Living with Stage 4 Chronic Kidney Disease

Why work to keep CKD from getting worse?

It is important to try to slow the loss of kidney function, even at stage 4 CKD. Following your treatment plan and managing other health problems can give you the best chance to delay CKD progression and kidney failure, and thus, hold off on the need for dialysis for a kidney transplant. It should be noted that even if you get treatment in stage 4 and are careful about your health, your kidneys may still fail.

However, any steps you can take now to improve or maintain your health can help you over the long term. For example, maintaining good overall health can also lessen certain risks and improve the chances of a successful kidney transplant. It can also make you a better transplant candidate.

Also, if you continue to take care of yourself, even if you go on dialysis, it is possible to maintain a small amount of kidney function (also known as “residual” kidney function). Just because you might need dialysis, residual kidney function can help you in a number of ways (such as a fewer dialysis treatments per week, and/or shorter dialysis treatments), whether you need to continue on dialysis indefinitely, or while you are receiving dialysis and waiting for a transplant.

Also, the more kidney disease progresses, the higher the risk for other diseases such as heart disease. So managing your health now gives you the chance to help lower the risk for other health problems later in life.

Managing CKD and related health problems

You may have conditions such as diabetes and high blood pressure, which can damage your kidneys and create heart and blood vessel problems. One of the goals of your treatment is to make sure these are controlled. In order to do this, you will need to stay with your treatment plan. This is to help protect both the heart and kidneys. You should also avoid certain drugs and herbal supplements that can harm kidneys. Healthy habits such as physical activity and exercise can help both the heart and kidneys. Harmful habits, such as smoking, should be avoided. Smoking can harm the lungs and many different organs, including the heart and kidneys.

You should also do what you can to manage other complications of kidney disease. Kidney disease can cause other health problems throughout your body, including anemia (low red blood cell count), mineral and bone problems, or hyperkalemia (high potassium). If you have stage 4 CKD, you probably have some of these problems already. Your healthcare team will work with you to make a treatment plan to help manage these problems and keep them from getting worse. Treatment may include diet, exercise, and medicines.

You can watch the following video for more information on keeping kidneys healthy:

Avoiding drugs that can harm the kidneys

Before taking any medicine, speak with your pharmacist or other members of your healthcare team to make sure your medicines won’t hurt your kidneys. A pharmacist is someone who prepares your medicines and answers your questions about how to take them. You can let your pharmacist know about your CKD so they can review your medicines with you. Be sure to tell them if you’re taking any vitamins, minerals, herbs, or non-prescription drugs.

Many prescription and over-the-counter (OTC) medications are filtered by the kidneys. This means that normal kidneys remove medicines from the body. When your kidneys aren't working well, certain medicines can build up and cause you harm. Exposure to intravenous contrast dyes (put in your veins) used in imaging (MRI, CT or angiograms) can also cause kidney damage, so be sure to speak with your healthcare team before scheduling one of these tests.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a specific group of pain medicines. Some NSAIDs are available over the counter. This includes different brands of ibuprofen and naproxen sodium. NSAIDs are usually safe for occasional use when taken as directed, but if you have CKD, they should be avoided. NSAIDs may cause an increased risk of sudden kidney failure and even progressive kidney damage. You can speak with a primary care clinician about other solutions for managing pain.

You can watch the following video on what medicines should be avoided by people with kidney disease:

Caution with herbal supplements

You should avoid herbal supplements if you have kidney disease or are on dialysis. Herbal supplements can cause kidney damage or other side effects, and they can also interact with your prescribed medicines. Always speak to your clinician before taking any herbal remedies, OTC medicines, or dietary supplements. All dietary and herbal supplements are not tested, and many of these products can have toxic or unknown ingredients.

You can a watch the following video on herbal supplements and kidney disease:

What should I do to manage my health?

It is important to stay with any treatment plan recommended by your healthcare team and to know and track your lab numbers. You should also understand the kidney-heart connection.

There are many ways you can manage your health. Lifestyle changes include:

• Losing weight if you are overweight
• Cutting down on salt in your diet to control blood pressure
• Managing your blood sugar, especially if you have diabetes
• Avoiding NSAIDs, dietary supplements, or herbal remedies that might harm the kidneys
• Stopping smoking if you smoke
• Exercising and getting more physical activity

You should also remain engaged with your healthcare team:

• Review your medicines with a doctor, pharmacist or other member of you healthcare team
• Ask about monitoring blood pressure at home
• If you have not done so, ask your primary care clinician about a referral to a kidney specialist (nephrologist)
• Talk to a dietitian about your diet, the foods you should eat, and the foods you should avoid
• Talk to a social worker if you feel you need counseling, or help finding services, food, shelter, or medicine

And finally, remember your emotional health and well-being:

• Set aside time to rest or relax
• Keep doing the things that you find relaxing, such as listening to music, reading, or whatever else works for you
• Get plenty of sleep
• Maintain a positive attitude and outlook
• Don’t keep your feelings inside. Speak to someone
• Ask people for help
• Consider peer support. You can speak to someone or connect online:

-Peer Support

-Online Communities