>> Hi, I'm Sue Thavarajah.
I'm one of the Nephrologists at Johns Hopkins,
and welcome to the ABCs of kidney disease.
In this section today,
we're going to review management of chronic kidney disease.
We're going to start with talking a little bit about medications.
Now the medications are broken down into two categories.
They're either prescribed to treat
the risk factors that can speed up kidney damage,
so blood pressure medications,
diabetes medications are all part of your kidney treatment plan.
Then there are medications that we prescribe to
manage the complications of kidney disease.
If people develop anemia,
the medications such as the iron or
the erythropoietin are part of that treatment plan.
Not everyone will get the same treatment plan.
It's really going to be individualized based on what
your risk factors for kidney disease progression are,
and what other health conditions you have,
and what your lab work is looking like.
Now there's some basic recommendations we give to
people regardless of the type of kidney disease
they have and the stage that they have in
terms of some things that can help slow down the progression.
One are some of the basic dietary changes.
We want to restrict the sodium intake
to less than two grams a day.
We want to reduce the consumption of processed foods and
high sugary foods because those are
all things that the kidneys have to work harder to get rid of.
We talk about a moderate protein restriction.
We need a certain amount of protein to maintain our muscle mass,
maintain our immune system,
but too much protein,
our body can't use and our kidneys
have to work harder to get rid of it.
Then there's more discussion
lately about using plant-based options.
Those are sometimes better choices
because they have a lower amount
of uric acid and a lower amount of cholesterol.
Sometimes swapping out some of the meals for
a plant-based option will help
with slowing down the progression of kidney issues.
Now there's always a lot of discussion about water intake.
You do want to stay hydrated because dehydration
can cause some changes in your kidney function panel.
But there's no specific amount of water that someone
needs to drink unless they have a history of kidney stones.
Now you may be on certain water restrictions or
fluid restrictions depending on
what other health conditions you have.
This is going to be individualized
and driven by discussions you have with your health care team.
Now your doctor will also give you
other guidelines for your diet based on your lab work.
Some people might be on a potassium restriction,
some people might be on a phosphorus restriction,
but that's not 100 percent
across the board for people who have kidney disease.
Just because you hear about somebody else being
treated with those dietary restrictions
doesn't mean that that would be what
you need to have done for your kidney disease.
When we're doing those restrictions,
it's really to try to accommodate what
the kidneys can't get rid of efficiently.
When we look at the overall plan
for slowing down the progression of kidney disease,
it comes down to a couple of categories: Blood pressure control,
blood sugar control, smoking cessation,
regular exercise,
reduction of protein in the urine if you have that,
and keeping a healthy weight.
Now these are standard recommendations regardless of what type
of kidney disease you might have or
what level of kidney issues you have.
When we also talk about kidney disease progression,
we also want to worry about things that
could put an extra stressor on the kidneys,
so we keep in mind things like imaging studies that
use contrast may have an impact on the kidney function.
It doesn't mean that you don't have those studies.
It doesn't mean that those studies may not be necessary.
But it is something that you would discuss
with your health care team to see if that's
an appropriate choice for you or what they can
do to help reduce your risk of having problems.
Also, medication interactions can be
harmful when people have kidney issues.
No one can look at you and know what
your level of kidney function is.
A lot of us go to
multiple different doctors or we
might go to an urgent care center.
It's really important for you to be able to
know what your level of kidney function is,
or makes sure that if somebody is prescribing medications for you,
that they're aware that you have kidney disease,
so they pick medications that are going to be
safe for the kidneys or adjust the dosing.
You want to be careful with regular use of
non-steroidal anti-inflammatory agents such
as ibuprofen and Motrin, Advil.
Those agents are over the counter,
so people often think that they can't cause any harm.
Some of these can interact with
your blood pressure medications
or prevent your blood pressure from being
under good control and long-term use can end
up causing some scarring and some damage in the kidneys.
You also want to be careful with some of the bowel agents,
such as milk of magnesia and some of the preps for colonoscopy.
You want to make sure people know that you have
kidney issues so that they prescribe the appropriate one.
If you're ever unsure,
double-check with your pharmacist or
your physician before starting any new medications.
Another key part of kidney disease management is
really being engaged and being part of your health care team.
You want to be monitoring your progress by
tracking your labs and knowing what the trend is,
you want to know your medications and ask
questions as to what they're for and how to take them,
you want to be engaged with that health care team,
and you want to incorporate healthy lifestyle choices because
that overall will help your outcomes.
Ask for help. If you're struggling with dietary choices,
if you don't know what to do with your medications,
there's teams of people that are taking care of you
that are willing to help and they just
need to know what resources you need.
Thank you for listening to our presentation today.
This was part of Johns Hopkins
Nephrology Patient Education Program
with the goal of improving lives of
individuals living with kidney disease.
If you want to learn more,
here are several resources which have
information about being engaged in your own health care,
learning what your labs mean,
learning what your different medications are,
and some different dietary choices. Thank you.