Preventing the progress of chronic kidney disease
A diagnosis of chronic kidney disease (CKD) can be a surprise for many who discover they have it. CKD often has few if any symptoms until at a more advanced stage. This progressive and irreversible disease can have many complications; however there are steps you can do to slow its progression, helping you live longer without complications or the need for renal replacement therapy.
Fast facts on CKD
Having CKD means your kidneys are damaged and can’t filter blood like they should. This can lead to wastes building up in your body leading to other health problems. Because CKD is a progressive disease, it can possibly lead to kidney failure with the only treatment options being dialysis or a kidney transplant.
Here are other facts on CKD:
· 30 million people or 15% (more than 1 in 7) of US adults are estimated to have CKD
· 48% of those with severely reduced kidney function but not on dialysis are not aware of having CKD
· Most (96%) of people with kidney damage or mildly reduced kidney function are not aware of having CKD
· Approximately 1 in 3 adults with diabetes and 1 in 5 adults with high blood pressure may have chronic kidney disease
· CKD is estimated to be more common in women than in men (16% vs 13%)
· CKD is also estimated to be more common in non-Hispanic blacks than in non-Hispanic whites (18% vs 13%)
· 15% of Hispanics are estimated to have CKD
People who are at the highest risk of developing CKD are adults with diabetes, high blood pressure or both. Other risk factors include heart disease, obesity, and a family history of CKD.
Treatment strategies to slow the progression of CKD
People with CKD may not feel ill or notice any symptoms. The only way to find out for sure if you have CKD is through specific blood and urine tests. These tests include measurement of both the creatinine level in the blood and protein in the urine.
Kidney disease usually gets worse over time though treatment has been shown to slow it down. When the kidneys stop working, dialysis or kidney transplant is needed for survival. To avoid this scenario, the earlier CKD is found the earlier treatment strategies can begin, slowing the progression of it. These strategies can be addressed by making lifestyle changes that include the following:
· Nutritional interventions
· Lifestyle interventions
· Medical management to control blood pressure and blood glucose, and reduce albuminuria
The purpose of making nutritional changes is to delay the progression of CKD and to prevent and treat complications, including malnutrition. The first steps in diet therapy are to:
· Limit sodium to no more than 2,300 mg/day to help control blood pressure
· Provide adequate but not excessive protein which may help reduce albuminuria and slow the progression of CKD
· Choose heart healthy foods
· As CKD progresses, one may have to limit intake of the minerals phosphorus and potassium.
· For individualized nutrition therapy, see a registered dietitian who can help plan out a dietary regimen suited for you
There are several lifestyle changes that are necessary to be made to reduce CKD’s progression:
· Anyone with CKD who smokes, needs to take steps to quit. Smoking is associated with abnormal urine albumin and progression of CKD. Smoking also contributes to death from stroke and heart attack in people with CKD.
· Increase physical activity. Like the general population, people with CKD need to obtain at least 20 to 30 minutes of exercise most days of the week. Both aerobic and strength training are encouraged. Physical activity may help prevent heart disease, improve glucose control in those with diabetes, and maintain muscle mass.
· If you have diabetes, keep it under control by constantly maintaining normal blood sugar levels and following the diet and taking any medications recommended by your doctor.
· Watch your weight. Limit high-fat, fried foods and rich desserts. Obesity is linked to high blood pressure, heart disease and CKD. Speak with a registered dietitian to help you plan your meals.
· Your doctor may tell you to avoid high-protein diets if you have stage 3 CKD or above. These diets increase pressure inside the kidneys’ filters. Over time, this pressure damages the filters, which then leak protein into the urine. This leakage over time further damages the kidneys’ filters.
· It’s a must to keep your blood pressure under control. Your doctor may tell you to follow a diet called DASH (Dietary Approaches to Stop Hypertension). This is a diet that’s basically low in salt and high in potassium and calcium. It emphasizes choosing low-fat dairy products instead of high-fat ones, choosing vegetable proteins instead of animal proteins and avoiding dark cola beverages. Talk with your doctor about the potassium factor. Not everyone with kidney disease needs to or should increase potassium in their diet.
The key intervention here is to control blood pressure, blood glucose, and to block the renin-angiotensin aldosterone system (RAAS) with ACE inhibitors. Other steps in medical management include:
· Improve blood pressure using medications if necessary. Controlling blood pressure is probably the most effective intervention to slow progressive CKD.
· Use of ACE-inhibitors/ARBs for blood pressure control and to reduce albuminuria.
· Blood glucose control for those with diabetes. Individuals who have good blood glucose control prior to the development of CKD may prevent its development altogether. Blood glucose control can be achieved in three main ways – diet, exercise and medications.