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Kidney Topics
Treatment & Management Options

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  • In less than 5 minutes, learn all about kidney diseases and treatment options

    • Worldwide, IgA nephropathy (IgAN) is a leading cause of chronic kidney disease and end-stage kidney disease. Luckily, new treatment options are becoming available. You can learn more about sparsentan (Filspari) here:

    • APOL1 genetic variants are linked to an increased risk of kidney disease in people of African descent. Exciting new therapies targeting APOL1-associated kidney disease are on the horizon. Learn more about Inaxaplin here:

  • Dialysis is a life-saving treatment for people whose kidneys can no longer effectively filter waste, toxins, and excess fluid from the blood. Understanding dialysis, how it works, and what to expect can help you feel more confident and prepared if you or a loved one needs this treatment.

    • Dialysis is a medical procedure replicating some of the functions of the kidneys. When the kidneys cannot remove waste products, extra fluid, and toxins from the blood, dialysis helps. It also helps balance electrolytes, control blood pressure, and remove excess fluid, which can build up when kidney function is impaired.

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      While dialysis is not a cure for kidney disease, it can significantly improve the quality of life and extend survival in people with kidney failure.

    • Dialysis is typically recommended when kidney function declines to less than 10-15% of normal. This stage is known as end-stage kidney disease (ESKD) or kidney failure. However, dialysis may also be needed temporarily in cases of acute kidney injury (AKI), a sudden loss of kidney function due to illness, injury, or certain medications.

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      Your healthcare team will monitor your kidney function through tests such as:

      • eGFR (Estimated Glomerular Filtration Rate): A measure of how well your kidneys filter blood.

      • Creatinine and BUN (Blood Urea Nitrogen) levels: High levels indicate that waste products are building up in your blood.

      Common symptoms that may indicate the need for dialysis include:

      • Severe fatigue

      • Swelling in the legs, ankles, and face (edema)

      • Nausea and vomiting

      • Shortness of breath

      • Difficulty concentrating or confusion

    • There are two main types of dialysis: hemodialysis and peritoneal dialysis. Each type has its benefits and challenges, and the right choice depends on your medical condition, lifestyle, and personal preferences.

       

      1. Hemodialysis

      Hemodialysis involves using a machine to filter blood outside the body. The blood is cleaned in a dialyzer (artificial kidney) and then returned to the body.

      • How it works: A vascular access point (fistula, graft, or catheter) allows blood to flow out of your body and into the dialysis machine. The machine removes waste, toxins, and extra fluid from the blood before returning it to your body.

      • Frequency: Typically, hemodialysis is performed thrice a week, lasting 3-5 hours each session. However, some patients may opt for more frequent or shorter sessions at home.

      • Where it’s done:

        • In-center hemodialysis: Performed at a dialysis clinic by nurses and technicians

        • Home hemodialysis: Done at home by patient and their caregiver themselves after proper training and equipment, offering greater flexibility.

      • Pros:

        • High efficiency in removing waste and fluid.

        • Mostly performedin a center by nurses and technicians.

        • Available in many healthcare facilities.

      • Cons:

        • Requires regular visits to a dialysis center (if in-center).

        • It can cause fatigue, low blood pressure, and muscle cramps.

        • Risk of infection at the access site.

        • Dietary limitations as dialysis is done every other day

      ​

      2. Peritoneal Dialysis (PD)

      Peritoneal dialysis uses the lining of your abdomen (peritoneum) as a natural filter. A special fluid (dialysate) is introduced into your abdominal cavity to absorb waste and excess fluid.

      • How it works: A catheter is surgically placed into your abdomen. Dialysate is introduced into the abdominal cavity, absorbing waste and toxins. After a few hours, the fluid is drained and replaced with fresh dialysate.

      • Types of PD:

        • Continuous Ambulatory Peritoneal Dialysis (CAPD): Done manually 4-5 times daily.

        • Automated Peritoneal Dialysis (APD): Done at night using a machine while you sleep.

      • Pros:

        • It can be done at home, offering more flexibility and independence.

        • No needles are required.

        • It is gentler on the body than hemodialysis.

