EARLY MANAGEMENT OF KIDNEY FAILURE 

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Treatment options :-  Home Dialysis  I  Unit-based Dialysis  I  Transplantation  I  Conservative care

Advice for early Chronic Kidney Disease - Stages 2 to 4

Appropriate management of Chronic Kidney Disease (CKD) can help to prevent or delay the progression of the illness to its end stages when dialysis or transplantation is required to sustain life. Effective management of CKD can also help to control symptoms or side effects, such as high blood pressure, loss of appetite, nausea, tiredness and swelling of the hands, face and feet. Management of your CKD should be done in conjunction with your general practitioner, kidney specialist (if applicable) and allied health team and often involves addressing factors related to nutrition, fitness, medication and mind/spirit. It can also impact on sexuality.

Nutrition
Helping kidneys to control body chemistry by eating a sensible diet is an important part of managing CKD. Being careful about what is eaten can reduce the amount of fluid and waste build-up, helping to minimise symptoms and side effects of CKD.

Other than reducing salt, sugar and fat intake, there is no standard kidney disease diet.

An Accredited Practising Dietitian experienced in treating kidney disease can help plan your meals, taking into account how you are feeling, your age, lifestyle, weight, muscle size, health status and blood test results. You can ask your GP or kidney specialist for a referral to an Accredited Practicing Dietitian.

Note: Advice on nutrition needs to be personalised and based on your individual kidney function. Your nephrologist can refer you to a renal dietician who will design a specific diet for your needs - contact Dietitians Association of Australia to find a local renal dietitian on1800 812 942. If you have seen a dietician, information below should not take the place of the diet prescribed for you

Things that are important to nutrition include getting the right amount of energy from food, as well as staying at a healthy body weight. Controlling important nutrients in the diet is also helpful. These nutrients are summarised below.

Protein
Getting the right amount of protein is important to overall health and affects how well a person feels. The body needs protein for building muscles, repairing tissue and fighting infections. You may need to follow a diet with controlled amounts of protein. This can help regulate the amount of waste in your blood and increase the life of your kidneys. Protein comes from animal or plant based products. Animal base products based products include: eggs, fish, meat, chicken, cheese, milk and other dairy foods. Plant-based products include: nuts, peanut butter, lentils, baked beans, bean soup mix, beans salad mix, chickpeas and hommus dip.

Sodium (Salt)
Kidney disease, high blood pressure and sodium are all linked. You may need to limit the amount of sodium in your diet. Even if you don’t use salt in cooking or at the table, your diet can still be high in sodium. This is because sodium is found in many processed foods. Generally, foods that have a lot of sodium include:

• salty seasonings like soy sauce, teriyaki sauce and garlic or onion salt
• most canned foods and some frozen foods
• processed meats like ham, bacon, sausage and cold cuts
• salted snack foods like chips and crackers 
• most restaurant and take-away foods
• canned or dehydrated soups like packaged noodle soup

Salt substitutes are often high in potassium and should not be used without consulting your doctor or Accredited Practising Dietitian. See Australian World Action on Salt and Health's Drop the Salt Campaign for helpful tips.

Potassium
Potassium is an important mineral in the blood helping your muscles, nerve endings and heart to work properly. Too much or too little potassium in the blood can be dangerous and can cause irregular heartbeat. You may need to limit the amount of high-potassium foods you consume. Potassium is found in large amounts of fruits and vegetables such as:

• potato, sweet potato, pumpkin (inc. crisps)
• tomato, avocado, beans (i.e. baked beans, soy beans) and lentils
• banana, custard apple, stone fruits such as nectarines
• dried fruits and vegetables, vegetable juice, kiwi fruit and olives
• spinash, mushrooms
• tinned and homemade soups
• high fibre breakfast cereals, unprocessed bran
• liqueurs, red wine, cider and stout

How much potassium can you have?
This depends on your blood results, as well as the amount of urine you are passing. Your doctor and dietitian can advise you on what food would be best for your individual health. Foods high in potassium include:

Phosphate & Calcium
Phosphate and calcium are minerals found in your blood and bones. With CKD, your kidneys may not remove enough phosphate from your blood. A high blood phosphate level may cause you to itch and lose calcium from your bones which may then become weak and break easily. Avoiding large amounts of foods high in phosphate will help lower your blood phosphate level.

