Chronic Kidney Disease (cont.)
Chronic Kidney Disease Medical Treatment
There is no cure for chronic kidney disease. The four
goals of therapy are to:
- slow the progression of disease;
- treat underlying causes and contributing factors;
- treat complications of disease; and
- replace lost kidney function.
Strategies for slowing progression and treating conditions underlying chronic kidney disease include the following:
- Control of blood glucose:
Maintaining good control of diabetes is critical. People with diabetes who do
not control their blood glucose have a much higher risk of all complications of diabetes, including chronic kidney disease.
- Control of high blood pressure: This also slows progression of chronic kidney disease. It is recommended to keep
blood pressure below 130/80 mm Hg if one has kidney disease. It is often useful to monitor blood pressure at home. Blood pressure medications known as angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) have special benefit in protecting the kidneys.
- Diet: Diet control is
essential to slowing progression of chronic kidney disease and should be done in close consultation with
a health care
practitioner and a dietitian. For some general guidelines, see the Chronic
Kidney Disease Self-Care at Home section of this article.
The complications of chronic kidney disease may require medical treatment.
- Fluid retention is common in kidney disease and manifests with swelling. In late phases, fluid may build up in the lungs and cause shortness of breath.
- Anemia is common with CKD. The two most common causes of anemia with kidney disease are iron deficiency and the lack of erythropoietin. If one is anemic, the doctor will run tests to determine if the anemia is secondary to kidney disease or due to alternative causes.
- Bone disease develops in kidney disease. The kidneys are responsible for excreting phosphorus from the body and processing Vitamin D into its active form. High phosphorus levels and lack of vitamin D cause blood levels of calcium to decrease, causing activation of the parathyroid hormone (PTH). These and several complex changes cause the development of metabolic bone disease. Treatment of metabolic bone disease is aimed at managing serum levels of calcium, phosphorus, and parathyroid hormone.
- Metabolic acidosis may develop with kidney disease. The acidosis may cause breakdown of proteins, inflammation, and bone disease. If the acidosis is significant, the doctor may use drugs such as
sodium bicarbonate (baking soda) to correct the problem.
Pranay Kathuria, MD, FACP, FASN, FNKF
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