Treatment

Lifestyle changes

The following lifestylemeasures are usually recommended for people with kidney disease:

• stop smoking if you smoke
• eat a healthy, balanced diet
• restrict your salt intake to less than 6g (0.2oz) a day
• do regular exercise aim to do at least 150 minutes aweek
• moderate your alcohol intake so it's within the recommended limits of no more than 14 alcohol units a week
• lose weight if you're overweight or obese
• avoidover-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen , except when advised to by a medical professional these medicines can harm your kidneys if you have kidney disease

Read about living with CKD for more information about what you can do to stay healthy.

Medication

There's no medicine specifically for CKD, but medication can help control many of the problems that cause the condition and complications that can occur as a result of it.

You may need totake medicationto treat or prevent:

High blood pressure

High cholesterol

Water retention

Anaemia

Bone problems

Glomerulonephritis

High blood pressure

Good control of blood pressure isvital to protect the kidneys.

People with kidney disease should usually aim to get their blood pressure down to below 140/90mmHg, but you should aim to get it down to below 130/80mmHgif you also have diabetes .

There are many types of blood pressure medication, but medicines called angiotensin converting enzyme (ACE) inhibitors are often used. Examples includeramipril, enalapriland lisinopril.

Side effects of ACE inhibitors can include:

• a persistent dry cough
• dizziness
• tiredness or weakness
• headaches

If the side effects of ACE inhibitors are particularly troublesome, you can be given a medication called an angiotensin-II receptor blocker (ARB) instead.

This is because some of the causes ofkidney diseaseare the same as those for cardiovascular disease, including high blood pressure and high cholesterol.

You may be prescribed medication called statins to reduce your risk of developing cardiovascular disease. Examples include atorvastatin, fluvastatin and simvastatin.

Side effects of statins can include:

• headaches
• feeling sick
• constipation or diarrhoea
• muscle and joint pain

This is because your kidneys aren't as effective at removing fluid from your blood, causing it to build up in the body tissues (oedema) .

You may be advised to reduce your daily salt and fluid intake, including fluids in food like soups and yoghurts, to help relieve the swelling.

In some cases you may also be given water tablets (diuretics) to take, such asfurosemide.

Side effects of diuretics can include dehydration and reduced levels of sodium and potassium in the blood.

Anaemia

Many people with later-stagekidney diseasedevelop anaemia , which is a lack of red blood cells.

Symptoms of anaemia include:

• tiredness
• lack of energy
• shortness of breath
• apounding, fluttering or irregular heartbeat (palpitations)

If you experience anaemia, you may be given injections of a medication callederythropoietin. This is a hormone thathelps your body produce more red blood cells.

If you have an iron deficiency as well, iron supplements may also be recommended.

But if your phosphate level rises too much, it can upset the balance of calcium in your body andlead to thinning of the bones.

You may be advised to limit the amount of high-phosphate food in your diet, such as red meat, dairy products, eggs and fish.

If this doesn't lower your phosphate level enough, you may be given medicines called phosphate binders. Commonly used medicines include calcium acetate and calcium carbonate.

Some people withkidney diseasealso have low levels of glomerulonephritis .

In some cases this occurs as a result of the immune system mistakenly attacking the kidneys.

If a kidney biopsy finds that this is the cause of your kidney problems, you may be prescribed medicine to reduce the activity of your immune system, such as steroid medication or a medication called cyclophosphamide.

Dialysis

In asmallproportion of people with kidney disease, the condition will eventually get to a point where their kidneys stop working.

This rarelyhappens suddenly,so there should be time to plan the next stage of your treatment.

One of the options when CKD reaches this stage is to have dialysis. This is a procedureto remove waste products and excess fluid from the blood.

There are two main types of dialysis:

• haemodialysis this involves diverting blood into an external machine, where it's filtered before being returned to the body
• peritoneal dialysis this involves pumping dialysis fluid into the space inside your tummy to draw out waste products from the blood passing through vessels lining the inside of your tummy

Haemodialysis is usually done about three times a week, either at hospital or at home. Peritoneal dialysis is normally done at home several times a day, or overnight.

If you don't have a kidney transplant, treatment with dialysis will usually need to be lifelong.

Talk to your doctor about the pros and cons of each type of dialysis and discuss which type you would prefer if your kidney function becomes severely reduced.

Want to know more?

• About 90% of transplants still function after five years and many work usefully after 10 years ormore.

  Want to know more?

  • This is also called palliative or conservative care.

    The aim is to treat and control the symptoms of kidney failure.It 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:

    • are unlikely to benefit from or have a good quality of life with treatment
    • don't want to go through the inconvenience of treatment with dialysis
    • are advised against dialysis because they have other serious illnesses, 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 illness, such as severe heart disease or stroke, that will shorten their life

    If you choose to have supportive treatment, your kidney unit will still look after you.Supportive care can still allow you to live for some time with a good quality of life.

    Doctors and nurses will make sure you receive:

    • medicines to protect your remaining kidney functionfor 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
    • helpto plan your home and money affairs
    • bereavement support for your family

    Want to know more?

    • Bereavement support from CRUSE
    • Kidney Patient Guide: information on choosing not to start dialysis
    • National Kidney Federation: end of life care for people with advanced kidney disease