Managing and Treating Chronic Kidney Disease

If your kidneys don’t function well, toxic waste and extra fluid accumulate in your body and may lead to high blood pressure, heart disease, stroke and even death. You can take steps to protect your kidneys with the help of your health care providers.

Your health care providers focus on slowing the progression of your kidney damage by attempting to control the cause of the damage. However, even controlling the cause might not keep kidney damage from progressing to end-stage kidney disease, which can be fatal without replacing the failed kidney function with dialysis or through a kidney transplant.

Depending on the cause of your kidney disease, your health care providers may prescribe one or more of the following medications:

  • An angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) to lower your blood pressure and protect your kidney function from worsening.
  • Sodium-glucose cotransporter-2 (SGLT-2) inhibitors.
  • Specific medications for treatment of glomerulonephritis, lupus and other diseases.
  • Phosphate binder if your kidneys can’t eliminate phosphate.
  • A diuretic to help your body eliminate excess fluid.
  • Medications to lower your cholesterol levels.
  • Erythropoietin to build red blood cells if you have anemia.
  • Vitamin D and calcitriol to prevent bone loss.

SGLT-2 inhibitors

A new generation of diabetes drugs could help patients with chronic kidney disease (CKD). Drugs known as SGLT-2 inhibitors work by preventing blood glucose from being absorbed by the kidneys. Another class of drugs called GLP-1 receptor agonists mimic a hormone that helps the pancreas produce insulin. These drugs promote and support healthy blood glucose levels. The National Library of Medicine reports that not only do they dramatically cut deaths from kidney disease, but they can reduce rates of heart failure and death from cardiovascular causes. Your nephrologist may prescribe these medications for treatment of chronic kidney disease in both diabetic and non-diabetic kidney diseases.

Dialysis

End-stage kidney disease happens when kidney functions fail completely. Complete kidney failure results in death if not treated with dialysis or kidney transplantation.

Dialysis partially replaces kidney function by removing waste products and excess fluids from the body. Dialysis does not replace other kidney functions such as hormones that make red blood cells and help keep your bones strong.

There are two major types of dialysis:

  • Hemodialysis is a treatment that circulates your blood through a machine that removes waste products and excess fluids. The blood is then returned to your body. On average, hemodialysis is performed for four hours three times per week. A four- to six-week training program on performing hemodialysis at home is available.
  • Peritoneal dialysis is usually performed by someone at night in their home. It involves infusing a dialysis solution directly into the abdomen through a catheter. The solution helps remove waste and excess water which are then drained out by the same catheter. A fresh solution is added to continue the process of cleaning. There are two types of peritoneal dialysis:
    • Continuous ambulatory peritoneal dialysis (CAPD), which involves a change in dialysis solution four times a day.
    • Continuous cycling peritoneal dialysis (CCPD), which uses a machine to automatically fill, remove and refill the fluid three to five times overnight.

Kidney Transplant

Kidney transplantation involves replacing the completely failed kidneys with one healthy kidney. The healthy kidney can be obtained from two sources:

Living Donors

Most living donors are family members, partners or friends. It’s safe to donate a kidney since a person can live a normal life with one healthy kidney.

Occasionally, a person volunteers to donate a kidney to someone they don’t know. In this situation, the transplant center might ask the person to donate a kidney when the person is a match for someone who is waiting for a kidney in their area. This is called kidney paired donation.

Sometimes a transplant candidate has someone who wants to donate a kidney to them, but tests show that the kidney is not a good match. Kidney paired donation (KPD), also called kidney exchange, is another option. This involves swapping kidneys from a living donor so each recipient receives a compatible transplant. The United Network for Organ Sharing (UNOS) works with transplant centers throughout the U.S. to search for cases where the donor in each pair is compatible with the recipient in another pair (or multiple pairs). By exchanging donors, a compatible match for both recipients can be found.

Deceased Donors

Deceased donor kidneys usually come from people who decide they want to help save people by donating their organs when they die. All donors are carefully screened to make sure the match is suitable and to prevent any transmissible diseases or other complications.

On average, people wait about two to five years for a kidney from a deceased donor according to the National Kidney Foundation. It’s usually quicker to receive a kidney from a living donor.

Living With Chronic Kidney Disease

Most people with chronic kidney disease who receive treatment for kidney disease never progress to kidney failure. That is why it’s important for you to keep all your appointments and work with your health care providers on a treatment plan.

Untreated chronic kidney disease can lead to death. But many people, even those with end-stage kidney disease who are treated with maintenance dialysis or by kidney transplant, live long and happy lives. The leading cause of death in people with chronic kidney disease is heart disease, not kidney failure, according to the National Institute of Diabetes and Digestive Kidney Diseases.