Treatment Options for Chronic Kidney Disease (CKD)

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Video

This video is a great overview of treatment options for CKD (Chronic Kidney Disease).  The video was created by John Hopkins Nephrology Patient Education and is presented by Dr. Sumeska Thavarajah. 

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Video Transcript

Hi, my name is Sumeska Thavarajah. We're doing a presentation for the ABCs of Kidney Disease. This is a section on Treatment Options for Chronic Kidney Disease. This is one of the presentations in the Johns Hopkins Nephrology Patient Education Program. And we appreciate the funding from the Edward Kraus Endowment Fund, and the Shaw Foundation.

We're going to start with medications. Now, there are no medications that we have that actually reverse kidney damage. And the medications that we prescribe are not specifically kidney medications. They're medications that fall into two categories. Either they manage the risk factors that can speed up kidney damage, or they manage the complications that are related to kidney damage.

So, medications for your blood pressure, medications for your diabetes or high cholesterol are medications that treat the risk factors for kidney disease. Whereas, if I prescribe a medication like a diuretic to get rid of extra salt and water, or a medication for anemia, I'm trying to address those complications of kidney disease.

So, all of your medications are falling into those two categories.

Now there's some general recommendations we make regardless of the cause of kidney disease, or regardless of what stage someone has of kidney disease. And a lot of it focuses on diet.

You have to think about kidney disease as your kidneys are already working much harder than they should, and they don't have as much reserve. So, if we can do some things with dietary changes, we might take some of that workload off of the kidneys. So, we start off with things like restricting the sodium in our diet to less than two grams a day or 2,000 milligrams when you're reading food labels.

Also, we want to cut back on the amount of processed food and sugar. So, if something can sit on a shelf for about a year or two, it probably is those kind of food items you want to cut out of your diet, or really reduce significantly.

Sometimes your kidney doctor might ask you to cut back on a couple of the minerals like potassium and phosphorus intake.

Both potassium and phosphorus are not harmful to the kidneys, but they're both cleared by the kidneys. And so, we might have to cut back on them because your kidneys are already struggling to get rid of them.

Now you may have somebody with the same level of kidney function who won't be given those dietary recommendations. These are part of that individualized treatment plan for your kidneys. Now when somebody has to cut back on potassium, they might have to cut back on potatoes, tomatoes, bananas.

And then, when they're looking at phosphorus, we're looking at dairy products, meat, and also, a lot of foods that have a lot of preservative agents. This doesn't mean you can't ever have these foods, you're basically reducing them to about once or twice a week instead of every day. Now other things that we talk about with diet are moderate protein restriction.

So, what does that mean?

Protein's important for the body. You need it to maintain your muscle mass, maintain your immune system, maintain your strength. But too much protein, your body can't absorb and you actually end up having to urinate it out and your kidneys have to get rid of it.

So, a moderate amount of protein is looking at the serving size. So, for men, the size of a deck of cards is about an appropriate serving size for chicken, beef, lamb. If you have a piece of fish, about the size of a TV remote control.

For a woman, a size of the palm of their hand is an appropriate serving size for meat. And that's for each meal. Anything more than that is just perhaps something you might need if you're recovering from an injury, recovering from a surgery. But anything more than that your body really can't use, and it's going to put an extra stress on your kidneys. A common question that people have for us is how much water should I be drinking?

There's no specific amount of water to be drinking every day for your kidneys, unless you have a history of kidney stones. Other than that, it's mainly drinking for your thirst. Water is probably a better choice than other beverages because it doesn't have any preservative agents, it doesn't have any calories. And usually, you want to aim for your urine to be almost clear to a pale yellow and that way you know you're getting enough water in your system.

Other than that, those basic dietary recommendations, your doctor's going to give you other recommendations based on what your lab work looks like and how your kidney disease is progressing.

Now, when somebody looks at you, they're not going to be able to know that you have kidney issues. So really, we're depending on you to be your health advocate and tell people when you have kidney problems.

Because there are certain tests that can be ordered that may impact on your kidney function. Or you might be prescribed medications at a dose that's not appropriate or not safe for your kidneys. Imaging studies or x-ray studies like CAT scans with contrast or angiograms, or MRIs with gadolinium, can be problematic when somebody has kidney issues. The contrast that we use for CAT scans and for angiograms can be harmful and irritating to the kidneys. The MRIs with gadolinium rely on a certain amount of kidney function to be able to clear it out of the system. If you have kidney disease, it's going to be a discussion with your doctor as to whether or not that's the right test for you, whether the test can be done in another way. Or if there should be an alternative test.

Now when we think about medications, there are a lot of medications that could be harmful to the kidneys. Medications are either cleared by the liver, or they're cleared by the kidneys.

So, whenever someone has kidney disease, you want to make sure you're knowing your level of functions so that any doctor who's prescribing medications, even if you're going to an urgent care center in the middle of the night, going to the dentist, that they all know they might have to adjust the dose of the medication or give you an alternative medication that would be safer from your kidneys.

The other key thing to remember is just because it's over-the-counter, doesn't mean that it's actually safe to use. There's a big category of over-the-counter medications called non-steroidal anti-inflammatory agents. Things like Motrin, Advil, ibuprofen, naproxen.

These medications were never designed to be taken on a regular basis. And when you have kidney disease, they can actually cause more kidney damage and interfere with blood pressure medications.

Additionally, medications that are for bowel agents such as Milk of Magnesia, phosphates, enemas, those are all problematic when you have kidney disease, because you're not going to be able to clear those minerals out of your system.

It's always a good idea to double check with your pharmacist and your physician before taking any of those medications. Kidney disease is sort of an overall plan of care as opposed to just a certain medication or a certain treatment.

So, you want to be able to be part of that healthcare team.  You want to be monitoring your progress by tracking your labs. You want to know your medications and what they're for. You want to be engaged with that team and ask questions when you don't understand what the plan is.

Also, engage your family and friends. It's a lot easier to make some of the dietary changes, it's a lot easier to be exercising when you've engaged your family members.

And when you're looking at kidney disease, we're looking at that overall plan. We're looking at controlling the blood pressure. We're looking at controlling the cholesterol, treating the complications like the anemia, the bone and mineral disease, malnutrition, depression, and maintaining existing kidney function.

For more information about treatment of chronic kidney disease, dietary changes, management strategies, please look at these following resources. And for information about treatment of end-stage kidney disease, tune in for our next video.

• Kidney School
• Home Dialysis Central
• Life Options
• American Kidney Fund
• Dialysis Patient Citizens
• Medline Plus
• National Kidney Foundation
• National Institute of Diabetes and Digestive and Kidney Disease
• Renal Support Network

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Reference

John Hopkins

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Related Articles

What is Chronic Kidney Disease?

What Do Your Kidney Do?

Signs that You Have Chronic Kidney Disease

What Causes Chronic Kidney Disease?

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‍About the Speaker

Dr. Sumeska Thavarajah is a nephrologist in Baltimore, Maryland and is affiliated with Johns Hopkins Bayview Medical Center. She received her medical degree from Wayne State University School of Medicine and has been in practice for more than 20 years.

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Patient Education Disclaimer

This material is for informational purposes only. It does not replace the advice or counsel of a doctor or health care professional. KidneyLuv makes every effort to provide information that is accurate and timely, but makes no guarantee in this regard. You should consult with, and rely only on the advice of, your physician or health care professional.

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