What can you do if you have been diagnosed with kidney disease?
If it is confirmed already that indeed you have a kidney problem, there are general recommendations that any patient with kidney disease can follow. And there are also specific recommendations for distinct conditions.
In general, we advise patients to modify any risk factor (i.e. diet or lifestyle habits) that could enhance disease progression.
For instance, avoid smoking, aim for better control of your blood pressure, better control of diabetes, aim for a healthier weight, and so on.
This in fact works in some patients, and on occasions that alone can halt or at least slow down disease progression to kidney failure, prolonging the life of the kidneys for as long as possible.
But if you have kidney problems or a specific disease of the kidneys, on top of managing the specific disease, you then need to ensure you manage well other conditions you might have or put efforts in not developing other conditions, by following a healthy diet and lifestyle.
For instance, you might have inflammation of the kidneys, but ideal for you to lose weight if you have excess weight to avoid first that your kidneys overwork, and second to avoid added insults, which can increase the rate of disease progression.
For some diseases, especially the ones related to inflammation or allergy in the kidneys, patients need to undergo special treatments with powerful anti-inflammatory drugs, which sometimes successfully can halt the disease.
But sometimes the disease is too aggressive; or, severe damage has been already caused to the kidneys, that the expectations of recovery and to avoid dialysis are low.
All this information can be puzzling, therefore it can cause you additional stress, which is not good for your overall health. In Francisco Kidney & Medical Centre, we provide empathetic, approachable and flexible specialist renal and medical care; because we can imagine the struggles our patients could face, and we care about the physical and mental wellbeing of our patients and their families. So, we are happy to spend extra time being sure our patients understand very well their diseases and the rationale of our management strategies.
What is the difference between chronic kidney disease and kidney failure
Both chronic kidney disease and renal failure are the spectrum of the same disease process that affects the kidney function and the well-being of the kidneys.
That process goes through different progressive stages of chronic kidney disease, where the last stage is referred to by many as total kidney failure, when the kidneys stop working; although the preferred medical term for the last stage is end-stage kidney disease.
For clarity, I will use the term of total kidney failure.
Chronic kidney disease is the consequence of the damage caused by many different disorders and diseases in the kidneys.
These disorders result in the progressive damage to the kidneys, impairing all the functions of the kidneys.
There are five stages of chronic kidney disease, from stage 1 to 5; where stage 1 is the least advanced and stage 5 the most advanced, and which can lead to total kidney failure, when the kidneys completely stop working and this is typically irreversible.
When kidney function drops below 5-10%, patients can become very ill.
The situation can be life-threatening, and dialysis or a transplant needs to be performed to replace the lost kidney function or a patient might lose his or her life.
In Francisco Kidney & Medical Centre, we understand how confusing this can be. So, we give detailed explanations to our patients, with the aim of answering their queries and dissipating their concerns.
What is the treatment of chronic kidney disease?
The treatment or management of chronic kidney disease can be divided into:
a) specific treatment of the original cause of kidney disease
b) treatment of the accompanying diseases
c) general management
Specific treatment aims to control the original cause of the kidney problems and prevent further or continuous damage as a consequence of it.
Specific causes of chronic kidney disease include diabetes, high blood pressure, different types of inflammation of the kidneys like glomerulonephritis, allergies, urine flow problems, rare diseases, recurrent infections, side-effects of medications or other agents, etc. So, the specific treatment includes treating specifically these conditions.
I will not be able to mention all the specific treatments for distinct diseases or associated conditions, but the principle is simple: specific treatment is directed to the specific cause. For instance, if diabetes is the cause, aim for good sugar control and follow all general recommendations for diabetic patients.
Plus knowing there are many ways to achieve good diabetic control. If blood pressure is the cause or accompanying factor, aim for good blood pressure control and do the necessary diet and lifestyle modifications. If inflammation is the cause, the patient might need to receive powerful anti-inflammatory drugs like steroids or more targeted specialised (and expensive medications) to treat the original disease process more effectively.
And there are many options to achieve those targets, that is, many ways to achieve good diabetic control, for example, etc.
The treatment of any accompanying disease or diseases, irrespective of being the cause or not of the kidney problem, will prevent extra insults and injury to the kidneys, which are already under siege by the original disease.
