Managing. Kidney Disease. You Can Take Control to Stay Healthier
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1 Managing Kidney Disease You Can Take Control to Stay Healthier
2 Understanding Kidney Disease If you ve been told you have kidney disease, this booklet is for you. You may have been born with a kidney problem. Or your kidney disease may be the result of another health problem. (Diabetes, high blood pressure, and immune disorders are leading causes of kidney disease.) In any case, this booklet can t replace the support of people close to you. But it can help you learn what kidney disease is and what it means to your health. How Kidney Disease May Affect Your Life In its early stages, kidney disease may not cause any symptoms. Later, though, your body becomes less able to rid itself of wastes and regulate salt and fluids. You may then notice swelling in your ankles or hands. You may feel short of breath or low on energy. As you and your healthcare provider adjust your treatment, you re likely to feel better. But your kidney disease may keep progressing. And at some point, both of your kidneys may stop working (called ESRD or end-stage renal disease). Special types of treatment will be needed if this happens. Right now, you can take control to prevent or delay the end stage of this disease. 2 This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem. 1997, 2010, 2012, 2015 The StayWell Company, LLC All rights reserved. Made in the USA.
3 You Have Some Control Making certain changes in your life can help you stay more healthy. Start by following your treatment plan. It s also helpful to learn more about your kidneys. Follow Your Treatment Plan Whether you have symptoms or not, follow your treatment plan. By doing so, you help slow any progression of your kidney disease. Follow your healthcare provider s advice on eating right and exercising. Take medications as directed. Also do your best to control diabetes and high blood pressure. Table of Contents Page Limit Certain Foods and Fluid 4 Exercise Often 6 See Your Doctor 7 If You Have Diabetes 8 If You Have High Blood Pressure 10 The Kidneys Main Role 12 Learn What Your Kidneys Do The kidneys play a major role in keeping your body running. Once you learn what the kidneys do, your treatment may make more sense. And the closer you follow your treatment plan, the more healthy you re likely to be. Choosing Future Treatment 14 Finding Support 15 3
4 Limit Certain Foods and Fluid My Daily Protein Intake grams My choices include: oz red meat oz chicken or turkey oz fish eggs oz milk, cheese, yogurt other, such as My Daily Salt Intake milligrams Ways to limit salt: Eat fresh foods instead of canned or processed ones. Avoid fast food. Do not add salt to food. 4 Eating right is essential for people with kidney disease. When your kidneys are not working right, waste products and excess fluid build up in your blood. By limiting certain foods and fluid, fewer waste products will remain in your body. A Diet Made for You Each person with kidney disease has unique dietary needs. Because of this, a dietitian (a person trained in nutrition) may teach you the types and amounts of foods you can eat. Your diet may change based on the stage of your disease. As your disease progresses, you may be told to drink less fluid and take phosphate binders. You may also have to restrict your intake of potassium. If Anemia Is a Problem Anemia (lack of red blood cells) is a common problem for kidney disease patients. You may need to take iron supplements or have injections of a synthetic hormone. Your blood count and iron levels will also need to be monitored. And you may be told to eat high-fiber foods to prevent constipation. Manage Your Protein Intake Your body needs a certain amount of protein for proper nutrition. But kidney disease causes filtering problems. As a result, wastes from the body s use of protein (blood urea nitrogen or BUN) may build up in the blood. Talk with a dietitian about choosing the right amount of protein for your diet. Choose Complete Proteins The body uses certain proteins (complete proteins) better than others. Chicken, turkey, fish, and lean red meats are examples of complete proteins. Try to choose your daily protein from these sources.
