work by blocking sugar reabsorption in the kidney, lowering blood pressure and reducing glomerular stress.
These medications have been proven to slow the decline of GFR and reduce the risk of kidney failure, independent of their blood sugar-lowering effects. They are now considered a standard pillar of treatment for CKD in people with diabetes and even non diabetics.
Insulin regimens may need to be adjusted as kidney function declines, as the kidneys help clear insulin from the body. Reduced kidney function can prolong insulin’s time in the bloodstream, increasing the risk of low blood sugar.
Anemia is a common complication that must be treated to improve quality of life and reduce cardiac strain. The first step is usually iron supplementation. Oral iron is tried first, but intravenous iron may be necessary if absorption is poor or losses are high.
When iron stores are adequate, but anemia persists, Erythropoiesis Stimulating Agents (ESAs) are used. These are synthetic versions of the hormone erythropoietin. They signal the bone marrow to produce more red blood cells.
The goal of ESA therapy is not to normalize hemoglobin levels completely, but to maintain it within a safe range (usually 10-11.5 g/dL) to avoid cardiovascular risks associated with higher levels. Regular blood monitoring is essential during treatment.
Treating anemia helps improve energy levels, cognitive function, and heart health. It is a critical component of supportive care in stage 3, 4, and 5 CKD.
As kidneys fail, phosphate builds up in the blood, and calcium levels drop. This triggers the parathyroid glands to release Parathyroid Hormone (PTH), which pulls calcium from the bones. To prevent this renal osteodystrophy, phosphate binders are prescribed. These are taken with meals to block the absorption of dietary phosphorus.
Active Vitamin D (calcitriol) supplements are also used to help absorb calcium and suppress PTH production. Calcimimetics are another class of drugs that trick the parathyroid gland into thinking calcium levels are normal, reducing PTH secretion.
Dietary restriction of phosphorus is challenging but necessary. Managing this axis prevents bone pain, fractures, and the calcification of blood vessels, which is a significant heart risk.
Monitoring calcium, phosphorus, and PTH levels is a routine part of follow-up care. The goal is to maintain bone integrity and prevent soft tissue calcification.
Nutritional management is a cornerstone of CKD treatment. A renal dietitian helps patients navigate a complex diet that may restrict sodium, potassium, phosphorus, and protein. Protein restriction can help slow the buildup of wastes, but it must be balanced to prevent malnutrition.
Sodium restriction is universal for controlling blood pressure and fluid balance. Potassium restriction becomes necessary only when blood levels rise, typically in later stages. The diet is dynamic, changing as the disease progresses.
For patients on dialysis, protein needs actually increase due to losses during treatment. Navigating these shifting requirements requires ongoing professional guidance. Proper nutrition preserves muscle mass and immune function.
When the kidneys can no longer support life (ESRD), dialysis is initiated. Hemodialysis filters blood through a machine, usually three times a week at a center or more frequently at home. It requires a vascular access point, such as a fistula.
Peritoneal dialysis uses the lining of the abdomen to filter blood. Fluid is instilled into the abdomen via a catheter and drained hours later. This can be done manually during the day or by a machine at night, offering greater flexibility.
The choice of modality depends on the patient’s lifestyle, medical condition, and preference. Dialysis is a life-sustaining treatment but not a cure. It replaces filtration but does not fully replace the kidney’s endocrine functions.
Kidney transplantation offers the best outcomes for survival and quality of life. It involves placing a healthy kidney from a living or deceased donor into the patient. A successful transplant frees the patient from dialysis and restores near-normal kidney function.
The process involves a rigorous evaluation to ensure the patient is a suitable candidate. After surgery, patients must take immunosuppressive medications for the life of the kidney to prevent rejection.
Transplantation is a treatment, not a total cure, as it introduces new medical management challenges involving immune suppression. However, it provides the highest degree of rehabilitation and freedom.
For some patients, dialysis or transplant may not be the right choice due to age or other serious illnesses. Conservative management or supportive care focuses on managing symptoms without dialysis. This includes treating anemia, fluid overload, and pain to maintain quality of life.
Palliative care teams support decision-making and advance care planning. The focus shifts from extending life at all costs to ensuring comfort and dignity during the final stages of kidney disease.
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Common side effects include a persistent dry cough, dizziness due to lower blood pressure, and increased potassium levels. If the cough is bothersome, your doctor can switch you to an ARB, which works similarly but rarely causes a cough.
Dialysis requires a significant time commitment. Center-based hemodialysis typically takes 4 hours, 3 times a week. It can cause fatigue afterwards (“washout”). Home dialysis offers more flexibility but requires you to manage the treatment yourself daily. Travel is possible but requires planning.
It is the closest thing to a cure, but technically it is a treatment. It restores kidney function, but you trade kidney disease for the need to take anti-rejection medicines for life, which have their own side effects and risks.
No. Kidney disease is often silent. You might feel fine even as your function declines. Stopping blood pressure or diabetes medications can lead to a rapid worsening of kidney damage or a sudden cardiovascular event like a stroke.
If you choose not to start dialysis when your kidneys fail, you will receive supportive care to manage symptoms. Toxins will build up, leading to sleepiness and eventual coma. Death is usually painless and peaceful. This is a valid choice for some patients with multiple severe health issues.
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