ABCs of Kidney Disease | Treatment Options for Chronic Kidney Disease (CKD)
>> Hi, my name is Su Thavarajah. We’re doing a presentation forthe ABCs of Kidney Disease. This is a section onTreatment Options forChronic Kidney Disease. This is one of the presentations in theJohns Hopkins NephrologyPatient Education Program. And we appreciate the funding fromThe Edward Kraus Endowment Fund,and The Shaw Foundation. We’re gonna start with medications. Now, there are no medications that we havethat actually reverse kidney damage. And the medications that we prescribeare not specifically kidney medications. They’re medications thatfall into two categories. Either they manage the riskfactors that can speed upkidney damage, or theymanage the complicationsthat are related to kidney damage. So medications for your blood pressure,medications for yourdiabetes or high cholesterolare medications thattreat the risk factorsfor kidney disease. Whereas, if I prescribe amedication like a diureticto get rid of extra salt and water,or a medication for anemia,I’m trying to address thosecomplications of kidney disease. So all of your medicationsare falling into those two categories. Now there’s some generalrecommendations we makeregardless of the cause of kidney disease,or regardless of what stagesomeone has of kidney disease. And a lot of it focuses on diet. You have to think aboutkidney disease as your kidneysare already working muchharder than they should,and they don’t have as much reserve. So if we can do some thingswith dietary changes,we might take some of thatworkload off of the kidneys. So we start off with things likerestricting the sodium in our dietto less than two grams aday or 2,000 milligramswhen you’re reading food labels. Also, we wanna cut back onthe amount of processed food and sugar. So if something can sit on a shelffor about a year or two, itprobably is the those kind offood items you wanna cut out of your diet,or really reduce significantly. Sometimes your kidney doctormight ask you to cut back ona couple of the minerals likepotassium and phosphorus intake. Both potassium andphosphorus are not harmfulto the kidneys, but they’reboth cleared by the kidneys. And so, we might have to cut back on thembecause your kidneysare already strugglingto get rid of ’em. Now you may have somebodywith the same level of kidney functionwho won’t be given thosedietary recommendations. These are part of thatindividualized treatment planfor your kidneys. Now when somebody has tocut back on potassium,they might have to cut back on potatoes,tomatoes, bananas. And then, when they’relooking at phosphorus,we’re looking at dairy products, meat,and also a lot of foodsthat have a lot of preservative agents. This doesn’t mean you can’tever have these foods,you’re basically reducing themto about once or twice aweek instead of every day. Now other things thatwe talk about with dietare 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 andyou actually end up having tourinate it out and yourkidneys have to get rid of it. So a moderate amount of proteinis looking at the serving size. So for men, the size of a deck of cardsis about an appropriate serving sizefor chicken, beef, lamb. If you have a piece of fish,about the size of a TV remote control. For a woman, a size ofthe palm of their handis an appropriate serving size for meat. And that’s for each meal. Anything more than thatis just perhaps somethingyou might need if you’rerecovering from an injury,recovering from a surgery. But anything more than thatyour body really can’t use,and it’s gonna put an extrastress on your kidneys. A common question that people have for usis how much water should I be drinking?There’s no specific amountof water to be drinkingevery day for your kidneys,unless you have ahistory of kidney stones. Other than that, it’s mainlydrinking for your thirst. Water is probably a betterchoice than other beveragesbecause it doesn’t haveany preservative agents,it doesn’t have any calories. And usually you wanna aim foryour urine to be almost clearto a pale yellow and that way you knowyou’re getting enoughwater in your system. Other than that, those basicdietary recommendations,your doctor’s gonna giveyou other recommendationsbased on what your lab work looks likeand how your kidneydisease is progressing. Now, when somebody looks atyou, they’re not gonna be ableto know that you have kidney issues. So really we’re depending onyou to be your health advocateand tell people when youhave kidney problems. Because there are certaintests that can be orderedthat may impact on your kidney function. Or you might be prescribedmedications at a dosethat’s not appropriate ornot safe for your kidneys. Imaging studies or x-raystudies like CAT scanswith contrast or angiograms,or MRIs with gadolinium,can be problematic whensomebody has kidney issues. The contrast that we use forCAT scans and for angiogramscan be harmful andirritating to the kidneys. The MRIs with gadoliniumrely on a certain amount ofkidney function to be able toclear it out of the system. If you have kidney disease,it’s gonna be a discussionwith your doctor as to whether or notthat’s the right test for you,whether the test canbe done in another way. Or if there should be an alternative test. Now when we think aboutmedications, there are a lot ofmedications that could beharmful to the kidneys. Medications are eithercleared by the liver,or they’re cleared by the kidneys. So whenever someone has kidney disease,you wanna make sure you’reknowing your level of functionsso that any doctor who’sprescribing medications,even if you’re going toan urgent care centerin the middle of the night,going to the dentist,that they all know theymight have to adjust the doseof the medication or giveyou an alternative medicationthat would be safer from your kidneys. The other key thing toremember is just becauseit’s over-the-counter,doesn’t mean that it’sactually safe to use. There’s a big category ofover-the-counter medicationscalled non-steroidalanti-inflammatory agents. Things like Motrin, Advil,ibuprofen, naproxen. These medications were never designedto be taken on a regular basis. And when you have kidney disease,they can actually cause more kidney damageand interfere with bloodpressure medications. Additionally, medicationsthat are for bowel agentssuch as Milk of Magnesia,phosphates, enemas,those are all problematicwhen you have kidney disease,’cause you’re not gonna be able toclear those minerals out of your system. It’s always a good idea todouble check with your pharmacistand your physician beforetaking any of those medications. Kidney disease is sortof a overall plan of careas opposed to just a certain medicationor a certain treatment. So you wanna be able to bepart of that healthcare team. You wanna be monitoring yourprogress by tracking your labs. You wanna know your medicationsand what they’re for. You wanna be engaged withthat team and ask questionswhen you don’t understandwhat the plan is. Also, engage your family and friends. It’s a lot easier to makesome of the dietary changes,it’s a lot easier to be exercisingwhen 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 controllingthe blood pressure. We’re looking atcontrolling the cholesterol,treating the complicationslike the anemia,the bone and mineral disease,malnutrition, depression,and maintaining existing kidney function. For more information abouttreatment of chronic kidney disease,dietary changes, management strategies,please look at these following resources. And for information about treatment ofend-stage kidney disease,tune in for our next video.