Ok, I get it, CKD is serious. So when does my nephrologist come into the picture?

1. GFR under 30 mL/min.

2. When it’s under 60 mL/min ALONG WITH either:

  • Blood in urine (very serious)
  • Family history of kidney disease
  • Hypertension
  • Anemia

3. When GFR is over 60 mL/min ALONG WITH either:

  • Blood in urine (repeat, very serious)
  • Abnormal CT scans/kidney ultrasound
  • Family history of kidney disease

If you meet any of the above criteria, you are at risk for CKD!

At this point, your Nephrologist will stage your disease, determine the cause and set a course for treatment.

What’s the first thing I should know about CKD?

High blood pressure is a self-perpetuating cycle since hypertension can be the cause AND effect of CKD.

Remember…
    Blood pressure control
    Blood pressure control
    Blood pressure control
IS KEY!

What kind of medications will I be taking?

1. ACE inhibitors or ARB’s help kidney function by lowering blood pressure and reducing protein in urine.  Diuretics or water pills are sometimes prescribed in conjunction to prevent salt and water buildup.

2. High cholesterol and triglycerides increases heart disease risk. The best treatments are the mantras you already know: eat well, stop smoking, lose extra weight and strict blood sugar control! If that’s not enough, medication may be needed.

3. Phosphate binders: Bind to phosphate in food so the digestive system doesn’t absorb the molecules. Blood phosphorus will go up in kidney failure because we get phosphorus in our food and can’t be eliminated by our kidneys. If it remains high, it combines with the calcium in your blood and you will get calcium deposits in the wrong places. Avoid this by taking phosphate binders—they need to be taken with each meal!

4. Diuretics (“Water pills”):  Diuretics lower BP by getting rid of salt and water accumulation. A diuretic can also get rid of fluid accumulated in your lungs, ankles, and feet, which makes breathing easier. BP and electrolytes must be monitored closely while taking diuretics.

IMPORTANT! Pay special attention to dosage amount and timing of doses. Failure to do so may send you on a trip to the ER!

5. Vitamin D:  Since the kidney produces vitamin D, having CKD will lower your natural levels. A vitamin D prescription helps prevent osteoporosis and other bone disorders.

What should I do going forward?

Closely follow up with your doctor to track symptoms.  

Keep a blood pressure log. Diet restriction may be necessary.  Checking daily weights is the best day to day guide of salt and water retention.

Stop smoking!  You’ve heard it before, and you’re hearing it again. Tobacco consumption has been linked to CKD, so it is in your best interest to break any bad habits there.

Diabetes. ALWAYS monitor your blood sugar!

Monitor protein. It’s a good idea to monitor how much protein is in your diet. General recommendation is 0.8 to 1.0 gram/kg per day

For late stage CKD (4-5), discuss dialysis and kidney transplantation options with your doctor.