That is if diabetes is the cause of the kidney problem but you have high blood pressure, blood pressure control is a crucial aspect of your management to prevent added and extra injuries to your kidneys, in other words, to aim to prolong the life of your kidneys.
On the other hand, general management consists of general and similar recommendations given to most patients suffering from the kidneys, irrespective of the original cause of the kidney problem, aiming to halt or slow down the progression of the chronic kidney disease by minimising extra insults to the kidney coming from certain risk factors, medications, diet or lifestyle, in other words to prolong the life of the kidney; and to prevent developing new conditions that will make the kidneys suffer further.
I will go into further deep about general measures to treat and protect the kidneys in the next section.
What are the general recommendations to take care of your kidneys – especially if you have risk factors for kidney disease or the disease already?
1. Blood pressure control is very important to protect the kidneys. When high, it can cause what we call hydrostatic injury to the kidneys. You can imagine the higher the pressure, the more the damage. To achieve good blood pressure control, it is essential for you to monitor your blood pressure at home and consult your doctor if any issues, to take your blood pressure tab-lets as prescribed, and to reduce salt intake in your diet. Exercise and losing weight also help keeping a healthier blood pressure and sometimes to reduce it.
2. Quit smoking. Smoking is very toxic for many organs of your body including the kidneys. This will be good for your general wellbeing, but also to minimise insults to the kidneys.
3. We already commented a bit about the effect of losing weight for blood pressure control. But also controlling your weight can help protect the kidneys.
In a way, the larger your body size the more effort the kidneys tend to put to clean your body; and with time some consequences of that overwork (what we kidney doctors call over-filtration) can cause kidney damage (let’s call it fatigue of the kidneys).
You probably know what you need to do to lose weight: Diet improvements (for example, eat a more balanced and moderate diet with reduction of sugar and fatty food), and to have a more active lifestyle.
This will be simpler with the help of a dietician, or if you join a healthy weight loss programme, especially if you find it is too difficult to do it alone or you have tried and failed and about to or already given up.
In fact, I developed a weight loss programme with the same aim to improve health, prevent diseases like diabetes, to protect the kidneys (and the general health) for my patients and clients – The OLYMPIA Lifestyle Health Enhancement & Weight Loss Programme. If interested to know more, you know how to contact me.
4. Do exercise (as tolerable, but consult your doctor first) to maintain your weight and improve your health.
5. Control your blood cholesterol, and if high, consult your doctor for diet advice. On many occasions, medications are needed.
6. If you have pre-diabetes or diabetes, reduce sugary food and sugary drinks and aim for good blood sugar control. Plus follow all general advice for diabetic people. But, irrespective of this, even if you do not have these conditions, it is always advisable to minimise your sugar content to prevent them. In my weight loss programme, we focus also on better metabolic control of people with diabetes, pre-diabetes or at high risk of it.
7. If your doctor prescribed certain diet restrictions to protect your kidneys, the so-called renal diet, consult an experienced dietician. She or he will guide you.
It will be simpler and more effective than figuring out those diet recommendations and restrictions on your own. The dietitian can translate that into a tailored diet plan for your needs.
In general, patients with kidney problems benefit from a diet low in sodium, fat and sugar; and in many occasions low in potassium, phosphate, and protein content.
To control the phosphate some patients need phosphate lowering medications.
8. Protein restriction in the diet can benefit many patients, slowing down some of the progression of kidney disease, but please check this with your doctor and your dietitian.
First, if it is necessary. Second, to what degree. This must be adjusted greatly to the degree of kidney dysfunction, your nutritional condition and if you have any other accompanying diseases. Third, how to make your diet more balanced, to avoid over-restriction and prevent consequent malnutrition. Especially, patients with kidney problems, in particular in more advanced stages, they are more susceptible to malnutrition.
9. Control of fluid intake; what we call fluid or water restriction. It is important to stress that it is fluid restriction not only water restriction.
The restriction includes any fluid including other beverages like coffee, soda and juices, any soups or watery dishes like porridge, or even fruits like watermelon and others.
Many patients claim to attach to water restriction and maybe they have, but they need to review their diet from these other sources of dietary water.
In patients with more advanced stages of kidney disease, fluid restriction might be necessary as progressively it is more difficult for ill kidneys to handle the excess of water and you can develop fluid retention.
Water is vital, but when the kidneys do not work well, an excess of water can become toxic.
