Living with Chronic Kidney Disease

The stages of chronic kidney disease - know your numbers
How can I slow down chronic kidney disease and prevent complications?
A Note on Over-the-Counter (OTC) Pain Relieving Medications
Coping strategies: the emotional side
Tips for Working with Your Doctor
When to seek medical help?
Your Chronic Kidney Disease Team

The stages of chronic kidney disease - know your numbers

Chronic kidney disease (CKD) progression is now described as 5 stages, based on estimated glomerular filtration rate (eGFR) and other signs of kidney damage such as abnormalities in blood or urine tests. If you have been diagnosed with chronic kidney disease, you should know which stage you are at. Treatment for CKD will vary depending on stage. If detected early, appropriate treatment may stop or slow progression. This may involve diet and exercise, and making sure diabetes and/or high blood pressure are well-managed. As kidney disease progresses and symptoms increase, decisions will need to be made about kidney replacement therapy. By stage 4, you and your doctor should be discussing treatment options such as hemodialysis, peritoneal dialysis and transplantation. Talk with your doctor about your eGFR numbers and the corresponding stage of CKD (see information about kidney function tests, under how is chronic kidney disease diagnosed?).

Stage	Description	GFR (mL/min)
1	Kidney damage with normal or higher GFR	90 or higher
2	Kidney damage with mildly lowered GFR	60 - 89
3	Moderately lowered GFR	30 - 59
4	Severely lowered GFR	15 - 29
5	Kidney failure	Under 15 (or dialysis)

For more information, see the B.C. guideline: Identification, Evaluation and Management of Patients with Chronic Kidney Disease.

How can I slow down chronic kidney disease and prevent complications?

There is no cure for chronic kidney disease (CKD), but there are some things you can do to help keep your kidneys functioning as long as possible. While a diagnosis of CKD can be distressing, it is important to realize that many people with kidney disease manage to live full and active lives.

Consider using the Chronic Kidney Disease Patient Log (see the Chronic Kidney Disease Patient Guide) to monitor your symptoms and to keep track of your progress in managing your condition. You can take this log with you when you visit your doctor.

Other important things you can do include:

• Control diabetes. If you have diabetes, keep your blood glucose levels as close to normal as possible. Along with taking your medications as prescribed, keep your weight under control and exercise regularly. Your doctor should regularly test whether your kidneys are functioning properly. See Diabetes: Information for Patients.
• Control hypertension. Beware - high blood pressure not only causes kidney damage, but can also cause kidney function to deteriorate more quickly. Control your high blood pressure to 130/80 mm/HG. Work with your doctor to find the anti-hypertension medications that work best for you. Keeping your weight under control, exercising regularly, and reducing your salt intake are important in keeping your blood pressure under control. See Hypertension: Information for Patients.
• Lead a smoke free life. This includes stopping smoking and eliminating your exposure to second hand smoke. For smoking cessation information, see Stop Smoking.
• Maintain a healthy diet. If you have chronic kidney disease, it is important to have a food plan that meets your nutritional needs. Your nutritional needs will change depending on your stage of chronic kidney disease. Avoid fad diets, particularly high protein diets, since excess protein puts too much stress on the kidneys. Talk to a nutritionist, preferably one with expertise in chronic kidney disease, in order to find a food plan that is right for you. See Diet and Nutrition.
• Exercise and control your weight. Exercising regularly is one of the most important things you can do to improve your overall health. Exercise helps you lower your blood sugar and your blood pressure, lose or maintain your weight, improve your heart and lung health and improve your physical, mental and emotional well-being. See Exercise.
• Reduce stress. Recognize that it may take time to adjust to CKD - so be patient and set realistic goals. Keep involved in the pleasures, activities and responsibilities of daily life and share your feelings with family and close friends. Consider joining a support group. See Resources for People with Chronic Kidney Disease.
• Use over-the-counter medicine carefully. Prolonged and frequent use of anti-inflammatory and anti-pain medications can damage your kidneys. Talk to your doctor or pharmacist to find out how to use non-prescription medication that won't damage your kidneys. See A Note on Over-the-Counter (OTC) Pain Relieving Medications, below.

