In primary care, we talk to patients about a wide variety of topics. From diabetes to knee pain, we cover it all. But, what we don’t seem to talk much about is chronic kidney disease, or CKD. I can say this because every time I meet a new patient and bring it up, I’m stared at and inevitably asked, “what are you talking about?” “No one has ever told me that,” they tell me. Here is a summary of the conversation that follows.
Chronic kidney disease is simply a condition that many people have in which the kidney doesn’t filter as well as it did or could. The kidney has many functions, but most importantly it filters the blood of toxins or excess electrolytes, like potassium and calcium. Some people develop chronic kidney disease sooner than others. High blood pressure and diabetes are two of the most common conditions that cause people to develop chronic kidney disease. Chronic kidney disease is measured in stages, I-V. The higher the number, the more severe the disease is. Most people never “feel” chronic kidney disease. In all likelihood, you wouldn’t even know you had it without blood work. But, it plays a role in many decisions I make in your health.
Many medications are filtered out of the body through the kidneys. This means that when you have chronic kidney disease, some medications are dosed differently or even prohibited entirely. Over the counter medications such as ibuprofen(Advil or Motrin) or naproxen (Aleve) are harmful to people with chronic kidney disease, especially if used frequently. Unfortunately, many people who have chronic kidney disease also have arthritis or chronic pain. In those cases, medications like acetaminophen(Tylenol) or prescription pain medications may be more appropriate long-term choices. Some natural herb products or supplements, such as St. John’s wort, ginkgo or ones high in potassium or magnesium, need to be monitored or avoided in chronic kidney disease. Medications as basic as antibiotics can require kidney function adjustment, so it’s very important to work with your doctor and know your kidney function.
Chronic kidney disease can also cause changes in the body, such as anemia or bone disease. The kidneys secrete a hormone that stimulates bone marrow to produce blood cells. If the hormone is not secreted adequately, anemia may develop. The kidneys also help the body use calcium and vitamin D properly. Without the full function of the kidneys, people may develop bone disease, such as osteoporosis.
Well, given all of this information, what can you do to prevent it? By far and away the most important things a person can do is regulate blood sugar and pressure. Blood pressure should be checked often and diet should be built around the DASH diet, a nationally recognized low blood pressure diet. Many resources for this diet are available online. Low sodium is key. Like I tell my patients: wherever salt goes, water follows.
The more salt, the higher the blood pressure. High sugar also damages the kidney. If you are overweight, or have family history of diabetes, it’s important to have blood sugar checked. The DASH diet is also a good resource for sugar control. Simple sugars are to be avoided. Medications like I discussed are also to be used sparingly. Follow these guidelines, work with your doctor and you will be successful in preventing chronic kidney disease.
Andrew Eckert, D.O.