      • Cons:

        • Requires strict hygiene to prevent infection (peritonitis).

        • It may not suit everyone, especially those with prior abdominal surgery.

        • Hernias can occur requiring surgery .

    • In some cases, patients may be eligible for specialized dialysis options, such as:

      1. Nocturnal Hemodialysis: A longer, slower form of hemodialysis done overnight while you sleep, either at home or in a center.

      2. Daily Hemodialysis: Shorter, more frequent sessions that can improve quality of life and reduce side effects.

    • Dialysis requires significant lifestyle adjustments, but with proper planning and support, many patients can continue to work, travel, and enjoy life.

      ​

      Diet and Nutrition

      Dialysis patients must follow a special diet to manage fluid intake and prevent complications. Key dietary considerations include:

      • Limiting sodium, potassium, and phosphorus: These minerals can build up in the blood and cause problems.

      • Controlling fluid intake: Too much fluid can lead to swelling and high blood pressure.

      • Getting enough protein: Dialysis removes protein, so you may need to eat more high-quality protein sources.

      Your healthcare team, including a dietitian, will help create a personalized meal plan.

       

      Exercise and Activity

      Staying active can help improve overall well-being and reduce some side effects of dialysis. Light activities like walking, stretching, or yoga can be beneficial, but always consult your doctor before starting a new exercise routine.

       

      Emotional Health

      Starting dialysis can be emotionally challenging. It’s normal to feel anxious or depressed. Seeking support from counselors, social workers, or support groups can help you cope with these feelings.

      1. Infections: Proper care of the access site is crucial to prevent infections.

      2. Low Blood Pressure: Removing too much fluid during hemodialysis can cause low blood pressure, leading to dizziness and fatigue.

      3. Muscle Cramps: Some patients experience cramps during hemodialysis.

      4. Peritonitis: A potential complication of peritoneal dialysis caused by infection of the peritoneum.

      5. Hernias: Increased abdominal pressure from peritoneal dialysis can lead to hernias.

      1. Which type of dialysis is best for me?

      2. How will dialysis affect my daily life and activities?

      3. What side effects should I expect, and how can I manage them?

      4. How should I care for my dialysis access point?

      5. Are there any support groups or resources available for dialysis patients?

      6. Can I travel while on dialysis?

    • Dialysis is a crucial treatment for managing kidney failure and maintaining quality of life. While it requires lifestyle changes, many patients continue to lead fulfilling lives with proper care and support. Understanding your options and working closely with your healthcare team can help you make informed decisions and adapt to life on dialysis.

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      If you’re considering or starting dialysis, don’t hesitate to contact your healthcare providers for guidance and support.

  • A kidney transplant is often the best treatment option for people with end-stage kidney disease (ESKD). Unlike dialysis, a transplant can restore normal kidney function, improve quality of life, and increase life expectancy.

    • A kidney transplant involves surgically placing a healthy kidney from a donor into a person whose kidneys no longer function properly. The new kidney filters waste, balances fluids and produces important hormones to keep you healthy.

      ​

      People with ESKD who receive a transplant may experience significant improvements in energy levels, fewer dietary restrictions, and the ability to return to a more normal lifestyle.

    • A kidney transplant is recommended when:

      • Your kidney function has declined to less than 10-15% of normal.

      • You have been diagnosed with chronic kidney disease (CKD) that is progressing toward kidney failure.

      • Dialysis is no longer a sustainable or preferred treatment option.

      ​

      Your healthcare team will assess your overall health, medical history, and lifestyle to determine if you are a good candidate for a transplant.

    • To be eligible for a kidney transplant, you need to meet certain criteria:

      1. Good overall health: Conditions like cancer, severe heart disease, or infections may disqualify you from being a candidate until they are treated.

      2. No active infections: Infections can pose a serious risk after surgery due to immunosuppressive medications.

      3. Ability to manage post-transplant care: This includes taking medications as prescribed and attending regular follow-up appointments.

      4. Psychological readiness: Undergoing a transplant is a significant life change, so emotional and mental health is important.

      ​

      Your healthcare team will perform a series of tests, including:

      • Blood tests: To check for infections, blood type, and tissue matching.

