The Basics of Chronic Kidney Disease Self-Care

Living with chronic kidney disease (CKD) can affect your life in many ways, some of them unexpected. But diagnosis isn’t destiny. There are things you can do — and lifestyle changes you can make — to protect both your kidneys and quality of life.

Nephrologist Hernán Rincón-Choles, MD, walks us through the basics of CKD self-care.

Tips for taking care of yourself with CKD

Like many chronic conditions, CKD can cause complications throughout your body and strain your mental health. Embracing CKD self-care means taking a holistic approach to your treatment plan.

What self-care really means

The term “self-care” may conjure images of bubble baths and shopping sprees, but it’s really about making lifestyle choices that benefit your physical and mental health. When you’re living with CKD, self-care means understanding your condition — and making adjustments as needed to better support your kidneys.

Food choices

Your eating habits can make a big difference in your CKD symptoms and progression, but that doesn’t mean there’s a one-size-fits-all CKD diet that works for everyone. Dr. Rincón-Choles says it’s important to tell your provider about:

• Other chronic illnesses you have
• Dietary restrictions you observe (for example, veganism or keeping kosher)
• Whether you’re trying to lose weight
• Food allergies or sensitivities

Your provider may refer you to a renal dietitian, depending on how advanced your CKD is and how complex your dietary needs are.

Medications

A CKD diagnosis often means having to add a few things to your medicine cabinet — and subtract others.

Depending on how severe your kidney disease is and your medical history, your provider may prescribe:

• Diuretics (water pills)
• Renin-angiotensin system (RAS) inhibitors
• SGLT2 inhibitors
• Blood pressure medications
• Oral diabetes medications

Dr. Rincón-Choles says your provider will likely urge you to avoid the following, whenever possible:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Cox-2 inhibitors
• Proton pump inhibitors
• IV contrast dyes

And Dr. Rincón-Choles is quick to recognize that transitioning off some of these medicines can be tough. But it’s also necessary.

“Many of these are medications that people use for many years or even decades. They’ve relied on them to help with uncomfortable symptoms,” he empathizes. “But the research shows that being on these medicines increases the risk of kidney failure.”

If you’re receiving certain forms of immunotherapy for cancer, it’s important for your nephrologist to talk to your oncologist.

“This therapy sometimes causes the immune system to attack your kidneys and other organs,” he explains. By working together, your care teams can figure out how to safely treat both conditions.

Supplements

What about supplements? Is there anything you could take to reduce your symptoms or improve your renal health?

“There are so many different supplements out there, coming from so many different sources — almost all unregulated — that there’s no way to prove they are safe,” Dr. Rincón-Choles states.

“And if they’re contaminated with harmful impurities like lead, arsenic, heavy metals or even certain types of plants, they could be toxic to your kidneys.”

In general, nephrologists urge people with CKD to avoid supplements. Check with your provider if you’re considering a supplement for any reason, even if another provider recommends it.

Other substances

When you talk to your nephrologist, it’s important to tell them everything you’re taking, even if it’s uncomfortable to talk about. Here are a few examples:

• Alcohol: In the short-term, drinking too much may cause dehydration, which is extra dangerous when you have CKD. In the long-term, excessive drinking can accelerate kidney damage. Your nephrologist can help you figure out whether you can imbibe safely.
• Medications for erectile dysfunction (ED): Whether it’s safe to take ED meds depends on many factors, including the type you’re on, your blood pressure and the severity of your CKD. You may need to switch or stop your medication to avoid complications.
• Cocaine: “Some forms of cocaine cause direct damage to the kidneys, but there are indirect effects, too,” Dr. Rincón-Choles says. “For example, taking cocaine can cause very high blood pressure, which can indirectly affect kidney function and accelerate the damage.”

Health monitoring

Tracking kidney health indicators helps you stay involved in and proactive about your CKD care. Talk to your provider about recording your:

• Weight: Obesity often co-occurs with CKD. If your weight is going up, it could indicate increased swelling. If your weight’s gone down, it could signal a complication that’s affecting your muscles or nutrition.
• Swelling: Damaged kidneys don’t do as good a job removing fluids from your body. That fluid retention becomes most noticeable in your lower legs, feet, hands and around your eyes. Weigh yourself and look for skin changes (like a tight, shiny appearance or pitting) — both can signal fluid retention.
• Blood pressure: Monitoring your blood pressure at home is key to CKD self-care. When it’s too high, it can damage the blood vessels in your already damaged kidneys. If your blood pressure isn’t well managed, tell your provider. They may need to tweak your treatment plan.
• Urine output: You don’t have to measure your pee or anything, but keep in mind how often you’re hitting the restroom every day. If you’re peeing less than usual, it could be a sign that your kidney function is declining.

Part of the reason CKD is so easy to miss is that it often doesn’t cause noticeable symptoms until it reaches stage 4 or 5. But if you’re in the late stages of kidney disease, recording your symptoms is helpful, too.

Physical activity

“In general, physical activity is beneficial when you have CKD, especially aerobic exercise,” Dr. Rincón-Choles says. Getting 150 minutes of moderate-intensity cardiovascular exercise a week can help:

• Improve your estimated glomerular filtration rate (eGFR)
• Lower creatinine levels
• Reduce your blood pressure
• Manage your blood sugar
• Achieve or maintain a healthy weight
• Enhance sleep and curb stress

Strength training is also extremely important because advanced CKD impacts your muscles, bones and joints.

“People who develop advanced chronic kidney disease tend to deteriorate physically and become less active,” he explains. “It becomes a vicious cycle because being inactive speeds the progression of the disease. It also makes you more prone to falls and complications of falling, like fractures.”

People with advanced CKD may benefit from working with a physical therapist to improve their strength, balance and flexibility.

Whatever stage your CKD is in, Dr. Rincón-Choles stresses the importance of speaking with your provider before starting an exercise program, to ensure your plan is safe and realistic.

Sleep

Rest and rejuvenation are important for all of us, but it’s even more important when you’re living with CKD. Researchers say the condition’s linked to sleep disorders that can make quality sleep hard to come by.

But the opposite is also true: Having a sleep disorder can cause issues like high blood pressure, inflammation and hormone imbalances that impact your kidney function. In fact, studies suggest that getting too much or too little sleep raises your CKD risk.

“When you have kidney disease, it’s common to develop other chronic health problems that can affect your sleep,” Dr. Rincón-Choles explains. He recommends seeing your primary care provider or a sleep specialist for extra support.

Stress management

Developing healthy coping strategies is crucial when you have CKD because stress impacts both your kidney function and your ability to follow your treatment plan. That’s why Dr. Rincón-Choles recommends working with a mental health provider as you navigate your “new normal.”

But if therapy isn’t your thing, that’s OK! Studies suggest that both yoga and meditation are helpful supplemental therapies for people living with CKD.

Still not your style? Try something else. There are lots of mindfulness techniques that can relieve stress and help improve your well-being.

Support team

Daunting as a CKD diagnosis is, there are many organizations and people out there who want to help. If you don’t have one already, now is a good time to start building your support network.

Not sure where to start? Dr. Rincón-Choles says the National Kidney Foundation (NKF) and the American Association of Kidney Patients (AAKP) offer great information, resources and opportunities to connect. The AAKP also maintains a list of virtual support groups.

And always remember: Your providers aren’t just on your team; they’re also your cheerleaders. They can plug you in with local support services and answer any questions you have. So, don’t hesitate to reach out. You don’t have to confront CKD alone.