What is a treatment plan for kidney disease?

Medications

High blood pressure makes chronic kidney disease more likely. And kidney disease can affect your blood pressure. So your doctor may prescribe one of these types of blood-pressure medicines:

“ACE” inhibitors, such as …

• Captopril [Capoten]
• Enalapril [Vasotec]
• Fosinopril [Monopril]
• Lisinopril [Prinivil, Zestril]
• Ramipril [Altace]

“ARBs,” such as …

• Azilsartan [Edarbi]
• Eprosartan [Teveten]
• Irbesartan [Avapro]
• Losartan [Cozaar]
• Olmesartan [Benicar]
• Valsartan [Diovan]

Along with controlling blood pressure, these medicines may lower the amount of protein in your urine. That could help your kidneys over time.

The diabetes medicine dapagliflozin [Farxiga] has been show to work even in non-diabetics at slow kidney disease. 

You might also need to take a medicine to help your body make erythropoietin, which is a chemical that prompts your body to make red blood cells. So you might get a prescription for darbepoetin alfa [Aranesp] or erythropoietin [Procrit, Epogen] to curb anemia.

Medicines to Avoid

If your kidneys don’t work well, check with your doctor before you take any medications, including over-the-counter drugs [medicines you can get without a prescription.]

Your doctor may tell you to avoid certain pain relievers such as aspirin, ibuprofen, naproxen [Aleve] and celecoxib [Celebrex]. These drugs, which doctors call “NSAIDs” [nonsteroidal anti-inflammatory drugs], could play a role in kidney disease. If you take a type of heartburn drug called a “proton pump inhibitor [PPI],” you may also want to know that some studies show a link between those medicines and chronic kidney disease. Your doctor may want to check on whether you need these medicines, or if a different dosage or something else might work better for you.

Tell your doctor if you take any herbal products or other supplements. It’s best to have that talk before you start to take them.

Diet

Your doctor may put you on a special diet that’s lower in sodium, protein, potassium, and phosphate.

This diet helps because if your kidneys are damaged, it’s harder for them to get those nutrients out of your blood. The special diet means that your kidneys don’t have to work as hard.

You may also have limits on how much water can be in the foods you eat, and how much you drink.

A kidney diet specialist, called a renal dietitian, can help. Your doctor can refer you to one.

Your doctor may also advise you to take specific amounts of vitamins and minerals, such as calcium and vitamin D.

If you have diabetes or high blood pressure, you’ll need to follow your doctor’s diet advice if you have either or both of these conditions, as well as kidney disease.

With diabetes, it’s important to make the right food choices so that your blood sugar levels stay under control throughout the day.

And if you have high blood pressure, you may need a low-salt diet to help manage it.

Dialysis

If your kidneys don’t work well anymore, you’ll need dialysis to do their job.

Hemodialysis uses a machine with a mechanical filter to help cleanse your blood. You can get this done at a dialysis center, or at home [after you or a caregiver learn how].

The at-home version of the machine may seem like it would give you more freedom. But it takes longer than those that dialysis centers use. You may have to do it up to six days a week, about 2 1/2 hours per day, instead of three times a week at a clinic. There is also the option of hemodialysis treatment at night.

Before you start hemodialysis, you’ll need surgery to make a place of access for the machine. Your surgeon may connect an artery and vein in your arm through a “fistula.” This is the most common type of access. It needs at least six weeks to heal before you can start hemodialysis.

If you need to start dialysis sooner than that, the surgeon might be able to make a synthetic graft instead of a fistula.

If neither of those options will work -- for instance, if you need to start dialysis right away -- you may get a dialysis catheter that goes into the jugular vein in your neck.

When you get hemodialysis, another tube connects the machine to your access point, so that your blood goes through the dialysis machine to get cleaned and pumped back into your body. This will take several hours.

Peritoneal dialysis is a different form of dialysis. It uses the lining of the abdomen, or peritoneal membrane, to help clean the blood.

First, a surgeon implants a tube into your abdominal cavity. Then, during each treatment, a dialysis fluid called dialysate goes through the tube and into your abdomen. The dialysis fluid picks up waste products and drains out after several hours.

You’ll need several cycles of treatment -- sending in the fluid [or “instilling” it], time for the fluid to work in your abdomen, and drainage -- every day. Automated devices can now do this overnight, which may give you more independence and time during the day for usual activities. If you do it during the day, you may need to do the whole cycle several times.

Both types of dialysis have possible problems and risks, including infection. You’ll want to talk with your doctor about the pros and cons of each option.

Kidney Transplant

If your kidney disease is advanced, you could talk with your doctor about whether a kidney transplant could be an option.

A "matching" kidney may come from a living family member, from someone who’s alive and isn’t a relative, or from an organ donor who has recently died. It’s major surgery, and you may go on a wait list until a donated kidney becomes available.

A successful transplant would mean that you don’t have to get dialysis. After your transplant, you will need to take medicines so that your body accepts the donated kidney.

A kidney transplant might not be right for you if you have other medical conditions. Your age might also be an issue. And you may need to go on a wait list until a kidney is available. You’d get dialysis until your transplant can happen.

A kidney from a living donor will generally last 12 to 20 years. One that’s donated from someone who recently died may last 8 to 12 years. If you have “end stage” renal [kidney] disease, doctors consider a transplant to be the best option, if you’re a good candidate.