Signs of Chronic Kidney Disease

Your kidneys possess an incredible ability to compensate for their reduced function. This is why chronic kidney disease can progress silently for an extended period, often until very little kidney function remains.

Given that the kidneys play multiple vital roles in the body, this disease can manifest in a variety of ways, resulting in diverse symptoms. Most notably, many patients maintain their urine output even in advanced stages of chronic kidney disease.

• 1. Fatigue and weakness (caused by anemia or the accumulation of waste products in the body)
• 2. Loss of appetite, nausea, and vomiting
• 3. Frequent urination, especially at night
• 4. Swelling of the legs and puffiness around the eyes (due to fluid retention)
• 5. Itching, easy bruising, and pale skin (resulting from anemia)
• 6. Headaches, numbness in the feet or hands (peripheral neuropathy), disrupted sleep, altered mental status (encephalopathy from the buildup of waste products or uremic toxins), and restless legs syndrome
• 7. High blood pressure, chest pain due to pericarditis (inflammation around the heart)
• 8. Shortness of breath due to fluid in the lungs
• 9. Bleeding (poor blood clotting)
• 10. Bone pain and fractures
• 11. Decreased sexual interest and erectile dysfunction

Self-Care at Home

Managing chronic kidney disease is a process that requires close collaboration with your healthcare provider. Self-treatment is not advisable.

However, there are essential dietary guidelines you can follow to slow down the progression of your kidney disease and reduce the risk of complications.

This is a complex process that should be customized, typically with the guidance of your healthcare provider and a registered dietitian.

The following are general dietary recommendations:

• Restricting protein: Reducing your protein intake can help slow the progression of chronic kidney disease. Consult with a dietitian to determine the appropriate protein amount for your needs.
• Limiting salt intake: Keep your daily salt consumption to 4-6 grams to avoid fluid retention and manage high blood pressure.
• Managing fluid intake: Excessive water consumption does not prevent kidney disease and may even be restricted under your doctor's advice.
• Reducing potassium intake: In advanced kidney disease, limiting potassium is necessary because the kidneys cannot effectively eliminate it. High potassium levels can lead to abnormal heart rhythms. Examples of potassium-rich foods include bananas, oranges, nuts, and potatoes.
• Minimizing phosphorus intake: Lowering phosphorus intake is recommended to protect bone health. Foods high in phosphorus include eggs, beans, cola drinks, and dairy products.

Other important steps you can take include:

• 1. Diligently follow prescribed regimens to manage your blood pressure and/or diabetes.
• 2. Quit smoking
• 3. Shed excess weight

In chronic kidney disease, some medications can be harmful to the kidneys and may need to be avoided or administered in adjusted doses. Among over-the-counter medications, the following should be avoided or used cautiously:

• 1. Certain pain relievers - Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g., Motrin)
• 2. Fleet enemas or phosphosoda enemas due to their high phosphorus content
• 3. Laxatives and antacids containing magnesium and aluminum, like Milk of Magnesia and Mylanta
• 4. Ulcer medications - H2-receptor antagonists like cimetidine (Tagamet) and ranitidine (Zantac) (use at reduced dosage with kidney disease)
• 5. Decongestants such as pseudoephedrine (Sudafed), especially if you have high blood pressure
• 6. Alka Seltzer, as it contains a high salt content
• 7. Herbal remedies

If you have underlying conditions like diabetes, high blood pressure, or high cholesterol contributing to your chronic kidney disease, follow your healthcare provider's guidance for medication and schedule regular follow-up and monitoring.

Dialysis

In end-stage renal disease, kidney function can only be replaced through dialysis or kidney transplantation. Refer to the Transplant section for more information on transplants. There are two types of dialysis: 1) hemodialysis and 2) peritoneal dialysis.

Hemodialysis

Hemodialysis involves circulating blood through a filter on a dialysis machine. The blood is cleansed of waste products and excess water. It normalizes acid levels and the concentration of various minerals, such as sodium and potassium, in the blood. The purified blood is then returned to the body.

For long-term dialysis, access to a blood vessel is required for the machine to withdraw and return blood to the body. This can be achieved through a dialysis catheter, arteriovenous fistula, or graft