General Management

Early recognition and intervention are crucial to slow  disease progression, maintaining quality of life, and improving outcomes. Family physicians have the opportunity to screen at-risk patients, identify affected patients, and ameliorate the impact of chronic kidney disease by initiating early therapy and monitoring disease progression.

These are general treatment that may be required for anyone with failing kidneys, whatever the cause.

• Restrict fluid and salt intake
  Reducing sodium in your diet helps you control high blood pressure, keeps you from being thirsty, and prevents your body from holding onto extra fluid. A low-salt diet is usually needed. When your kidneys are not healthy, extra sodium and fluid build up in your body. This can cause swollen ankles, puffiness, a rise in blood pressure, shortness of breath, and/or fluid around your heart and lungs. You need to restrict salt intake. Occasionally people have the opposite problem, and need to take extra fluid and salt. Avoid eating junk food,canned food, smoked meat, chips, processed cheese, and crackers. Look for food labels that say Low sodium, No salt added, Sodium-free, Sodium reduced, and Unsalted. DO not use salt substitutes because they contain potassium.
• Lowering blood pressure
  BP target that should be achieved to slow the progression of renal damage, and the influence of baseline and current proteinuria on the renoprotective effects of antihypertensive therapy. Additional research suggests that nighttime BP, removed from physical, emotional and other stresses, may be a better measure of a patient's actual BP status and his or her risk for cardiovascular problems. Excellent blood pressure control has been shown to slow down the progression of chronic renal failure, in addition to the benefits to the heart and blood vessels elsewhere in the body. It is recommended that people with chronic kidney disease use whatever therapy is necessary, including lifestyle changes and medicines, to keep their blood pressure below 130/80.
• Treat anaemia
  All patients with chronic kidney disease, regardless of stage or cause, should be screened for anemia, which should be diagnosed and evaluated when Hb level is less than 12.0 g/dL in adult women and less than 13.5 g/dL in adult men. The anaemia that goes with renal failure is mainly due to a deficiency of a hormone called erythropoietin (Epo). Epo is produced by the kidney to stimulate red blood cell production from the bone marrow. A deficiency of Epo leads to anaemia.
• Diet
  The purpose of this diet is to maintain a balance of electrolytes, minerals, and fluid in patients who are on dialysis. In kidney patients, typically the calcium level in the blood becomes low and the phosphate level high. Your recommended diet may change over time if kidney disease gets worse. For stages 3 and 4 CKD, the protein intake in your diet should be limited. The amount allowed will depend on your body size and the condition of your kidneys. Potassium is needed to help keep your heart beating steadily. A daily diet containing the following mineral ingredients should be strictly maintained. Kidney diseases and salt are almost synonymous. Higher the salt intake, higher the risk of the CKD, high blood pressure and heart disease. fluid intake must be watched. Some fruits like orange, apples, grapes and vegetables like lettuce also contain a lot of water. So, avoid such fruits. Alfacalcidol or calcitriol: these are active forms of Vitamin D, which is often short in renal failure, as the kidneys fail to process it.
• Prevention of heart disease, stroke and vascular disease
  People with kidney disease are at greatly increased risk of heart disease, stroke and problems with the circulation.
• Acidaemia
  In chronic kidney disease the kidneys are unable to excrete the normal acid waste products of the body, so neutralising acidemia is very important by taking bicarbonate tablet. People in renal failure often have too much acid in the blood (acidaemia) and have to take bicarbonate tablets to neutralise this.