Chronic Kidney Disease Management
What is Chronic Kidney Disease?
Chronic kidney disease (CKD) is a long-term condition in which the kidneys gradually lose their ability to filter waste, toxins, and excess fluids from the blood. This can lead to a buildup of harmful substances in the body and cause complications like high blood pressure, swelling, anemia, and bone disease. CKD essentially means a portion of the kidneys are scarred, and the more severe the CKD stage, the more scar tissue present. At Advanced Kidney Care, we specialize in early detection and management, including lifestyle changes and medical therapy, to help slow the progression of the disease.
Our Comprehensive Approach to Managing CKD
We believe that effective management of CKD requires a personalized and proactive approach. CKD is a leading cause of morbidity and mortality in the United States and across the world. Our treatment plans are tailored to address both your CKD but also the underlying causes of your kidney disease, such as hypertension, diabetes and heart failure. Advanced Kidney Care's goal is to prevent the transition of CKD to ESRD by offering support and treatments that manage symptoms and modify disease progression.
Hypertension
Hypertension is the second leading cause of CKD in the United States and a major contributor to heart attacks and strokes. Managing high blood pressure with medications like ACE inhibitors and angiotensin receptor blockers (ARBs) not only improves blood pressure control but also provides kidney-protective benefits by reducing proteinuria and slowing CKD progression.
Electrolyte Management
In advanced CKD, the kidneys struggle to maintain normal electrolyte levels, often leading to imbalances such as hyperkalemia (high potassium levels). Hyperkalemia can be dangerous, affecting heart and muscle function.
Initial management typically involves dietary changes to limit potassium-rich foods, but if levels remain elevated, special medications like diuretics (furosemide) or potassium binders (Lokelma® or Veltassa®) may be required to help lower potassium levels. Uncontrollable potassium levels can be a reason to initiate dialysis.
Proteinuria, the presence of excess protein in the urine, is a key marker of kidney damage and can indicate underlying kidney disease or systemic conditions like diabetes and hypertension. Persistent proteinuria is associated with an increased risk of progression to CKD, cardiovascular complications, and overall mortality. Early detection and management are crucial to slowing kidney damage and improving long-term health outcomes.
Proteinuria management replies on treating the underlying disease in addition to special classes of medications: ACEi/ARB (lisinopril/losartan), SGLT2 inhibitors (Farxiga®/Jardiance®) and MRB (Kerendia®/spironolactone).
Anemia in CKD
Anemia is common in CKD due to decreased production of erythropoietin, a hormone secreted by the kidney that is essential for red blood cell production. It can lead to fatigue, reduced quality of life, and worsening cardiovascular health. The goal hemoglobin (Hgb) level in CKD is typically 10-11.5 g/dL, managed with treatments such as erythropoiesis-stimulating agents (ESAs), iron supplementation, and addressing underlying causes
Volume Status
Maintaining appropriate fluid balance is crucial in managing CKD, as the kidneys’ ability to regulate fluid levels is often impaired. Excessive fluid intake can lead to swelling (edema) and breathing difficulties due to fluid buildup in the lungs.
We recommend limiting fluid intake to approximately 64 ounces per day and following a low-sodium diet (<2 grams/day) to reduce swelling and manage volume overload. In some cases, diuretics (furosemide, torsemide) may be necessary to help the kidneys eliminate excess fluid and maintain normal volume status.
Acid/Base Irregularities
Metabolic acidosis, a condition where the blood becomes too acidic, is common in CKD as the kidneys lose their ability to regulate acid-base balance. Chronic acidosis can lead to muscle wasting, bone loss, and worsening kidney function, contributing to overall disease progression. Managing acidosis with dietary modifications (eating more fresh fruits & vegetables) or medications (bicarbonate supplementation, diuretics).
Lipids in CKD
Cholesterol control is vital in CKD as patients are at increased risk for cardiovascular complications, which are a leading cause of morbidity and mortality in CKD. High cholesterol levels can contribute to atherosclerosis and further strain the kidneys. Treatment typically involves lifestyle modifications and medications like statins to lower cholesterol and reduce cardiovascular risk.
Bone Mineral & Density (BMD)
CKD disrupts calcium, phosphorus, and vitamin D balance, leading to bone weakening. This can trigger secondary hyperparathyroidism, where excessive parathyroid hormone (PTH) levels worsen bone loss and increase the risk of fractures. Treatment focuses on managing phosphorus levels with dietary restrictions and phosphate binders, ensuring adequate vitamin D levels, and using medications like calcimimetics to control PTH levels and protect bone health.