Different Treatments for Different Stages
There are several types of treatments related to kidney disease. Some are used in earlier stages of kidney disease to keep your kidneys healthier longer. These medications and lifestyle changes help you maintain kidney function and delay kidney failure. Other treatments, such as dialysis and transplantation, are used to treat kidney failure. These methods help replace kidney function if your own kidneys have stopped working.
Treatments for Early Kidney Disease
Treatments for early kidney disease include both diet and lifestyle changes and medications.
- Making heart-healthy food choices and exercising regularly to maintain a healthy weight can help prevent the diseases that cause further kidney damage.
- If you already have diabetes and/or high blood pressure, keeping these conditions under control can keep them from causing further damage to your kidneys.
- Choose and prepare foods with less salt and sodium. Aim for less than 1,500 milligrams of sodium each day.
- Eat the right amount of protein. Although it is important to eat enough protein to stay healthy, excess protein makes your kidneys work harder. Eating less protein may help delay progression to kidney failure. Talk to your dietitian or other health care provider about what is the right amount of protein for you.
- If you have been diagnosed with kidney disease, ask your doctor about seeing a dietitian. A dietitian can teach you how to choose foods that are easier on your kidneys. You will also learn about the nutrients that matter for kidney disease. You can find a dietitian near you through the Academy of Nutrition and Dietetics directory.
- If you smoke, take steps to quit. Cigarette smoking can make kidney damage worse.
Medications can also help keep kidneys healthier longer. Two types of blood-pressure medications -- angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs) -- have been shown to slow down kidney disease and delay kidney failure. These medications have been shown to work in people who have either diabetes or high blood pressure, and many other kinds of kidney disease, to protect kidney function.
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The most important step you can take to treat kidney disease is to control your blood pressure. Many people need two or more types of medicines to keep their blood pressure below recommended levels to keep the kidneys healthy. (Your systolic blood pressure—the first number—should be less than 140.) A diuretic (water pill) also can be important. Your healthcare provider will determine which medication or combination of medications is right for you.
Some older adults with kidney disease may be taking medications for other diseases as well. As kidney disease progresses, it is likely that the doctor will need to adjust the dosages of all medications which affect the kidney or are removed by the kidney.
Treatments for Later Stages
If kidney disease progresses to kidney failure, the goal of treatment changes. Since the kidneys no longer work well enough to maintain health, it is necessary to choose a treatment in order to maintain health. There are two main options for this: dialysis and transplantation. Some patients choose not to treat kidney failure with dialysis or a transplant.
Before you and your health care team decide on a treatment plan, it is important that you understand how each treatment option is likely to affect how long you will live or how good you will feel. If your kidney disease is progressing, talk with your health care provider about choosing a treatment that is right for you.
Two Kinds of Dialysis
Dialysis is a treatment that takes waste products and extra fluid out of your body. In hemodialysis, your blood passes through a filter outside of your body and the clean blood is returned to your body.
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In hemodialysis, blood is run through a filter outside of your body and the clean blood is returned to the body. Hemodialysis is usually done at a dialysis center three times a week, but it can also be done at home. Each session usually lasts between three and four hours.
Peritoneal dialysis is another way to remove wastes from your blood. This kind of dialysis uses the lining of your abdominal cavity (the space in your body that holds organs like the stomach, intestines, and liver) to filter your blood. It works by putting a special fluid into your abdomen that absorbs waste products in your blood as it passes through small blood vessels in this lining. This fluid with the waste products is then drained away. A key benefit of peritoneal dialysis is that it can be done at home, while you sleep.
Hemodialysis and peritoneal dialysis do not cure kidney failure. They are treatments that help replace the function of the kidneys and may help you feel better and live longer. But, for some people who have many health problems and are age 75 or older, studies show that treatment with dialysis may be not be beneficial.
If You Are on Dialysis
Although patients with kidney failure are now living longer than ever, over the years kidney disease can cause problems such as
- heart disease
- bone disease
- nerve damage
To stay as healthy as possible for as long as possible while on dialysis, follow your dietician's recommendations, take your medications, and continue to follow the lifestyle and dietary habits you adopted to slow the progression of kidney disease.
Dialysis can be a special challenge for older adults, especially those who have other diseases or conditions. For example, hemodialysis requires that a person be able to leave home, travel to the dialysis facility, and sit for 4 hours during treatment. Peritoneal dialysis can be done at home, but requires someone to help. Often, older adults require assistance with some or all of these activities, and they and their families need to consider these issues as they choose treatment options and living facilities.
Instead of dialysis, some people with kidney failure -- including older adults -- may be able to receive a kidney transplant. This involves having a healthy kidney from another person surgically placed into your body. The new, donated kidney replaces the failed kidneys. The donated kidney can come from an anonymous donor who has recently died, or from a living person -- usually a relative. But you might also be able to receive a kidney from an unrelated donor, including your spouse or a friend. Due to the shortage of kidneys, patients on the waiting list for a deceased donor kidney may wait many years.
Kidney transplantation is a treatment for kidney failure -- not a cure. You will need to see your healthcare provider regularly. And you will need to take medications for as long as you have your transplant to suppress your immune system so it doesn't reject the transplanted kidney.
Choosing Not to Treat With Dialysis or Transplant
You may choose not to treat kidney failure with dialysis or a transplant. Instead, you may choose to focus on treating its complications. If you choose this path, you will still get care from your health care team. Your care may include
- medicines to protect remaining kidney function for as long as possible
- medicines to treat symptoms of kidney failure (such as nausea, anemia, and poor appetite)
- advice on diet and lifestyle choices, and
- palliative care services to ease symptoms, provide relief from physical and emotional pain, and enhance quality of life.
You have the right to choose not to start dialysis or undergo transplant surgery if you feel that the burdens would outweigh the benefits, or that these treatments would reduce your quality of life. Only you know what it is like for you to live with kidney failure.
Treatment with no dialysis or transplant may be a choice for you if
- you and your doctor feel dialysis or transplant will not improve your health. For some people who have many health problems and are age 75 or older, studies show that treatment with dialysis may not be beneficial.
- You feel you’ve accomplished what you wanted in life.
- Family and friends support your decision.
Choosing the Right Treatment
Not all treatments are right for all people. Be sure to talk to your doctor and other health professionals -- including nurses, dietitians, and diabetes educators -- to figure out the best treatment plan for you. The right choice for you depends upon your medical condition, lifestyle, and personal likes and dislikes.
Each treatment option may have a different effect on:
- how long you live
- your overall health
- what and how much you can do
- how well you can get around
- how you feel emotionally
- how well you can think, learn, and remember, and
- your sex life.
Talk to your health care team about the best treatment for you. The right choice for you depends upon what’s most important to you, your medical condition, your lifestyle, and your personal likes and dislikes.