There are 5 Helpful Things to know if you have failing kidneys. Kidney failure can be terrifying emotionally and physically but being aware and prepared can help ensure that you have the best possible outcome. You are not alone: there is an entire community of people with chronic kidney disease (CKD): more than 37 million Americans COD. There are helpful resources including people just like you who have experienced what you are going through and are very supportive. We will provide links further below.
The information below will help to give you a perspective of what to expect and resources to help you navigate the days to come. You should always be in contact with your doctor and healthcare team because your doctor’s advice takes precedence as he or she has details that no one else is privy to. This list is not everything you need to know but it is a good start.
The 5 Helpful Things to Know if You Have Failing Kidneys
The 5 Helpful Things to know if you have failing kidneys are crucial to help your understanding of your current status, what to do to help protect your health, and help ensure the best possible outcome.
- Your Doctor’s Instructions: Follow your doctors’ instructions
- Know the stage of your kidney disease, the cause and what to avoid
- Food: Know what not to eat: Learn more about Salt, Potassium, Phosphorus, Water, & Protein
- Treatment: Know your options for treatment
- Know that some of your medicines may need to be adjusted & accompanying tests are important
Know Your Doctor’s Instructions
It is very important to know your doctor’s instructions. One of the 5 helpful things to know If you have failing kidneys, is that your doctor will make detailed plans for your future treatment which include:
- Careful monitoring of your lab test results
- Careful monitoring of your blood pressure
- Careful monitoring of your medications and the need for changes whenever necessary
- Referrals for procedures to prepare you for the treatment options which are listed further below.
It is very important to keep all the paperwork your doctor provides that contains these instructions because some of the preparation will require multiple steps and time. If you are not aware of your doctor’s instructions or if you do not understand your doctor’s instructions, do not hesitate to ask for clarification and repetition, because missing steps, or not following instructions can result in serious consequences.
For example, if your doctor requests a blood test to check the potassium level in your blood because that level was high: it is important to do that test. If your doctor instructs you to stop taking a particular medication for example lisinopril or losartan or spironolactone due to a high blood potassium level and instructs you to stop eating foods that are high in potassium like potato chips, tomatoes, coconut water etcetera: you should follow the instructions. If You have failing kidneys and you do not follow the instructions, your potassium level can become even higher and cause an emergency that can be life threatening.
Similarly, if you do not follow your doctor’s instructions necessary for the preparation of your treatment, then you can end up with an emergency, unplanned dialysis start in order to preserve your life. An emergency, unplanned dialysis start, sometimes referred to as “crashing into dialysis,” is associated with a greater risk of death, infection, or other consequences that can result in serious disability.
Therefore, one of the 5 helpful things to know if you have failing kidneys is that you must follow your doctor’s instructions.
Know The Stage of Your Kidney Disease, The Cause of Your Kidney Disease & What to Avoid
Advanced chronic kidney disease (CKD) is defined as CKD stages 4 and 5. The earlier stages of chronic kidney disease (CKD Stages 1, 2, 3A & 3B) tend to be silent meaning there are no symptoms. However, at CKD stages 4 and 5 subtle symptoms begin and start to progress depending on many factors including blood pressure, diet and medications.
The GFR levels in advanced chronic kidney disease are as follows:
- CKD Stage 4: 15-29
- CKD Stage 5: <15
At these stages, attention to details become significantly more important. These details include those regarding:
- Appropriate dosing of medications to match the lower level of kidney function
- Attention to the diet because at these levels the kidneys are less able to efficiently handle sodium and potassium. Failing kidneys are also less able to regulate phosphorus. The effects of salt are sodium tend to be more noticeable on the blood pressure and swelling. the kidneys are also less able to eliminate potassium so that closer monitoring is necessary for the blood potassium levels which will become more sensitive especially when certain medications are being taken.
- Additional monitoring with some medications and the possibility of needing to discontinue some medicines based on the kidney function, potassium level and other factors. For example regarding the medication Fenofibrate (otherwise known as Lofibra, Tricor, Fenoglide, Antaraor Triglide), both the manufacturer and the FDA both state that at GFR less than 30 the medication is contraindicated (should not be taken). Other medications like Metformin should also be avoided if you have CKD stage 4 or stage 5.
Know the cause of your kidney disease to help you understand how to best protect your kidneys. For example, if your kidney disease was caused by one of the two leading causes: diabetes or hypertension (high blood pressure), then you should make a special effort to control your diabetes and high blood pressure.
Know what to avoid in terms of over-the-counter medications and salty foods. There are certain medications that can harm your kidneys, and many are available without a prescription. Learn more about medications that can harm your kidneys by visiting this helpful page by the National Kidney Foundation and by checking out our helpful list.
Regarding salty foods: a high salt intake increases the rate of progression or the rate of worsening of chronic kidney disease.
Food: Know What Not to Eat: Learn about Salt, Potassium, Phosphorus, Protein & Water
In advanced chronic kidney disease (CKD), your kidneys are not capable of performing their functions normally. Therefore the 5 Helpful things to know if you have failing kidneys have a lot to do with learning about salt (or sodium), potassium, phosphorus and water.
