Facts About Chronic Kidney Disease
* People who are at the highest risk of developing CKD are those with diabetes, hypertension (high blood pressure) or a family history of kidney disease. However, there are other reasons you may develop it, too. In fact, one-third of adults are considered at risk for kidney disease.
* There is a high correlation between kidney disease and heart disease. Most of the people who die after a kidney disease diagnosis will actually die from heart disease. This makes it essential that you take care of both your kidneys and your heart.
* Hispanics, Pacific Islanders, African Americans, American Indians and senior citizens (anyone over the age of 60) have the highest risk. As a result of this last category, Baby Boomers and older retirees need to have their kidney function tested so they can make appropriate lifestyle changes, if necessary.
* There are simple tests which can detect CKD: high blood pressure, urine albumin and serum creatinine. The last one is often included in your routine blood lab tests, so you do not have to do anything special, other than ask that your doctor use your test result to estimate your kidney function.
* Your doctor can easily estimate your GFR or glomerular filtration rate, which is a test of your kidney function. It is calculated from your blood creatinine test, combined with your age, race, gender and other factors. If you know your creatinine, you can even find online sites which will do the calculation for you. Your doctor may also want to perform an ultrasound or CT scan on the kidneys or do a kidney biopsy.
What to do if You are Diagnosed with Kidney Disease
It can be terrifying to be told that you have CKD and may eventually have to go on dialysis or get a transplant. If that happens to you, you should immediately do the following:
* Find out your glomerular filtration rate (GFR) and keep track of it over the years. It is a good indication of how well you are slowing the progression of the disease ... which you can actually do by making simple changes to your diet.
* Know what stage of kidney disease you have. The five stages are listed below.
* Get your blood pressure checked frequently. High blood pressure damages the kidneys.
* Ask for a referral to a nephrologist (kidney doctor) and a dietician who can help you understand the diet. The nephrologist will also review all your medications, including over-the-counter ones, and take you off or reduce those which put stress on your kidneys. Make sure your other doctors are aware of your kidney disease and take it into consideration when they perform any imaging tests or other procedures, because they may have to take special precautions.
* Find out what you can do to reduce your risk of heart disease, including keeping your blood pressure and cholesterol in check.
* Stop smoking and get exercise.
Stages of Chronic Kidney Disease
Despite the fact that as many as 10 percent of Americans will develop CKD, most people have no idea whether or not they are at risk or if they are in the early stages of the disease. The most common way to find out the condition of your kidneys is to ask your doctor to perform a routine blood test and estimate your GFR (referred to as your eGFR). Once you have that information, you can determine whether or not you have kidney disease and how serious it is.
The various stages of CKD are:
Stage 1 - GFR of 90 to 120
Stage 2 - GFR of 60 to 89
Stage 3 - GFR of 30 to 59
Stage 4 - GFR of 16 to 29
Stage 5 - GFR of 15 or less (this is also known as End Stage Renal Disease)
Anyone with a GFR under 60 should talk to their doctor about changing their diet and taking whatever other steps their physician deems important to slow down the progression of the disease. Your goal is to postpone dialysis as long as possible and many people have been able to go years without dialysis, but only if they make the necessary lifestyle changes.
The Kidney Disease Diet
The CKD diet is restrictive, but it can make a significant difference in your ability to slow down the progression of the disease. Most people with kidney disease realize they need to reduce their intake of salt. However, sodium is not the only nutrient which should concern you. You also want to control your protein, potassium and phosphorous. The entire diet is quite lengthy, which is why it may benefit you to talk to a dietician, but the information below will help you get started.
Protein - You do not want to eat too much protein, especially from red meat or processed meat. Avoid sausage and lunch meats. Limit yourself to only two to four ounces of protein at a meal, primarily from chicken, turkey, and fish.
Salt - Limit your sodium to a maximum of 1800 mg. a day. This can be difficult to determine, since it is hidden in so many foods. Do not add salt to your food when cooking and read labels carefully to make sure you are not eating more than about 400 to 500 mg. in a meal.
Potassium - Too much potassium can be very dangerous for someone with kidney disease. Avoid potatoes, tomatoes, avocados, bananas, artichokes, bran, granola, beans, brown rice, spinach (and most other dark green leafy vegetables). Instead, eat white rice, white bread, tortillas, cauliflower, peppers, lettuce, apples, grapes, pineapples, blueberries and strawberries.
Phosphorus - Avoid whole grain bread, bran, oatmeal, nuts, sunflower seeds, and dark colored soda. Instead, eat white or sourdough bread, corn or rice cereals, cream of wheat, unsalted popcorn, and lemonade.
You also want to minimize your consumption of milk, cheese, butter and other dairy products. In addition, you should avoid chocolate and limit your consumption of caffeine. If you regularly take NSAIDs such as aspirin, Tylenol or Motrin, you will want to discuss this with your doctor. These over-the-counter medications can put additional stress on your kidneys. If you also have diabetes, your diet will be even more complicated, because you will have to monitor your consumption of sugar.
A registered dietician who specializes in kidney disease should be able to give you a complete list of the foods which are good and poor choices. If you eventually go on dialysis, your dietary restrictions may change to meet your new nutritional needs. You may also want to buy a kidney disease diet book, such as the "Renal Diet Cookbook."
Treatment Options for Renal Failure
Once you are in late Stage 4 or early Stage 5, you will have to decide what type of treatment you would like to receive as you approach end-stage renal failure. There are advantages and disadvantages to each of your choices, so you need to research them carefully and decide which one seems to be the best choice for you during the remaining years you have left.
Transplant: In most cases, this involves a long wait, during which time you will probably be on dialysis. After the transplant, especially if you are an older adult, you will be at an increased risk for problems and possible death from a variety of causes, including heart disease and sepsis. You will need to take a large number of anti-rejection drugs every day, or the transplant will fail. The anti-rejection drugs can pose health problems of their own. Many people are not aware that transplants do not last forever. Depending on your age at the time of the transplant and whether the donated kidney came from a living or deceased donor, your transplant may last only a couple of years, or up to a dozen or so years. In rare cases, they have lasted longer. The older you are when you get a transplant, the riskier it is.
Dialysis: You can get dialysis either at home or in a dialysis center. There are a variety of types available in both locations. You can do your dialysis while awake or while sleeping, including staying overnight at some dialysis centers. You will need to have surgery in advance to insert a port or fistula. The type you will need depends on the type of dialysis you decide to have. You will want to thoroughly discuss the options with your nephrologist and a dialysis nurse before choosing a type of dialysis. Ask for a complete explanation of the choices as well as both the advantages and disadvantages of each type of dialysis you are considering.
No treatment: Some people choose not to go on dialysis or get a transplant. Others stop dialysis after a few months. This is a personal decision and it is entirely up to you.
Consider Trying a Trial Medication
My husband and I believe there are two reasons why he has lived as long as he has without needing to go on dialysis.
First, he has followed the dietary restrictions carefully, and used frequent blood tests to make sure he was controlling the levels of protein, potassium and phosphorus in his blood. He has also followed a very low sodium diet.
Second, within months of his diagnosis he went on a trial medication to counteract the severe anemia which is common with CKD patients. This medication has helped him maintain a normal hemoglobin level in his blood and, in turn, helped him slow the progression of his disease.
Sources of More Information:
If you or someone you love has been diagnosed with CKD, you will want to keep up with all the research available, in order to postpone dialysis or a transplant as long as possible. Two of the best sites are:
National Kidney Foundation (which has a wealth of information on its website)
American Kidney Fund
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