Managing Chronic Kidney Disease: Tips for Diet and Medication

Q: Managing Chronic Kidney Disease: Tips for Diet and Medication

Hello： Kalimate is an exchange resin that binds potassium ions for excretion from the body. <br>The excretion of potassium ions (K+) decreases during renal function deterioration and end-stage renal disease, leading to hyperkalemia. <br>Elevated potassium levels can cause arrhyth

Chronic Kidney Failure

Hello Doctor, my grandmother has issues with hypertension, diabetes, and anemia.
Additionally, she was diagnosed this year with proteinuria and chronic kidney failure, but she has not yet started dialysis.
Her reports show creatinine levels from June to September as 5.0, 5.8, 6.0, 5.5, 5.2, and 6.4, fluctuating between high and low.
She has been prescribed a medication called Calcitriol.
Can you explain how this medication works? I didn't understand what the doctor said.
Also, how can we improve her diet? Currently, she is drinking Abbott's Nepro for renal nutrition.

Lin Xiansheng, 20~29 year old female. Ask Date: 2016/11/14

Dr. Wu Hongjie reply Internal Medicine

Hello: Kalimate is an exchange resin that binds potassium ions for excretion from the body.
The excretion of potassium ions (K+) decreases during renal function deterioration and end-stage renal disease, leading to hyperkalemia.
Elevated potassium levels can cause arrhythmias and sudden cardiac death.
Therefore, to prevent end-stage patients from dying due to high potassium levels and arrhythmias, this type of medication may be prescribed.
There are many dietary considerations associated with this medication.
It is recommended to consult a dietitian during clinic visits for specialized guidance, such as avoiding starfruit, focusing on low-phosphorus and low-potassium foods, and refraining from consuming unknown herbal medicines that may harm renal function.
Additionally, it is advised not to take medications that could further impair kidney function indiscriminately.
For other important considerations, it is suggested to seek education from dietitians, case managers, and other healthcare professionals at the hospital.
Wishing you health and safety.

Reply Date: 2016/11/14

More Info

Managing chronic kidney disease (CKD) requires a comprehensive approach that includes dietary modifications, medication management, and regular monitoring of kidney function. Given your grandmother's health conditions—hypertension, diabetes, anemia, proteinuria, and chronic kidney failure—it's crucial to tailor her diet and medication regimen to support her kidney health while managing her other medical issues.

Dietary Recommendations
1. Protein Intake: In CKD, especially when proteinuria is present, managing protein intake is essential. While protein is necessary for overall health, excessive protein can strain the kidneys. A registered dietitian can help determine the appropriate amount of protein for your grandmother based on her stage of CKD and overall health. Generally, a lower protein diet is recommended, but this should be individualized.

2. Sodium Reduction: High sodium intake can exacerbate hypertension and fluid retention, which can worsen kidney function. Aim for a low-sodium diet, avoiding processed foods, canned soups, and salty snacks. Fresh fruits, vegetables, and whole grains are good choices.

3. Potassium and Phosphorus Management: Depending on her blood test results, potassium and phosphorus levels may need to be monitored and potentially restricted. Foods high in potassium (like bananas, oranges, potatoes) and phosphorus (like dairy products, nuts, and beans) may need to be limited if her levels are elevated.
4. Fluid Intake: Depending on her kidney function and any swelling or fluid retention, fluid intake may need to be monitored. It's important to discuss this with her healthcare provider.

5. Diabetes Management: Since your grandmother has diabetes, controlling her blood sugar levels is critical. This involves choosing carbohydrates wisely, focusing on whole grains, and monitoring portion sizes.

6. Anemia Management: Anemia is common in CKD, often due to decreased erythropoietin production by the kidneys. Foods rich in iron (like leafy greens, beans, and fortified cereals) and vitamin B12 (like eggs and dairy) can help, but iron supplements may also be necessary, as directed by her physician.

Medication Management
Your grandmother is taking a medication called Calcium Acetate (often referred to as "加利美粉" in Mandarin), which is a phosphate binder. This medication helps to control phosphorus levels in the blood, which is crucial for patients with CKD. It is important to take this medication with meals to effectively bind dietary phosphorus.

In addition to Calcium Acetate, her healthcare provider may prescribe other medications to manage her blood pressure, diabetes, and anemia. Regular follow-ups are essential to adjust these medications based on her kidney function and overall health.

Monitoring and Follow-Up
Regular monitoring of kidney function (through serum creatinine and estimated glomerular filtration rate or eGFR), electrolytes (like potassium and phosphorus), and blood pressure is vital. This will help guide dietary and medication adjustments.

Conclusion
Managing chronic kidney disease, especially with coexisting conditions like hypertension and diabetes, requires a multidisciplinary approach. Collaborating with a nephrologist and a registered dietitian can provide personalized care that addresses your grandmother's unique needs. It's essential to communicate openly with her healthcare team about any concerns or side effects she may experience from medications or dietary changes. With the right management strategies, it's possible to slow the progression of kidney disease and improve her quality of life.

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