Your treatment will depend on the stage of your chronic kidney disease (CKD). Stages one, two and three CKD can usually be treated by your GP.
Treatment involves making changes to your lifestyle and, in some cases, taking medication to control your blood pressure and lower your blood cholesterol levels. This should help prevent any further damage to your kidneys and circulation.
If you have stage four or stage five CKD, you will usually be referred to a specialist. In addition to the treatments above, you may also be given a number of different medications to control or prevent the symptoms of CKD.
Kidney failure, also called established renal failure or ERF, occurs when you have lost nearly all your kidney function and the condition has become life threatening. About 1% of people with stage three CKD develop ERF.
If you have kidney failure, you will need to decide on the next stage of treatment. Your choice will be whether to have treatment with dialysis (a means of artificially replacing some functions of the kidney), a kidney transplant, or other treatment options that involve less intervention, also known as supportive care.
The following lifestyle changes are known to help reduce your blood pressure and control CKD:
- stopping smoking
- eating a healthy, low-fat, balanced diet
- restricting your salt intake to less than 6g (0.2oz) a day
- not using over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, except when advised to by a medical professional
- moderating your alcohol intake so that it is within recommended limits (no more than 21 standard drinks a week for men and 14 for women)
- losing weight if you are overweight or obese
- doing regular exercise for at least 30 minutes a day, five times a week
Medications for high blood pressure
One of the most important ways to reduce the progression of kidney damage is to manage high blood pressure. Good control of blood pressure is vital to protect the kidneys. If losing weight, reducing your salt intake and making other lifestyle changes do not control your blood pressure, medication may be needed.
There are many types of blood pressure drug. Medicines called angiotensin converting enzyme (ACE) inhibitors are especially used to control high blood pressure in people with CKD.
As well as reducing blood pressure around the body and reducing the strain on blood vessels, ACE inhibitors give additional protection to the kidney.
ACE inhibitors include:
Side effects of ACE inhibitors include:
- a persistent, dry cough
- tiredness or weakness
Most of these side effects should pass within a few days, although some people continue to have a dry cough.
If the side effects of ACE inhibitors are particularly troublesome, you can be given an alternative medication called an angiotensin-II receptor blocker (ARB). This group of medicines includes candesartan, eprosartan, irbesartan and losartan. The side effects of ARBs are uncommon, but can include dizziness.
Both ACE inhibitors and ARBs can cause a reduction in kidney function and increased levels of potassium in the blood, so blood tests will need to be performed after you start treatment and whenever the dose changes.
Aspirin or statins
Studies have shown that people with CKD have a higher risk of cardiovascular disease, including heart attacks and strokes. This is because some of the risk factors for CKD are the same as those for heart attacks and strokes, including high blood pressure and high levels of cholesterol in the blood (atherosclerosis).
To help reduce your risk of having a heart attack or stroke, you may be given low-dose aspirin or statins.
Statins are a type of medication used to lower cholesterol levels. Cholesterol causes narrowing of the arteries that can lead to blockage of the blood supply to the heart (causing a heart attack) or the brain (causing a stroke). Statins work by blocking the effects of an enzyme in your liver (called HMG-CoA reductase), which is used to make cholesterol.
Statins sometimes have mild side effects, including:
- abdominal pain
Occasionally, statins can cause muscle pain, weakness and tenderness. If you experience any of these symptoms, contact your GP. You may need to have a blood test or change your treatment.
Oedema (fluid retention)
If you have kidney disease, you may be asked to reduce your daily fluid and salt intake. You may develop a build-up of fluid as your kidneys will not be able to get rid of fluid as well as they did before. If you are asked to reduce the amount of fluid you drink, you must also take into account fluid in foods, such as soup and yoghurt. Your GP or dietitian can advise you about this.
The excess fluid that occurs as a result of kidney disease often builds up in your ankles or around your lungs. You may also be given diuretics (water tablets), such as furosemide, which will help get rid of the excess fluid from your body.
