Approaching Kidney Disease Treatment

ANC Team

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October 14, 2024

Approaching Kidney Disease Treatment

Treatment for chronic kidney disease (CKD) usually has four goals: treat the condition causing it, slow further kidney damage, lower your risk of heart disease and stroke, and manage complications. For most people that means medicines, food and lifestyle changes, and regular blood and urine tests. If the kidneys fail, the choices become dialysis, a kidney transplant, or conservative care without dialysis.

Key Takeaways

CKD treatment usually aims to treat the cause, slow kidney damage, lower heart and stroke risk, and manage complications.
Medicine classes such as ACE inhibitors, ARBs and SGLT2 inhibitors can help slow CKD, and the right mix depends on your health.
Diet changes are personal, so ask whether you need to limit sodium, potassium, phosphorus or protein before cutting foods out.
Anemia, mineral and bone problems, acid buildup and high potassium each have their own treatments.
If the kidneys fail, the options are hemodialysis, peritoneal dialysis, a kidney transplant, or conservative management.

What Are the Goals of Kidney Disease Treatment?

The National Kidney Foundation (NKF) describes four goals: managing the condition most likely causing CKD, slowing CKD progression, lowering the risk of heart disease and stroke, and treating complications. Which treatments you need depends on your CKD stage, your test results and your other health conditions. If you are not sure of your stage, read about CKD stages and whether kidney function can improve.

Progress is tracked with two tests. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says the aims are to keep your GFR, a blood test of how well the kidneys filter, the same, and to keep your urine albumin the same or lower.

How Is the Cause of Kidney Disease Treated?

Diabetes and high blood pressure are the two leading causes of kidney failure in the United States, so treating them is part of treating CKD. NIDDK calls blood pressure control the most important step you can take to treat kidney disease. If you have diabetes, reaching your blood glucose goal also helps protect your kidneys.

Other causes need their own plan. CKD can also come from glomerular diseases such as IgA nephropathy, genetic conditions such as polycystic kidney disease, or autoimmune diseases such as lupus nephritis. When the cause is uncertain, the international kidney guideline group KDIGO lists that as a reason for specialist kidney care, and tests such as an ultrasound or a kidney biopsy may help find it so treatment can target the specific disease.

Which Medicines Can Slow Chronic Kidney Disease?

Depending on your health, your doctor may prescribe medicines from these classes:

ACE inhibitors or ARBs, blood pressure medicines that may slow kidney disease even in people without high blood pressure
SGLT2 inhibitors, which KDIGO recommends for many adults with CKD, with or without diabetes
A newer type of medicine called a nonsteroidal mineralocorticoid receptor antagonist (nsMRA), for some adults with type 2 diabetes and albumin in the urine
Statins, to lower the risk of heart disease and stroke

For people with type 2 diabetes, KDIGO also includes GLP-1 receptor agonists where they fit the diabetes plan.

Not everyone takes all of these, and each needs monitoring. KDIGO advises checking blood pressure, creatinine and potassium within 2 to 4 weeks of starting or increasing an ACE inhibitor or ARB. Tell your team about every over-the-counter medicine and supplement, since pain relievers called NSAIDs can harm the kidneys, and never start or stop a medicine without talking to your doctor or pharmacist.

How Do Diet and Daily Habits Fit Into Treatment?

Food is part of treatment, but the right plan depends on your stage, blood pressure, diabetes and lab results. NKF says a doctor or kidney dietitian can help you understand whether you need to limit sodium, potassium, phosphorus, calcium or protein. Not everyone needs every limit, so ask before cutting out healthy foods. KDIGO suggests a varied diet with more plant-based foods and fewer ultra-processed foods, and keeping sodium under 2 grams a day for people with CKD.

Daily habits help too. NIDDK suggests being active for 30 minutes or more on most days, aiming for a healthy weight, getting 7 to 8 hours of sleep, quitting smoking, and finding healthy ways to cope with stress.

How Are CKD Complications Treated?