5 Use Less Salt Salt (sodium) makes the body hold fluid. This can cause swelling, breathing trouble, and high blood pressure. Using less salt can help reduce these effects. Your taste buds will adjust to less salt. To use less salt in your diet, try these tips (and see page 10): Compare food labels for sodium content. Choose foods with less than 400 milligrams (mg) per serving. Use low-salt dressings and sauces. Avoid salt substitutes that contain potassium. When dining out, ask your waiter about low-salt food choices. If You re Told to Drink Less Fluid If your kidney disease progresses, you may be told to drink less fluid. The amount of fluid you can have will depend on how well your kidneys make urine. If you re told to limit fluid: Suck on a lemon wedge to wet your mouth. Use less salt. This will help control thirst. Drink only when thirsty. Do not drink out of habit or to be social. Control your blood sugar if you have diabetes. This will make you less thirsty. If You Take Phosphate Binders Eating certain foods may create a high level of phosphorus in your blood. If your kidneys can t reduce this level enough, your bones begin to weaken. To prevent this, you may be told to take medications called phosphate binders with meals. These medications keep phosphorus from entering your blood. Certain foods, such as beans, chocolate, and dairy products, contain more phosphorus than others. This may affect the amount of binders you need to take. Talk with your dietitian about choosing the right amount of binders. Nutrition Facts Serving Size 1 cup Servings Per Container 2 Amount Per Serving Calories 140 Calories from Fat 10 % Daily Value Sodium 140mg 5% To feel less thirsty, try sucking on a lemon wedge. Take phosphate binders with meals. 5
6 Exercise Often Exercise Choices My doctor suggests that I try the following types of exercise: Stretching Swimming Walking Bicycling Doing aerobics Taking a dance class Using an exercise machine, such as Other When you make exercise part of your life, you ll feel more healthy. Staying fit is more important than ever now that your kidneys are not working fully. If you exercise often, your heart and lungs are likely to function better. This improves blood flow to all your other organs, helping them work better, too. How You Benefit When you exercise, blood flow to your organs and tissues increases. This gives you more energy. Exercise also improves muscle tone, which may help make your bones stronger. This is helpful because kidney disease sometimes weakens bones. Frequent aerobic exercise (a nonstop activity that makes your heart work harder) can also help reduce high blood pressure. Make Exercise Part of Your Life For best results, exercise on most days of the week. Make it a goal to work out for 15 to 30 minutes each time. Talk with your healthcare provider about the safest way to start. To Be More Active All types of movement count. Try the tips below: Swim laps at a local pool. Go for a walk, mow the lawn, or wash the car. Take the stairs. Choose a parking spot farther away from your destination. 6
7 See Your Doctor Your doctor will monitor the health of your kidneys. That way, treatment can be adjusted if your condition changes. If you have other health problems that affect the kidneys, such as diabetes or high blood pressure, they will also be monitored. Keep Appointments To check the health of your kidneys, your doctor may want to see you every few months. Your visits may include any of these tests: Blood tests measure wastes (such as BUN and creatinine) left in the blood. Urine tests measure the amount of certain wastes in your urine. Imaging tests show damage to the kidneys and blood vessels. NOTE: Before you have any imaging test, be sure to tell the technologist that you have kidney disease. Some x-ray tests use dyes or fluids that can be harmful to your kidneys or body. To Maintain Health Stick to your diet. Control health issues, such as diabetes, high blood pressure, and anemia. Take your blood pressure at home regularly, as directed. Talk to your kidney doctor about any prescription you re given. Be sure to ask before taking pain medications, antibiotics, or herbal remedies. Stop smoking. Smoking can increase kidney damage. If you are overweight, talk to your doctor about a weight-loss plan. Too much excess weight can hasten the progression of kidney disease. Blood Pressure Target is Mine is Creatinine Level Mine is Date Mine is Date Mine is Date BUN Level Mine is Date Mine is Date Mine is Date 7
8 If You Have Diabetes Complex Carbohydrates These foods turn to glucose slowly: Breads and cereals Pasta Corn Rice Simple Carbohydrates These foods turn to glucose quickly: Candy Cookies Cake Pie Jam and jelly Diabetes is a disease that makes your body less able to use the food you eat. As a result, glucose (the form of sugar that the body uses as fuel) builds up in the blood. Over time, having too much glucose in the blood can damage blood vessels and cause kidney disease. By controlling your glucose level, you can slow the rate of damage to your kidneys. Stick to Your Diet Diabetes makes it harder for the body to absorb glucose and gain energy from food. Because of this, sticking to your diet is a very good thing to do. Eat the right types and amounts of foods. Don t forget, your diet helps control your diabetes and your kidney disease. If you have questions about what you can eat, talk with a dietitian. He or she can help you plan healthy meals that fit your diet. Learn About Carbohydrates If you have diabetes, you need to balance the kinds and amounts of carbohydrates that you eat. Carbohydrates are a food group that includes sugars and starches. Some sources of carbohydrates may affect you more than others. To maintain your health, learn which foods contain carbohydrates. Then find out how eating each of these foods affects your blood glucose level. 8
