Chronic kidney disease treatment
Certain kidney diseases can be treated and cured, but others lead damaged kidney function. However, chronic kidney disease (CKD) is incurable. To be clear, CKD is managed, not cured. However, doctors have many tools in their arsenal to extend one’s life, and quality of life. Symptoms can also be alleviated to varying extents with medicines, dietary changes, and different procedures. Treatment can control the symptoms, reduce complications, and slow the disease’s progress. In fact, there are things that can be done to minimize or slow the damage done by kidney disease, even if the actual cause cannot be removed. These include:
1. Control underlying causes - Controlling the condition responsible for kidney failure and its complications is the first priority. In cases of diabetes or high blood pressure (hypertension), doctor's recommendations for diet, exercise, and medications must be followed carefully.
2. Treat complications - Treating complications of chronic kidney failure is important to any kidney disease treatment plan. For example, anemia might require supplements of the hormone erythropoietin to induce production of red blood cells. Also, a form of vitamin D (calcitriol) may be prescribed to prevent weak bones, as well as a phosphate-binding medication to lower the amount of phosphate in the blood. Lowering phosphate increases the amount of calcium available for bones so they don't become weak and vulnerable to fracture.
Types of kidney disease treatment
Doctors recommend different types of treatment depending on the type of kidney or urinary disease diagnosed. If kidney or urinary disease is recognized early, it is more likely to be treatable. For example, dietary restrictions, drug therapy, and surgical procedures may be effective treatment options in this stage. Additionally, control of diabetes, high blood pressure, and blood sugar is essential to prevent or minimize kidney damage. On the other hand, when kidneys can no longer effectively remove waste and water from the body, a dialysis machine used several times a week is needed for kidney filtration. Types of treatment for kidney disease include:
Early stages treatment – People diagnosed in the early stages of CKD can make their kidneys last longer by taking certain steps, such as keeping blood glucose levels under control or avoiding pain pills. Substances toxic to the kidneys, such as nonsteroidal anti-inflammatory drugs, some oral phosphate preparations used as laxatives before colonoscopy, and contrast dyes used with certain X-rays may need to be avoided. Minimizing the risks of heart attack and stroke are important since CKD patients are also at risk of developing these conditions.
End-stage kidney disease – During end-stage kidney disease, the kidneys function at less than 10 percent to 15 percent of capacity. Conservative measures used to treat chronic kidney failure — diet, medications and controlling the underlying cause and complications — will no longer be effective. The kidneys can’t keep up with waste and fluid clearance, and dialysis or a kidney transplant becomes the only option to support life. Those in the later stages of CKD need to learn about options for treatment so they can make an informed choice between hemodialysis, peritoneal dialysis, and transplantation.
Following a proper diet is also important in treating kidney failure. Diet can speed kidney failure in cases of end-stage kidney disease. Restricting the amount of protein eaten can help slow the disease’s progress. Diet can also help ease symptoms such as nausea, vomiting and lack of appetite. The amount of salt in the diet will likely need to be limited, to control high blood pressure. Eventually, potassium and phosphorus amounts consumed may be limited as well. Some common principles people can follow include:
Limit fluids - The amount of fluids consumed each day may need to be limited. Limiting fluids means more than reducing one’s water intake. It can include cutting back on ice cubes and ice chips, coffee and tea, sodas, fruit and vegetable juices, soups, milk, cream, ice cream, sherbet, sorbet and even gelatin. Those limiting liquids may have a hard time controlling their thirst. The following suggestions may help:
- sucking on a lemon wedge or a few ice chips.
- rinse the mouth with water but don't swallow it.
- eat a piece or two of sour candy or chew gum to increase the moisture level in the mouth.
Protein - Protein helps the body repair muscles and fight disease. It comes mostly from meat but can also come from eggs, milk, nuts, beans, and other foods. Healthy kidneys remove waste in the blood but leave the protein. Impaired kidneys may fail to separate protein from the waste. Some kidney patients must limit the amount of protein eaten so the kidneys work less. But protein cannot be avoided entirely. People diagnosed with CKD can work with a dietician to create a proper food plan.
