Chronic Kidney Disease (CKD): How To Prevent And Slow The Progression Of The Disease?

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Chronic kidney disease (CKD) is the presence of kidney damage or decreased levels of kidney function for 3 months or more. It usually affects both kidneys. It is common and harmful, but can usually be treated in its early stages. The prevalence of CKD is approximately 8%-12% of the adult population, and the incidence may increase by 10-12% per year. A person who has been diagnosed with CKD spends his life taking care of his kidney function. CKD can lead to other health problems (cardiovascular disease), leading to premature death or disability. If not caught early, it can progress to kidney failure and then require renal replacement therapy (RRT) in the form of dialysis or kidney transplantation to survive.

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Taking the following steps can ensure that chronic kidney disease is prevented from progressing and kidney function is prolonged, thereby avoiding early renal replacement therapy.

The kidneys are vital organs, and if the kidneys do not work properly, life will be at risk. Not only does it balance water and eliminate waste from the body, but it also produces hormones that regulate certain important body functions, such as regulating blood pressure, production of red blood cells in the blood, and strengthening bones.

Although there are many causes of CKD, the two leading causes are diabetes and high blood pressure. Other risks for developing kidney disease are positive family history, obesity, prolonged pain medication or substance abuse, existing severe cardiovascular disease, and aging.

CKD Screening

Early kidney disease usually has no symptoms. Therefore, early detection is very important to prevent disease progression. Patients with risk factors need to be screened for CKD. Standard screening tests are blood tests (kidney function tests) to calculate e-GFR and measure urine protein or microalbumin.

Stages of CKD

Based on e-GFR, chronic kidney disease starts from stage I with minimal loss of renal function (<10%) GFR >90 ml/min/1.73 m2, stage II GFR 60-90 ml/min/1.73 m2, stage III GFR 30 -60 ml/min/1.73 m2, stage IV GFR 15-30 ml/min/1.73 m2 and stage V severe loss of renal function or end-stage renal disease (renal failure) GFR <15 ml/min/1.73 m2.

Why is prevention important?

As scary as it is to be diagnosed with chronic kidney disease, even if someone is diagnosed with early CKD (stages 1-3), there are many steps a person can take to preserve existing kidney function and delay further Loss of kidney function An opportunity that requires close cooperation with his doctor, even if he has kidney disease, it is still possible for him to enjoy a healthy life.

Steps to prolong kidney function

Once a person has CKD, there are a number of actions a person can take to prolong kidney function. This includes treatment of the underlying disease, i.e. control of diabetes, hypertension, and proteinuria, avoidance of nephrotoxic drugs, and diet, and lifestyle changes (such as smoking cessation and regular exercise).

control blood pressure

Aggressive blood pressure control can help delay the decline in kidney function in people with CKD. The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) recommends a target blood pressure of less than 130/80 mmHg. Systolic blood pressure (SBP) control is considered more important than diastolic blood pressure control.

Diabetes and prolonged kidney function

In people with diabetes, hemoglobin A1c (a test that checks for optimal sugar control) should be kept below 6.5%, and kidney function tests should be done at least every 6 months. In CKD, hemoglobin A1c (HbA1c) levels above 9% are associated with poorer clinical outcomes.

Treatment of proteinuria

In diabetic kidney disease with or without proteinuria, drugs like ACEIs or ARBs are often prescribed. However, in non-diabetic kidney disease, these drugs are also effective in slowing disease progression in patients with proteinuria above 500 mg/day.

Calcium and Vitamin D Supplements

Routine use of calcium and vitamin D is recommended for all CKD patients to not only maintain good bone health but also to delay disease progression. In patients with stage 3-4 CKD with low vitamin D levels and high parathyroid hormone (PTH) levels, daily vitamin D supplementation can reduce proteinuria.

Avoid nephrotoxins

Many individuals with CKD may be unaware of their disease and therefore may be at risk for further kidney damage from NSAID use. They should be informed of their renal function status before initiating any antibiotics for proper selection and titration of doses to avoid nephrotoxicity.

Management of metabolic acidosis

Correction of acidosis with sodium bicarbonate was associated with significantly slower progression of CKD. Achieving target serum bicarbonate levels (24-28 mmol/L) requires an average of approximately 6 g/day of sodium bicarbonate taken twice daily (2 to 4 tablets).

Cardiovascular Risk Management

The Improving Global Outcomes (KDIGO) Task Force recommends that all adults with newly diagnosed CKD should undergo lipid profile testing. Adults 50 years or older with CKD and an e-GFR of 60 mL/min/1.73 m2 or higher should be treated with statins.

Diet modification

A plant-based diet slows the progression of ESRD and dialysis and has the potential to improve survival. Adding alkali-inducing fruits and green leafy vegetables to your diet may help reduce kidney damage.

Protein restriction

The Modified Diet for Kidney Disease (MDRD) study showed that a low-protein diet can slow GFR decline and reduce proteinuria, however, if a patient begins to restrict protein intake, it is important to closely monitor the patient's nutritional status. Protein restriction is not recommended in pediatric CKD patients. About 56 grams of protein per day can easily meet the average protein requirement of a 60kg man. A person should avoid red meat (beef, bison, lamb, pork, venison, and offal such as liver, etc.)

Salt limit

Reduction in salt intake slows the progression of diabetic CKD by lowering blood pressure. In general, a healthy sodium level should be 2,300 mg (1 teaspoon of salt) or less per day. Avoid taking salt substitutes because they are made with potassium and can raise potassium to dangerous levels. Meal preparation at home is encouraged to control salt levels in foods. Drink water instead of sports drinks or sodas.

Other dietary restrictions:

Limit phosphates (starting with CKD): Avoid meat, seafood, nuts, and milk or dairy products in excess of 500 mg per day.

Limit potassium levels (avoid potassium-rich foods such as bananas, avocados, citrus fruits, potatoes, beans, spinach, and fish).

Limit the amount of water as needed (especially at higher water levels) to avoid excess volume.

Lifestyle changes

Smoking should be strictly avoided as this reduces the risk of kidney failure in the future. Patients with CKD should also exercise regularly to match their cardiovascular fitness, ideally at least 5 minutes per week for 30 minutes.

Adoption of the above measures can definitely prevent the progression of chronic kidney disease and prolong renal function, thereby avoiding the need for early renal replacement therapy.