When you have failing kidneys your body becomes more sensitive to sodium, potassium, phosphorus and water because your kidneys are not able to balance nor eliminate these from your body as the normally would. Sodium, potassium, and phosphorus are present in foods in varying quantities depending on the food you eat. Therefore, if you consume foods that have very high amounts and your kidneys cannot get rid of the high amounts (because the kidneys are failing), then they will remain in your body and cause harmful effects. You must therefore be very careful in reading food labels and adjusting your portion sizes to ensure that you do not exceed the amount recommended by your doctor.
It is very important to speak with your doctor about the amounts that you are allowed to eat. For example, in a person with chronic kidney disease stage five (5), the managing nephrologist (kidney doctor) may give dietary instructions you to limit intake as follows:
Sodium: 2000mg or 2g per day
Potassium: 2000mg or 2g per day
Phosphorus: 1000mg or 1 g per day
Fluid: 2000ml or 2 Liters per day
Protein: 0.8g per kg per day: For example if you weigh 80kg (176 pounds): your maximum protein intake should be 64 grams for the day.
Visit our nutrition pages for more information and links to helpful resources.
Treatment Options: Know Your Options
Unfortunately, kidney failure is ultimately fatal if not treated. It is therefore very important to know the treatment options. The kidneys have a great deal of responsibility including:
- Fluid balance in your body that impacts the blood pressure and our ability to breathe comfortably. When the kidneys have failed they are no longer able to produce urine that removes excess fluid from the body. One of the consequences of kidney failure is therefore accumulation of fluid in the lungs, High blood pressure that is difficult to control and swelling of the extremities. When fluid accumulates in the lungs it manifests as shortness of breath and difficulty breathing. When fluid accumulates in the extremities you may notice that your feet and legs are swollen and that your shoes become uncomfortable or do not fit anymore; Also rings may not fit as easily anymore.
- Regulating potassium which helps to ensure that all of our cells function optimally: in kidney failure potassium cannot be removed from the body efficiently and so the levels in the blood can rise resulting in potentially catastrophic effects on the heart.
- Getting rid of toxins: your kidneys are usually tasked with getting rid of toxins and therefore when they are failing, those toxins accumulate and can manifest as tiredness, drowsiness, sleepiness, nausea, vomiting, a weird metallic taste in the mouth and other manifestations.
Therefore, if you have failing kidneys you will need treatment in order to be comfortable and live longer. The three treatment options are:
- Dialysis: there are two types of dialysis
- Kidney transplantation: subject to eligibility
- Conservative care: No treatment except medications and dietary interventions with the understanding that the ultimate outcome is death. This option may be selected by some patients with other medical conditions and factors that may result in complications or increased risk of poor outcome if dialysis is done.
Dr Mike Evans’ Video Explains the Options very well! You should check out His Youtube Channel DocMikeEvans for this and other very helpful, constructive health topics.
Know That Some of Your Medicines May Need to be Adjusted or Monitored: Pay Special Attention to Your Doctor’s Instructions
Among the 5 Helpful Things to know if you have failing kidneys, is that it is crucial to know that some of your medicines may need to be adjusted or monitored.
The kidneys are awesome organs that have multiple functions and among those functions is the ability to help your body eliminate medications, metabolites of medications, and toxins. Failing kidneys are not able to do a very good job of eliminating medications, their metabolites or toxins and consequently, if some medication doses are not decreased Exaggeration of the adverse effects or harm can result.
For example, the medication Baclofen that is usually used for muscle spasms with only mild side effects, if given at the same dose to someone with advanced chronic kidney disease, for example, stage 5: can result in altered mental status, unconsciousness or even the appearance of a coma.
There are therefore many medications that have to be specially monitored or dose adjusted if you have failing kidneys. This is referred to as “renal dosing” according to your unique kidney function numbers that you’re a doctor will obtain from your lab test results.
It is therefore very important to comply with your doctor’s instructions in a timely fashion. Your blood tests from three months ago may not necessarily give an accurate representation of the level of function of your failing kidneys on today’s date. Please visit or page dedicated to medications in kidney disease For more information and additional links to resources.
Support
You are not alone. Chronic kidney disease (CKD) can be difficult to accept and navigate. There are resources available for help. In addition to the available resources, sometimes it is helpful to have a partner like a close friend, spouse, or family member who can be a reliable source of support and help along your journey. There is a community of people just like you who have been through the challenges of kidney disease and navigated the complicated medical system: The American Association of Kidney Patients (AAKP) and they have created many helpful resources: click here to learn more. Check out the AAKP nutrition counter in English & Spanish: They are free to download and contain a helpful alphabetical list of everyday foods and meals with their kidney-specific nutrition facts listed and other helpful information.
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The content on this webpage: 5 Helpful Things to know if you have failing kidneys, and this website is for information to help you understand kidney disease in a way that increases your awareness and helps empower you to make healthy choices. The information on this page is not medical advice and does not replace your doctor’s or medical provider’s expertise nor opinion. You must discuss all aspects of your treatment with your medical provider and follow their advice as your doctor and healthcare team possess the necessary details of your unique condition.