      • Heart and lung evaluations: To ensure your body can handle the surgery.

      • Cancer screenings: To rule out any undiagnosed malignancies.

    • 1. Living Donors

      A living donor is someone who donates one of their kidneys. Because people can live a healthy life with just one kidney, a living donation is a viable and often preferred option.

      • Who can be a living donor?

        • Family members (siblings, parents, children)

        • Close friends

        • Unrelated donors (altruistic donors)

      • Benefits of living donation:

        • Shorter wait time.

        • Better long-term outcomes for the recipient.

        • The surgery can be planned in advance.

       

      2. Deceased Donors

      A deceased donor is someone who has died, typically due to an accident or illness, and has donated their organs.

      • How does it work?

        • The kidney is harvested from the donor and matched to a recipient on the waiting list based on factors such as blood type, tissue compatibility, and wait time.

        • Depending on availability and compatibility, recipients may wait months or years for a deceased donor kidney.

    • 1. Pre-Transplant Evaluation

      Before being placed on the transplant list, you will undergo a comprehensive evaluation, including:

      • Medical history review

      • Blood and tissue typing

      • Imaging tests (e.g., ultrasound, CT scan)

      • Psychological assessment

       

      2. Getting on the Transplant List

      Once approved, you will be placed on a national transplant waiting list managed by organizations such as the United Network for Organ Sharing (UNOS) in the United States. Your position on the list is determined by:

      • Blood type

      • Tissue match

      • Waiting time

      • Overall health condition

       

      3. Finding a Match

      Matching involves ensuring compatibility between the donor and recipient. The main factors include:

      • Blood type: The donor and recipient must have compatible blood types.

      • HLA (Human Leukocyte Antigen) matching: Better matches reduce the risk of rejection.

      • Crossmatch test: This checks for harmful antibodies in the recipient's blood that may attack the donor's kidney.

       

      4. The Transplant Surgery

      • The surgery typically takes 3-4 hours.

      • The new kidney is placed in the lower abdomen, and the blood vessels and ureter are connected.

      • Your own kidneys are usually left in place unless they are causing complications (e.g., infection, high blood pressure).

    • Medications
      After a transplant, you will need to take medications for the rest of your life to prevent your body from rejecting the new kidney. These include:

      1. Immunosuppressants: These drugs suppress your immune system, preventing it from attacking the new kidney.

      2. Antibiotics and antifungals: To prevent infections.

      3. Blood pressure medications: High blood pressure is common after a transplant.

       
      It is crucial to take medications exactly as prescribed to avoid rejection and other complications.
       
      Regular Follow-Up Appointments
      Frequent follow-up visits are necessary to monitor your kidney function and overall health. These visits typically include:

      • Blood tests to check creatinine levels, electrolyte balance, and signs of rejection.

      • Urine tests to check for protein and other abnormalities.

      • Imaging tests as needed.

    • While kidney transplants are generally safe, complications can occur:

      1. Rejection: Your immune system may attack the new kidney. Early signs include fever, reduced urine output, and swelling.

      2. Infection: Immunosuppressive medications increase the risk of infections.

      3. Blood clots: These can occur in the blood vessels connected to the new kidney.

      4. Cancer: Long-term use of immunosuppressants slightly increases the risk of certain cancers.

    • Diet

      Post-transplant, you may have fewer dietary restrictions than when on dialysis, but it's still important to:

      • Eat a balanced diet rich in fruits, vegetables, and lean protein.

      • Limit salt to help control blood pressure.

      • Avoid foods that may interact with your medications (e.g., grapefruit).

       

      Exercise

      Staying active can help improve your overall health and reduce the risk of complications. Light to moderate exercise, such as walking or swimming, is generally recommended.

       

      Emotional Well-Being

      Adjusting to life after a transplant can be emotionally challenging. Support groups, counseling, and talking to others who have undergone a transplant can help.