9 Check Your Blood Glucose Check your blood glucose level as often as directed. For best results, find out whether to test your glucose before or after exercising. If your glucose levels are often below 80 or above 200, talk with your healthcare provider. By keeping the right glucose level, you can control your diabetes. This is one of the best ways to slow the rate at which your kidney disease progresses. Exercise Often Frequent exercise helps control your blood glucose level. Choose a nonstop activity, such as walking briskly. Try to do it on most days of the week at the same time each day. Always eat 1 to 2 hours before you start. Also, carry glucose tablets or hard candies with you. Eat them if you feel shaky, dizzy, or have clammy skin. Just to be safe, talk with your doctor before starting any exercise program. Take Medications As Directed Which medications you take may depend on the type of diabetes you have. Always take the following medications as directed: Pills or injections to increase your body s supply of insulin. Insulin is a hormone that helps your body use glucose. Your body may need less insulin if your kidney disease progresses. Certain blood pressure medications. These can help maintain the health of the blood vessels inside your kidneys. 9
10 If You Have High Blood Pressure Salt by Any Name No matter what it is called, too much salt is not good for you. Try to avoid foods, drinks, and antacids with any of these forms of salt listed on the label: Sodium Na (chemical symbol for sodium) Soy sauce Baking soda MSG (monosodium glutamate) Ongoing high blood pressure damages blood vessels. This makes the kidneys less able to filter blood. It can also cause kidney disease to progress more quickly. Controlling your blood pressure may help slow the worsening of your kidney disease. You also lessen your chances of having a heart attack or stroke. Stick to Your Diet You have high blood pressure and kidney disease, so sticking to your diet is important. Follow the advice of your dietitian and doctor. Eat the types and amounts of foods they recommend. This may mean eating less salt and fat. Doing so can help lower your blood pressure. Eat Less Salt and Fat Eating less salt and fat means less damage to your blood vessels. To reduce the amount of salt and fat that you eat, try the tips below (and on page 5): Cook with herbs instead of salt. Try using basil, curry, garlic, lemon, mint, and nutmeg. Do not add salt to your food. Your taste buds will adjust within 2 to 3 weeks. Then all foods will taste more flavorful. Bake or broil instead of frying. Use nonstick sprays or cookware instead of fat if you do fry foods. 10
11 Exercise Often Like any other muscle, the heart needs frequent exercise to stay fit. Start by warming up slowly to ease into action. Next, pick up the pace. You should move briskly but still be able to talk easily. As your workout nears its end, reduce your pace. This allows your body to cool down slowly. Then stretch to prevent stiffness. Be sure to talk with your doctor before starting any exercise program. Take Medication As Directed Blood pressure medication often plays a large role in treatment. Your medication will work best if it s taken as directed. Be sure to: Take your medication at the same time each day. Find out if it should be taken with food. Tell your doctor if the medication causes headaches or dizziness. Do not skip doses or stop taking a medication unless your doctor tells you to. Watch Weight and Blood Pressure Your weight and blood pressure can affect each other. A sudden increase in one may cause the other to rise also. To make sure that both remain stable, check them as often as directed. Your healthcare provider can help you fill in the section below. My target weight is between and pounds. My blood pressure should be near. My blood pressure should be checked every days. 11
12 The Kidneys Main Role 12 Kidney Ureter Urethra When the kidneys are healthy, one of their main jobs is to clean the blood. Two normal kidneys can filter wastes and excess fluid from hundreds of pints of blood each day. In this way, they maintain the chemical balance the body needs to stay healthy and alive. If both kidneys fail (end-stage renal disease), wastes produced by normal cell functions build up in the blood (uremia). Over time, this can threaten your health. Bladder Filtering unit Balance of fluid and chemicals Removing Wastes The kidneys are part of a system that removes wastes from your body. For this system to work, the kidneys and urinary tract must do their jobs fully. Blood vessels Vessels Carry Blood Tiny blood vessels inside the kidneys carry blood to the filtering units. These vessels also shrink or expand to control the pressure inside the kidneys. Filters Clean Blood Blood is cleaned as it passes through the filtering units. Wastes and excess fluid are taken out to make urine. The proper amounts of clean fluid and vital chemicals (salts and enzymes) are returned to the blood. Urinary Tract Removes Wastes Two tubes, called the ureters, connect the kidneys with the bladder (where urine collects). When the bladder is full, the urine is passed out of the body through a tube (urethra).
