KIDNEY DISEASE - MANAGEMENT

Once CKD is detected, the goal of therapy is to retard or halt the otherwise relentless progression of CKD to advanced kidney. Control of blood pressure and treatment of underlying disease (e.g. diabetes mellitus), whenever feasible, are the broad principles of management in CKD.

Similar to the management of all chronic diseases (CKD is a chronic disease), healthy lifestyle plays a pivotal role in the prevention and management of CKD. Reduction in the daily intake of salt (sodium) and protein in our diet are important steps to preserve the kidney function. Studies have proven that excessive salt intake may result in fluid retention and uncontrolled hypertension thus leading to further insult on the kidneys. Many studies show that a reduction in sodium intake to 2300 mg/day can lower systolic blood pressure by about 5-6 mmHg and diastolic pressure by 1-2 mmHg among hypertensive individuals. Moreover, many who are not yet on blood pressure medication respond nicely to sodium reduction, particularly in those whose blood pressure is the high normal range. Too much protein can make the already malfunctioned kidneys work too hard in removing the protein and toxic metabolites. Excessive protein when excreted in the urine can cause further kidney damage. Smoking cessation is also an important step in the management of CKD. Smoking not only damages the kidneys directly, it also increases the blood pressure and interferes with the medication used to treat hypertension.

Controlling the blood sugar level to the recommended target level is of paramount importance in those diabetic patients. Uncontrolled diabetes not only predisposes a diabetic patient to risk of developing CKD, it also accelerates the rate of worsening of the kidney function in diabetic patients with CKD.

As high blood pressure can lead to progression of CKD, it is important to lower the blood pressure to around 130/80mmHg as recommended by various international guidelines. Generally, all classes of anti-hypertensive agents are effectively in controlling blood pressure; however, in CKD patients, two classes of anti-hypertensive agents are preferred as first line blood pressure medicine. These are the Angiotensin converting enzymes inhibitors(ACE-inhibitors) and Angiotensin II receptor blockers (ARBs). These 2 classes of anti-hypertensive agents not only can effectively lower blood pressure, they have added functions of reducing protein in the urine and renal function preservation.

CKD can cause other associated complications such as high lipids, anemia and kidney bones disease. Medications may be required to treat these associated complications in CKD patients.

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Expert Author:

Dr Roger Tan, Consultant Nephrologist