Treatment Options

ACE-inhibitors and ARBS 

The main treatment options for CKD patients at all stages are ACE-inhibitors and ARBS.  These classes of drugs are used widely for lowering high blood pressure, and are also used for patients with heart disease.  They are a great treatment choice for CKD patients because they decrease the strain that is put on the kidneys.  When people take ACEIs and ARBS they will have less protein in their urine, and less scarring of the kidneys.  If treatment begins early enough they can not only slow the progression of CKD, but can also stop ESRD from occurring at all.   

The other great news about ACEIs and ARBS is that they have very few side effects.  The most common side effect is a dry cough that occurs with ACEI that will usually go away if a lower dose is used.  For people who still have a cough, ARBs can be used instead.  Rarely a patient will experience an allergic reaction called angioedema, in which the tongue swells up very quickly and can cause the throat to close.  This requires immediate medical attention, so anyone experiencing these symptoms needs to get to the emergency department right away. 

Dietary Modification 

The other common treatment plan for CKD is diet modification.  Diet modifications include cutting back on salt, eating less protein, and choosing “heart-healthy” foods.  For more information on diet modification visit the National Kidney Disease Educational Program website.  

The trouble with diet modification is that it can be very difficult to do.  In a study of African Americans at risk for developing CKD (family history of ESRD and self-reported diabetes, high blood pressure, heart disease, HIV or obesity) researchers found that patients believed that preventing CDK through dietary changes was possible.  However, the challenge to change their diet often seemed too difficult.  Reasons people believed dietary change was difficult included not having grocery stores selling healthy food near where they lived, perceptions that healthy food is more expensive, having family members that don’t like healthy foods, the convenience factor of unhealthy foods, and the difficulty of breaking lifelong habits. 

Often times the progression of kidney disease cannot be stopped.  Dialysis and transplantation are options for people who are in the last stage of CKD, also known as end-stage renal failure (ESRF).  

Below is a chart of the benefits and side effects of the most commonly used treatment options.

	ACE-Inhibitors and ARBS	Dietary Modification	Kidney Transplant	Hemodialysis	Peritoneal Dialysis
What it does	Drugs that decrease the strain on the kidneys	Cutting back on salt, eating less protein, and choosing “heart-healthy” foods	Getting a kidney from either a living donor or someone who has just died	Blood is filtered by a machine instead of the kidneys.  Can be done at home or a dialysis center 3 times a week for 3-4 hours at a time.	A machine helps the lining of the stomach filter the blood.  This is done everyday at home, usually when the patient is asleep.
Who does it	Patients with high blood pressure, heart disease, and CKD patients in the earlier stages	Early stages of CKD.	Patients in the late stages of CKD can begin preparing for transplantation.  It is best not to wait to be in complete failure before having this procedure done.	End-stage renal disease patients.	End-stage renal disease patients.
Benefits	If treatment is begun early enough they can not only slow the progression of CKD, but also stop ESRD from occurring at all.	Can be used in combination with other medications to allow the kidneys to not have to work so hard, thus slowing the progression of the disease.	Patients report feeling better almost immediately following surgery.	For people for whom transplant either is not an option of was unsuccessful this can mean the difference between life and death.  Compact dialyzers have made it possible for CDK patients to travel and not have to break their dialysis routine.	Like hemodialysis this can mean the difference between life and death.  PD can give patients more control of their schedules since they don’t have to go to a dialysis center 3 days a week.  This kind of dialysis can also be done over night so patients don’t feel like they are giving up hours everyday.
Side Effects	Very few side effects.  The most common side effect is a dry cough that occurs with ACEI that will usually go away with if a lower dose is used.	Can be difficult to do!  No grocery stores selling healthy food near where they lived, healthy food is thought to be more expensive, family members don’t like healthy foods, unhealthy foods are much more convenient, and people are unable to break lifelong habits.	Rejection of the new kidney, and side effects related to the drugs that are given to prevent rejection – called immunosuppressant drugs.  These drugs make it harder for the body to fight infection, and can in some cases lead to certain types of cancers.	Anemia, bone disease, itchy skin, sleep apnea (snoring), restless leg syndrome, and amyloidosis (blood deposits in the joints that causes arthritis like symptoms)	Same as hemodialysis.

Dialysis 

Watch this video of CKD patient and blogger, Bill Peckham, as he does dialysis while on a 10 day rafting trip down the Grand Canyon.  For a wealth of information on all things CKD, including the plethora of dialysis options available, visit his blog From the Sharp End of the Needle.

Transplantation 

Shown here a short video of a donor kidney transplant surgery:

Next week I'll be discussing nursing interventions!

References

1.         Eating Right of Kidney Health Tips for People with CKD. In: Program TNKDE, ed. Vol 14-7405: National Institute of Health; 2014.

2.         Living with Kidney Disease. Vol 2015: National Institute of Health; 2014.

3.         Johnson A, Bouldware L, Crews D. Perceived barriers and facilitators of using dietary modification for CKD prevention among African Americans of low socioeconomic status: a qualitative study. BMC Nephrology. 2014;15.

4.         Turner J, Bauer C, Abramowitz M, Melamd M, Hostetter T. Treatment of chronic kidney disease. Kidney International. 2011;81:351-362.