Treatment
Key Pillars of
Chronic Kidney Disease Management
1.
Management of the underlying cause and control of factors contributing to disease progression.
2.
Lifestyle changes: A healthy diet low in salt and processed foods, adequate hydration, weight management, and regular physical activity; avoiding smoking and nephrotoxic medications.
3.
Medications that protect the kidneys and slow the progression of chronic kidney disease, as well as drugs to manage complications associated with kidney disease.
Treatment of End-Stage Kidney Disease
When kidney function has severely deteriorated, renal replacement therapy is required. The main options are:
Dialysis
A procedure that helps remove waste and excess fluid from the blood when the kidneys are unable to do so. There are two main types: Peritoneal dialysis: The lining of the abdomen is used to filter the blood Diálisis peritoneal: Se usa el revestimiento del abdomen para filtrar la sangre
Hemodialysis
An external machine is used to filter the blood
Peritoneal dialysis
The lining of the abdomen is used to filter the blood
Conservative treatment
An approach focused on quality of life and symptom management without dialysis or transplantation, which may be an option for some elderly patients and/or those with other serious health conditions.
Kidney Transplant
Surgery is performed to implant a healthy kidney from a donor to treat end-stage chronic kidney disease.
Hydration
Hydration in kidney disease is a fundamental aspect of clinical management, but it must be tailored to the type and stage of the disease, as well as the patient’s clinical condition.
1. In chronic kidney disease (CKD)
Goal: to avoid both dehydration and fluid overload.
In early stages (1–3): normal fluid intake (approx. 1.5–2 L/day) may be maintained, unless otherwise indicated.
In advanced stages (stages 4–5 or dialysis): fluid intake is restricted if oliguria (low urine output) or edema is present.
2. Special considerations
In cases of heart failure, cirrhosis, or nephrotic syndrome, fluid management is more restrictive.
Low salt intake
A low intake of salt (sodium) is one of the most important recommendations for managing kidney disease, as it helps protect kidney function and control complications such as high blood pressure and fluid retention.
Por qué reducir la sal en enfermedades renales?
In kidney disease (acute or chronic), the kidneys lose their ability to eliminate excess sodium and water.
This leads to:
Fluid retention → edema (swelling in the feet, legs, or face).
High blood pressure → accelerates kidney damage.
Cardiac overload → risk of heart failure.
- Monitor blood pressure.
- Prevent swelling and fluid retention.
- Slow the progression of kidney damage.
- Improve the response to antihypertensive and diuretic treatment.
Practical Tips for a Low-Sodium Diet Avoid adding salt while cooking or at the table.
Read labels: Choose products with less than 140 mg of sodium per serving (“low sodium”).
Limit processed foods: deli meats, instant soups, sauces, fast food, canned foods, pickles, and salty snacks.
Choose fresh foods: fruits, vegetables, fresh meats, and legumes.
Use natural seasonings: lemon, garlic, onion, herbs, spices, vinegar, or pepper.
Avoid potassium-based salt substitutes (such as “light salt”) if you have advanced kidney disease, as potassium can also build up.
General recommendations:
Condition Sodium recommendation
Healthy individuals < 2,300 mg of sodium/day (≈ 5 g of salt)
Chronic kidney disease 1,500–2,000 mg of sodium/day (≈ 3–4 g of salt)
Hypertension or fluid retention < 1,500 mg of sodium/day (≈ 3 g of salt)
💡 1 g of salt = approximately 400 mg of sodium.
In summary
Goal Strategy
Control blood pressure Reduce sodium intake
Reduce fluid retention Avoid excess salt and adjust fluid intake
Protect the kidneys Maintain a low-sodium, balanced diet.
Nutrition
Nutrition plays a crucial role in kidney disease because it helps protect the kidneys, prevent complications, and maintain the body’s balance.
Overall Goal
To reduce the workload on the kidneys and control the amount of:
1. Protein
If your kidneys are damaged, you need to limit your protein intake, because protein produces waste products that the kidneys cannot eliminate effectively. Examples: meat, fish, chicken, eggs, milk, cheese. However, you don’t have to cut them out entirely: choose high-quality protein sources (eggs, fish, skinless chicken).