A Note on Over-the-Counter (OTC) Pain Relieving Medications

A number of pain relieving non-prescription drugs can have an adverse effect on your kidneys. If you are taking painkillers you should ask your doctor if, and how, they can affect your kidneys. Your doctor may be able to recommend a safer alternative. The following OTC drugs are known to cause damage to kidneys with prolonged and frequent use:

• NSAIDS. Taking large amounts of Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) over a long period of time can damage your kidneys. If you already have chronic kidney disease, even small amounts of NSAIDS can worsen kidney function and cause kidney failure. These medications include ibuprofen (e.g. Advil, Motrin), naproxen (Aleve), and aspirin.
• Acetaminophen. These drugs include Tylenol and Excedrin. If you are at risk for developing kidney disease, you should only use acetaminophen occasionally. Long-term use may damage the kidneys. If you have a medical need for long-term use (for example, for treating arthritis), you should take this medication under your doctor's supervision.

Coping strategies: the emotional side

When you have a chronic illness like chronic kidney disease (CKD), your emotional well-being is very important. With good medical treatment, taking your medications properly, and maintaining a healthy lifestyle, you will probably find that you feel well much of the time. Don't let your illness rule your life. Try to maintain as many of your usual, leisure and social activities as possible. Many people are able to return to their job or school after taking a bit of time off to start treatment and adjust to their new situation.

If you are experiencing a range of emotions, such as grief, anger, or depression, be assured that many people who have been diagnosed with CKD have felt the same way - and just as many have learned to deal effectively with their emotions and have regained their usual outlook on life.

Having someone to talk to can make a big difference. Talk to your health care team about support available in your community. Many people find that sharing their thoughts and feelings with other people who have CKD is very helpful. Contact the local branch of the Kidney Foundation of Canada to find out about peer support groups and/or patient workshops in your area. For more information on living with CKD, see Resources for People with Chronic Kidney Disease.

Tips for Working with Your Doctor

• Make sure you have a regular family doctor who is interested in working cooperatively with you. Your doctor should be familiar with the latest clinical guidelines and standards for chronic kidney disease (CKD) care.
• Learn as much as you can about CKD so you can ask questions and identify problems than may need extra attention.
• Be your own advocate. Understand what type of care is recommended for people with CKD, and ask your doctor about it.
• Work with your doctor to set goals for better management of your condition.
• Your family doctor will manage most of your care, but it is critical that you are also referred to a nephrologist (kidney disease specialist) or other medical specialist if the cause of your disease is not known or your disease is getting worse. Your family doctor and other medical specialists work together as a team.
• Proper nutrition is important in keeping your kidneys functioning longer and critical to compensating for kidney damage. Finding the food plan that is right for you may be a difficult and complicated task to do on your own. Your nephrologist will help you obtain advice from a registered nutritionist.
• Make sure you understand what medicines you should be taking, why they have been prescribed, how to take them, and possible side effects.
• If you find it difficult to follow your doctor's instructions or are reluctant to take a prescription medicine because of side effects, be sure to tell your doctor.
• Keep a health diary or logbook to help you remember medications, activities, and appointments and to record your symptoms or changes in your condition.
• Take responsibility for your own health. This may include making necessary lifestyle changes, taking your medications properly, eating differently or quitting smoking.
• Don't hesitate to express your concerns or ask questions about the care of your disease. Active involvement in your own care is critical. You can and should be involved in decisions about your treatment.

When to seek medical help?

See your physician if:

• You are experiencing increased fatigue, nausea, vomiting, loss of appetite or problems sleeping.
• You are vomiting blood or your stool contains blood.
• You have swelling in your ankles.
• You have shortness of breath when you are not exerting yourself.

• You have a very slow or a very rapid heart rate.
• You have chest pain or severe shortness of breath.

Your Chronic Kidney Disease Team

Management of chronic kidney disease (CKD) is a team effort. Your doctor will prescribe medications and manage your medical problems. There are other professionals who may help you manage your condition. Members of your CDK team may include:

• Nephrologist (medical specialist in diagnosing and treating kidney disease)
• Nutritionist/dietitian
• Pharmacist
• Nurse
• Social worker
• Other specialists (endocrinologists, cardiologists)

Last Revised: February 14, 2007