www.kotakenya.org – There’s no cure for chronic kidney disease (CKD), but treatment can help relieve the symptoms and stop it getting worse. Your treatment will depend on the stage of your CKD.
The main treatments are:
- lifestyle changes – to help you stay as healthy as possible
- medicine – to control associated problems, such as high blood pressure and high cholesterol
- dialysis – treatment to replicate some of the kidney’s functions, which may be necessary in advanced (stage 5) CKD
- kidney transplant – this may also be necessary in advanced (stage 5) CKD
The following lifestyle measures are usually recommended for people with kidney disease:
- stop smoking if you smoke
- eat a healthy, balanced diet
- restrict your salt intake to less than 6g a day – that’s around 1 teaspoon
- do regular exercise – aim to do at least 150 minutes a week
- manage your alcohol intake so you drink no more than the recommended limit of 14 units of alcohol a week
- lose weight if you’re overweight or obese
- avoid over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, except when advised to by a medical professional – these medicines can harm your kidneys if you have kidney disease
Find out more about living with CKD and what you can do to stay healthy.
There’s no medicine specifically for CKD, but medicine can help control many of the problems that cause the condition and the complications that can happen as a result of it.
You may need to take medicine to treat or prevent the different problems caused by CKD.
High blood pressure
Good control of blood pressure is vital to protect the kidneys.
People with kidney disease should usually aim to get their blood pressure down to below 140/90mmHg, but you should aim to get it down to below 130/80mmHg if you also have diabetes.
There are many types of blood pressure medicines, but medicines called angiotensin converting enzyme (ACE) inhibitors are often used. Examples include ramipril, enalapril and lisinopril.
Side effects of ACE inhibitors can include:
- a persistent dry cough
- tiredness or weakness
If the side effects of ACE inhibitors are particularly troublesome, you can be given a medicine called an angiotensin-II receptor blocker (ARB) instead.
Find out more about how high blood pressure is treated.
Diabetes or high ACR
If you also have type 2 diabetes or a high albumin to creatinine ratio (ACR) you may be offered a medicine called dapagliflozin, as well as medicines for high blood pressure. Dapagliflozin helps to lower your blood sugar and can reduce damage to your kidneys.
People with CKD have a higher risk of cardiovascular disease, including heart attack and stroke.
This is because some of the causes of kidney disease are the same as those for cardiovascular disease, including high blood pressure and high cholesterol.
You may be prescribed medicines called statins to reduce your risk of developing cardiovascular disease. Examples include atorvastatin and simvastatin.
Side effects of statins can include:
- feeling sick
- constipation or diarrhoea
- muscle and joint pain
Find out more about how high cholesterol is treated.
High potassium levels
People with CKD can develop high potassium levels in their blood, called hyperkalaemia, because their kidneys do not work properly.
Hyperkalaemia can cause muscle weakness, stiffness and tiredness. If it becomes severe, it can cause an irregular heartbeat (arrhythmia) which can lead to a heart attack.
If you have CKD, it’s important to avoid taking potassium supplements and some medicines used to treat high blood pressure and heart failure because they can make your potassium levels too high. Talk to a GP about the medicines you take if you’re worried.
A medicine called sodium zirconium cyclosilicate can be used to treat hyperkalaemia in adults, but only if it’s used:
- in emergency care for acute life-threatening hyperkalaemia alongside standard care
- in people with hyperkalaemia that does not get better, CKD stage 3b to 5, or heart failure
People with hyperkalaemia that does not get better (called persistent CKD) who also have CKD stage 3b to 5, or heart failure, should only take sodium zirconium cyclosilicate if they:
- have a serum potassium level of at least 6.0 mmol/litre and
- are not also taking a certain amount of renin-angiotensin-aldosterone system (RAAS) inhibitor because of hyperkalaemia and
- are not on dialysis
You should stop taking sodium zirconium cyclosilicate if RAAS inhibitors are no longer suitable for you.
You may get swelling in your ankles, feet and hands if you have kidney disease.
This is because your kidneys are not as effective at removing fluid from your blood, causing it to build up in body tissues (oedema).
You may be advised to reduce your daily salt and fluid intake, including fluids in food such as soups and yoghurts, to help reduce the swelling.
In some cases you may also be given diuretics (tablets to help you pee more), such as furosemide.
Side effects of diuretics can include dehydration and reduced levels of sodium and potassium in the blood.
Many people with advanced-stage CKD develop anaemia, which is a lack of red blood cells.
Symptoms of anaemia include:
- lack of energy
- shortness of breath
- a pounding, fluttering or irregular heartbeat (palpitations)
If you have anaemia, you may be given injections of a medicine called erythropoietin. This is a hormone that helps your body produce more red blood cells.
