Lifestyle
Lifestyle practice is one of the things that usually have to change, sometimes, drastically as a result of kidney disease. However, your kidney disease is unlikely to get worse or cause you serious day-to-day problems, it is a warning about your future health. That’s because kidney disease, even if it’s mild and stable, automatically puts you at a higher than average risk of heart disease and stroke.
If you have kidney disease, you’ll benefit from improving your lifestyle and looking after your heart even more than the general population. The NHS will support and advise you, and you can help yourself by doing the following:
- Lose any excess weight and exercise regularly (at least 150 minutes each week for the average adult). Find out if you are a healthy weight using this tool to check your BMI. Read more about how to lose weight.
- Stop smoking. Read more about how the NHS can help you stop smoking.
- Eat a healthy, balanced diet. If you have severe kidney disease, a dietitian will advise if you need to follow a special diet.
- Reduce the salt in your diet to help keep your blood pressure down, and avoid salt substitutes, too. Read more about how to cut down on salt.
- Take extra care to keep your blood pressure and blood sugar at normal levels if you have diabetes or high blood pressure.
- Drink water as normal when you feel you want to, unless you’ve been advised otherwise by your doctor or dietitian. There’s no evidence that drinking extra water or fluids will help if you have kidney disease. Read more about how much water you should drink
Vaccinations and kidney disease
It’s important that you are vaccinated against:
- flu (every year)
- pneumonia (also called the pneumo jab)
Kidney disease puts you at higher risk of catching flu. There’s also a greater chance if you catch flu that it will lead to more serious illnesses, including bronchitis and pneum
Flu and pneumonia vaccinations are free from your local GP surgery for kidney disease patients. The flu jab is available each autumn from September. The pneumo jab is usually only needed once, but some people need booster doses every five years.
If you have kidney failure, you should be vaccinated against hepatitis B before you start dialysis or have a kidney transplant.
Medicines and kidney disease
If you have kidney disease, it’s important to take care with pharmacy medicines as some can be potentially harmful.
Kidney problems are made worse by high blood pressure (hypertension) and diabetes. If you also have either of these conditions, your doctor will probably prescribe long-term daily tablets to prevent kidney damage.
Blood pressure-lowering tablets called ACE inhibitors are usually prescribed. These protect the kidneys, but can sometimes cause a cough. If that happens, a similar group of tablets known as angiotensin receptor blockers (ARBs) can be used.
Although both ACE inhibitors and ARBs protect your kidneys, they can cause problems if you are dehydrated, so you should ask your doctor or pharmacist for advice if you have diarrhoea and vomiting.
Because kidney disease puts you at a higher risk of cardiovascular disease (heart attacks and strokes), your doctor may offer you medicines called statins. Statins lower the level of cholesterol in the blood, reducing the risk of cardiovascular disease.
If you have kidney disease, your doctor may alter the doses of medicines you are taking for other conditions. They may also advise that you temporarily stop taking some of your prescribed medicines if you become unwell with diarrhoea, vomiting or a fever. That’s to avoid the risk of further dehydration or damage to your kidneys.
However, you should never stop taking any prescribed medicines without checking with a doctor or pharmacist first. It’s important to restart your medicines once you are better.
Chronic Kidney Disease
Sometimes it’s not possible to stop kidney disease getting worse. If your kidney disease is already severe or in decline, your GP will refer you to a hospital-based kidney specialist team, who will work out a treatment plan for you.
This may include following a special diet and taking additional medicines, such as iron treatment to prevent anaemia, and vitamin D supplements for healthy bones and muscles.
The hospital team of doctors, nurses, dietitians, social workers and pharmacists will help you prepare for the possibility of going on to dialysis or having a kidney transplant.
Although there is no cure for kidney disease, treatment can help relieve symptoms, slow or prevent progression of the condition, and reduce the risk of developing related problems.
Treatment involves making changes to your lifestyle and, sometimes, taking medication to control your blood pressure and lower your blood cholesterol levels. This should help to prevent further damage to your kidneys and circulation.
If you have kidney failure, you will need to decide on the next stage of treatment. Your choice will be whether to have treatment with dialysis (a means of artificially replacing some functions of the kidney), a kidney transplant, or other treatment options that involve less intervention, also known as supportive or conservative care.
Lifestyle changes
The following lifestyle changes are known to help reduce your blood pressure and help control CKD:
– stopping smoking
– eating a healthy, low-fat, balanced diet
– restricting your salt intake to less than 6g (0.2oz) a day
– not using over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), – such as ibuprofen, except when advised to by a medical professional
– moderating your alcohol intake so it is within recommended limits (no more than 3-4 units a day for men and 2-3 units a day for women)
– losing weight if you are overweight or obese
– doing regular exercise for at least 30 minutes a day, five times a week
Medications for high blood pressure
One of the main ways to reduce the progression of kidney damage is to manage high blood pressure. Good control of blood pressure is vital to protect the kidneys.
