PtEd – CHRONIC KIDNEY DISEASE (CKD)

CHRONIC KIDNEY DISEASE (CKD)

PROBLEM

Chronic kidney disease (CKD) means the kidney is having trouble performing its normal function to maintain health.

FUNCTIONS OF A NORMAL KIDNEY

The kidney has several functions:

A.Removal and absorption of fluids to maintain balance.

B.Filtration of blood to remove waste products.

C.Regulation of blood pressure.

D.Hormone regulation for blood production in the bone marrow.

E.Regulation of hormones and minerals.

F.Maintenance of healthy bones.

CAUSES

CKD has many causes:

A.Diabetes is the leading cause of CKD in the United States.

B.High blood pressure is the second leading cause of CKD in the United States.

C.Other causes of CKD:

1.Kidney/bladder infections.

2.Genetic (inherited) disease: polycystic kidney disease and Alport syndrome.

3.Congenital diseases.

4.Autoimmune disease.

5.Drugs (legal and illegal) and toxic substances.

DETECTION

CKD can be detected by:

A.Blood tests: Blood urea nitrogen (BUN) and creatinine.

B.Urine tests: Protein in urine and creatinine clearance.

C.Other types of tests: Ultrasound, immunoassays, CT scan, biopsies, and so on.

D.The most important test is the blood test for glomerular filtration rate (GFR):

1.Normal GFR rate: 90 or higher without protein in the urine.

2.Gets lower with age.

3.An indicator on the function of the kidney.

4.Used to determine CKD stages.

5.Is lower as the kidney function worsens.

STAGES OF CKD

TABLE III.2 Stages of Chronic Kidney Disease

GFR, glomerular filtration rate.

SYMPTOMS OF CKD

Symptoms can vary:

A.Usually unnoticed in early stages. A urine test at a routine office visit may be the first time you learn there are problems with your kidneys.

B.More noticeable symptoms appear as CKD worsens (usually around Stage III).

C.Those symptoms can include the following:

1.Nausea.

2.Fatigue/weakness; no energy.

3.Decreased or lack of appetite.

4.Weight loss or rapid weight gain.

5.Shortness of breath, which may worsen with activity or at rest (when awakening in the morning).

6.Swelling of the legs and feet and around the eyes.

7.Cloudy mind or difficulty with concentration.

8.Muscle cramps.

9.Frequent nighttime urination.

10.Difficulty sleeping or staying asleep.

PROBLEMS CAUSED BY CKD

CKD can cause multiple problems:

A.Heart, including heart failure and other blood vessels:

1.High blood pressure.

2.Cholesterol abnormalities.

3.Heart attack.

4.Stroke.

B.Poor nutritional status.

C.Weak and unhealthy bones.

D.Anemia.

E.Water retention (swelling).

F.Progression to kidney failure.

LIFESTYLE CHANGES TO PREVENT PROGRESSION OF CKD

Ways you may slow down the progression of CKD and deal with its other effects:

A.Take charge and be proactive:

1.Be familiar with your healthcare team.

2.Provide information on beliefs and practices relating to health.

3.Inform your healthcare team about herbs and other alternative medicine you are using.

4.Be involved in the treatment plan.

B.Diet:

1.Meet with a registered dietitian.

2.Read food labels.

3.Eat well-balanced meals.

4.Some dietary restrictions may be necessary based on kidney function and stages of CKD.

5.Your dietitian or provider will help you understand the restrictions of proteins, fat, salt, and minerals in the food you eat. Follow dietary instructions:

a.Dietary intake of protein is usually restricted to 0.8 to 1.0 g/kg/d.

b.Dietary sodium (salt) should be restricted to no more than 2 g/d.

c.Potassium should be restricted to 40 to 70 meq/d.

d.Calories should be restricted to 35 kcal/kg/d; for your height and weight, a__________-calorie diet is your recommended goal.

e.Fat intake should be about 30% to 40% of total daily caloric intake.

f.Phosphorus should be restricted to 600 to 800 mg/d.

g.Calcium should be restricted to 1,400 to 1,600 mg/d.

h.Magnesium should be restricted to 200 to 300 mg/d.

i.Carbohydrates: The recommended normal intake is 225 to 358 g/d.

C.Exercise:

1.Avoid being inactive. Some physical activity is better than none.

2.Moderate exercise is recommended for at least 150 minutes (2 hours and 30 minutes) a week:

a.Aerobic exercise that increases your heart rate should be done in episodes of at least 10 minutes and should be spread throughout the week, at least 3 days a week.

b.Muscle-strengthening activities should be done at least 2 days a week.

3.The benefits of exercise:

a.Lowers blood pressure.

b.Improves cholesterol.

c.Lowers hemoglobin A1C in diabetes.

d.Strengthens bones.

e.Leads to weight loss.

f.Improves signs/symptoms of depression.

g.Boosts the immune system.

h.Reduces stress.

i.Provides an overall better feeling.

D.Target heart and blood vessels:

1.Control blood pressure: Goal is less than 130/80 mmHg.

2.Lower your cholesterol, especially low-density lipoprotein (LDL).

3.Lose weight. Every pound counts.

4.Lower hemoglobin A1C level with the goal less than 6.9% if you have diabetes:

a.Exercise.

b.Diet: No restrictions, low-saturated-fat, low-carbohydrate diet.

c.Smoking cessation is essential.

d.Reduce or eliminate alcohol intake.

e.Medications may be necessary for the following:

i.Hypertension: Blood pressure medications.

ii.Hyperlipidemia: Cholesterol medications.

iii.Diabetes: Medications to control blood sugar.

E.Target bones:

1.Become familiar with your lab results (vitamin D level, calcium level, phosphorous level).

2.Supplements: Vitamin D, calcium supplements, and phosphate binders may be necessary.

3.Low phosphorous diet may be necessary.

4.Exercise: Weight-bearing exercise will help strengthen bones (walking, dancing, lifting weights, etc.).

F.Target anemia:

1.Goal of the hemoglobin should be 11 g/dL or better.

2.Diet rich in iron.

3.Medication may be necessary (depends on the type of anemia):

a.Erythropoietin-stimulating agents.

b.Vitamin B12.

c.Folic acid.

G.Target water retention:

1.Limit salt intake.

2.Diet (avoid processed foods/fast foods).

3.Medications may be needed (diuretics).

FOODS HIGH IN PHOSPHORUS

Amount of phosphorus in foods. Limit portions (registered dietitian consult is recommended).

POTASSIUM-FRIENDLY FOODS

Limit portion to 1/2 cup unless otherwise noted (registered dietitian consult is recommended).

TABLE III.3 List of Foods High in Phosphorus

TABLE III.4 List of Potassium-Friendly Foods

RESOURCES

American Diabetes Association: www.diabetes.org

•Food and Fitness: www.diabetes.org/food-and-fitness/?loc=GlobalNavFF

BC Renal Agency: www.bcrenalagency.ca

•Shopping Guide for Kidney Health: http://www.bcrenalagency.ca/resource-gallery/Documents/Kidney%20Friendly%20Shopping%20Guide%20Final.pdf

•Diabetes Kidney-Friendly Grocery List: http://www.bcrenalagency.ca/resource-gallery/Documents/Diabetes%20Kidney-Friendly%20Shopping%20Guide.pdf

National Kidney Foundation: www.kidney.org

•Kidney Cooking, A Family Recipe Book for kidney Patients: https://www.kidney.org/sites/default/files/docs/kidney_cookbook_lr.pdf