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Treatments and drugs
By Mayo Clinic staff
Chronic kidney failure has no cure, but treatment can help control signs and symptoms, reduce complications, and slow the progress of the disease. If you have chronic kidney failure, your primary doctor will likely refer you to a kidney specialist (nephrologist), if you aren't seeing one already.
Treating the underlying condition
The first priority is controlling the condition responsible for your kidney failure and its complications. If you have diabetes or high blood pressure (hypertension), for instance, that means carefully following your doctor's recommendations for diet and exercise and taking any medications as directed. Most people with chronic kidney failure are treated with medications to lower their blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers — and to preserve kidney function. Because these medications can initially increase serum potassium and decrease overall kidney function, you may have frequent blood tests to check your potassium levels. Over the long term, these medications tend to both lower blood pressure and preserve kidney function. To protect kidney function, your blood pressure may need to be lower than if your kidneys were functioning normally.
In addition, following a proper diet is extremely important in treating kidney failure itself. Restricting the amount of protein you eat may help slow the progress of the disease. It can also help ease such symptoms as nausea, vomiting and lack of appetite. You'll likely need to limit the amount of salt in your diet to help control high blood pressure. Over time, you may also need to restrict the amount of potassium and phosphorus you consume.
Your doctor may also recommend that you avoid substances that can be toxic to your kidneys, such as nonsteroidal anti-inflammatory drugs, some oral phosphate preparations used as laxatives before colonoscopy, and contrast dyes used with certain X-rays.
Treating complications
You'll also need treatment for complications of chronic kidney failure. For example, anemia may require supplements of the hormone erythropoietin to induce production of more red blood cells. In addition, your doctor may prescribe a form of vitamin D (calcitriol) to prevent weak bones, as well as a phosphate-binding medication to lower the amount of phosphate in your blood. Lowering phosphate will increase the amount of calcium available for your bones so that they don't become weak and vulnerable to fracture.
End-stage kidney disease
By the time end-stage kidney disease develops, your kidneys are functioning at less than 10 percent to 15 percent of capacity. At this point, conservative measures used to treat chronic kidney failure — diet, medications and controlling the underlying cause and complications — are no longer enough. Your kidneys aren't able to keep up with waste and fluid clearance on their own, and dialysis or a kidney transplant becomes the only option to support life.
Exactly when it becomes necessary to start dialysis varies from person to person. In most cases, doctors try to manage chronic kidney failure as long as possible because both dialysis and transplantation may have potentially life-threatening complications.
Kidney dialysis
Dialysis is an artificial means of removing waste products and extra fluid from your blood when your kidneys aren't able to perform these functions. It's not a miracle treatment, and it presents significant risks, including infection. Still, it can help prolong life for people with end-stage kidney disease.
There are two main types of kidney dialysis, each with subtypes involving slightly different techniques. They include:
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Hemodialysis. Hemodialysis removes extra fluids, chemicals and wastes from your bloodstream by filtering your blood through an artificial kidney (dialyzer). Blood is pumped out of your body to the artificial kidney through one of two routes — a catheter placed surgically in one of your main blood veins, or a surgically created junction between a vein and artery in your arm. Inside the artificial kidney, your blood moves across membranes that filter out waste before being returned to your body. Less than 1 cup (237 milliliters) of blood is outside your body in the dialyzer and tubing at any one time. Hemodialysis is usually performed three times a week for three or more hours.
However, it's now recognized that more frequent dialysis — up to six times a week either during the day or at night while you sleep — results in significantly better quality of life, better control of complications and a reduction in risk of death. Newer, easy-to-use home dialysis machines are making this option more feasible for many.
- Peritoneal dialysis. Instead of filtering your blood through a machine, this type of dialysis uses the vast network of tiny blood vessels in your own abdomen (peritoneal cavity) to filter your blood. First, a small, flexible tube (catheter) is implanted into your abdomen. Then, a dialysis solution is infused into and drained out of your abdomen for as long as is necessary to remove waste and excess fluid.
- Continuous ambulatory peritoneal dialysis. You perform this type of peritoneal dialysis yourself at home, exchanging the dialysis solution in your abdomen four times a day, seven days a week. You space out these exchanges throughout the day.
- Continuous cycling peritoneal dialysis. In this type of peritoneal dialysis, a machine (cycler machine) automatically infuses dialysis solution into and out of your peritoneal cavity over a period of 10 to 12 hours while you sleep.
Kidney transplant
If you have no life-threatening medical conditions other than kidney failure, a kidney transplant is usually a better option than dialysis, although you may need to undergo dialysis temporarily until a suitable donor kidney becomes available.
A successful kidney transplant depends on finding the best immunologic match possible. Ideally, you and the kidney's donor will have the same blood type, cell-surface proteins and antibodies. The more closely these features are matched, the lower the risk that your body will reject the new kidney. A sibling is likely to be the best donor. If that's not possible, another blood relative, such as a parent, aunt, uncle or cousin, or even a non-blood-related adult may be considered. When a living donor isn't available, tissue-typing centers throughout the country may search for a cadaver kidney from an accident victim or other person who has offered to donate organs after his or her death.
