The Science of Organ Transplantation – Part VI
Strategies to stabilize kidney function in Chronic Kidney Disease
In the past few columns, we have talked about replacement of the organ (transplantation) as the best treatment of irreversible organ failure. Currently, kidney transplantation is one of the most common forms of transplantation done in the United States because of the high prevalence of Chronic Kidney Disease (CKD). And CKD is a major public health issue affecting nearly one in seven adults in the United States and it’s a progressive condition associated with high rates of major complications, especially heart disease. This is particularly true with the older population (>65 years) where the mortality rate is almost twice compared to those without CKD. Also, without carefully coordinated management, a significant majority of patients with CKD would quickly progress to ESRD (End Stage Renal Disease) requiring dialysis. As a result, CKD imposes a tremendous economic burden on our health care system.
Study after study has confirmed that there are many self management strategies that patients can and should adopt and put into daily practice to effectively control the relentless progression of the CKD. Unlike any other organs, when your kidneys have sustained significant damage, the disease appears to be progressive and hence steps need to be taken to help slow down this worsening. These self-management interventions aim to facilitate an individual’s ability to make lifestyle changes and manage symptoms, treatment and the physical and psychosocial consequences inherent in living with CKD and associated concomitant diseases – ‘comorbidities’ in medical parlance. If patients carefully practice these measures, they can certainly delay the onset of ESRD and the necessity for dialysis or transplantation. Along with their family physician, they should also enlist the help of a kidney specialist (nephrologist) for this purpose
Here are some self management interventions patients need to consider.
Learn all what you can about your disease, why you got it in the first place, the many factors that will influence its course and the tests you should do to monitor its progression.
Diet: While the diet has to be nutritious, daily salt intake has to be restricted to control the high blood pressure. Also, needs some protein and fat restriction to ease the work load of kidneys and slow the progression of atherosclerosis, so common in these patients. CKD can raise your blood levels of potassium and phosphorous too, so beware – foods with low levels of these elements are recommended.
Fluid intake has to be adjusted according to the current status of CKD. Damaged kidneys can produce either too much or too little urine, so discuss with your nephrologist.
Regular aerobic physical activity like walking, swimming, etc., to maintain your cardio-pulmonary and general fitness. This will also improve the circulation and help prevent cardiovascular complications so common in renal patients.
Infections: many types of infections are major sources of morbidity and mortality in patients with end-stage renal disease especially in those receiving chronic hemodialysis therapy. So, take all precautions you can.
Medications: CKD patients usually have to take a number of medications since they have many concomitant diseases like hypertension, diabetes, high cholesterol, bladder dysfunction, etc. Some may need blood thinners and the older patients may have to take medicines for prostate problems as well. Learn all about these drugs, starting with their names, actions, interactions with other drugs and side effects.
Co-morbidities: Most patients with CKD die of complications resulting from their comorbidities like hypertension, diabetes, lipid problems, etc. – all leading to atherosclerosis. Many die from cardiovascular complications. Hence, these have to be managed carefully with the help of appropriate specialists.
Symptom management: Patients may suffer from many symptoms and some of them may be quite serious and need to be managed quickly. Just to give you a couple of examples: significant headache may result from uncontrolled hypertension and black stools would mean bleeding from the stomach or intestines – both serious issues; so be on the lookout for any major symptoms and get prompt treatment.
In the end, the success of CKD management depends on how well each patient can work with his/her physicians and other caregivers like nurse practitioner, home health nurse, etc. Take advantage of all the modern technology such as electronic communication, web site information, audio recordings, data transmission, etc., to be in touch with your caregivers. Many such management programs that include forming a true partnership with caregivers and monitoring all the clinical parameters like target BP, blood glucose and lipid levels and renal function benchmarks may significantly improve the process of care, potentially decrease cardiovascular and other complications and may slow down the decline in renal function.
To be continued …
M.P. Ravindra Nathan, M.D., is a cardiologist and Emeritus Editor of AAPI Journal. For further reading: “Second Chance – A Sister’s Act of Love” by Dr. Nathan from Outskirts Press can be found at www.amazon.com