Living with Stage 4 Chronic Kidney Disease

Lab testing and tracking your numbers

There are different tests to measure kidney function and kidney damage. Overall, these blood and urine tests are used to find out how well your kidneys are working, check for signs of kidney disease, and look for any changes in a person’s kidney health over time. You should keep track of your kidney tests and other lab numbers. You can speak to a clinician about access to your lab results (printout or online access, depending on the practice). You may also be able to directly access your lab tests straight from the lab.

You can print this sheet to help track your lab numbers.

Or use this spreadsheet

Kidney lab tests

eGFR and ACR – what do the numbers mean?

Estimated glomerular filtration rate (eGFR) is a measure of how well your kidneys filter blood. It is calculated using your serum creatinine and your age, race and gender. By including these factors that are specific to you, this measurement accounts for the possible differences in creatinine levels among people, to find out your correct level of kidney function. The normal value for eGFR is 90 or above. An eGFR below 60 is a sign that the kidneys are not working well. Once the eGFR decreases below 15, one is at high risk for needing treatment for kidney failure, such as dialysis or a kidney transplant.

Albumin-to-creatinine ratio (ACR) is a urine test to see if you have kidney damage. The amount of a protein called “albumin” is measured in your urine, and that amount is divided by the creatinine also found in your urine. Albuminuria (albumin in the urine) means that there is more albumin in the urine than there should be, which is a sign of kidney damage. An ACR below 30 is considered normal. An ACR between 30-300 means you have moderately increased albuminuria. An ACR above 300 means you have severely increased albuminuria.

The importance of managing your heart health

People with kidney disease, especially stage 4 CKD or kidney failure are at risk for heart disease. In fact, most people with kidney disease do not die of kidney failure - they die of heart disease. Working with your dietitian and healthcare team will help you find a lifestyle that can lower your chances of getting heart disease —or help keep heart disease from getting worse.

High blood pressure and diabetes not only raise the risk of heart disease, but they also raise the risk of kidney disease. Managing your blood pressure and blood sugar are important ways to take care of your kidneys, heart and blood vessels. It is important to keep blood sugar and blood pressure levels within normal limits and follow the plan of care recommended by your clinician. Talk to your healthcare team about the blood pressure and blood sugar treatment goals that are right for you. You can also ask about taking your blood pressure at home and other types of self-management.

Managing your weight is another way to improve heart health. Body mass index (BMI) is a measure of body fat based on height and weight. BMI is a quick and simple way to know if someone is overweight or obese. A BMI between 25 and 29.9 is considered overweight. A BMI of 30 or more is considered obese.

Making healthy food choices is important to us all, but it is even more important if you have kidney disease. It can also help your heart health. You should avoid high sodium foods, such as many processed foods (such as canned soup and frozen TV dinners), cured foods (ham, olives, luncheon meats), and salted snacks (pretzels, potato chips). To manage your cholesterol, lower your saturated fat. Eat healthier foods and avoid foods that are higher in saturated fat (or avoid fats from red meats, cheese, ice-cream, pizza, fast foods, and fried food). You can choose foods that are “high quality’ sources of protein, such as fish, egg whites, nonfat-dairy, lean chicken, pork, and beef, and complement these with fresh fruits and vegetables. You might also need to avoid foods high in sugar, especially if you have diabetes.

You can ask your clinician or a dietitian for a diet plan that works for you. Dietitians have specialized degrees in dietetics and must be registered. They know what foods are right for patients and they can help you plan your meals.

You can watch the following video for tips to lower salt in your diet:

Coping with emotions and managing stress

It is important to remember that your emotions and physical health are connected. A healthy emotional life will help you to live longer and feel better. Some ways to manage stress can include:

• Find out as much as possible about your disease through local support groups, written materials educational classes, or by contacting organizations such as the National Kidney Foundation
• Share your feelings with family or close friends
• Be patient and set realistic goals in adjusting to all lifestyle changes

• Find ways to relax, such as calling a friend, doing exercise, reading, listening to music, or other ways that work for you

Managing your care and working with your care team

Having concerns about your disease and any future treatment is normal and expected. Understanding and taking charge of your disease and treatments can help you to feel more in control of your life. Take part in all decisions about type of treatment and ask questions. Discuss all your concerns with the healthcare team.

You should also follow any prescribed diet and tell the healthcare team about any problems in following the diet, including lack of food. Take medicine as prescribed and tell your healthcare team about any problems, including side effects, lack of money, missing doses, or other problems with taking medicines.

You can also ask a clinician about getting help from a social worker. Nephrology social workers are trained in kidney disease counseling to help patients and their families cope with their disease and changes in the family, home, workplace and community. They identify sources of emotional support for patients who need it. They also identify services within federal, state and community agencies to meet patients' needs and help patients and families access services when necessary.