      1. Am I a good candidate for a kidney transplant?

      2. What are the risks and benefits of a transplant compared to dialysis?

      3. How long is the wait time for a donor's kidney?

      4. Will my kidney disease recur in transplanted kidney?

      5. What lifestyle changes will I need to make after the transplant?

      6. How will I know if my body is rejecting the new kidney?

    • A kidney transplant can offer a new lease on life for people with end-stage kidney disease. While it involves a significant commitment to post-transplant care and lifestyle changes, many patients experience improved quality of life. If you are considering a kidney transplant, working closely with your healthcare team and staying informed can help you make the best decisions for your health.

    • When managing kidney disease, your diet is crucial in preserving kidney function and preventing further damage. A kidney-friendly diet helps control the levels of waste, fluids, and electrolytes in your body, making it easier for your kidneys to function. 

      • Your kidneys filter waste and maintain the balance of nutrients in your blood. When your kidneys are impaired, certain foods can cause waste or toxins to build up, leading to complications. Adopting a kidney-friendly diet helps:

        • Reduce the workload on your kidneys.

        • Control blood pressure and blood sugar.

        • Prevent complications like swelling, high potassium levels, or weak bones.

      • 1. Limit Sodium (Salt)

        Excess sodium can increase blood pressure, cause fluid retention, and strain your kidneys.

        • Aim for less than 2,300 mg of sodium per day.

        • Avoid processed foods like canned soups, frozen meals, and salty snacks.

        • Use herbs, spices, or lemon juice as salt substitutes to flavor your food.

         

        2. Control Potassium Intake

        High potassium levels can lead to dangerous heart rhythms if your kidneys can't remove potassium effectively.

        • Avoid high-potassium foods: Bananas, oranges, potatoes, tomatoes, spinach, and avocados.

        • Opt for low-potassium alternatives: Apples, berries, carrots, cabbage, and white bread.

        • Soak vegetables in water before cooking to reduce potassium content.

         

        3. Manage Phosphorus Levels

        Too much phosphorus can weaken your bones and lead to calcium deposits in your blood vessels.

        • Avoid high-phosphorus foods: Dairy products, processed meats, nuts, seeds, and dark-colored sodas.

        • Choose phosphorus-free alternatives: Almond milk, fresh chicken, and fresh or frozen vegetables.

        • Take phosphate binders if prescribed by your doctor.

         

        4. Balance Protein Intake

        Your body needs protein, but too much can produce waste that your kidneys must filter.

        • Focus on high-quality proteins: Lean meats, fish, eggs, tofu, and low-fat dairy (if allowed).

        • Adjust portion sizes based on your stage of kidney disease and consult your dietitian.

         

        5. Monitor Fluid Intake

        Managing fluid intake is essential if you experience swelling or are on dialysis.

        • Follow your doctor's recommendations for daily fluid limits.

        • Limit high-water-content foods like soups, watermelon, and gelatin if needed.

        • Use small sips and ice chips to quench your thirst without overhydrating.

         

        6. Avoid Processed and Packaged Foods

        Packaged foods are often high in sodium, phosphorus, and preservatives.

        • Check food labels for sodium and phosphorus content.

        • Opt for fresh, homemade meals whenever possible.

      • Create a Weekly Meal Plan

        • Plan meals that incorporate low-sodium, low-potassium, and low-phosphorus ingredients.

        • Prepare meals in advance to avoid relying on processed foods.

         

        Work with a Dietitian

        • A dietitian can create a personalized meal plan based on your stage of kidney disease and other health conditions.

        • They can help identify safe substitutes for your favorite foods.

         

        Read Labels Carefully

        • Look for "low sodium," "no added phosphorus," or "reduced potassium" on food labels.

        • Be cautious of hidden phosphorus listed as "phosphate" in ingredients.

      • Foods to Enjoy

        • Low-potassium fruits: Apples, grapes, cherries, and berries.

        • Vegetables: Cauliflower, green beans, and bell peppers.

        • Proteins: Chicken, fish, eggs, and tofu.

        • Grains: White rice, pasta, and white bread.

         
        Foods to Avoid

        • High-sodium items: Canned soups, chips, and processed meats.

        • High-potassium foods: Bananas, potatoes, and spinach.

        • High-phosphorus items: Cheese, nuts, and colas.

      • 1. Can I still eat out at restaurants?

