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A Primer on Managing Chronic Kidney Disease

Chronic Kidney Disease is defined as ongoing kidney damage for greater than 3 months.  It can be structural, electrolyte abnormalities, functional (decrease in glomerular filtration rate). The most common cause of CKD in Africa Hypertensive Neuropathy ( Hypertension) and Diabetes.

Despite the increased prevalence of CKD, the National Kidney Foundation studies showed that there is no significant benefit of screening the general public for CKD. Yearly testing is however recommended for people with familial history, Diabetes, or Hypertension, obesity,  or metabolic syndrome and those over the age of 55 years.

Management of CKD involves a multidisciplinary approach, with doctors, dietician, patient and patient’s family, and social workers all working in tandem. CKD management is simultaneously related to the underlying cause. One of the primary and most important aspects of management is that of the Renin-Angiotensin-Aldosterone blockage, which will be managed by a Nephrologist. The goal is to decrease progression to End-Stage Kidney Disease and this is done by using Pharmacotherapy ( ACE inhibitors and ARBS).

Blood Pressure Control

It is essential that patients within the above high-risk groups monitor their blood pressure daily and know their numbers. Systolic of 130 and Diastolic pressure of 80 is recommended (talk to your doctor because individual numbers can vary based on baseline). Blood pressure control can reduce the progression of Chronic Kidney Disease and reduce cardiac mortality and morbidity. It is important that patients know their numbers and engage in lifestyle modification (e.g. dietary adjustments –  paying special attention to sodium, potassium, and phosphorus intake; smoking cessation; and increase in physical activities).

Diabetes Mellitus

Lifestyle modification ( diets, weight management, and physical activities) is usually the first line of treatment alongside pharmacotherapy (typically Metformin). Maintenance of Hemoglobin A1c of 7 or less. Regular monitoring of Serum Creatinine is also recommended in this population; the frequency is based on clinical presentation and clinician’s recommendations. 

Cardiovascular Disease

CVD – generally defined as the buildup of cholesterol in the blood vessels surrounding the heart – is the leading cause of mortality in patients with CKD. Statin is a pharmacotherapy that is prescribed to people with CVD. Statin reduces the risk of a cardiac event. This is primarily managed by a clinician, but lifestyle modifications are also useful.

 

Other complications to consider

Other complications of CKD include:

  • Anemia – which can be managed by pharmacotherapy ( iron pills or iron-rich diet i.e. spinach for iron deficiency anemia). Blood transfusion might be needed depending on the Hemoglobin level
  • Vitamin D deficiency – can be managed by taking Vitamin D supplements.
  • Hyperkalemia – monitor potassium and advocate for a low potassium diet
  • Nephrotoxic medication – there are a few over the counter and everyday pharmacotherapy that increases/worsen kidney damage, the most common of which are Non-steroidal Anti Inflammatory Drugs ( NSAIDS). NSAIDs (such as Naproxen, ibuprofen aka Advil) are associated with an increased risk of kidney disease, and gastric bleeding. Nephrotoxic medicines have a greater impact on the elderly population and a doctor should always be consulted before taking such medications

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