Although there is no cure for chronic kidney disease (CKD), it is important that measures are taken to prevent or slow down progression, even in early stages of the disease, as this can help to prevent end-stage kidney failure.
The management of stage 1-3 of chronic kidney disease primarily involves monitoring for progression of the disease and does not usually require specialist attention. For more severe cases or individuals with stage 4 or 5 CKD, referral to a specialist for help in making the treatment decisions may be beneficial.
Aim of Treatment
The primary treatment aims for chronic kidney disease are to:
- Prevent or slow the progression of the disease
- Relieve any symptoms associated with the condition
If there is an underlying health condition that is responsible for causing the disease, such as hypertension or diabetes, this should be managed first and an improvement in kidney function is likely to be seen following this.
It is also important that affected individuals are aware that CKD can increase their risk of developing hypertension and cardiovascular disease. For this reason, they should be advised of ways to reduce their risk of the disease, including lifestyle modifications and pharmacological interventions.
Managing Underlying Conditions
Several health conditions may be responsible for causing CKD and these should be identified and managed in an appropriate manner to lessen the load on the kidneys and progression of the disease. This may include:
- Diabetes: pharmacological intervention to control blood sugar
- Hypertension: diet, lifestyle and pharmacological intervention to lower blood pressure to less than 130/80 mmHg
- Recurring UTI: prophylactic antibiotics to prevent infection
- Urinary obstruction: surgery to remove obstruction
Slowing Progression of Disease
Chronic kidney disease tends to slowly worsen over time, even when treatment methods for any underlying causes are in place. For this reason, it is important that regular tests are employed to monitor the kidney function and disease progression.
A review of other medications is useful to identify potential causes of progression, such as lithium or non-steroidal anti-inflammatory drugs (NSAIDS) that are usually avoided. As the renal function decreases, the ability of the body to excrete renally cleared drugs can become compromised and should be avoided.
Some medications such as angiotensin-converting enzyme (ACE) inhibitors can have a protective effect on the function of the kidneys and slow the progression of the disease, in addition to reducing the risk of cardiovascular disease.
Reducing Cardiovascular Disease Risk
Patients with CVD are more likely to be affected by heart disease, stroke and peripheral artery disease. This often includes an array of medications to control blood pressure, cholesterol and blood glucose. It is also essential to make lifestyle modifications that help to reduce cardiovascular risk such as:
- Quitting smoking
- Reducing alcohol intake
- Increasing fruits and vegetables in diet
- Limiting salt intake
- Keeping physically active
Symptomatic Relief
In severe cases of CKD, symptoms can present and may require medical management. For example, fatigue from anemia can be improved with administration of iron or erythropoietin.
The diet can also have a significant impact on the kidney function and the severity of symptoms for those affected. It is usually advised to reduce the intake of salt and the fluid consumption may also be controlled in some cases.
Immunization
Patients with stage 3 or higher CKD should receive an annual vaccination to offer protection against infections such as influenza, in addition to a once-off pneumococcus immunization. Those with stage 4 CKD should also be immunized against hepatitis B.
End-Stage Kidney Failure
For patients with stage 5 CKD, the function of the kidneys is significantly compromised and cannot usually keep up with daily demands. For this reason, patients will often require kidney dialysis or a transplant to survive.
References
Further Reading
The long-term outcomes of diabetes remission and its impact on health