2. Sodium (salt)
Too much salt raises blood pressure and makes the kidneys work harder. Avoid: deli meats, instant soups, processed foods, and salty snacks. Use herbs or lemon for flavor instead of salt.
3. Potassium
If the kidneys do not eliminate potassium properly, it builds up and can affect the heart. Limit: bananas, avocados, potatoes, tomatoes, oranges, spinach. Choose instead: apples, grapes, pineapple, peaches, cooked carrots.
4. Phosphorus
If phosphorus builds up, it can weaken your bones. Avoid: excessive dairy, processed meats, dark-colored soft drinks, chocolate, and nuts. Choose: rice, fruits, and vegetables (in moderation, as advised by your doctor).
5. Fluids
If you experience swelling or are producing little urine, limit your fluid intake. This includes soups, jellies, and fruits with high water content (such as watermelon or cantaloupe).
Physical activity
Physical activity is very beneficial for people with kidney disease, but it must be tailored to their overall health and kidney function.
Goals of exercise
Improve circulation and muscle strength.
Control blood pressure and blood sugar levels.
Reduce stress and improve mood.
Maintain a healthy weight.
1. Recommended types of exercise
Aerobic (cardiovascular) exercise strengthens the heart and improves endurance. Examples include brisk walking, stationary or regular cycling, swimming (if your doctor approves), and light dancing. Recommended: 30 minutes, 3 to 5 times a week, depending on your tolerance.
Strength Training (Muscle)
Keeps muscles active and prevents muscle loss. Examples: Lifting light weights, using resistance bands, gentle squats, or bodyweight exercises twice a week, using light weights and doing many repetitions.
Flexibility and balance exercises
Improves mobility and prevents falls. Examples: Stretching Yoga or gentle Pilates Breathing and relaxation
2. Important Precautions
Always consult your doctor or nephrologist before beginning. Avoid very intense exercise or heavy lifting. Stop immediately if you experience dizziness, pain, shortness of breath, or palpitations. If you are on dialysis, exercise may be done before or after treatment (as directed by your doctor). Maintain proper hydration, without exceeding the recommended fluid intake limit.
Sample weekly routine for stable kidney disease:
- Monday: Light walk, 30 min
- Tuesday: Stretching + light weights, 25 min
- Wednesday: Active rest (walk, light chores)
- Thursday: Stationary bike, 30 min
- Friday: Yoga or breathing exercises, 20 min
- Saturday: Gentle walk, 30 min
- Sunday: Rest —
Responsible Use of
Medications
The responsible use of medications in kidney disease is essential, because the kidneys eliminate many drugs from the body, and if they are not functioning properly, medications can build up and cause harm.
1. What does “responsible use” mean?
Use medications only as directed by your doctor, at the correct dose, and avoid self-medication.
This helps protect your kidneys and prevent complications.
2. Medications that can damage the kidneys (should be avoided without medical supervision)
Some medications and products can affect kidney function: pain relievers (ibuprofen, naproxen, diclofenac) can reduce blood flow to the kidneys; anti-inflammatory drugs (high-dose aspirin) can worsen kidney function; antibiotics (gentamicin, amikacin, vancomycin) require dose adjustment or may be toxic; laxatives or antacids containing magnesium or aluminum (some over-the-counter) can accumulate and cause damage; and “natural” supplements or herbs (unregulated products)—some affect the kidneys or interact with medications.
3. Medications That Are Typically Used with Caution or Require Dose Adjustment
Blood pressure medications, such as ACE inhibitors or ARBs (e.g., enalapril, losartan): protect the kidneys, but their use must be monitored with blood tests.
Diuretics (furosemide, hydrochlorothiazide): help eliminate fluid, but may affect potassium levels.
Erythropoietin: used to treat anemia caused by kidney damage.
Phosphorus binders: help control phosphorus levels in the blood.
4. Practical Recommendations
- Take your medications at the same time every day.
- Do not stop taking your medication or change the dose on your own.
- Tell your doctor about all medications, vitamins, or natural remedies you are taking.
- Have your kidney function checked regularly (creatinine, BUN, potassium).
- Stay well-hydrated, as directed by your nephrologist.
5. Avoid self-medication
Never take medications without a prescription or a doctor’s recommendation, and do not repeat previous treatments, because something that was “safe” before may be dangerous if your kidney function has changed.
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