So, despite how difficult it can be; when the kidneys do not work well, fluid restriction becomes vital. So, if your doctor prescribed fluid restriction, try to attach to it, otherwise you can develop fluid overload with leg swelling, breathlessness, tiredness, potentially flooding the lungs and precipitating a heart failure episode, needing emergent hospital admission or worse.
In addition, not controlling the fluid intake through long periods of time imposes on the heart, making it overwork and with more chances to get fatigued (that is, developing chronic heart failure).
To prevent fluid overload, a low salt diet helps. Salty food triggers thirst; and salt is also a sort of sponge for water, increasing its retention (and remember, it also can increase the blood pressure).
Frequently, patients need to take water tablets (diuretics) to eliminate excess of fluids retained. But again, water tablets work better if fluid and salt restrictions are optimised.
10. Attending appointments and not missing them, even if you feel ok. If you miss it, you might think you are saving time, hassle and money; especially if the doctor tells you everything is fine or stable.
But that is crucial. You gain peace of mind. You know the current approach is working and you are doing the necessary. However, if missing appointments and there were to be an issue, you can miss it or at least delay its discovery.
On many occasions those details can harm your health, can allow a complication to develop or can allow an underlying condition to cause damage or scarring in some organs like the kidneys, which might not be reversible. Also, feeling well can be deceiving of what actually is going on inside your kidneys.
Kidney problems in early and moderate stages are typically asymptomatic (meaning you do not feel anything wrong), so that can give you false reassurance. By missing appointments, you can miss to discover things on time and miss the chance to intervene opportunely with the aim of delaying progress of your kidney dysfunction. This is a common issue.
11. Take all your medications as prescribed. Again, I cannot stress how important is not to miss medications and to take them as prescribed, avoiding under or overdosing.
In this latter issue, if you think you would need less or more medications, that might be true, but make aware your primary doctor, so he can adjust your management. Otherwise, if missing medications or not having the right doses, it is difficult for the treatment to work, it is difficult for your condition to improve, halt or reduce its deterioration speed and can precipitate side-effects.
Talking about prevention and renal protection. Some patients are prescribed anti-proteinuric medications, as they can protect your kidneys, in a way, by reducing the blood pressure inside the kidney at the microscopic level, making the filtering of the blood more gentle, and by minimising leakage of protein.
But not everyone should or can take them. Some patients might have contraindications for them and cannot use them. Check this with your doctor.
12. Many patients with high cardiac risk factors can benefit from taking aspirin or especial types of blood pressure tablets, so ask your doctor if they are suitable for you as not everyone can take aspirin, for example.
13. If you have anaemia, take your iron supplements and/or administer your erythropoietin injections as prescribed to improve your haemoglobin levels to the recommended range.
14. If your blood is acidic (low serum bicarbonate), take your bicarbonate supplements.
15. If your uric acid is high, take care of your diet and take anti-uric acid medications if prescribed by your doctor
16. Ask your doctor if you need some vitamin supplements.
17. If you have a stressful life, check what you can do to minimise your stress. Similarly, if you cannot sleep well, check what you can do to improve that. It could be from something like planning your life differently with the people around or involved in those situations, practicing meditations, mindfulness and other practices, or by asking help.
Sometimes is stress of busy modern lives with all their challenges. Sometimes there might be an underlying medical disorder.
18. Check with your doctor if your 25 vitamin levels must be checked, and if low, take supplements. In addition, some patients with advanced kidney disease might also need to take a more special active type of vitamin D or other medications to control the phosphorus and calcium in your body.
19. If you have high blood pressure and/or diabetes, you might need to see an eye doctor to examine the back of your eye.
20. Check what vaccinations are recommended for you. It varies patient to patient but typically vaccinations against influenza, pneumococcus and hepatitis B are advisable.
21. Follow all the necessary precautions recommended by international and local health advisory boards on COVID 19, for your own protection and the protection of the community in general. They can vary from country to country, so be attentive to that.
Overall, practice respiratory etiquette and wear a face mask when in public and especially if you are ill with flu-like symptoms; but if you are ill, better see a doctor and/or stay at home. Even if you are not ill, stay at home if you don’t need to commute or be outside, and avoid large crowds, keeping physical distance at your best capacity.
