Basic details of kidney disease treatment?

People with chronic kidney disease have three options: medical management, dialysis, and/or transplant. All patients who have chronic kidney disease are initially treated by medicines, dietary advice, and monitoring of the health status of their kidneys (referred to as medical management). People with end stage renal failure (end stage kidney disease) require dialysis or a kidney transplant to stay alive.


Medical management is vital for managing chronic kidney disease because no cure for the ailment currently exists. People in with end stage kidney disease need dialysis or kidney transplants to stay alive, and both options are very expensive – their high cost make them out of reach of 90-95% of people in India. Most people in India with severe kidney disease die without receiving proper care or treatment, and this is unacceptable. It is for this reason that early detection and effective medical management is the best option for people in India.

People with chronic kidney disease have a lifelong illness with no cure, and one which leads to continuous deterioration of the kidneys and decline in kidney function. Medical management exists with the following objectives: to slow the progression of the disease, to treat the underlying causes and contributing factors of kidney disease, to relieve its symptoms and complications, to reduce the risk of the patient developing heart disease, and to delay the need for dialysis or transplant.

Different stages of chronic kidney disease require different treatment strategies. People in all stages of kidney disease are advised to get regular monitoring and follow up for their kidneys, and make certain lifestyle changes.

The objectives for people with stage one kidney disease are to diagnose the disease and treat it to retard its progression, educate them on disease management, treat comorbid conditions, and reduce the risk of them developing heart disease. The objectives for people with stage two kidney disease are to estimate its progression, and treat comorbid conditions. The objectives for people with stage three kidney disease are to evaluate the disease, treat any arising complications, and refer them to a nephrologist. The objectives for people with stage four kidney disease are to educate them on kidney replacement options, and prep them for kidney replacement. The objectives for people with stage five kidney disease are to replace their kidneys, either through dialysis or transplant.


Nephrologists and doctors generally follow a nine step program in terms of medical management of chronic kidney disease.

Step one: manage the primary etiology of the patient

This involves identifying and treating the primary underlying conditions including: diabetes mellitus, high blood pressure, urinary tract infection or obstruction, glomerulonephritis, renovascular disease, analgesic nephropathy, etc

Step two: Formulate strategies designed to retard the progression of chronic kidney disease

These include strictly controlling blood pressure, and giving the patient medicines to block the production of angiotensin. These include: ACE inhibitors, or angiotensin receptor blockers (ARB II blockers). The patients are also advised to restrict the amount of protein they consume daily, and go on a therapy to reduce their lipid levels and to correct any anemia problems they may have.

Step three: Supportive and symptomatic treatment

Supportive and symptomatic treatment consists of a plan in which the patient is given a water pill (also referred to as a diuretic) to increase daily urine volume and output, and to reduce swelling. The patent is also given medicine designed to control nausea, vomiting, and gastric discomfort. The doctor will prescribe calcium, phosphate binders, and an active form of Vitamin D in the form of vitamin supplements to prevent and correct bone disease caused by chronic kidney disease. The doctor will prescribe iron and vitamin supplements, and erythropoitein injections to address any low hemoglobin issues the patient may have. The doctor will also prescribe a daily dose of aspirin to prevent heart problems from developing, unless the patient is contraindicated.

Step four: Management of reversible factors

Doctors search for and treat those factors which may have worsened the degree of kidney failure. They may be able to reverse the kidney failure somewhat by this measure, and they may even be able to improve overall kidney function to a more stable level. The common causes of kidney failure which can be reversed are: fluid volume depletion, medicines (non steroidal anti-inflammatory medicines, NSAIDs, contra agents, aminoglycosides, and antibiotics), infection, and congestive heart failure.


Step five: Identify and treat chronic kidney disease complications

Chronic kidney disease complications require early diagnosis and early treatment to maximize the patients survival chances. The most common complications are: severe fluid overload, high blood potassium levels (potassium>6.0mEq/L), and damage caused to the heart, lungs, and brain because of kidney failure.

Step six: Lifestyle modifications and general measures

Patients must make the following lifestyle changes if they want to improve kidney function, and preserve their kidneys: cease smoking, maintain a healthy weight, exercise regularly, and remain physically active regularly, limit alcohol consumption, follow a healthy diet that minimizes salt consumption, take prescribed medicines as required, and adjust them according to the severity of kidney failure, and attend regular follow up and treatment appointments as directed by the nephrologist.

1. Dietary restrictions

Patients with severe kidney disease, and who are in advanced stages of kidney failure need to follow certain dietary recommendations and restrictions. They need to limit their intake of sodium and salt to control high blood pressure, and swelling. Because they do not produce as much urine (because their kidneys are functioning well below capacity), they need to limit the amount of fluid consumed daily because consuming excess fluid can result in swelling and shortness of breath.

High potassium levels are a problem for all patients with chronic kidney disease because it can adversely affect their overall heart functions. They must avoid potassium rich foods as much as possible as their doctor advises. Patients should avoid consuming foods high in protein as much as possible, because high levels of protein in their bloodstream can dramatically accelerate the rate of kidney damage.


Step 8: Preparation for kidney replacement therapy

The first priority is to protect the veins of the upper left arm once the patient is diagnosed with chronic kidney disease – they should NOT be used for blood collection, IV, or long line insertion. The second priority is to educate the patients and their families regarding an AVFistula, ideally 6-12 months before the patients undergo hemodialysis. The third priority is to administer the Hepatitis B vaccine while the patient is in the early stages of chronic kidney disease to reduce the risk of the person contracting Hepatitis B during the process of dialysis or kidney transplant. They should receive four doses of the vaccine at zero, one, two, and six months, which each double dose given intramuscularly in the deltoid region. The fourth priority is to educate the patients and their families about the plan for future dialysis or transplant.

Step 9: Refer the patient to a nephrologist

People with chronic kidney disease need to be referred to a nephrologist early on because it increases their chances of survival dramatically. It also reduces the rate of kidney damage, thereby postponing the need for dialysis, or kidney transplant.

However, the most important treatment by far to prevent or delay the progression of chronic kidney disease is strictly controlling blood pressure through medicines because uncontrolled blood pressure leads to rapid deterioration of the kidneys, and other complications including heart attack, and/or stroke.


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