>> Hi, my name is Su Thavarajah.
We're doing a presentation for the ABCs of Kidney Disease.
This is a section on
Treatment Options for Chronic Kidney Disease.
This is one of the presentations in the
Johns Hopkins Nephrology Patient Education Program.
And we appreciate the funding from
The Edward Kraus Endowment Fund,
and The Shaw Foundation.
We're gonna start with medications.
Now, there are no medications that we have
that actually reverse kidney damage.
And the medications that we prescribe
are not specifically kidney medications.
They're medications that fall into two categories.
Either they manage the risk factors that can speed up
kidney damage, or they manage the complications
that are related to kidney damage.
So medications for your blood pressure,
medications for your diabetes or high cholesterol
are medications that treat the risk factors
for kidney disease.
Whereas, if I prescribe a medication like a diuretic
to get rid of extra salt and water,
or a medication for anemia,
I'm trying to address those complications of kidney disease.
So all of your medications
are falling into those two categories.
Now there's some general recommendations we make
regardless of the cause of kidney disease,
or regardless of what stage someone has of kidney disease.
And a lot of it focuses on diet.
You have to think about kidney disease as your kidneys
are already working much harder than they should,
and they don't have as much reserve.
So if we can do some things with dietary changes,
we might take some of that workload off of the kidneys.
So we start off with things like
restricting the sodium in our diet
to less than two grams a day or 2,000 milligrams
when you're reading food labels.
Also, we wanna cut back on
the amount of processed food and sugar.
So if something can sit on a shelf
for about a year or two, it probably is the those kind of
food items you wanna cut out of your diet,
or really reduce significantly.
Sometimes your kidney doctor might ask you to cut back on
a couple of the minerals like
potassium and phosphorus intake.
Both potassium and phosphorus are not harmful
to the kidneys, but they're both cleared by the kidneys.
And so, we might have to cut back on them
because your kidneys are already struggling
to get rid of 'em.
Now you may have somebody
with the same level of kidney function
who won't be given those dietary recommendations.
These are part of that individualized treatment plan
for your kidneys.
Now when somebody has to cut back on potassium,
they might have to cut back on potatoes,
tomatoes, bananas.
And then, when they're looking at phosphorus,
we're looking at dairy products, meat,
and also a lot of foods
that have a lot of preservative agents.
This doesn't mean you can't ever have these foods,
you're basically reducing them
to about once or twice a week instead of every day.
Now other things that we talk about with diet
are moderate protein restriction.
So what does that mean?
Protein's important for the body.
You need it to maintain your muscle mass,
maintain your immune system, maintain your strength.
But too much protein,
your body can't absorb and you actually end up having to
urinate it out and your kidneys have to get rid of it.
So a moderate amount of protein
is looking at the serving size.
So for men, the size of a deck of cards
is about an appropriate serving size
for chicken, beef, lamb.
If you have a piece of fish,
about the size of a TV remote control.
For a woman, a size of the palm of their hand
is an appropriate serving size for meat.
And that's for each meal.
Anything more than that is just perhaps something
you might need if you're recovering from an injury,
recovering from a surgery.
But anything more than that your body really can't use,
and it's gonna put an extra stress on your kidneys.
A common question that people have for us
is how much water should I be drinking?
There's no specific amount of water to be drinking
every day for your kidneys,
unless you have a history of kidney stones.
Other than that, it's mainly drinking for your thirst.
Water is probably a better choice than other beverages
because it doesn't have any preservative agents,
it doesn't have any calories.
And usually you wanna aim for your urine to be almost clear
to a pale yellow and that way you know
you're getting enough water in your system.
Other than that, those basic dietary recommendations,
your doctor's gonna give you other recommendations
based on what your lab work looks like
and how your kidney disease is progressing.
Now, when somebody looks at you, they're not gonna be able
to know that you have kidney issues.
So really we're depending on you to be your health advocate
and tell people when you have kidney problems.
Because there are certain tests that can be ordered
that may impact on your kidney function.
Or you might be prescribed medications at a dose
that's not appropriate or not safe for your kidneys.
Imaging studies or x-ray studies like CAT scans
with contrast or angiograms, or MRIs with gadolinium,
can be problematic when somebody has kidney issues.
The contrast that we use for CAT scans and for angiograms
can be harmful and irritating to the kidneys.
The MRIs with gadolinium rely on a certain amount of
kidney function to be able to clear it out of the system.
If you have kidney disease, it's gonna be a discussion
with your doctor as to whether or not
that's the right test for you,
whether the test can be done in another way.
Or if there should be an alternative test.
Now when we think about medications, there are a lot of
medications that could be harmful to the kidneys.
Medications are either cleared by the liver,
or they're cleared by the kidneys.
So whenever someone has kidney disease,
you wanna make sure you're knowing your level of functions
so that any doctor who's prescribing medications,
even if you're going to an urgent care center
in the middle of the night, going to the dentist,
that they all know they might have to adjust the dose
of the medication or give you an alternative medication
that would be safer from your kidneys.
The other key thing to remember is just because
it's over-the-counter,
doesn't mean that it's actually safe to use.
There's a big category of over-the-counter medications
called non-steroidal anti-inflammatory agents.
Things like Motrin, Advil, ibuprofen, naproxen.
These medications were never designed
to be taken on a regular basis.
And when you have kidney disease,
they can actually cause more kidney damage
and interfere with blood pressure medications.
Additionally, medications that are for bowel agents
such as Milk of Magnesia, phosphates, enemas,
those are all problematic when you have kidney disease,
'cause you're not gonna be able to
clear those minerals out of your system.
It's always a good idea to double check with your pharmacist
and your physician before taking any of those medications.
Kidney disease is sort of a overall plan of care
as opposed to just a certain medication
or a certain treatment.
So you wanna be able to be part of that healthcare team.
You wanna be monitoring your progress by tracking your labs.
You wanna know your medications and what they're for.
You wanna be engaged with that team and ask questions
when you don't understand what the plan is.
Also, engage your family and friends.
It's a lot easier to make some of the dietary changes,
it's a lot easier to be exercising
when you've engaged your family members.
And when you're looking at kidney disease,
we're looking at that overall plan.
We're looking at controlling the blood pressure.
We're looking at controlling the cholesterol,
treating the complications like the anemia,
the bone and mineral disease, malnutrition, depression,
and maintaining existing kidney function.
For more information about
treatment of chronic kidney disease,
dietary changes, management strategies,
please look at these following resources.
And for information about treatment of
end-stage kidney disease, tune in for our next video.