Is it possible to reverse and "cure" chronic kidney disease? How do you treat chronic kidney disease?

BACKGROUND

It is estimated that more than 20 million Americans may have chronic kidney disease (CKD). That means roughly 1 in 15 Americans. Subjectively speaking, and for some reason, the rate seems to be even higher where I practice (Bradenton / Sarasota, Florida), but that could be related to the older aged population here.

Whether you could "cure" CKD would depend on the cause of kidney disease. Quite often, the cause happens to be a chronic disease that can only be "controlled" (like diabetes or hypertension), but not technically cured. And so is the case with CKD. That is, you can usually not cure and get rid of CKD, but you should be able to control the worsening of your CKD and prevent the fall in your GFR. 

I have discussed in my previous posts about how physicians measure your kidneys' function and the concept of GFR. You may want to take a look at the picture of the "GFR meter" again wherein I had mentioned that the needle on this meter usually swings only one-way. In other words, you cannot increase your GFR once it is chronically low, BUT you can try to keep it from getting worse.
This is where the specialist kidney disease physician, the nephrologist, comes in to the picture and can help you come up with a treatment plan. There are medical studies that have shown that patients who are referred late to a nephrologist tend to do worse in the long run. 


TREATMENT

So with the above background in mind, lets see what you and your nephrologist could focus on to treat your CKD:

1) Get checked: the first step is to get checked and diagnosed to see if you have CKD. People with high risk who need to be regularly assessed include diabetics and hypertensives. This is very important because most patients with CKD will not have any symptoms and would not even know they have the disease. Here is a short video:



2) If you have diabetes, make sure it is well controlled. Strict blood sugar control can partially reverse glomerular hyperfiltration (an abnormal process that occurs in the kidneys of patients with diabetes), delay development of albuminuria/proteinuria, reduce the level of proteinuria if it has already developed,  and reduce the decline in GFR. One of the tests done to assess diabetes control is the hemoglobin A1C level. Target A1C levels for patients with CKD might be different from the regular population, and this is something you will need to talk to with your nephrologist.  

3) If you have high blood pressure, make sure it is controlled within the target range. This would be about 130/80 for most patients with CKD.

4) Certain medications like ACE inhibitors and ARBs might be protective for the kidneys. These are blood pressure medications, but could be used in patients with CKD even if they have normal blood pressure. Talk to your doc about these.

5) Eat right! This would be a diet low in salt and red meat, and high in fruits, whole grains, and vegetables.

6) Control your cholesterol. You might need medications in addition to diet for this.

7) Lifestyle changes: quit smoking, make sure you use alcohol only in moderation, and most importantly, exercise. 

Kidney disease treatment is often a long, drawn out, and frustrating process. The rewards are not instantaneous; so be prepared to work with your nephrologist, decide on your goal, and then work towards it! Being aggressive about your treatment could make a difference between you advancing to CKD stage 5 and needing dialysis, vs. being able to control CKD in stages 1 through 4.

Veeraish Chauhan, MD, FACP, FASN
Nephrology 
Sarasota, Bradenton, Lakewood Ranch, FL  

Comments

  1. Great advice and information! Thank you!

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  2. I appreciate your advice as mentioned above..I fone controls his blood pressure well and is at stage 3 and reason for his ckd is high Blood pressure only..can he stick to it for long time i.e. in stage III and iv...

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  3. If there are no other markers of kidney damage (protein in the urine, blood, small shrunken kidneys on ultrasound), the majority of people with CKD stage 3, WILL NOT progress to CKD stage 5.

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  4. Creatinine level 3.1. Patient is 70 yrs old, has diabetes, hypertension. History of heart disease, stroke. She is on erythropoietin injections, bad taste in mouth, no appetite to eat. What is the prognosis for this patient? What can be done to reverse this? Thank you

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    Replies
    1. The symptoms you describe could be consistent with advanced kidney disease related uremia. If this is from CKD, then reversal usually is not possible. What you could do is slow it down a bit. I hope the patient is being seen regularly by a nephrologist

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