If you have an iron deficiency as well, iron supplements may also be recommended.
Find out more about how iron deficiency anaemia is treated.
If you have anaemia but do not have iron deficiency, you may be given a medicine called Roxadustat. This medicine helps your body to produce more red blood cells and comes as tablets.
Want to know more?
National Institute for Health and Care Excellence (NICE): treating anaemia in people with chronic kidney disease
If your kidneys are severely damaged, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it.
Along with calcium, phosphate is important for maintaining healthy bones. But if your phosphate level rises too much, it can upset the balance of calcium in your body and lead to thinning of the bones.
You may be advised to limit the amount food you eat which are high in phosphate, such as red meat, dairy products, eggs and fish.
If this does not lower your phosphate level enough, you may be given medicines called phosphate binders. Commonly used medicines include calcium acetate and calcium carbonate.
Some people with CKD also have low levels of vitamin D, which is necessary for healthy bones.
If you’re low in vitamin D, you may be given a supplement called colecalciferol or ergocalciferol to boost your vitamin D level.
Kidney disease can be caused by inflammation of the filters inside the kidneys, known as glomerulonephritis.
In some cases this happens as a result of the immune system mistakenly attacking the kidneys.
If a kidney biopsy finds this is the cause of your kidney problems, you may be prescribed medicine to reduce the activity of your immune system, such as a steroid or a medicine called cyclophosphamide.
Want to know more?
Kidney Care UK: medicines for chronic kidney disease
Improving muscle strength
If you are having a bad flare-up and are unable to exercise, you may be offered electrical stimulation to make your muscles stronger.
This is where electrodes are placed on your skin and small electrical impulses are sent to weak muscles, usually in your arms or legs.
For a small proportion of people with CKD, the kidneys will eventually stop working.
This usually happens gradually, so there should be time to plan the next stage of your treatment.
One of the options when CKD reaches this stage is dialysis. This is a method of removing waste products and excess fluid from the blood.
There are 2 main types of dialysis:
- haemodialysis – this involves diverting blood into an external machine, where it’s filtered before being returned to the body
- peritoneal dialysis – this involves pumping dialysis fluid into a space inside your tummy to draw out waste products from the blood as they pass through vessels lining the inside of your tummy
Haemodialysis is usually done about 3 times a week, either at hospital or at home. Peritoneal dialysis is normally done at home several times a day, or overnight.
If you don’t have a kidney transplant, treatment with dialysis will usually need to be lifelong.
Talk to your doctor about the pros and cons of each type of dialysis and which type you would prefer if your kidney function becomes severely reduced.
Want to know more?
- Find out more about dialysis
- Kidney Patient Guide: treating kidney failure with dialysis
- Kidney Care UK: dialysis
An alternative to dialysis for people with severely reduced kidney function is a kidney transplant.
This is often the most effective treatment for advanced kidney disease, but it involves major surgery and taking medicines (immunosuppressants) for the rest of your life to stop your body attacking the donor organ.
You can live with one kidney, which means donor kidneys can come from living or recently deceased donors.
But there’s still a shortage of donors, and you could wait months or years for a transplant.
You may need to have dialysis while you wait for a transplant.
Survival rates for kidney transplants are very good. About 90% of transplants still function after 5 years and many work usefully after 10 years or more.
Want to know more?
- Find out more about kidney transplants
- Kidney Patient Guide: transplants
- Kidney Care UK: kidney transplant
You’ll be offered supportive treatment if you decide not to have dialysis or a transplant for kidney failure, or they’re not suitable for you. This is also called palliative or conservative care.
The aim is to treat and control the symptoms of kidney failure. It includes medical, psychological and practical care for both the person with kidney failure and their family, including discussion about how you feel and planning for the end of life.
Many people choose supportive treatment because they:
- are unlikely to benefit from or have a good quality of life with treatment
- do not want to go through the inconvenience of treatment with dialysis
- are advised against dialysis because they have other serious illnesses, and the negative aspects of treatment outweigh any likely benefits
- have been on dialysis, but have decided to stop this treatment
- are being treated with dialysis, but have another serious illness, such as severe heart disease or stroke, that will shorten their life
Supportive care through the kidney unit can still help you to live for some time with a good quality of life.
Doctors and nurses will make sure you receive:
- medicines to protect your remaining kidney function for as long as possible
- medicines to treat other symptoms of kidney failure, such as feeling out of breath, anaemia, loss of appetite or itchy skin
- help to plan your home and money affairs
- bereavement support for your family
Want to know more?
- Cruse Bereavement Care
- Kidney Patient Guide: the emotional effects of kidney failure
- Kidney Research UK: information on choosing not to start dialysis
- Kidney Care UK: deciding not to have dialysis (conservative treatment)