Chronic Kidney Disease - Treatment Overview

Treatment Overview

The goal of treatment for chronic kidney disease is to prevent or slow additional damage to your kidneys. Another condition such as diabetes or high blood pressure usually causes kidney disease, so it is important to identify and manage the condition that is causing your kidney disease. It is also important to prevent diseases or avoid situations that can cause kidney damage or make it worse.

Initial treatment

One of the most important parts of treatment for chronic kidney disease is to control the disease that is causing it. If you have diabetes or high blood pressure, you and your doctor will develop a plan to aggressively treat and manage your condition to help slow additional damage to your kidneys.

Your doctor will also check you for other conditions or diseases that may cause kidney damage, including a blockage (obstruction) in the urinary tract or long-term use of medicines that can damage the kidneys, such as some antibiotics or pain relievers (such as NSAIDs).

You can take steps at home to help control your kidney disease:

• Follow an eating plan that is good for your kidneys. A dietitian can help you make an eating plan with the right amounts of sodium, fluids, and protein. For more information, see:

  Eating plan for chronic kidney disease.

• Participate in a daily exercise program. Work with your doctor or other health professional to design an exercise program that is right for you. Exercise may help you control diabetes and high blood pressure, which can lead to kidney disease.
• Avoid taking medicines that can damage your kidneys, like ibuprofen (such as Advil), naproxen sodium (Aleve), and celecoxib (Celebrex). Be sure your doctor knows about all prescription medicines, over-the-counter medicines, and herbs that you are taking.
• Avoid dehydration. Get treatment right away for illnesses, such as diarrhea, vomiting, or fever, that can cause you to lose fluids. Be especially careful when you exercise or during hot weather. For more information, see the topic Dehydration.
• Do not smoke or use other tobacco products. Smoking can lead to atherosclerosis, which reduces blood flow to the kidneys and increases blood pressure. For more information on how to quit, see the topic Quitting Tobacco Use.
• Do not drink alcohol or use illegal drugs.

Ongoing treatment

As part of your ongoing treatment for chronic kidney disease, you may be prescribed a blood pressure medicine, such as an ACE inhibitor or an angiotensin II receptor blocker (ARB). These medicines are used to increase the blood supply to the kidneys, reduce protein in the urine, and help manage high blood pressure. The recommended target blood pressure for people with kidney disease is less than 130/80.³

If you have diabetes, it is important to control your blood sugar levels with diet, exercise, and medicines. A persistently high blood sugar level can damage the blood vessels in the kidneys.

Your doctor will use blood and urine tests to regularly check how well your kidneys are functioning and whether changes to your treatment plan are needed. These tests include:

• Glomerular filtration rate (GFR), to find out how well the kidneys filter the blood.
• Tests to measure the amount of protein in your urine, to find out whether your medicines need to be adjusted.

Depending on the stage of your disease, you may be able to take steps at home to help control your kidney disease:

• Follow the eating plan your dietitian developed for you. Your eating plan will balance your need for calories with your need to limit certain foods, such as sodium, fluids, and protein. For more information, see:

  Eating plan for chronic kidney disease.

• Participate in a daily exercise program. Exercise may help you control diabetes and high blood pressure.
• Avoid taking medicines that can damage your kidneys, like ibuprofen (such as Advil), naproxen sodium (Aleve), and celecoxib (Celebrex). Be sure your doctor knows about all prescription medicines, over-the-counter medicines, and herbs that you are taking.
• Avoid dehydration. Get treatment right away for illnesses, such as diarrhea, vomiting, or fever, that can cause you to become dehydrated. Be especially careful when you exercise or during hot weather. For more information, see the topic Dehydration.
• Do not smoke or use other tobacco products, alcohol, or illegal drugs. Smoking can lead to atherosclerosis, which reduces blood flow to the kidneys and increases blood pressure. For more information on how to quit, see the topic Quitting Tobacco Use.

Treatment if your condition gets worse

Chronic kidney disease is often progressive. If the disease gets worse, your symptoms, such as fatigue, nausea, and loss of appetite, may occur more frequently or become more severe. Work with your doctor to develop a treatment plan to help control these symptoms. An eating plan that limits the amount of protein, fluids, and salt in your diet is usually needed to help slow the progression of kidney failure.

Uremic syndrome (uremia) is a serious complication of chronic kidney disease. It occurs when waste products build up in the body because the kidneys are not able to eliminate them. These substances can become poisonous (toxic) to the body if they reach high levels. Uremic syndrome can affect many body systems, including the intestines, nerves, and heart. If it develops, the mechanical removal of wastes and fluids (dialysis) or replacement with a donor kidney (kidney transplant) will be needed.

