Chronic kidney disease is a disease that must be managed in close consultation with your healthcare provider. Self-treatment is not appropriate.

• There are, however, several important dietary rules you can follow to help slow the progression of your kidney disease and decrease the likelihood of complications.
• This is a complex process and must be individualized, generally with the help of your healthcare provider and a registered dietitian.

Chronic kidney disease can not be cured. The four goals of therapy are as follows:

1. To slow the progression of disease

2. To treat underlying causes and contributing factors

3. To treat complications of disease

4. To replace lost kidney function

Strategies for slowing progression and treating conditions underlying chronic kidney disease include the following:

• Control of high blood pressure: This also slows progression of chronic kidney disease. It is recommended to keep your blood pressure below 130/80 mm Hg if you have kidney disease. It is often useful to monitor blood pressure at home. Blood pressure medications known as angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) have special benefit in protecting the kidneys.
• Control of blood glucose: Maintaining good control of diabetes is critical. People with diabetes who do not control their blood glucose have a much higher risk of all complications of diabetes, including chronic kidney disease.
• Diet: Diet control is essential to slowing progression of chronic kidney disease and should be done in close consultation with your health care provider and a dietitian.

The following are general dietary guidelines:

• Protein restriction: Decreasing protein intake may slow the progression of chronic kidney disease. A dietitian can help you determine the appropriate amount of protein for you.
• Salt restriction: Limit to 4-6 grams a day to avoid fluid retention and help control high blood pressure.
• Fluid intake: Excessive water intake does not help prevent kidney disease. In fact, your doctor may recommend restriction of water intake.
• Potassium restriction: This is necessary in advanced kidney disease because the kidneys are unable to remove potassium. High levels of potassium can cause abnormal heart rhythms. Examples of foods high in potassium include bananas, oranges, nuts, and potatoes.
• Phosphorus restriction: Decreasing phosphorus intake is recommended to protect bones. Eggs, beans, cola drinks, and dairy products are examples of foods high in phosphorus.

Other important measures that you can take include:

• Carefully follow prescribed regimens to control your blood pressure and/or diabetes.
• Stop smoking
• Lose excess weight

In chronic kidney disease, several medications can be toxic to the kidneys and may need to be avoided or given in adjusted doses. Among over-the-counter medications, the following need to be avoided or used with caution:

• Certain analgesics - Aspirin; nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen [Motrin, for example])
• Fleets or phosphosoda enemas because of their high content of phosphorus
• Laxatives and antacids containing magnesium and aluminum such as Milk of Magnesia and Mylanta
• Ulcer medication H2-receptor antagonists - cimetidine (Tagamet), ranitidine (Zantac), (decreased dosage with kidney disease)
• Decongestants like pseudoephedrine (Sudafed) especially if you have high blood pressure
• Alka Seltzer, since this contains a lot of salt
• Herbal medications

If you have a condition such as diabetes, high blood pressure, or high cholesterol underlying your chronic kidney disease, take all medications as directed and see your healthcare provider as recommended for follow-up and monitoring.

The complications of chronic kidney disease that may require medical treatment are:

• Anemia can be treated with erythropoiesis stimulating agents. Erythropoiesis stimulating agents are a group of drugs that replace the deficiency of erythropoietin, which is normally produced by healthy kidneys. Often, patients treated with such drugs require either to take iron by mouth or sometimes even intravenously.
• Fluid retention can be treated with any of a number of diuretic medications, which remove excess water from the body. However, these drugs are not suitable for all patients.
• Bone disease develops in patients due to an inability to excrete phosphorus and a failure to form activated Vitamin D. In such circumstances, your physician may prescribe drugs binding phosphorus in the gut, and may prescribe active forms of vitamin D.
• Acidosis may develop with kidney disease. The acidosis may cause breakdown of proteins, inflammation and bone disease. If the acidosis is significant, your doctor may use drugs such as sodium bicarbonate (baking soda) to correct the problem.

In end-stage renal disease, kidney functions can be replaced only by dialysis or by kidney transplantation. See the Transplant section for more information about transplants.