• Dr Francisco

Dr Francisco and All against chronic kidney disease

Updated: May 6, 2018

General recommendations for patients with chronic kidney disease (the more recommendations you follow the better your health and the lesser the complications you can have). But discuss with your doctor if all of them apply to you or if there is any contraindication.

It is not simple to follow all the recommendations and it takes time, effort and perseverance; but you can do it, you just need to believe it is important and good for you and your life as a whole, including your family. But at the end of the day, it depends mainly on you and on the effort you put on it. The effort is worth as you could reduce complications and likely live longer and better for you to enjoy a healthier life with your family and friends.

Consult your doctor for specific advice and clarifications.


Dr Francisco's recommendations:

1.Aim to have a blood pressure below 140/90 mmHg (but in many occasions is better if below 130/80 mmHg). The target can vary among patients and expert opinions, so, talk to your doctor to decide which readings are the best for you. Ensuring your blood pressure is within the recommended range is very important to prevent further injury to your kidneys and many organs like the heart, eyes and brain.

2.Avoid very salty food, especially if you have high blood pressure. This can improve your blood pressure control and increases the benefits of many of the medications your doctor prescribe for your kidney condition.

3.Buy a blood pressure machine to monitor your blood pressure at home and ask your doctor how to use it. This is very useful for you and your doctor for a better monitoring and control of your blood pressure and the prevention of complications…It is an extra cost, but see it as an important investment in your health.

4.If you smoke…sincerely, stop smoking. It is not easy, ask for help if having difficulties, there are many methods to help you to quit smoking. But tobacco is very toxic for all your body, but importantly also affects your kidney, worsens your blood pressure and increase your risk for heart disease, heart attacks, strokes and many other vascular problems; not forgetting about lung problems and causing several types of cancer.

5.If overweight or heavier, aim to lose weight through diet improvements and exercise.

6.Do at least light to moderate exercise if no heart problems (consult first your doctor) several days a week

7.Reduce fried, fatty, oily food (reduce saturated fats, especially)

8.If you have high blood cholesterol, you might need anti-cholesterol medications and to be more strict in your diet, but check if you can take them as their side-effects are more common in people with kidney problems

9.If you have diabetes, reduce sugary food and sugary drinks, and take your anti-diabetes medications as prescribed by your doctor to target the right level of blood HbA1c (consult your doctor regarding which level of HbA1c is the right for you and try to achieve it)

— Even if you are not diabetic, your metabolism will benefit from avoiding or reducing sugary drinks and food in your diet, and you will reduce the chances of developing diabetes in the future.

10.Consult a dietician (and your doctor) to see if you need any diet restriction. In general, patients with kidney problems benefit from a diet low in sodium, fat and sugar; and in many occasions low in potassium and phosphate.

Protein restriction in the diet can benefit many patients, retarding in some the progression of kidney disease, but please check this with your doctor as it depends greatly in how advanced your disease is, your nutrition status and many other factors.

When the phosphate is high, besides following certain diet restrictions, some patients can benefit from taking medications called phosphate binders. Non-calcium containing phosphate binders are preferable over calcium-containing, unless your calcium is low, but the former are much more expensive than the latter.

11.In early and moderate stages of disease, you can drink sufficient amount of water according to your thirst and activities, avoiding dehydration. Despite water is the vital fluid, drinking water in excess is also not good as it can dilute the salts in your blood and cause other problems.

Importantly, in more advanced stages of kidney disease, water 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 if water restriction is not implemented. This is very important as fluid retention worsens your blood pressure, causes leg swelling, makes you feel breathless and tired and makes your heart overwork, with the risk of your heart getting tired = going into failure, endangering even your life. But consult your doctor if developing fluid retention to see how much water and salt restriction you need and if you need to take water tablets (diuretics).

12.Attend regularly your appointments and do not miss them, even if you feel OK. Kidney problems in early and moderate stages are typically asymptomatic (ie 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.

13.Take all your medications as prescribed. Some patients are on anti-proteinuric medications, as they can protect your kidneys, but some patients might have contraindications and cannot use them. Check this with your doctor.

14.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. For instance, not everyone can take aspirin

15.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.

16.If your blood is acidic (low serum bicarbonate), take your bicarbonate supplements

17.If your uric acid is high, take care of your diet and take anti-uric acid medications if prescribed by your doctor

18.Ask your doctor if you need some vitamin supplements. Many patients with kidney problems, especially if the disease is advanced, benefit from multivitaminics.

Importantly, it is ideal to measure your 25-vitamin D levels to see if you are deficient and need vitamin D replacement. In addition, some patients with advanced kidney disease might need also 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. Ask your doctor if this is appropriate.

20. It is advisable you have yearly influenza vaccination. Pneumococcal vaccination as well if it is not up to date. Hepatitis B vaccination is advisable: consult your doctor.

21.Regarding alcohol, if possible, avoid it, otherwise, do not binge-drink and avoid drinking in excess.

22.Patients with chronic kidney disease and renal cysts 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

24.Go back to consult your doctor if you have queries or worries about your health or side effects of therapies or recommendations or you do not respond as both expected to the strategy proposed by your doctor

If you would like more specific advice, Dr Francisco will be happy to advise you.

Wishing you the best possible health,

Dr Francisco Salcido-Ochoa

Specialist Nephrologist and Transplant Immunologist.

Active promoter of healthy living and a provider of approachable, flexible and empathic care in Singapore for Singaporeans, Expats and International patients.