Chronic kidney disease - Treatment

Treatment-Chronic kidney disease

There's no cure for chronic kidney disease (CKD), but treatment can help relieve the symptoms and stop it getting worse.
Your treatment will depend on the stage of your CKD.
The main treatments are:
  • lifestyle changes – to ensure you remain as healthy as possible
  • medication – to control associated problems, such as high blood pressure and high cholesterol
  • dialysis – treatment to replicate some of the kidney's functions, which may be necessary in advanced (stage 5) CKD
  • kidney transplant – this may also be necessary in advanced (stage 5) CKD

Lifestyle changes

The following lifestyle measures are usually recommended for people with kidney disease:
Read about living with CKD for more information about what you can do to stay healthy.

Medication

There's no medicine specifically for CKD, but medication can help control many of the problems that cause the condition and complications that can occur as a result of it.
You may need to take medication to treat or prevent the different problems caused by CKD.

High blood pressure

Good control of blood pressure is vital to protect the kidneys.
People with kidney disease should usually aim to get their blood pressure down to below 140/90mmHg, but you should aim to get it down to below 130/80mmHg if you also have diabetes.
There are many types of blood pressure medication, but medicines called angiotensin converting enzyme (ACE) inhibitors are often used. Examples include ramipril, enalapril and lisinopril.
Side effects of ACE inhibitors can include:
If the side effects of ACE inhibitors are particularly troublesome, you can be given a medication called an angiotensin-II receptor blocker (ARB) instead.

High cholesterol

People with CKD have a higher risk of cardiovascular disease, including heart attacks and strokes.
This is because some of the causes of kidney disease are the same as those for cardiovascular disease, including high blood pressure and high cholesterol.
You may be prescribed medication called statins to reduce your risk of developing cardiovascular disease. Examples include atorvastatin, fluvastatin and simvastatin.

Water retention

You may experience swelling in your ankles, feet and hands if you have kidney disease.
This is because your kidneys aren't as effective at removing fluid from your blood, causing it to build up in the body tissues (oedema).
You may be advised to reduce your daily salt and fluid intake, including fluids in food like soups and yoghurts, to help relieve the swelling.
In some cases you may also be given diuretics (tablets to help you pee more), such as furosemide.
Side effects of diuretics can include dehydrationand reduced levels of sodium and potassium in the blood.

Anaemia

Many people with later-stage kidney disease develop anaemia, which is a lack of red blood cells.
Symptoms of anaemia include:
If you experience anaemia, you may be given injections of a medication called erythropoietin. This is a hormone that helps your body produce more red blood cells.
If you have an iron deficiency as well, iron supplements may also be recommended.

Want to know more? 

Bone problems

If your kidneys are severely damaged, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it.
Along with calcium, phosphate is important for maintaining healthy bones. But if your phosphate level rises too much, it can upset the balance of calcium in your body and lead to thinning of the bones.
You may be advised to limit the amount of high-phosphate food in your diet, such as red meat, dairy products, eggs and fish.
If this doesn't lower your phosphate level enough, you may be given medicines called phosphate binders. Commonly used medicines include calcium acetate and calcium carbonate.
Some people with kidney disease also have low levels of vitamin D, which is necessary for healthy bones, too.
If you're low in vitamin D, you may be given a supplement called colecalciferol or ergocalciferol to boost your vitamin D level. 

Glomerulonephritis

Kidney disease can be caused by inflammation of the filters inside the kidneys, known as glomerulonephritis.
In some cases this occurs as a result of the immune system mistakenly attacking the kidneys.
If a kidney biopsy finds that this is the cause of your kidney problems, you may be prescribed medicine to reduce the activity of your immune system, such as steroid medication or a medication called cyclophosphamide.

Dialysis

In a small proportion of people with kidney disease, the condition will eventually get to a point where their kidneys stop working.
This rarely happens suddenly, so there should be time to plan the next stage of your treatment.
One of the options when CKD reaches this stage is to have dialysis. This is a procedure to remove waste products and excess fluid from the blood.
There are 2 main types of dialysis:
  • haemodialysis – this involves diverting blood into an external machine, where it's filtered before being returned to the body
  • peritoneal dialysis – this involves pumping dialysis fluid into the space inside your tummy to draw out waste products from the blood passing through vessels lining the inside of your tummy
Haemodialysis is usually done about 3 times a week, either at hospital or at home. Peritoneal dialysis is normally done at home several times a day, or overnight.
If you don't have a kidney transplant, treatment with dialysis will usually need to be lifelong.
Talk to your doctor about the pros and cons of each type of dialysis and discuss which type you would prefer if your kidney function becomes severely reduced.

Want to know more?

Kidney transplant

An alternative to dialysis for people with severely reduced kidney function is a kidney transplant.
This is often the most effective treatment for advanced kidney disease, but it involves major surgery and taking medications to stop your body attacking the donor organ (immunosuppressants) for the rest of your life.
You can live with one kidney, which means donor kidneys can come from recently deceased or living donors. 
But there's still a shortage of donors, and sometimes you could wait months or years for a transplant.
You may need to have dialysis while you wait for a transplant.
Survival rates for kidney transplants are extremely good nowadays. About 90% of transplants still function after 5 years and many work usefully after 10 years or more.

Want to know more?

Supportive treatment

You'll be offered supportive treatment if you decide not to have dialysis or a transplant for kidney failure, or they're not suitable for you. This is also called palliative or conservative care.
The aim is to treat and control the symptoms of kidney failure. It 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.
Many people choose supportive treatment because they:
  • are unlikely to benefit from or have a good quality of life with treatment
  • don't want to go through the inconvenience of treatment with dialysis
  • are advised against dialysis because they have other serious illnesses, and 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 illness, such as severe heart disease or stroke, that will shorten their life
If you choose to have supportive treatment, your kidney unit will still look after you. Supportive care can still allow you to live for some time with a good quality of life.
Doctors and nurses will make sure you receive:
  • 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

Want to know more?