        Yes, but choose wisely:

        • Ask for sauces and dressings on the side.

        • Avoid fried or heavily seasoned dishes.

        • Opt for grilled meats and steamed vegetables.

         

        2. Do I need to cut out potassium, sodium, or phosphorus completely?

        Not entirely. It's about moderation and choosing low-content alternatives.

         

        3. Can I drink coffee or tea?

        Yes, but limit creamers and choose unsweetened options. Check phosphorus levels in flavored beverages.

      • Following a kidney-friendly diet is an essential step in managing kidney disease. However, the limitations will depend on the stage of your kidney disease. So, recommend discussing with your medical team about the dietary changes that you need to make. Limiting sodium, potassium, and phosphorus while balancing protein intake and staying hydrated can reduce the strain on your kidneys and improve your overall health.

         

        Work with your healthcare team and dietitian to tailor your diet to your needs. Small dietary changes can significantly affect your kidney health and quality of life.

    • Staying active is essential to managing kidney disease. Regular physical activity can improve overall health, reduce symptoms, and slow the progression of kidney damage. This guide provides practical advice on incorporating exercise into your routine safely and effectively.

      • Exercise offers a wide range of benefits for kidney disease patients, including:

        • Improved cardiovascular health: Reduces the risk of heart disease, which is common in kidney disease patients.

        • Better blood pressure control: Helps lower and stabilize blood pressure levels.

        • Improved muscle strength: Enhances physical function and energy levels.

        • Weight management: Supports a healthy weight to reduce strain on your kidneys.

        • Enhanced mood: Reduces stress, anxiety, and depression.

        • Better blood sugar control: Essential for patients with diabetes, a leading cause of kidney disease.

      • The type and intensity of exercise you choose should depend on your health condition, stage of kidney disease, and doctor’s recommendations. Safe and practical exercises include:

         

        1. Aerobic Exercise

        • Examples: Walking, swimming, cycling, dancing.

        • Benefits: Improves heart health and helps maintain a healthy weight.

        • Goal: Start with 10-15 minutes per session and gradually increase to 30 minutes, 5 days a week.

         

        2. Strength Training

        • Examples: Light weightlifting, resistance bands, bodyweight exercises (e.g., squats, wall push-ups).

        • Benefits: Builds muscle strength and endurance.

        • Goal: Include 2-3 weekly sessions focusing on major muscle groups.

         

        3. Stretching and Flexibility

        • Examples: Yoga, Pilates, and simple stretching routines.

        • Benefits: Increases the range of motion, reduces stiffness, and improves balance.

        • Goal: Stretch daily or include a flexibility session after aerobic exercise.

         

        4. Low-Impact Activities

        • Examples: Tai chi, water aerobics.

        • Benefits: Gentle on joints and suitable for people with mobility issues.

      • 1. Start Slowly

        • If you’re new to exercise, begin with short, light sessions (5-10 minutes) and gradually increase intensity and duration.

        • Listen to your body and rest if you feel fatigued or short of breath.

         

        2. Stay Hydrated

        • Drink water before and after exercise, but follow your doctor’s guidance if you are on fluid restrictions.

         

        3. Monitor Your Symptoms

        • Stop exercising and contact your doctor if you experience:

          • Dizziness or lightheadedness.

          • Chest pain or tightness.

          • Severe shortness of breath.

          • Swelling or cramping in your legs.

         

        4. Adjust for Dialysis

        • If you are on dialysis, plan your exercise sessions around your treatments.

        • Light activities such as walking or stretching can be done on dialysis days to improve circulation and energy levels.

         

        5. Work with a Professional

        • Consider working with a physical therapist or exercise trainer experienced in managing kidney disease patients. They can create a safe, personalized exercise plan.

      • 1. Can I exercise if I have fatigue?

        Yes, light activities like walking or yoga can help combat fatigue. Start with small sessions and increase gradually as your energy improves.

         

        2. Is exercise safe for patients with high blood pressure?

        Yes, regular exercise helps lower blood pressure. However, avoid high-intensity workouts and consult your doctor for specific recommendations.

         

        3. How can I stay motivated?

        • Set realistic, achievable goals.