Phosphate is found in large amounts in:

• dairy products such as milk, cheese, yoghurt and ice cream
• dried beans and peas such as kidney beans, split peas and lentils
• nuts and peanut butter
• drinks such as cocoa, beer and cola drinks

Fluids
When diagnosed with CKD, some people need to drink large amounts of fluid while others may need to limit fluid intake. Your suggested fluid intake will depend on your urine output, fluid build-up and blood pressure. Fluids are any foods that are liquid at room temperature including ice cream, yoghurt and ice cubes. Fluid is also contained in food like cooked pasta and rice, salad ingredients, soup and watermelon. Remember, whatever fluid amount you need, always 'Drink water instead'.

Fitness
There is a growing body of evidence showing beneficial effects of exercise specifically for people with CKD that may help to prevent the negative side effects of CKD. Getting fit doesn’t mean you have to be able to run a marathon, but being physically active has many positive effects on health and wellbeing.

Positive benefits of physical exercise
Many organs in the body benefit from physical exercise – more than you might think. The heart muscle gets stronger, the amount of blood pumped out with each heart beat increases and the pulse slows down with regular exercise. The blood flow to the heart and muscles being exercised improves with activity. This makes them stronger and more efficient. The blood volume increases and more red blood cells are made to carry oxygen around the body. Blood cholesterol can also improve.

Breathing also improves with exercise. If you exercise regularly, you will be able to brethe easier at the same level of exertion thanks to a more effective heart and lung function. Exercise also improves muscle strength and endurance which enables you to do more for longer.

With regular exercise, muscle cells are better able to take up sugar from the blood, helping to control blood sugar levels and manage diabetes. The hormonal system also undergoes changes as you exercise more. The immune system improves even with moderate physical exercise and you may become less vulnerable to infection. The skeleton becomes stronger when the body is allowed to work and is exposed to mechanical loads. Cartilage and connective tissues in the joints benefit from reasonable load as well. Finally, the brain and nervous system also benefit from regular physical activity. For instance, coordination, balance and reaction time all improve. More physical movement reduces the symptoms of depression and boosts self-esteem.

How much exercise do you need?
If you want to improve your heart health and blood pressure, 30 minutes of low-moderate intensity activity (walking the dog, gardening) most days can be enough. If you need to lose weight, you will need to do more exercise to burn off extra energy and fat. This may mean doing 45-60 minutes of moderate-intense exercise (fast walking, cycling, swimming, slow jogging) 4-5 times per week. It is important to remember that there are many simple everyday opportunities for physical activity, cleaning, gardening, playing with children or grandchildren, walking the dog, using the stairs instead of the lift, walking to the shops rather than driving or taking the bus.

Useful weblink: Exercise advice - National Kidney Foundation USA

Mind and spirit
Having an illness is never a pleasant experience. Having a chronic disease for which there is no cure can be much harder. Being diagnosed with CKD arouses strong feelings in most people – from anger and despair to total surrender and complete inability to act. There are a number of things you can do to help yourself cope emotionally and spiritually.

Sexuality
One of the areas related to CKD which is often overlooked is sexuality. Sexuality involves more than just sex and can influence who you are, how you see yourself, how you express yourself, your sense of self-worth and your sexual feelings for others. CKD brings many physical changes that can affect how you feel about your body and your sexuality.

Useful weblinks:
Sexuality, intimacy and Kidney Disease - KHA Fact Sheet
Healthy Sex Life - Renal Resource Centre NSW

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UPDATED 21 MARCH 2012
Disclaimer: This information is intended as a general introduction to this topic and is not meant to substitute for your doctor's or health professional's advice. All care is taken to ensure the information is relevant and applicable to each Australian state. It should be noted Kidney Health Australia recognises each person's experience is individual and variations do occur in treatment and management due to personal circumstances. Should you require further info always consult your doctor or health professional.