The treatment of chronic kidney disease is based on three basic pillars:
The treatment employed will depend on the degree of chronic kidney disease.
In early stages it is important to:
Control blood pressure
Monitor sugar intake, especially in people with diabetes
Control blood lipid levels
Manage protein, salt, fluid, potassium and phosphorus intake to avoid overloading the now reduced level of kidney function
If the condition progresses to what is known as stage V or end-stage kidney disease, then replacement therapy must be considered, whether it is a kidney transplant, dialysis or conservative medical treatment.
The patient is always the person who decides, with help from the medical team, how to manage their disease. The type of treatment should be chosen after receiving detailed information about each option to ensure the most suitable one is selected with respect to the patient’s lifestyle, preferences and overall health.
The first decision involves the choice between treatments that fulfil some renal functions (renal replacement therapy) or treatments that manage the symptoms of kidney disease (conservative treatment).
During a transplant the patient receives a donor kidney that will cover the loss of function due to their kidney failure.
There are two types of kidney transplant depending on the origin of the donor kidney:
Living-donor kidney transplant. In such cases the donors are usually the patient’s relatives: a spouse, parents, siblings or somebody close to the family. The advantage of this type of transplant is that it can be carried out in very advanced stages of kidney disease, maybe without even having to start dialysis.
Deceased-donor kidney transplant. In this case the kidney is taken from a dead person and the recipient will normally be administered dialysis for a certain period, which varies according to the patient’s clinical characteristics, blood group and age, before receiving the transplant. Patients are placed on a waiting list so they may receive a kidney that best matches their characteristics as soon as one becomes available.
Chronic kidney disease patients undergo exhaustive assessments before receiving a transplant to rule out any medical conditions that would contraindicate the procedure. It is important to remember that 45 in 100 people (45%) cannot receive a kidney transplant for medical reasons.
Approximately 33 in every 100 people receiving dialysis are on a transplant waiting list. Of these 33 patients, about 15 will actually receive a transplant.
Kidney transplant recipients must follow a strict, lifelong treatment to prevent kidney rejection (immunosuppressive therapy) and attend regular appointments at transplant clinics to confirm the kidney is working correctly and to adjust their medication according to test results.
Transplanted kidneys do not always fulfil their function. On average, 15 years after the transplant, kidneys taken from deceased donors still work in 50 out of every 100 recipients (50%). Whereas kidneys taken from living donors are still functioning correctly at 15 years post-transplant in 60 per 100 individuals (60%). If the transplanted kidney fails, then the recipient must decide between another transplant, dialysis or conservative treatment.
ñón de un donante vivo, el riñón trasplantado funciona un promedio de 15 años. Las personas que sufren un fallo del riñón trasplantado deben decidir entre recibir otro trasplante, someterse a diálisis o a un tratamiento conservador.
Dialysis is a procedure used to replace some of the lost kidney function. Patients receive a combination of dialysis and other medicines, such as erythropoietin and vitamin D, to compensate for the reduction in kidney function.
Conservative treatment is intended to treat the symptoms of end-stage kidney disease through a strategy that involves drugs, lifestyle changes and other treatments.
In other words, with this type of treatment there is no attempt to replace renal function, there is no dialysis and the patient’s damaged kidneys continue to deteriorate. This treatment approach means the kidneys will continue functioning for as long as the actual kidney disease allows them to.
Conservative treatment must only be selected after reaching a consensus with the patient and their family.
Patients who are offered conservative treatment instead of renal replacement therapy also present other medical problems or are in poor health due to certain situations, such as to be a person an elderly age; suffer severe or seriously incapacitating diseases with a poor prognosis; or to have a relatively short life expectancy.
Under these circumstances some individuals may consider the disease managing benefits of dialysis do not outweigh the effort required by the procedures involved.
Several studies have shown that dialysis does not improve the prognosis for patients with these characteristics, whereas conservative treatment can improve their quality of life in the sense that it offers greater control over hospital admissions; there are less visits to accident and emergency departments due to complications; and there are no invasive procedures requiring a venous puncture or catheter placement, etc.