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Manage Your Chronic Kidney Disease Stage 5

As you are being treated for your chronic kidney disease (CKD) Stage 5, there are 2 areas of concern that you and your renal (kidney) care team should discuss.

Diet
Following a renal-friendly diet can help limit the amount of waste in your body, which will aid in your treatment. You and your renal dietitian can work together to monitor the foods you eat and the fluids you drink. Some things you may discuss include

Limiting fluids
Avoiding salt
Being aware of hidden phosphorus

Sticking to the diet you and your dietitian create may not only help you feel better, it may help make your treatments more comfortable, as limiting sodium, and therefore fluids, can alleviate some cramping.

Nutrient Intake
One of the kidneys’ functions is to balance different nutrients in your body. For patients with CKD Stage 5, several nutrients are important to monitor:

Sodium
Potassium
Protein
Phosphorus
Calcium

If these nutrients get out of check, serious health problems can occur. That’s why it’s important for you and your kidney care team to check your nutrient levels regularly.

Patients on dialysis have an increased need for protein. Foods high in protein are often high in phosphorus as well.

So it’s important to be aware of what you’re eating and to work with your renal dietitian to create a menu that balances your need for protein with your phosphorus intake.

As you read the rest of the articles in this classroom, you’ll learn more about treating your CKD Stage 5 and how taking an active role in your treatment is one of the most important things you can do

The Power of 3
Hyperphosphatemia can be a serious condition. In fact, watching what you eat and taking a phosphate binder are very important, as is going to dialysis. It takes the power of 3 – diet, dialysis, and medication – to manage chronic kidney disease Stage 5 and high phosphorus levels.

Diet
Making the right food choices, such as eating low-phosphorus foods, can help keep extra phosphorus from building up in your body.

Dialysis
Dialysis cleanses the blood by removing waste and excess fluids that build up. In fact, based on average dietary phosphorus intake, dialysis may remove approximately 50% of the extra phosphorus.

Medication
When diet and dialysis cannot remove enough excess phosphorus, your doctor may prescribe a phosphate binder to help remove the rest.

Your actions — eating kidney-friendly foods, going to dialysis, and taking your medication — can help you get the most from your care.

Understanding Your Treatment Options

Understanding your chronic kidney disease (CKD) Stage 5 should be the first step. Knowing what treatment options are available is the next step. For CKD Stage 5 patients, treatment options focus on 3 main areas.

Dialysis
When your kidneys no longer work well enough to cleanse your blood and rid your body of excess waste, dialysis becomes a necessary treatment. You have a couple of dialysis treatment options to choose from.

Hemodialysis - Hemodialysis is a treatment that uses a machine to act as an artificial kidney, removing the fluids and wastes that your kidneys cannot. Tubes transfer small amounts of your blood to the machine to be cleaned and then moved back to your body. You can have hemodialysis in a clinic or at your home.

Peritoneal Dialysis - Peritoneal dialysis uses a membrane in the empty space of your belly to clean your blood. A tube inserted into your torso is injected with a liquid that fills that empty belly space. The waste is filtered through tiny holes in the membrane and into the liquid, which can then be drained out of your body. Clean liquid is again put in your belly and the cleaning begins again.

Your kidney care team will have more information about dialysis options. Together you can decide which option may work best for you.

Know Your Kidney Care Team

Kidney Care Team Responsibilities

Your doctor, renal dietitian, nurses, and technicians are all part of your kidney care team with you. Each team member has a unique set of responsibilities that can help care for your total health.

In the chart below, match the team member with the appropriate description.

TEAM MEMBER	DESCRIPTION
1. Dialysis technician	A. Helps find community resources (support, financial, etc.) to help you manage your chronic kidney disease
2. General practitioner	B. The most valuable member of your kidney care team; responsible for following the treatment plan
3. Nephrologist	C. Monitors your dialysis treatment and handles any other dialysis issues you may have
4. Pharmacist	D. Checks your health and how you respond to medications
5. Renal dietitian	E. Fills prescriptions and gives tips for taking your medications
6. Renal nurse	F. Doctor who specializes in kidney disease
7. Social worker	G. Helps you choose kidney-friendly foods
8. You	H. Performs your yearly physical and monitors your overall health

ANSWERS: 1.C 2.H 3.F 4.E 5.G 6.D 7.A 8.B

Tips for Communicating with Your Kidney Care Team

It’s easy to get confused when you’re trying to talk with your kidney care team. Sometimes they use complicated, unfamiliar terms.

