The three treatment options for CKD are medical management, dialysis or transplant.
There is no cure for CKD. Advanced CKD needs dialysis or kidney transplant to maintain life. Because of the high cost and problems of availability, in India only 5 -10% of kidney patients get treatment like dialysis and kidney transplant, while the rest die without getting any definitive therapy. Therefore, early detection and meticulous conservative medical management is the only feasible and less expensive way to manage CKD and delay the need for dialysis or transplant.
Initiation of proper therapy at early stages of CKD is most rewarding. Most patients are asymptomatic or feel very well with proper therapy in early stages. Because of the absence of symptoms many patients and their families fail to recognize the seriousness of the disease and discontinue medicine and dietary restrictions. Discontinuation of therapy may lead to rapid worsening of kidney function requiring expensive dialysis or kidney transplantation.
In CKD with early medical management patients can live a long life.
CKD is a progressively deteriorating condition with no cure. The aims of medical management are to:
Treatment strategies and recommended actions in different stages of chronic kidney disease are summarized in this table.
|All Stages||Regular follow up and monitoring|
|Life style changes and general measures:|
|1||Diagnose/treat to slow down the progression|
|Educate patients on disease management|
|Treat comorbid conditions, cardiovascular disease risk reduction|
|2||Estimate progression; treat co-morbid conditions|
|3||Evaluate/treat complications; refer to nephrologist|
|4||Educate patients on kidney replacement options Prepare for kidney replacement therapy|
|5||Kidney replacement by dialysis or transplant|
Identifying and treating these underlying primary conditions may help prevent, delay or reverse the progression of CKD.
your doctor may prescribe important and effective measures to slow down the progression of CKD such as:
Search and treat reversible factors that may have aggravated or exacerbated the degree of kidney failure. By correction of reversible factors kidney failure may improve, and kidney function may return to stable base level of function. The common reversible causes are:
Complications of CKD require early diagnosis and immediate treatment. The common complications which need attention are severe fluid overload, high potassium level in blood (potassium > 6.0 mEq/L), and severe ill effects of advanced kidney failure on heart, brain and lungs.
These measures are important in reducing overall risk:
Depending on the type and severity of kidney disease, dietary restrictions are needed in CKD (discussed in detail in Chapter 25).
In CKD, dietary restrictions may delay the progression and prevent complications.
A person with CKD needs early referral to a nephrologist and pre- dialysis education to decrease morbidity and mortality. Early referral reduces the rate of progression to ESKD and may delay the need to initiate kidney (renal) replacement therapy.
Which is the most important treatment to prevent or delay the progression of CKD?
Whatever the underlying cause of CKD, strict control of blood pressure is the most important treatment to prevent or delay the progression of CKD. Uncontrolled blood pressure leads to rapid worsening of CKD and complications such as heart attack and stroke.
Which drugs are used to control high blood pressure?
The nephrologist or physician will select appropriate agents to control high blood pressure. The most common drugs used are angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, beta blockers and diuretics.
ACE inhibitors and ARBs are recommended as first line therapy to reduce blood pressure and also helps by slowing the progression of kidney damage, thereby, protecting the kidneys.
What is the goal of blood pressure control in CKD?
It is recommended to keep blood pressure below 130/ 80 mmHg.
Which is the best method to assess and monitor blood pressure control in CKD?
Periodic visits to a doctor help to know the blood pressure status. But buying a blood pressure instrument and using it regularly at home may be helpful to assess and monitor blood pressure control in CKD. Maintaining a chart of blood pressure recordings may help , the doctor adjust drug dosages and times of administration
How do diuretic drugs help CKD patients?
Doctors may prescribe diuretic which are medicines that help to increase the volume of urine and reduce swelling and breathlessness in some patients. It is important to remember that these medicines may increase the volume of urine but do not improve the function of the kidney.
Why does anemia occur in CKD and how is it treated?
When kidneys are functioning properly, they produce a hormone callederythropoietin, which stimulates the bone marrow to produce red blood cells. In CKD with reduction of kidney function, erythropoietin production also decreases, leading to anemia.
Iron tablets, vitamins and, at times, intravenous iron injections are the first steps to treat anemia due to CKD. Severe anemia, or anemia not responding to drug therapy, needs injections of synthetic erythropoietin, which help bone marrow to produce oxygen-carrying red blood cells. Erythropoietin injections are safe, effective and the preferred method of treating anemia due to CKD. Transfusion of blood is quick and effective to correct anemia in an emergency but is not the preferred method due to the risk of infection and allergic reactions
Why does anemia in CKD need treatment?
Red blood cells carry oxygen from lungs to all parts of the body. Anemia (low hemoglobin) in CKD leads to weakness, fatigue, poor exercise capacity, breathlessness, rapid heartbeat, loss of concentration, intolerance to cold and chest pain and therefore, this needs early and proper treatment.
Source: Kidney Education Foundation
Last Modified : 2/12/2020