Control your blood pressure — This is the most important step you can take to prevent further kidney damage. Your blood pressure should be kept below 140/90 mm Hg. Some steps you can take to manage your blood pressure include:
- Instituting a heart-healthy and low-sodium diet
- Quitting smoking
- Being active
- Getting enough sleep
- Taking medications as prescribed
If you have diabetes, meet your blood glucose levels — Check your blood glucose levels regularly to make sure they are within a normal range. This will reduce long-term kidney damage caused by poorly managed blood glucose levels that will increase kidney damage over time.
Work closely with your health-care team to monitor kidney function — As kidney disease tends to get worse over time, it is important to track kidney function and disease progression. To slow disease progression, your goals should be to maintain your estimated GFR and either maintain or lower your urine albumin level. Your physician will also monitor your blood pressure and, if you have diabetes, your blood sugar levels will be monitored with a hemoglobin A1C test. It is recommended you bring this document to your appointments to keep track of your test results.
It is also recommended that when you prepare to meet with your health-care provider(s) that you keep track of questions to ask about your disease and how your lifestyle choices could be having an impact on your CKD progression.
Who makes up your health-care team is up to you, but it may include a number of different healthcare providers to support you in living with CKD, including your primary healthcare provider, a registered dietitian, a nurse, a diabetes educator, a social worker, a psychologist, and/or a nephrologist.
|Sample Questions to Ask Your Doctor
|What causes kidney disease?
|How well are my kidneys functioning now?
|What treatments do you recommend for my current symptoms?
|What are the symptoms of worsening disease?
|How can I reduce my chances of progressing to ESKD?
Review your current prescription medications with your physician — Certain medications may cause dangerous drug interactions for CKD patients. Some drugs can prevent your CKD medications from working as they should; others may create severe side effects when combined with your CKD treatments. For example, some antibiotics, antifungal drugs, and diabetes medications may require a change in dosage to prevent kidney damage. You and your physician should review what medications you take to ensure that you avoid any serious adverse interactions.
Take medicines as prescribed — It is very important that you take your medications as prescribed by your health-care providers. Although there is no medication specifically for CKD, taking your other medications appropriately can significantly slow the progression of CKD and kidney failure. Medications your doctors may prescribe include:
- Blood pressure medications: You may be prescribed blood pressure medications even if you do not have high blood pressure because they can slow CKD progression by changing the rate of blood flow to the kidneys. The most common forms of blood pressure medications prescribed for CKD are angiotensin converting enzyme (ACE) inhibitors, such as ramipril, enalapril, and lisinopril, and angiotensin receptor blockers (ARBs). However, these blood pressure medications should be monitored closely by your physician because as the disease progresses and your kidney functioning decreases, blood pressure medication can damage the kidneys.
- Cholesterol medications: You are at a higher risk of heart attack or stroke if you have CKD. Because of this, you may be prescribed statins in a kidney-friendly dosage to reduce your likelihood of developing cardiovascular disease.
- Diuretics: It is possible that your kidneys may have a hard time removing fluids from the blood. This may cause your tissues to retain water, which can cause your ankles, hands, and feet to swell. In addition to reducing your salt intake, you may be prescribed a diuretic to help remove fluids or to lower your blood pressure.
- Medications to address anemia: 10 Your kidneys are responsible for producing and releasing a hormone called erythropoietin (EPO) that signals the bone marrow to make more red blood cells. However, damaged kidneys may not be able to produce enough EPO and, in turn, the bone marrow will not produce enough red blood cells. A lack of healthy red blood cells is called anemia. The two main treatments for anemia caused by reduced EPO production are a subcutaneous injection of a synthetic form of EPO, called erythropoietin-stimulating agent, or supplemental iron pills or injections. Your doctor may also recommend vitamin B12 or folic acid supplements. In rare instances of severe anemia, your doctor may recommend a blood transfusion.
The dose and frequency with which you take medications will change over time as your disease progresses. It is important to follow the instructions given by your health-care provider since your kidneys may have troubling filtering certain medications as your disease progresses, causing an unsafe buildup in your system.
Pay attention to over-the-counter medications — Please consult with your physician and/or pharmacist before taking any over-the-counter (OTC) medications or supplements. Specifically, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can damage your kidneys and lead to acute kidney injury. NSAIDs are sold under many different brand names, and you should always check with your physician and/or pharmacist before taking any OTC medications to treat pain.
If you do plan on purchasing and taking OTC medications, here are some tips to avoid complications:
- Keep a running list of all the medications you take (this includes prescription and OTC medications, as well as supplements) in your wallet and bring this list with you to the pharmacy and all your healthcare visits
- Check for any harmful interaction warnings on medication labels
- Always ask your pharmacist how the medication may affect your kidneys or if there may be interactions with the current medications you are taking
- Fill all your prescriptions and purchase all OTC medications at the same pharmacy
Develop a meal plan with a dietitian — Healthful food and drink play an important role in kidney health and can also help you lower your blood pressure, maintain a healthy blood sugar (glucose) level, and delay or even prevent problems caused by CKD. A dietitian can help you develop healthy meal plans and help you meet the goals set by your physician, such as decreasing your sodium intake to reduce or maintain a healthy blood pressure. Additionally, with advanced stages of CKD your dietitian will likely recommend eating foods with less phosphorus and potassium. To learn more about ways you can use food and nutrition to support your CKD, click here.
Introduce physical activity into your routine — Physical activity for 30 minutes a day can help you maintain a healthy weight, reduce stress, and achieve blood glucose and pressure goals. Before you begin regular physical activity, it is recommended you first speak with your health-care provider.
Maintain or strive toward a healthy weight — Being overweight can make your kidneys work harder and may speed up disease progression. Monitoring what you eat (with the help of a dietitian) and exercising regularly can help you reach your weight loss goals and/or maintain a healthy weight to slow CKD progression.
Sleep 7 to 8 hours a night — Getting adequate and restful sleep is important for physical and mental health and can help you maintain a healthy weight and healthy blood pressure and glucose levels.
Don’t smoke — Smoking can increase CKD disease progression and cause damage to the kidneys. Additionally, smoking is associated with increased blood pressure and a greater likelihood of heart disease and stroke, which make it harder to effectively treat CKD.
Cope with your stress and depression in healthy ways — Long-term stress is associated with increased blood pressure, blood glucose, and depression. Mind-body methods such as meditation and mindfulness, maintaining regular physical activity, and getting an adequate amount of sleep can all help with stress reduction. Depression can make it harder to engage in self-care and other activities that can help slow kidney disease progression. Seeking the help of a trained therapist can also help you manage your stress and/or depression.