Chronic Kidney Disease (CKD)

 

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Treatment of CKD

There is no "pill" specific to kidney disease. Treatment involves a very strict control of sugar levels and blood pressure.

The recommended targets for BP must be actively sought. Most patients are content with achieving readings of 140/90 mmHg and are averse to suggestions in further reductions in BP. This has to be overcome and optimum BP control achieved.

The target BP in diabetics is 130/80 millimeters of mercury (mmHg) and  it is 125/75 mmHg if the patient has protein loss in urine.

The fasting Sugar level must be between 90 and 110 mg % and definitely never above 120 mg%.

Treatment of Anemia in Kidney Disease

The first step here is to supplement iron. Iron stores in patients with CKD are often very low. In early CKD, iron containing pills can be sufficient to correct the deficit. But in advanced CKD, the deficit is large and pills are often insufficient. In such cases, intravenous (IV) iron is given and the entire deficit can be corrected over a few days.

Since the specific defect is absence of erythropoeitin (EPO), starting EPO injections is the backbone of anemia treatment in CKD. This is given subcutaneously (s.c.) ( under the skin) once a week in pre-dialysis patients and two to three times a week in patients on hemodialysis.

Target hemoglobin in CKD patients is 12 g/dL. Once the target is achieved, dosage of EPO is reduced.

Addition of vitamins like folic acid, B6 and B12 completes the anemia treatment in CKD.

Correction of Bone Disorders in CKD

Phosphorus levels in blood are often high, especially in advanced CKD and those are corrected by phosphate binding agents given along with major meals.

If the calcium is low, it is supplemented by calcium containing tablets.

Parathyroid hormone (PTH) levels are often very high in CKD stage IV and stage V. They have to be dealt with in a complex manner and involves correction of phosphorus, calcium and use of vitamin D and/or a new drug called Cinacalcet.

Rarely, a bone biopsy may be required.

Correction of Acidosis

Acids need to be neutralized by supplementing base. Sodium bicarbonate is available as tablets and 2 to 5 tablets are taken after food, three to five times a day.

Once dialysis is started, bicarbonate is available from the dialysis fluid.

Nutrition

Click here for details on diet in kidney diseases.

Dialysis

Once kidney functions have fallen below an estimated GFR of 10mL/min, dialysis needs to be started.

Transplantation

This is available as an option once estimated GFR falls below 15mL/min. Click here for a detailed discussion on Kidney transplantation.

 

 

 

 

 

 

 

 

 
 

Chronic Kidney Disease