ABCs of Kidney Disease | Treatment Options for Chronic Kidney Disease (CKD)

ABCs of Kidney Disease | Treatment Options for Chronic Kidney Disease (CKD)


>>Hi, my name is Su Thavarajah. We’re doing a presentation for
the ABCs of Kidney Disease. This is a section on Treatment Options for
Chronic Kidney Disease. This is one of the presentations in the Johns Hopkins Nephrology
Patient Education Program. And we appreciate the funding from The Edward Kraus Endowment Fund, and The Shaw Foundation. We’re gonna start with medications. Now, there are no medications that we have that actually reverse kidney damage. And the medications that we prescribe are not specifically kidney medications. They’re medications that
fall into two categories. Either they manage the risk
factors that can speed up kidney damage, or they
manage the complications that are related to kidney damage. So medications for your blood pressure, medications for your
diabetes or high cholesterol are medications that
treat the risk factors for kidney disease. Whereas, if I prescribe a
medication like a diuretic to get rid of extra salt and water, or a medication for anemia, I’m trying to address those
complications of kidney disease. So all of your medications are falling into those two categories. Now there’s some general
recommendations we make regardless of the cause of kidney disease, or regardless of what stage
someone has of kidney disease. And a lot of it focuses on diet. You have to think about
kidney disease as your kidneys are already working much
harder than they should, and they don’t have as much reserve. So if we can do some things
with dietary changes, we might take some of that
workload off of the kidneys. So we start off with things like restricting the sodium in our diet to less than two grams a
day or 2,000 milligrams when you’re reading food labels. Also, we wanna cut back on the amount of processed food and sugar. So if something can sit on a shelf for about a year or two, it
probably is the those kind of food items you wanna cut out of your diet, or really reduce significantly. Sometimes your kidney doctor
might ask you to cut back on a couple of the minerals like potassium and phosphorus intake. Both potassium and
phosphorus are not harmful to the kidneys, but they’re
both cleared by the kidneys. And so, we might have to cut back on them because your kidneys
are already struggling to get rid of ’em. Now you may have somebody with the same level of kidney function who won’t be given those
dietary recommendations. These are part of that
individualized treatment plan for your kidneys. Now when somebody has to
cut back on potassium, they might have to cut back on potatoes, tomatoes, bananas. And then, when they’re
looking at phosphorus, we’re looking at dairy products, meat, and also a lot of foods that have a lot of preservative agents. This doesn’t mean you can’t
ever have these foods, you’re basically reducing them to about once or twice a
week instead of every day. Now other things that
we talk about with diet are moderate protein restriction. So what does that mean? Protein’s important for the body. You need it to maintain your muscle mass, maintain your immune system,
maintain your strength. But too much protein, your body can’t absorb and
you actually end up having to urinate it out and your
kidneys have to get rid of it. So a moderate amount of protein is looking at the serving size. So for men, the size of a deck of cards is about an appropriate serving size for chicken, beef, lamb. If you have a piece of fish, about the size of a TV remote control. For a woman, a size of
the palm of their hand is an appropriate serving size for meat. And that’s for each meal. Anything more than that
is just perhaps something you might need if you’re
recovering from an injury, recovering from a surgery. But anything more than that
your body really can’t use, and it’s gonna put an extra
stress on your kidneys. A common question that people have for us is how much water should I be drinking? There’s no specific amount
of water to be drinking every day for your kidneys, unless you have a
history of kidney stones. Other than that, it’s mainly
drinking for your thirst. Water is probably a better
choice than other beverages because it doesn’t have
any preservative agents, it doesn’t have any calories. And usually you wanna aim for
your urine to be almost clear to a pale yellow and that way you know you’re getting enough
water in your system. Other than that, those basic
dietary recommendations, your doctor’s gonna give
you other recommendations based on what your lab work looks like and how your kidney
disease is progressing. Now, when somebody looks at
you, they’re not gonna be able to know that you have kidney issues. So really we’re depending on
you to be your health advocate and tell people when you
have kidney problems. Because there are certain
tests that can be ordered that may impact on your kidney function. Or you might be prescribed
medications at a dose that’s not appropriate or
not safe for your kidneys. Imaging studies or x-ray
studies like CAT scans with contrast or angiograms,
or MRIs with gadolinium, can be problematic when
somebody has kidney issues. The contrast that we use for
CAT scans and for angiograms can be harmful and
irritating to the kidneys. The MRIs with gadolinium
rely on a certain amount of kidney function to be able to
clear it out of the system. If you have kidney disease,
it’s gonna be a discussion with your doctor as to whether or not that’s the right test for you, whether the test can
be done in another way. Or if there should be an alternative test. Now when we think about
medications, there are a lot of medications that could be
harmful to the kidneys. Medications are either
cleared by the liver, or they’re cleared by the kidneys. So whenever someone has kidney disease, you wanna make sure you’re
knowing your level of functions so that any doctor who’s
prescribing medications, even if you’re going to
an urgent care center in the middle of the night,
going to the dentist, that they all know they
might have to adjust the dose of the medication or give
you an alternative medication that would be safer from your kidneys. The other key thing to
remember is just because it’s over-the-counter, doesn’t mean that it’s
actually safe to use. There’s a big category of
over-the-counter medications called non-steroidal
anti-inflammatory agents. Things like Motrin, Advil,
ibuprofen, naproxen. These medications were never designed to be taken on a regular basis. And when you have kidney disease, they can actually cause more kidney damage and interfere with blood
pressure medications. Additionally, medications
that are for bowel agents such as Milk of Magnesia,
phosphates, enemas, those are all problematic
when you have kidney disease, ’cause you’re not gonna be able to clear those minerals out of your system. It’s always a good idea to
double check with your pharmacist and your physician before
taking any of those medications. Kidney disease is sort
of a overall plan of care as opposed to just a certain medication or a certain treatment. So you wanna be able to be
part of that healthcare team. You wanna be monitoring your
progress by tracking your labs. You wanna know your medications
and what they’re for. You wanna be engaged with
that team and ask questions when you don’t understand
what the plan is. Also, engage your family and friends. It’s a lot easier to make
some of the dietary changes, it’s a lot easier to be exercising when you’ve engaged your family members. And when you’re looking at kidney disease, we’re looking at that overall plan. We’re looking at controlling
the blood pressure. We’re looking at
controlling the cholesterol, treating the complications
like the anemia, the bone and mineral disease,
malnutrition, depression, and maintaining existing kidney function. For more information about treatment of chronic kidney disease, dietary changes, management strategies, please look at these following resources. And for information about treatment of end-stage kidney disease,
tune in for our next video.


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