Why is medical management very important in CKD?

There is no cure for CKD. Advanced CKD needs dialysis or kidney transplant to maintain life. Because of the high cost and problems of availability, in India only 5 -10% of kidney patients get treatment like dialysis and kidney transplant, while the rest die without getting any definitive therapy. Therefore, early detection and meticulous conservative medical management is the only feasible and less expensive way to manage CKD and delay the need for dialysis or transplant.

Initiation of proper therapy at early stages of CKD is most rewarding. Most patients are asymptomatic or feel very well with proper therapy in early stages. Because of the absence of symptoms many patients and their families fail to recognize the seriousness of the disease and discontinue medicine and dietary restrictions. Discontinuation of therapy may lead to rapid worsening of kidney function requiring expensive dialysis or kidney transplantation.

•  In CKD with early medical management patients can live a long life.
•  In CKD with early medical management patients can live a long life.

What are the goals of medical management in CKD?

CKD is a progressively deteriorating condition with no cure. The aims of medical management are to:

•  Slow down the progression of the disease.
•  Treat underlying causes and contributing factors.
•  Relieve symptoms and treat complications of the disease.
•  Reduce the risk of developing cardiovascular disease.
•  Delay the need for dialysis or transplant.

Life Style Modification and General Measures

These measures are important in reducing overall risk:

•  Stop smoking.
•  Maintain healthy weight, exercise regularly and remain physically active on a regular basis.
•  Limit alcohol intake.
•  Follow a healthy eating plan and reduce dietary salt intake.
•  Medications should be taken as directed by the doctor. They may be adjusted according to the severity of the kidney damage.
•  Regular follow up and treatment as directed by a nephrologist.

Dietary Restrictions

Depending on the type and severity of kidney disease, dietary restrictions are needed in CKD

•  Salt (sodium): To control high blood pressure and swelling, salt restriction is advised. Salt restriction includes: not adding salt to foods at the table and avoiding salt rich food such as fast food, papad, pickles and minimizing the use of most canned foods.
•  Fluid intake:Decreased urine volume in CKD patients can cause swelling and in severe cases even breathlessness. Therefore, fluid restriction is advised for all CKD patients with swelling.
•  Potassium Blood potassium levels usually rise in CKD patients. This can have life-threatening effects on the heart activity. To prevent this, intake of potassium-rich foods (such as dry fruit, coconut water, potatoes, oranges, bananas, tomatoes etc.) should be restricted as advised by a doctor.
•  Protein: Patients with CKD should avoid high-protein diets which may accelerate the rate of kidney damage.