        • Exercise with a friend or join a group.

        • Track your progress and celebrate milestones.

        1. What types of exercise are safe for my condition?

        2. Are there activities I should avoid?

        3. How can I manage fatigue during exercise?

        4. Should I monitor any specific symptoms while exercising?

        5. Can I exercise on dialysis days?

      • Exercise is a powerful tool for improving your health and quality of life while living with kidney disease. By incorporating safe, low-impact activities into your routine, you can manage symptoms, enhance physical fitness, and protect your kidneys.

         

        Always consult your healthcare provider before starting a new exercise program to ensure it aligns with your health needs. Small, consistent steps can lead to significant improvements in your overall well-being.

    • For patients with kidney disease, managing fluid intake is critical to maintaining balance and preventing complications like swelling, high blood pressure, and heart strain.

      • When your kidneys are not functioning correctly, they struggle to remove excess fluid from your body. This can lead to fluid buildup, which may cause:

        • Swelling (edema) in the legs, ankles, and face.

        • High blood pressure.

        • Shortness of breath due to fluid in the lungs.

        • Increased strain on the heart.

        By managing your fluid intake, you can help reduce these risks and maintain better overall health.

      • The amount of fluid you need depends on:

        • Your stage of kidney disease.

        • Whether you are on dialysis.

        • Your urine output.

         

        Your healthcare provider will give you a personalized recommendation, but standard guidelines include the following:

        • Chronic Kidney Disease (CKD): Moderate fluid intake based on symptoms and labs.

        • Dialysis Patients: They are typically limited to 32-48 ounces (1-1.5 liters) per day, including all fluids and foods with high water content.

      • 1. Track Your Fluid Intake

        • Use a journal or app to record how much fluid you drink daily.

        • Remember to include fluids from all sources, such as soups, ice cream, and popsicles.

         

        2. Choose the Right Beverages

        • Best choices: Water, unsweetened teas, and small amounts of coffee (if your doctor approves).

        • Avoid: Sugary drinks, sodas, and beverages high in phosphorus or potassium.

         

        3. Limit High-Water-Content Foods

        Some foods contribute significantly to your fluid intake. Be mindful of:

        • Fruits: Watermelon, oranges, and grapes.

        • Vegetables: Cucumbers, celery, and lettuce.

        • Soups and broths.

         

        4. Control Thirst

        Managing thirst is key when limiting fluid intake. Try these strategies:

        • Sip, don’t gulp: Take small sips of water throughout the day.

        • Chew ice chips: They provide relief without adding too much fluid.

        • Use frozen fruits: Such as grapes or berries, for a refreshing treat.

        • Rinse your mouth: Swishing water or sucking on sugar-free mints can reduce dry mouth.

        • Stay cool: Avoid overheating to reduce thirst.

         

        5. Use Smaller Cups

        Drink from smaller glasses or cups to control portion sizes without feeling deprived.

      • Too Much Fluid

        • Swelling in your legs, ankles, or face.

        • Sudden weight gain.

        • Difficulty breathing or shortness of breath.

         

        Too Little Fluid

        • Dry mouth and skin.

        • Dizziness or fatigue.

        ​

        Report any of these symptoms to your healthcare provider for further evaluation.

      • Dialysis patients have unique needs for fluid management because the treatment removes excess fluid. However, drinking too much between sessions can lead to complications, such as:

        • Excessive weight gain between treatments.

        • Cramping or low blood pressure during dialysis.

         

        Tips for Dialysis Patients

        • Stick to your daily fluid allowance as prescribed by your doctor.

        • Monitor your weight daily to track fluid retention.

        • Avoid salty foods, which can make you thirsty.

        1. How much fluid should I drink each day?

        2. Are there specific beverages I should avoid?

        3. How can I tell if I’m retaining too much fluid?

        4. What can I do to manage my thirst more effectively?

        5. How does my fluid intake affect my lab results?

      • Managing fluid intake is an essential part of living with kidney disease. You can reduce complications and feel more comfortable by monitoring your fluid consumption, choosing the right foods and beverages, and working closely with your healthcare team.

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