Cholesterol - Another problem associated with kidney failure is high cholesterol. Cholesterol builds up on the inside walls of blood vessels. This build up makes pumping blood through the vessels harder, potentially causing heart attacks and strokes. A low-fat diet can result in lower levels of cholesterol in the blood.
Sodium - Sodium is found in salt and other foods. Sodium raises blood pressure, so people diagnosed with CKD should limit foods containing high levels of sodium. High-sodium is found in canned or processed foods like frozen dinners and hot dogs.
Potassium - Potassium is a mineral in many fruits and vegetables, such as oranges, potatoes, bananas, dried fruits, dried beans and peas, and nuts. Healthy kidneys regulate potassium in the blood and remove excess amounts. Diseased kidneys may not effectively remove excess potassium. High potassium levels can affect the heart rhythm.
Dialysis artificially removes waste products and extra fluid from the blood when kidneys aren't able to. It's not a miracle treatment, and it presents significant risks, such as infection. But it can help prolong life for those experiencing end-stage kidney disease. It’s been found that more frequent dialysis — up to six times a week either during the day or at night while during sleep — results in significantly better quality of life, control of complications and a reduction in mortality risk. Newer, easy-to-use home dialysis machines make this option more feasible for many.
The point when dialysis is needed varies from person to person. In most cases, doctors try to manage chronic kidney failure as long as possible. This is because both dialysis and transplantation can have life-threatening complications. There are two main types of dialysis; each having subtypes involving slightly different techniques. They include:
1. Hemodialysis - Hemodialysis removes extra fluids, chemicals and wastes from the bloodstream by filtering blood through an artificial kidney (dialyzer). Blood is pumped out of the body to the artificial kidney through one of two routes — a surgically placed catheter in one of the main blood veins, or a surgically created junction between a vein and artery in one’s arm. Inside the artificial kidney, blood moves across membranes that filter out waste before being returned to the body. Hemodialysis is normally performed three times a week for three or more hours.
2. Peritoneal dialysis. Rather than filtering the blood through a machine, this type of dialysis uses the vast network of tiny blood vessels in the patient’s abdomen (peritoneal cavity) to filter the blood. A small, flexible tube (catheter) is implanted into the abdomen, then a dialysis solution is infused into and drained out of the abdomen for as long as is necessary to cleanse the blood.
- Continuous ambulatory peritoneal dialysis - This type of peritoneal dialysis can be self-administered at home, exchanging the dialysis solution in the abdomen four times a day, seven days a week. A person can space out these exchanges throughout the day.
- Continuous cycling peritoneal dialysis – During this type of peritoneal dialysis, a cycler machine automatically infuses dialysis solution into and out of the peritoneal cavity over a period of 10 to 12 hours while the subject sleeps.
If no life-threatening medical conditions other than kidney failure are present, doctors usually recommend a kidney transplant before dialysis. However, dialysis may be needed temporarily until a suitable donor kidney becomes available. A successful kidney transplant depends on finding the best immunologic match possible. Ideally, the donor and recipient will have the same blood type, cell-surface proteins and antibodies. The more closely these are matched, the lower the risk of the body rejecting the new kidney. A sibling is usually the best donor. If that's not possible, another blood relative, such as a parent, aunt, uncle or cousin, or even a non-blood-related adult may be viable substitutes. When a living donor isn't available, tissue-typing centers throughout the country may opt for a cadaver kidney from an accident victim or other person who is registered as an organ donor.
Controlling Blood Pressure – Those with reduced kidney function and high blood pressure need to control their blood pressure with an ACE inhibitor or an ARB. Many will require two or more types of medication to keep blood pressure below 130/80. A diuretic is a crucial addition when the ACE inhibitor or ARB does not attain blood pressure goals.
Not Smoking - Smoking increases the risk of kidney disease, and contributes to deaths from stroke and heart attack in people with CKD.
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