Eat healthy and maintain yourself active (eg do exercise outdoors -if allowed- or at home). If you smoke, stop smoking. Control your diabetes as best as possible and any other medical conditions that you might have. Lose weight if you have excess weight. And remember stay vigilant, stay safe and stay healthy.
22. If you have chronic kidney disease and renal cysts, you might need monitoring of the appearance and size of the cysts by ultrasound, performed at different intervals. Consult your doctor to see if this is necessary for you.
23. Inform your doctor immediately after becoming pregnant as you might need to discontinue medications like anti-cholesterol and anti-proteinuric medications or any other special medication given for certain kidney problems (diseases with inflammation in the kidneys) like some immunosuppressants
Go back to consult your doctor if you have queries or worries about your health or side effects of therapies, which can be more common in patients with kidney problems, or if you do not respond as both of you expected to the strategy proposed by your doctor.
Your doctor must be told about that, so he can advise you what will be the next step. Not all medications work for all patients or to the same degree in all patients.
Finally, I need to mention there is no magical answer, medication or strategy to make the kidneys recover or to never go into failure, especially if the process is ongoing, the kidney function deteriorating progressively or the kidney dysfunction quite advanced.
Understandably many patients have great hopes on newer therapies or some unregistered approaches. We as doctors cannot destroy hope from patients, but we have the duty to be objective and frank, irrespective how doom the outlook or thin the hope is.
All these strategies above will help you to prolong the life of the kidneys to different degrees, but a more realistic expectation for many patients is to maintain the kidney function stable for as long as possible or if deteriorating, to deteriorate as slow as possible; that is, the aim is to prolong the life of the kidneys, hopefully for the rest of the lives of the patients.
Since the treatment is complex and diverse, it needs to be personalised to your condition and wishes, after carefully explained the rationale, pros and cons of all options, my practical recommendation is to visit your kidney doctor to explain all that to you, taking into account your personal priorities and preferences.
In Francisco Kidney & Medical Centre, we provide therapeutic and preventive advice to our patients, as we believe that prevention is better than cure. Please contact us if you need our help.
Does necessarily kidney disease end in kidney failure and the need for dialysis or a kidney transplant?
Not all patients with chronic kidney disease eventually develop kidney failure. In other words, not all patients with kidney disease need to undergo dialysis or a kidney transplant.
There are many factors responsible for this.
First of all, there is no single cause of kidney disease. And every disease behaves differently, some more aggressively than others. So, the progression and risk is different in every single patient; plus the fact that every patient is per se in general different.
Second, the current status of your kidney problem or the status of your kidney disease when it was detected can also determine your chances to progress to kidney failure or not.
For example, if the disease is detected early and is amenable to modification of habits and/or the use of medications to protect the kidneys, the chances of disease progression tend to be lower.
But if detected late or your percentage of kidney function left is already quite low, you will have higher chances of developing kidney failure as the time passes by.
This illustrates the importance of early detection and screening, especially if the patient has personal or family risk factors like diabetes, high blood pressure, or inheritable diseases like polycystic kidney disease; among many other causes.
Third, not every patient takes the same good care of their health; or adhere to their treatment for his or her underlying conditions; or modifies accordingly his/her diet and lifestyle.
As a consequence, and it is totally my professional experience and observation, patients with chronic metabolic conditions and kidney disease, who live a more frugal and active lifestyle, attending their appointments (i.e. getting opportune advice) and following that medical advice tend to have less risk of disease progression and chances of kid-ney failure. The opposite is true for those not taking good care of themselves.
There are other important factors to determine your chances to develop kidney failure, and as I mentioned, they vary patient to patient, so…taking into account your health and wellbeing is at stake, I recommend you to address your concerns with and be evaluated by a specialist kidney doctor, who can individualise his or her opinion to your particular case.
It is not easy living with kidney problems, the worry of disease progression, or having developed kidney failure already.
So, aiming to prevent or slow down kidney disease progression or its complications, and getting help to fully understand this process and managing properly is crucial. However, many times despite all the efforts, the kidneys still give up and go into failure…and we need to advise our patients to prepare or go for dialysis or a kidney transplant.
Before concluding, it is important to mention that there are cases of temporary kidney failure, what we doctors call acute kidney failure, where the patient can need dialysis for a variable period of time and later showing recovery and the dialysis can be stopped.
However, these patients need to continue on follow up as they have higher risk of developing progressive kidney disease than normal people.