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How to Delay the Onset of Dialysis
Although it’s scary to be diagnosed with chronic kidney disease (CKD), if you find out in the early stages of the disease, there are steps you can take to prolong kidney function. If you work closely with your doctor, chances are good you can still enjoy a healthful quality of life with kidney disease.
Following good health practices, staying on the job and continuing to enjoy social activities are ways a person can feel in control of their condition. In addition to doing everything physically and medically possible to prolong kidney function, having a job with health insurance provides security that income and health benefits will be available.
Although there are many causes of CKD, there are certain recommendations that, when followed, can help a person delay kidney failure, which leads to dialysis or kidney transplant.
The two main causes of CKD in Americans are diabetes and high blood pressure. These diseases should be controlled — or prevented — to help prolong kidney function.
Diabetes and prolonging kidney function
Diabetics need to keep their blood glucose level in an acceptable range and take all physician-prescribed medicines. In addition, the hemoglobin A1c should be kept below 6.5 percent and kidney function tests should be performed at least once a year. Studies have shown that certain high blood pressure medicines can protect the kidneys of people with diabetes, even if they have normal blood pressure.
High blood pressure and prolonging kidney function
Patients with high blood pressure, also known as hypertension, should take their blood pressure medicine as directed by their doctor. The National Heart, Lung, and Blood Institute recommends that blood pressure remain under control at 125/75 or lower for those with kidney problems who are not diabetic, or 130/85 or lower for those with diabetes.
Other disease that lead to kidney damage
Other diseases that can damage kidneys include IgA nephropathy, glomerulonephritis and lupus. With these diseases the immune system overacts and inflammation occurs in the kidneys. To slow the disease process, a doctor may prescribe steroids and other medications.
CKD may also be brought on by infections, blockages and medicines that damage the kidneys. Infections can sometimes be cleared up with antibiotics. Blockages may be removed with surgery or other procedures. Certain medications, such as prescription and non-prescription painkillers, some antibiotics and contrast dye (used in medical testing) may have adverse effects on the kidneys. A patient needs to tell all their doctors that they have CKD and provide a list of all the medicines they are taking, including over-the-counter drugs, to prevent further kidney damage.
Steps to prolong kidney function
Regardless of how a person develops CKD, there are actions an individual can take to prolong kidney function. Smoking causes faster progression of kidney disease, therefore, it’s recommended that those with kidney disease stop smoking. Naturally, eating a healthy diet and getting proper nutrition, losing excess weight and exercising are keys to better health that are completely in the patient's control. In fact, many type 2 diabetics can prevent diabetes by following those steps. People with high blood pressure are advised to limit sodium in their diet. Many doctors believe that avoiding too much protein and phosphorus in the diet may also slow the progression of kidney disease. Research continues on other foods and drugs to see their affect on delaying kidney failure, including: fish oil for IgA nephropathy; dietary intake of antioxidant or anti-inflammatory vitamins and foods; and prescribing the anti-fibrotic drug, pirfenidone, for the treatment of focal segmental glomerulosclerosis (FSGS).
Remember, your kidney condition is unique. You can talk with your doctor and work with your health care team for personalized tips on how to prolong your kidney function. An open and frequent dialog will produce the best results. As well as discussing your medical condition, talk to your doctor about your feelings and ask for advice on how to talk with your family about CKD. Your health care team wants to help keep you healthy both physically and emotionally.
How to delay the onset of dialysis — at a glance
◾Eat right and lose excess weight
◾Avoid excess salt in your diet
◾Control high blood pressure
◾Stay on the job and keep your health insurance
◾Talk with your health care team
◾Visit DaVita.com to learn all you can about your condition
If you would like to see a doctor who specializes in the care of kidneys, called a nephrologist, you can use DaVita's Find a kidney doctor tool to locate a nephrologist in your area.
Slowing the Progression of Chronic Kidney Disease
There are many ways to help delay or prevent kidney failure, especially when chronic kidney disease (CKD) is diagnosed in the earlier mild to moderate stages of CKD. Because CKD usually occurs gradually over time, finding out you have kidney disease in the early stages provides an opportunity to slow the progression.
Blood pressure control
Study after study has confirmed that good blood pressure control can help slow the rate of kidney disease. This is especially true in people who have diabetes and protein in the urine (proteinuria). In addition to helping prevent kidney failure, keeping blood pressure under control also helps prevent heart diseaseand stroke.
According to National Kidney Foundation (NKF) guidelines, you should strive to keep your blood pressure at or below 130/85 if you have kidney disease. If you have diabetes and/or proteinuria too, their suggested target blood pressure is 125/75.
Lifestyle changes such as losing weight, exercising, meditating, eating less salt and drinking less alcohol can help lower your blood pressure. Smoking is a risk factor for faster progression of kidney disease, so stopping smoking can also help slow progression.
Blood pressure medicine
Two types of blood pressure medicines slow the action of angiotensin, a substance that may contribute to kidney disease progression. Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are the two types of high blood pressure medicines. The generic names of some common ACE inhibitors are captopril, enalapril and lisinopril. Some common ARBs are losartan, candesartan and valsartan.
If you’re diagnosed with hypertension, your doctor will prescribe blood pressure medicine for you to take as directed to control it and help slow the rate of kidney disease. If you have diabetes and have normal blood pressure, your doctor may still prescribe blood pressure medicine because studies have shown that ACE inhibitors and ARBs can help slow the rate of kidney disease in people with diabetes, even if they don’t have high blood pressure.
Other types of blood pressure drugs such as a diuretic (water pill) or a calcium-channel blocker may be added, as needed. Ask your doctor what you can do to keep your blood pressure at a healthy level.
Blood glucose control
If you have diabetes, strict controls of your blood glucose levels can help slow the progression of kidney disease.
◾Keep your hemoglobin A1c, which measures blood glucose control over the last two to three months, to less than 6.5 percent.
◾To reach this level of strict glycemic control, you will need to monitor your blood glucose closely to avoid hypoglycemia.
You may need to use frequent insulin injections or an insulin pump. Talk to your doctor about your diabetes treatment options.
Diet and lifestyle
Ongoing research continues on dietary changes and drugs that may help to slow the progression of kidney disease. Examples include:
◾Fish oil for IgA nephropathy
◾Pirfenidone (an anti-fibrotic drug) in the treatment of focal segmental glomerulosclerosis (FSGS)
◾Dietary intake of antioxidant or anti-inflammatory vitamins and foods
Some studies have shown that limiting protein and phosphorusin the diet can help slow kidney disease progression. Talk to a renal dietitian about your CKD non-dialysis diet and recommendations to prevent kidney failure.
Repairing kidney damage
In some cases, the kidney disease itself can be treated. If you have an obstruction that blocks your urine flow, surgery may help. If you have an infection, antibiotics may clear it up.
If your kidney damage is due to the effects of prescription or non-prescription medicines, your doctor may be able to suggest a different drug that’s less harmful to your kidneys. Antibiotics and painkillers (even over-the-counter medicines) can cause damage your kidneys. Sometimes diagnostic lab tests are ordered with contrast dye. It may be necessary for you to have the test, but first find out if there are alternative methods as contrast dye can be harmful to kidneys.
Some diseases, such as IgA nephropathy, glomerulonephritis, and lupus can cause kidney damage when your immune system overreacts and inflammation occurs. It’s sometimes possible to slow the disease process by controlling the immune system with steroids and/or other medicines.
Talk with your doctor about all medications and to find out what you can do to help slow the progress of your kidney disease.