If you do not have any fluid retention and you have not been told to reduce your fluid intake, there is no need to do so. In fact, it could be harmful in some circumstances.
Many people with stage three, four and five CKD develop anaemia. Anaemia is a condition in which you do not have enough red blood cells. Symptoms of anaemia include:
- shortness of breath (dyspnoea)
- palpitations (awareness of heartbeat)
Anaemia can occur because of many other conditions and your doctor will investigate to rule out any other possible causes.
Most people with kidney disease will be given iron supplements because iron is needed for the production of red blood cells. To boost iron levels, iron may be given as tablets, such as daily ferrous sulphate tablets, or as occasional intravenous injections.
If this is not enough to treat anaemia, you may given an injection of erythropoietin, a hormone which helps your body produce more red blood cells. These injections are often administered intravenously (into a vein) or subcutaneously (under the skin). Examples of these injections include epoetin alfa, beta and zeta, darbepoetin and methoxy polyethylene glycol-epoetin beta.
Correction of phosphate balance
If you have stage four or five kidney disease, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it. Phosphate is a mineral that, with calcium, makes up most of your bones. Phosphate is obtained through diet, mainly dairy foods. The kidneys usually filter out any excess phosphate. If phosphate levels rise too much, it can upset the normal calcium balance of the body. This can lead to thinning of the bones and furring of the arteries.
You may be asked to limit the amount of phosphate in your diet. Foods that are high in phosphate include red meat, dairy produce, eggs and fish. Your GP or dietitian should be able to advise you about how much phosphate you can eat. However, there is no advantage in reducing your intake of these foods unless you have a raised phosphate level. Always ask a healthcare professional before changing your diet.
If reducing the amount of phosphate in your diet does not lower your phosphate level enough, you may be given medicines called phosphate binders. These medicines bind to the phosphate in the food inside your stomach and stop it from being absorbed into your body.
To work properly, phosphate binders must be taken just before meals. The most commonly used phosphate binders are calcium carbonate and (less commonly) aluminium hydroxide.
The side effects of phosphate binders are uncommon but include:
- stomach ache
- flatulence (wind)
- skin rash
- itchy skin
Vitamin D supplements
People with kidney disease can have low levels of vitamin D, which is needed for healthy bones. This is because the kidneys need to activate the vitamin D from food and from the sun before it can be used by the body.
You may be given a vitamin D supplement called alfacalcidol or calcitriol to help boost vitamin D levels and reduce the risk of bone damage.
Treatment for kidney failure - dialysis or transplant
Many people with kidney failure can continue with treatment using medicines and will have good-functioning kidneys for the rest of their lives.
In a few people, kidney disease will progress to the stage where the kidneys stop working and it becomes life threatening. This is called kidney failure or established renal failure (ERF).
This rarely happens suddenly, and there will be time to plan the next stage of your condition. The decision whether to have dialysis, a kidney transplant or supportive treatment should be discussed with your healthcare team.
If you decide not to have dialysis or a transplant for kidney failure, or they are not suitable for you, you will be offered supportive treatment. This is also called palliative care. The aim is to treat and control the symptoms of kidney failure without using dialysis or transplantation. Supportive treatment includes medical, psychological and practical care for both the person with kidney failure and their family, including discussion about how you feel and planning for the end of life.
Many people choose supportive treatment because they:
- do not want to go through the inconvenience of treatment with dialysis or transplantation
- are advised against dialysis because they have other serious illnesses that will shorten their life, and the negative aspects of treatment outweigh any likely benefits
- have been on dialysis but have decided to stop this treatment
- are being treated with dialysis, but have another serious physical illness, especially severe heart disease, that will shorten their life
If you choose to have supportive treatment, your kidney unit will still look after you.
Doctors and nurses will make sure you receive:
- medicines to protect your remaining kidney function for as long as possible
- medicines to treat other symptoms of kidney failure, such as feeling out of breath, anaemia, loss of appetite or itchy skin
- help to plan your home and money affairs
- bereavement support for your family after your death