13 Why Kidneys May Fail The kidneys may fail due to problems with their blood vessels or filtering units. These may be caused by things such as: An illness affecting the whole body, such as diabetes or high blood pressure. An illness that harms the kidneys directly, such as glomerulonephritis or polycystic disease. Kidney damage caused by taking certain medications or herbs. Damage caused by problems in the urinary tract. Wrong pressure in filtering unit Imbalance of fluid and chemicals Damaged blood vessels Problems in the Urinary Tract A problem with the shape of the urinary tract may be present from birth. Other problems, such as blockages, may be due to aging or chronic infection. For instance, an enlarged prostate can cause urine to back up in the bladder or ureters. If waste can t leave the body, your health is at risk. Problems with Blood Vessels An illness can damage blood vessels inside the kidneys. As a result, the filtering units receive less blood. Problems with Filtering Units Reduced blood supply or the wrong pressure can harm the filtering units. This makes them less able to remove wastes from the blood. As a result, the kidneys can t maintain the proper balance of fluid and chemicals in the body. Waste products may be returned to the blood, or vital chemicals and proteins may be lost in the urine. Urine backs up 13
14 14 Choosing Future Treatment The Right Choice for You Together, you and your doctor will choose the treatment that makes the most sense for you. Your choice may depend on the following: Any other health problems you have Your beliefs Your ability to cope with treatment requirements and costs Despite your best efforts, your kidney disease may progress. If both of your kidneys stop working, you will need treatment to replace the work they do to keep you alive. Talking over your choices now may help you accept future treatment more easily. Discuss future treatment choices with your family or close friends. Dialysis Kidney Transplant Sometimes people choose to stop Dialysis cleans your blood Transplant surgery places treatment. Their using a filter to replace the a working kidney in your lives end when kidneys. There are two body. The kidney may both kidneys stop types of dialysis: come from a living person working. This is a Hemodialysis passes who has agreed to be a personal choice. your blood through a donor. Or it may come But it often helps filtering machine outside from someone who has to talk with family of your body. It is done just died (cadaver donor). members or close at least 3 times a week You do not need to be friends about this related to the donor, but option. in a dialysis center or at home. Peritoneal dialysis filters blood through the sac that surrounds the organs in your abdomen. It is done at home several times a day. your blood types must be compatible. There is also a waiting list for kidneys from cadaver donors. Talk with your doctor about whether a transplant is right for you.
15 Finding Support Facing a chronic illness alone can be hard. If you have fears or concerns, try talking to people close to you. Also talk with your healthcare team and other people with kidney disease. Don t hesitate to ask for support or help when you need it. Talk to Your Team Over time, you ll work with a team of doctors, nurses, dietitians, technicians, and social workers. They want to help you feel as good as you can. If you are confused or worried, ask them questions. Find out what changes in treatment might mean. Knowing more about your illness may make its treatment less frightening and easier to follow. Talk to Other Patients When it comes to support, the experts are the people who are living with kidney disease. They know what you are going through. Talking with other patients can give you insight and offer new ways to cope. Sharing experiences may also help you see that you are not alone. And sometimes that s all it takes to make life a little easier. Sources of Support Information and support are offered by groups all over the nation. Contact the following: American Association of Kidney Patients American Kidney Fund National Kidney Foundation Members of your healthcare team can answer questions about treatment. Other patients with kidney disease can be good sources of support. 15
16 Enjoying Your Life Having kidney disease doesn t have to keep you from enjoying life s special moments. Once you accept your role in managing kidney disease, you ll be able to move on with your life. With time, following your diet, getting enough exercise, and taking medications can become a normal part of your day. Then you can focus on enjoying the people and events that hold meaning for you. Take our Patient Survey. Help us help other patients. Please visit to provide your feedback on this booklet. Consultants: Peggy Devney, RN, MSN, Nephrology and Transplant CNS Irma Ishkanian, MS, RD Hector L. Santiesteban, PhD, MD, Nephrology With contributions by: Jeanette K. Chambers, PhD, RN, CS, Renal CNS Cynthia Allen DeSoi, MD, Nephrology
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