People with CKD should aim to get their blood pressure down to below 140/90mmHg but if you also have diabetes you should aim to get it down to below 130/80mmHg.
There are many types of blood pressure drugs. Medicines called angiotensin converting enzyme (ACE) inhibitors are used to control high blood pressure in people with CKD.
As well as reducing blood pressure around the body and reducing the strain on blood vessels, ACE inhibitors give additional protection to the kidney.
ACE inhibitors include:
– ramipril
– enalapril
– lisinopril
– perindopril
Side effects of ACE inhibitors include:
– a persistent, dry cough
– dizziness
– tiredness or weakness
– headaches
Most of these side effects should pass within a few days, although some people continue to have a dry cough.
If the side effects of ACE inhibitors are particularly troublesome, you can be given an alternative medication called an angiotensin-II receptor blocker (ARB).
– candesartan
– eprosartan
– irbesartan
– azilsartan
– olmesartan
– temisartan
– valsartan
– losartan
The side effects of ARBs are uncommon, but can include dizziness.
Medication to reduce cholesterol. Studies have shown that people with CKD have a higher risk of cardiovascular disease, including heart attacks and strokes. This is because some of the risk factors for CKD are the same as those for heart attacks and strokes, including high blood pressure and high levels of cholesterol in the blood (atherosclerosis).
– constipation
– diarrhoea
– headaches
– abdominal pain
Occasionally, statins can cause muscle pain, weakness and tenderness. If you experience any of these symptoms, contact your doctor. You may need to have a blood test or change your treatment.
Anaemia
Many people with stage three, four and five CKD develop anaemia. Anaemia is a condition in which you do not have enough red blood cells. Symptoms of anaemia include:
– tiredness
– lethargy
– shortness of breath (dyspnoea)
– palpitations (awareness of heartbeat)
Anaemia can occur because of many other conditions and your doctor will investigate to rule out other possible causes.
Most people with kidney disease will be given iron supplements because iron is needed for the production of red blood cells. To boost iron levels, iron may be given as tablets, such as daily ferrous sulphate tablets, or as occasional intravenous infusions.
If this is not enough to treat anaemia, you may be started on injections of erythropoietin, a hormone which helps your body produce more red blood cells. These injections are often administered into a vein (intravenously) or under the skin (subcutaneously).
Correction of phosphate balance
If you have stage four or five kidney disease, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it. Phosphate is a mineral that, with calcium, makes up most of your bones. Phosphate is obtained through diet, mainly dairy foods.
The side effects of phosphate binders are uncommon but include:
– nausea
– stomach ache
– constipation
– diarrhoea
– flatulence (wind)
– skin rash
– itchy skin
Treatment for kidney failure – transplant or dialysis
Many people with kidney failure can continue with treatment using medicines and will have good-functioning kidneys for the rest of their lives.
This rarely happens suddenly, and there will be time to plan the next stage of your condition. The decision whether to have dialysis, a kidney transplant or supportive treatment should be discussed with your healthcare team.
Palliative Care
If you decide not to have dialysis or a transplant for kidney failure, or they are not suitable for you, you will be offered supportive treatment.
The aim is to treat and control the symptoms of kidney failure without using dialysis or transplantation. Supportive treatment includes medical, psychological and practical care for both the person with kidney failure and their family, including discussion about how you feel and planning for the end of life.
– are unlikely to benefit or have quality of life with treatment
– do not want to go through the inconvenience of treatment with dialysis
– are advised against dialysis because they have other serious illnesses that will shorten their life. The negative aspects of treatment outweigh any likely benefits
– have been on dialysis but have decided to stop this treatment
– are being treated with dialysis, but have another serious physical illness, especially severe heart disease or stroke, that will shorten their life
Supportive Care
– medicines to protect your remaining kidney function for as long as possible
– medicines to treat other symptoms of kidney failure, such as feeling out of – breath, anaemia, loss of appetite or itchy skin
– help to plan your home and money affairs
– bereavement support for your family after your death
What is good kidney disease care?
According to a national review, kidney disease services should:
– identify people at risk of kidney disease, especially people with high blood pressure or diabetes, and treat them as early as possible to maintain their kidney function
– give people access to investigative treatment and follow them up to reduce the risk of the disease getting worse
– give people good-quality information about managing their condition
– provide information about the development of the disease and treatment options
– provide access to a specialist renal (kidney) team
– give people access to transplant or dialysis services if required
– provide supportive care
– Your treatment for kidney disease will need to be reviewed regularly.
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