Delaying the Progression of Chronic Kidney Disease - March 7, 2022
Chronic Kidney Disease also called chronic kidney failure involves a gradual loss of kidney function over a period of months to years. The kidneys act as a filter removing waste products from our body in the urine. When kidney disease is present for a long period of time it can lead to build up of nitrogenous waste products such as urea, creatinine, and uric acid in the body. It can also lead to dangerous levels of fluid and electrolytes in our body.
Chronic kidney disease has become one of the most common causes of morbidity and mortality in the world today and is currently ranked as the ninth most common cause of death worldwide.
It also remains underdiagnosed as awareness related to chronic kidney disease is limited both in the patient population and among primary care physicians.
Diabetes mellitus remains the most common cause of chronic kidney disease worldwide accounting for close to forty percent of CKD cases. Other common causes of chronic kidney disease include hypertension, cystic kidney diseases, autoimmune kidney diseases like lupus etc. and urological causes such as long standing stone renal stone disease.
In the early stages chronic kidney disease may be asymptomatic or may have subtle signs and symptoms such as generalized weakness, loss of appetite, low hemoglobin etc. Patients may have high blood pressures, leg swelling or decreased urine output. Kidney function tests, urine evaluation and ultrasound of the kidneys may be helpful in diagnosing chronic kidney disease.
Chronic kidney disease by definition is considered irreversible and progressive in nature. However an attempt should always be made to find certain factors which may have led to acute worsening of kidney function and could be potentially reversible. The progression of kidney disease can be retarded or slowed to a great extent by instituting certain measures and using kidney protective medications.
Factors which can retard the progression of chronic kidney disease include:
Blood Pressure Control - This is the single most important step in delaying the progression of chronic kidney disease. The goal BP should generally be below 130/80 and many patients with CKD need several blood pressure medications to reach this goal.
Diabetes and Glucose Control - Controlling diabetes and lowering the blood sugar level is crucial in slowing progression of CKD. Care should be taken to avoid certain oral hypoglycemic agents which may not be safe in patients of chronic kidney disease.
Lowering Heart Disease Burden - Patients of CKD have a high burden of cardiovascular disease and this can further worsen CKD progression. Physical activity, avoidance of smoking, controlling cholesterol levels will help to decrease risk of heart disease as well as improve kidney health.
Avoiding potentially nephrotoxic medicines - Certain over the counter medicines such as painkillers like ibuprofen,high dose aspirin, naproxen etc can lead to worsening of kidney function. Also care should be exercised in using unregulated dietary supplements, certain antihypertensives and antidiabetics and antibiotics which may not be kidney safe.
Reduce Sodium Intake - Canned and packaged foods have a high sodium intake and should be avoided in chronic kidney disease as salt handling by the kidneys is affected. Reducing sodium intake will also help in controlling blood pressure.
Reduce protein intake - Patients with advanced CKD should limit their protein intake as it leads to increased protein filtration in the kidneys and hastens progression of CKD. However care should be taken not to excessively limit protein as it may induce malnutrition and increase the risk of infections.
Vaccination and reducing risk of common infections - Patients with CKD should maintain utmost hygiene and should be careful to not eat unhygienic food as it may lead to infections which can lead to further loss of kidney function. They should also get vaccinated with Hepatitis B, pneumonia and influenza vaccines.
Correction of Anemia - Low hemoglobin is very common in patients of chronic kidney disease and anemia should be treated with iron supplements and erythropoietin as it will help in delaying CKD progression.
Lifestyle Changes - Being overweight , smoking , sedentary lifestyle and deranged lipid profile add to the risk of CKD progression and appropriate measures should be taken.
Chronic kidney disease management can help these patients to avoid dialysis or renal transplant for a long duration so that they can lead a healthier happier life. Every attempt should be made to fully understand the disease burden of every patient, so that timely advice can be given which can go a long way in reducing morbidity and mortality associated with kidney disease.