When the kidneys do not produce enough of the protein that the body needs to produce new red blood cells (erythropoietin), anemia develops. This type of anemia is treated with a medicine called human recombinant erythropoietin (rhEPO) that helps your body make new red blood cells. Treatment with rhEPO may also help improve your appetite and general sense of well-being.

You may also need to be checked for iron deficiency and treated with an iron supplement.

Treatment for kidney failure

If you are not able to control chronic kidney disease, your kidney function will continue to get worse. When kidney function falls below a certain point, it is called kidney failure. Kidney failure has harmful effects throughout your body. It can cause serious heart, bone, and brain problems and make you feel very ill.

After you develop kidney failure, either you will need to have dialysis or you will need a new kidney. Both choices have risks and benefits. Talk with your doctor to decide which would be best for you.

Dialysis is a process that performs the work of healthy kidneys by clearing wastes and extra fluid from the body and restoring the proper balance of chemicals (electrolytes) in the blood. You may use dialysis for many years, or it may be a short-term measure while you are waiting for a kidney transplant.

The two types of dialysis used to treat severe chronic kidney disease are hemodialysis and peritoneal dialysis.

• Hemodialysis requires a machine that uses a man-made membrane called a dialyzer to clean your blood. You are connected to the dialyzer by tubes attached to your blood vessels. Before hemodialysis treatments can begin, a surgeon creates a site where blood can flow in and out of your body. This is called the dialysis access. Usually the surgeon creates the access by joining an artery and a vein in the forearm or by using a small tube to connect an artery and a vein. An access may be created on a short-term basis by putting a small tube into a vein in your neck, upper chest, or groin.
• Peritoneal dialysis uses the lining of your belly, which is called the peritoneal membrane, to filter your blood. Before you can begin peritoneal dialysis, a surgeon needs to place a catheter in your belly to be the dialysis access.

For more information about dialysis, see:

Which type of dialysis should I have?

Kidney transplant is often a better treatment option for kidney failure, because it may allow you to live a fairly normal life. But there are some drawbacks:

• If no one you know can donate a kidney, the wait for a transplant may be long. You will probably need to have dialysis while you wait for a kidney.
• It may be difficult to find a good match for your blood and tissue types. Sometimes, even when the match is good, the body rejects the new kidney.
• You will have to take medicine to suppress your immune system (immunosuppressants) for the rest of your life. These medicines help prevent your body from attacking your new kidney (rejection). Not taking the medicines properly is a common cause of rejection.
• Immunosuppressant medicines work by lowering your body’s disease-fighting ability, so they increase your risk of getting infections or cancer.
• In some cases, kidney transplant is not successful. If this is the case, transplant can be tried again.

For more general information about transplant, see the topic Organ Transplant.

Palliative care

As your disease gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have diseases that do not go away and often get worse over time. It is different than care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Some people combine palliative care with curative care, but usually this means they do not want dialysis treatments in order to sustain their lives.

Palliative care may help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a long-term disease, make future plans around your medical care, or help your family better understand your disease and how to support you.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

End-of-life issues

Chronic kidney disease progresses to kidney failure when damage to the kidneys is so severe that dialysis or a kidney transplant is needed to control symptoms and prevent complications and death. Many people have successful kidney transplants or live for years using dialysis. But at this point you may wish to talk with your family and doctor about health care and other legal issues that arise near the end of life.

A time may come when your goals or the goals of your loved ones may change from treating or curing your disease to maintaining comfort and dignity. You may find it helpful and comforting to state your health care choices in writing (with an advance directive such as a living will) while you are still able to make and communicate these decisions. Think about your treatment options and which kind of treatment will be best for you. You may wish to write a durable power of attorney or choose a health care agent, usually a family member or loved one, to make and carry out decisions about your care if you become unable to speak for yourself. You also have the option to refuse or stop treatment. For more information, see the topic Care at the End of Life.

What To Think About

If you have severe chronic kidney disease but have not yet developed kidney failure, discuss with your doctor which type of dialysis is best for you. The type of dialysis you have may sometimes depend on how quickly you need to begin dialysis.

Learning about dialysis (predialysis education) is an important step in preparing for dialysis. Most dialysis clinics offer predialysis services to help you better understand your choices.

Dialysis can be expensive. But Medicare or insurance may cover most or all of the costs. Check with your insurance or Medicare about your coverage. The dialysis center or hospital can help you find the best way to pay for your treatment.

Making treatment decisions when you are very ill is difficult. It is normal to be fearful and worried about the risks involved. Discuss your concerns with your family and your doctor. It may be helpful to visit the dialysis center or transplant center and talk to others who have chosen these options.