As CKD advances, problems can develop that need their own treatment:

Anemia (too few red blood cells): fixing iron or vitamin shortages, iron as a pill or IV infusion, or medicines called ESAs that signal the bone marrow to make more red blood cells. See Anemia and Chronic Kidney Disease for more.
Mineral and bone disorder: eating less phosphorus, phosphate binders, calcium and vitamin D, medicines that lower parathyroid hormone, and sometimes surgery on the parathyroid glands.
High potassium: diet changes guided by a dietitian, medicines called potassium binders, and a review of other medicines.
Metabolic acidosis, or acid buildup in the blood: medicine, with or without diet changes.

Many people with CKD have no symptoms until later stages or until complications develop, so regular blood tests help catch these problems.

What Are the Treatment Options if the Kidneys Fail?

NIDDK describes four options. Hemodialysis filters the blood through a machine, at a center or at home. Peritoneal dialysis uses the lining of the belly to filter the blood inside the body. A kidney transplant places a healthy kidney from a living or deceased donor. Conservative management continues care without dialysis or a transplant, focusing on symptoms and quality of life. None of these makes the kidneys better, but all can help you feel better. For detail on dialysis, read Understanding Dialysis: A Comprehensive Guide from ANC.

Planning ahead gives you more choice. Many people start dialysis when their GFR is between 5 and 10, and a transplant center can add you to the waiting list once permanent kidney damage brings your GFR to 20 or less. KDIGO suggests planning for a transplant before dialysis, called a preemptive transplant, or for dialysis access when GFR falls below about 15 to 20. NIDDK advises learning about the options before you need one.

When Should You Seek Care?

Call 911 or go to the emergency room if you suddenly have chest pain, shortness of breath, or heart palpitations (a very fast or pounding heartbeat), especially with nausea or vomiting. NKF notes these can be signs of sudden, very high potassium, which is life-threatening and needs immediate care.

Make an appointment if you notice new swelling in your legs, ankles or feet, peeing more or less than usual, foamy urine, itchy skin, tiredness, poor appetite, trouble concentrating or muscle cramps, or if your GFR is falling or your urine albumin is rising.

A nephrologist is not only for dialysis or transplant. Kidney specialists can help at any stage alongside your primary care clinician, and KDIGO lists referral reasons such as an uncertain cause, a GFR below 30, or a significant drop in GFR. What Does a Nephrologist Do and When Do You Need One? explains more.

What Should You Ask About Your Treatment Plan?

A few prepared questions help you get more from each visit:

What are my GFR and urine albumin, and have they changed since last time?
What is causing my kidney disease, and is it being treated?
Which of my medicines protect my kidneys, and do any need to change?
Do I need to change what I eat, and can you refer me to a dietitian?
When should I start learning about dialysis, transplant or conservative care?

Bring your medicine list or bottles, and consider bringing a family member or friend to take notes.

Frequently Asked Questions

Will Everyone With CKD Need Dialysis?

No. Not everyone with CKD reaches kidney failure, and your team can estimate your own risk from your GFR, urine albumin and other factors to decide when planning should start.

Do I Have to Follow a Strict Kidney Diet?

Not always. Limits depend on your stage, lab results and other conditions, so a doctor or kidney dietitian should tailor them to you.

Can I Get a Kidney Transplant Without Starting Dialysis First?

Sometimes. This is called a preemptive transplant, though some people need dialysis while they wait for a kidney.

Is Conservative Management the Same as Stopping Care?

No. Your care team keeps treating symptoms and problems such as anemia and weak bones, with a focus on quality of life, and you can change your treatment choice later.

Will My Medicines Change Over Time?

Often. As kidney function falls, some medicines need a smaller dose, less frequent dosing or a switch, so review every medicine and supplement with your team at each visit.

Talk to ANC About Your Kidney Disease Treatment

ANC’s physicians, nurse practitioners and physician assistants see patients with all types of acute and chronic kidney disease, including people approaching dialysis, on dialysis, or before and after a kidney transplant. Contact ANC or call 651-772-6251 to ask about an appointment.

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Medical Disclaimer

This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your specific care and treatment options.