But being able to communicate effectively with your kidney care team can help you have some control over your health care. One way to help you communicate effectively is to take P.A.R.T.:

Prepare. Make a list of important questions or concerns, and bring these up at the beginning of your visit.

Ask. Ask questions regarding tests, treatments, and any follow-up steps that are necessary. Make sure you understand the doctor’s answers. If you don’t, ask until you do.

Repeat. Once you have gotten the information from your doctor, repeat some of the key points. This will help you make sure you heard correctly and give the doctor the chance to correct any misunderstandings.

Take Action. When your appointment is over, know what your next steps are. Make sure you understand what you need to do and ask for help if you don’t.

You should keep in mind that there are lots of members of your kidney care team, and collectively they’re able to help answer any questions you may have.

Support Groups and Resources

Each of these highly regarded organizations has an informative Web site and can be contacted by telephone toll free

American Association of Kidney Patients at www.aakp.org [1] or 1-800-749-2257
American Kidney Fund at www.kidneyfund.org [2] or 1-800-638-8299
National Kidney Foundation at www.kidney.org [3] or 1-800-622-9010
Renal Support Network at www.rsnhope.org [4]or 1-866-903-1728

Support Groups

There are a variety of resources across the country, in your area, and, of course, on the Internet. Typing “CKD support groups” into a search engine such as Google reveals over 95,000 sites. Consider contacting some of the support groups listed below:

Renal Support Network at www.rsnhope.org [5]or 1-866-903-1728
Nationwide listing of support groups, by state, at https://aakp.org/support-groups/ [6]
DaVita at www.davita.com/education/ckd-life/support/support-groups-for-people-living-with-kidney-disease [7] or 1-800-244-0680

Be a Part of Your Kidney Care Team

Communicating Effectively with Your Kidney Care Team

You go to dialysis and stay for the entire session. You take your medication as directed by your doctor. You follow your kidney care team’s instructions. Is there anything else you can do to manage your condition?

There is. Learn to talk and work with your kidney care team so you understand their expectations and they understand yours.

Communicating with your kidney care team is more than just listening to them. It’s asking questions, letting them know your thoughts, and taking action. Be specific when talking with your kidney care team and

Write down your most important questions or concerns, and ask them at the beginning of your visit
Focus your questions on your tests, treatments, and any follow-up steps. Make sure you understand the health care provider’s answers

By asking for specifics, you can convey the information you want to get across and get the answers you are looking for.

Doing your part can help you get the most from your relationship with your kidney care team. Teamwork is the name of the game!

Sharing Important Information with Your Kidney Care Team

It may feel awkward to share some things with your kidney care team, but telling them any relevant medical information you have may help them design a more effective treatment plan for you.

Each member of your kidney care team handles different areas of your treatment, so you have plenty of people who can address your needs.

Taking medications. If you have problems taking your medications as directed, tell your doctor or nurse and let him or her know why
Trouble following diet. If you have difficulty following a kidney-friendly diet, tell your renal dietitian so that he or she can help you find foods that work for you
Getting to dialysis. If you’re having a hard time making it to all of your dialysis appointments at the clinic, talk to your social worker about making other arrangements for transportation

Also bring a list of the medications you are currently taking, and a list of the physicians you’ve seen since your last appointment and why. Make sure to tell your kidney care team about your medical history.

Talking to Your Kidney Care Team About Changes in Treatment

If you or your kidney care team may feel that your current treatment plan isn’t working well enough. This is when being able to talk openly and honestly to your doctor can benefit you.

Ask about all treatment options. Learn about the risks and benefits of each treatment option and understand any consequences of not managing your condition to help find the treatment that works for you
Share your thoughts and concerns. Your kidney care team won’t be able to help you if you don’t tell them what’s bothering you. For example, if you are hesitant to try a new medication due to side effects, speak up

Be sure to keep your doctor informed as to how you are feeling. Remember that you and your kidney care team need to communicate in order to get a treatment that works for you.