Chronic Kidney Disease Treatment

  • Treatment

    If late-stage symptoms such as decreased alertness, seizures, and coma develop, seek immediate medical attention. Other serious symptoms include shortness of breath and extensive swelling of the lower legs. People who have CKD have a higher risk of developing dangerously high levels of blood potassium, which can lead to life-threatening arrythmias.

    A high-carbohydrate, low-protein, low-salt diet can reduce the workload on the kidneys. Also, it is important to balance your fluid intake to your urine output to avoid dehydration. Patients with CKD may need to adhere to a strict diet to control symptoms and avoid complications. Common dietary recommendations include:

    • Adequate calorie intake
    • Carefully measured fluid intake
    • Protein restriction (limited to 0.6 g to 0.7 g of protein per kg of body weight per day)
    • Phosphate restriction
    • Sodium restriction
    • Potassium restriction
    • Vitamin supplements

    Proper treatment of underlying medical conditions, including hypertension and diabetes, can also minimize the progression of CKD.

    To relieve the stress of illness, patients may seek support groups where members share similar experiences and problems related to CKD.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Patients with severe CKD may need dialysis, which is a procedure that filters and cleans the blood when the kidneys no longer can do so. There are two types of dialysis: peritoneal dialysis and hemodialysis. In peritoneal dialysis, a special tube is inserted through the skin into the abdomen. Through the tube, a cleansing fluid called dialysate flows into the abdomen and is drained several hours later. Wastes that have been removed from the blood by the dialysate are also drained. This process is repeated several times per day, or can be done at night while the patient sleeps.

    In hemodialysis, a dialysis machine filters the blood. Through one set of tubes, blood leaves the body and travels into the dialysis machine where wastes and extra fluids are removed. Filtered blood then flows back into the body through another set of tubes. While the number of treatments and duration of each treatment varies depending on the severity of the patient's condition, the average dialysis patient undergoes treatment three times a week for three or four hours at each visit. Most people on dialysis in the U.S. undergo hemodialysis. New machines are being developed so that people can undergo hemodialysis at home.

    For most people with ESRD, dailysis should be a bridge to a kidney transplant. Patients with CKD who are headed for dialysis should be place on the transplant list early. Kidney transplants are the most common form of organ transplants, after cornea transplants. A kidney transplant can come from either a living (usually a blood relative) or a recently deceased person. There are restrictions on who is elligible for a transplant.

    Unfortunately, the demand for transplanted kidneys far exceeds supply. In the U.S. in 1996, only 11,330 living kidney donor transplants were performed, despite over 34,000 people on the kidney transplant waiting list. Living donor kidneys have a 50% chance of functioning for 24 years, and kidney transplants from cadavers have a 50% chance of functioning for nine years.

    Congenital kidney and urinary tract abnormalities are the main cause of CKD in children younger than five years old. Hereditary kidney diseases emerge in children between the ages of 5 and 15 years old. When CKD develops in infancy, the child's growth is more impaired than if the disease develops during the teenage years. CKD may be more difficult to manage in children.

    Fertility and libido are impaired by CKD, and pregnant women with CKD are less likely to carry their pregnancies to term than otherwise healthy women. Most women with CKD can still have children, but women with ESRD on dialysis are advised not to have children.

    Older adults experience the highest incidence of CRF, as renal disease usually occurs secondary to several age-related conditions, including diabetes and hypertension. In older patients, it is important to rule out hypercalcemia (high blood calcium), renal artery blockage, use of medications that are toxic to the kidney, and kidney stones as the cause of renal symptoms.

    There is no present medical therapy that can reverse CKD. If left untreated, CKD usually progresses to end-stage renal disease (ESRD). When compared with the general population, patients with CKD leading to ESRD have a significantly shortened life span.

    Early diagnosis and conservative management of renal failure is essential for improving quality of life and extending the lifespan of CKD patients. Lifelong treatment may be necessary to control the symptoms of CKD.

    Because symptoms can quickly worsen and complications can arise, patients with CKD should be observed closely. A provider may recommend that a patient monitor his or her blood and urine chemistries, blood pressure, and blood volume frequently.

    Possible complications associated with CKD include:

    • Malunitrition
    • Gout
    • Changes in calcium and phosphorous metabolism
    • Anemia
    • Lipid disorders
    • Hypothyroidism
    • Bone fractures
    • Infertility
    • Impotence
    • Miscarriages

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