Chronic Kidney Disease Treatment

What is chronic kidney disease?

The role of the kidney is to filter and remove waste, electrolytes, and excess fluids from the body.

Chronic kidney disease, also known as chronic kidney failure, describes the slow loss of kidney function. There are five stages of chronic kidney disease as described below.

· Stage 1 and 2 are the mildest stages and indicate that the kidney is not working at full capacity.
· Stage 3 occurs when the kidney function is at 50%, causing symptoms such as high blood pressure or bone problems.
· Stage 4 is when severe kidney damage has occurred. At this point, the treatment plan is to preserve function while managing the symptoms.
· Stage 5 is kidney failure where the kidney is unable to filter and remove waste, electrolytes and excess fluid on its own. Dialysis or a kidney transplant is the only viable life-sustaining options.

In the early stages of the disease, there may be few signs or symptoms which become more apparent as the kidney function severely deteriorates.

Treatment by a renal physician focuses on slowing down the kidney damage by controlling the underlying cause, largely due to diabetes and high blood pressure. Chronic kidney disease can develop into end-stage kidney failure, which is treated by dialysis or a kidney transplant.

When should I see a specialist for chronic kidney disease treatment?

You should consider seeing a renal physician if you have any of the following signs or symptoms:

· nausea
· vomiting
· loss of appetite
· fatigue and weakness
· unable to sleep well at night
· changes in urinary volume
· decreased mental acuity
· muscle cramps
· feet and ankles swelling
· persistent itches
· chest pain due to fluid buildup around the heart
· shortness of breath due to fluid buildup in the lungs
· difficult to control high blood pressure

These symptoms are not specific to chronic kidney disease. They can also be caused by other conditions. However, as signs of chronic kidney disease do not appear until there is permanent damage to the kidney, you are advised to see a specialist should you have any of the above symptoms.

If you have a medical condition such as high blood pressure or diabetes that increases your risk of kidney disease, you should monitor your blood pressure and kidney function with urine and blood tests regularly.

Did you know?

In Singapore, more than 50% of patients with stage 5 chronic kidney disease who were undergoing dialysis in 2015, have diabetes-related kidney damage (diabetic nephropathy) as the main underlying cause of their condition¹.

What are the complications of chronic kidney disease?

If you do not treat your kidney disease, this can cause other health problems throughout your body including:

· Heart and blood vessel problems
· Anaemia (low red blood cell count)
· Mineral and bone issues
· High blood pressure
· Poor nutritional health

How should I prepare for my appointment?

The renal physician will discuss your personal and family history with you. Your specialist is likely to ask questions regarding your blood pressure, any changes in your medication that might affect your kidney, changes in your urinary habits, or any family member who have any kidney disease.

You may wish to prepare the following information for the appointment:

· Your symptoms and how long you have had these symptoms, including those that may seem unrelated to your kidneys or urinary function

· All medication currently being consumed including dosage, vitamins, and other supplements

· You and your family’s medical history

The renal physician will also perform a physical examination and order certain tests and procedures such as

· Kidney function tests to assess the amount of waste products, such as creatinine and urea, in your blood

· Urine test to help identify the cause and reveal any possible abnormalities indicating chronic kidney failure

· Ultrasound of your kidneys to assess your kidneys’ structure and size

· Kidney biopsy where a sample of kidney tissue is removed under local anaesthesia. The biopsy sample is analysed at a lab to help determine the cause of your kidney condition

What can I expect during chronic kidney disease treatment?

In chronic kidney disease treatment, the renal physician will usually try to treat the underlying cause, to help control symptoms, reduce complications, and slow down the damage.

Treatments to control symptoms and reduce complications may include medications to:

· Reduce your high blood pressure and preserve kidney function such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers. Your specialist will also likely prescribe a diuretic (to help you pass more water) and a low-salt diet.

· Reduce cholesterol levels such as statins as people with chronic kidney disease often have high levels of bad cholesterol, which increases the risk of heart disease.

· Treat anaemia with the hormone erythropoietin and sometimes with iron added, to aid in more red blood cells production to help relieve fatigue associated with anaemia.

· Relieve swelling with diuretics to maintain fluid balance as people with chronic kidney disease may retain fluids, leading to high blood pressure.

· Protect your bone density by prescribing calcium and vitamin D supplements to lower your risk of a fracture. As blood vessels narrow from absorbing extra calcium and phosphorus that is being shed from your bones, your renal physician may also prescribe a drug known as a phosphate binder to lower the amount of phosphate in your blood and prevent calcium deposits in your blood vessels.

You will also be advised to start a lower-protein diet. When protein is processed by the body, waste products are formed which will mean more work for the kidney. Reducing protein consumption will mean less work for the kidney.

To ensure that your disease remains stable, your renal physician may recommend blood tests at regular intervals to monitor your condition.

You may need treatment for end-stage kidney disease if your kidneys cannot remove the waste and fluid on its own. You would need either dialysis or a kidney transplant.

· Dialysis artificially removes waste products and excess fluid from your blood. There are two common ways.

In hemodialysis, blood is passed through a machine that filters waste and excess fluids.

In peritoneal dialysis, your abdomen is filled with a thin tube (a catheter) with dialysis fluid that absorbs waste and excess fluids. After a period of time, this fluid is then drained, carrying the waste with it.

· A kidney transplant involves a surgical procedure to place a healthy kidney from a donor (living or deceased) into your body. Lifelong medication will need to be taken to prevent your body from rejecting the donor kidney. The donor kidney will take over the functions of your own kidneys.

A third option is to treat kidney failure conservatively, addressing the symptoms as they develop. Your life expectancy is generally only a few months.

How do I maintain my kidney health after I am diagnosed with chronic kidney disease?

Part of maintaining or preserving your kidney function is to understand how your condition changes over time and actively taking steps to prevent further deterioration.

Monitor your test results particularly for these two indicators:

o ACR (Albumin to Creatinine Ratio) is detected through a urine test to show how much albumin (a type of protein) is in your urine. Too much albumin is an indicator of early kidney damage.
o GFR (glomerular filtration rate) is found using a blood test which measures which stage of the 5 stages of chronic kidney disease you are at.

· Check your blood pressure regularly as high blood pressure can damage your kidneys. Find out from your doctor what those values are acceptable for your condition and actively work towards the desired range.

· Chronic kidney disease is a risk factor for heart problems just as heart conditions are a risk factor for chronic kidney disease. Find out from your renal physician how to lower your risk for heart problems or if you already have it, how to best to treat it.

· Make sure that your renal physician is aware of all the medications that you are taking. When the kidneys are not functioning well, the drugs could build up within the body, causing harm. Changes to current medication may also be made to ensure that they are safe for your kidneys.

· Discuss with a dietician about eating well. You are likely to be advised to reduce your salt intake.

· Stop smoking as it causes blood vessels to be inflamed and fatty deposits to build up which over time causes high blood pressure.

· Start exercising to maintain a healthy weight and stay active

If you are diagnosed with late stage (4 or 5) chronic kidney disease, you should find out more about the different treatment options for kidney failure so that you can choose one that best suits your health and lifestyle.

1. National Registry of Diseases Office (NDRO). Singapore Renal Registry Annual Report 2015. 2017. https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/singapore-renal-registry-annual-report.pdf?sfvrsn=0. Accessed December 9, 2017.