Chronic Kidney Disease (cont.)
IN THIS ARTICLE
The goal of treatment for chronic kidney disease is to prevent or slow further 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 and avoid situations that can cause kidney damage or make it worse.
Treatment to control kidney disease
Control the disease that's causing the kidney damage
One of the most important parts of treatment is to control the disease that is causing kidney damage. You and your doctor will create a plan to aggressively treat and manage your condition to help slow any more damage to your kidneys.
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. For more information about kidney disease caused by diabetes, see the topic Diabetic Nephropathy.
If you have high blood pressure, it is also important to control your blood pressure with diet, exercise, and any medicines your doctor prescribes. The goal is to keep your blood pressure less than 130/80.1 To learn ways to help control your blood pressure, see the topic High Blood Pressure.
If other conditions or diseases are causing kidney damage, such as a blockage (obstruction) in the urinary tract or long-term use of medicines that can damage the kidneys, you and your doctor will work out a treatment plan.
Take medicines if prescribed
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 reduce protein in the urine and help manage high blood pressure.
Have a healthy lifestyle
You can take steps at home to help control your kidney disease. For example:
Go to all follow-up visits
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 are critical to help monitor your disease. The tests include:
Treat any complications
As the disease gets worse, your symptoms—such as fatigue, nausea, and loss of appetite—may occur more often or become more severe. Work with your doctor to create a treatment plan to help control these symptoms.
If you develop anemia, you may need to take medicine called human recombinant erythropoietin (rhEPO). It helps your body make new red blood cells and may help improve your appetite and general sense of well-being.
You may also need an iron supplement if you have an iron deficiency.
Treatment for kidney failure
When your kidney function has fallen 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 can make you feel very ill.
After you have kidney failure, either you will need to have dialysis or you will need a new kidney. Both choices have risks and benefits.
Dialysis is a process that does 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.
To learn more about dialysis, see Other Treatment.
Kidney transplant is often a better treatment option than dialysis for kidney failure, because it may allow you to live a fairly normal life. But there are some drawbacks. For example, you will probably need to have dialysis while you wait for a kidney.
To learn more about kidney transplants, see Surgery.
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.
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 don't go away and that often get worse over time. It is different from 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 don't 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.
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.
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