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Chronic Kidney Disease: Management

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Practical Nephrology

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Abstract

This chapter aims to provide a pragmatic approach to the management of patients with CKD. First, we must correctly identify those with CKD, impart the information to the patient in an informative and appropriate way and then offer strategies to ameliorate the complications of CKD and prevent progression of the kidney disease.

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Author information

Authors and Affiliations

  1. Department of Renal Medicine, Southmead Hospital, Bristol, BS10 5NB, UK

    Charles R. V. Tomson MA, BMBCh, FRCP, DM (Oxon)

  2. Academic Renal Unit, University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK

    Shona Methven BSc, MD, MRCP

Authors
  1. Charles R. V. Tomson MA, BMBCh, FRCP, DM (Oxon)
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  2. Shona Methven BSc, MD, MRCP
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Corresponding author

Correspondence to Charles R. V. Tomson MA, BMBCh, FRCP, DM (Oxon) .

Editor information

Editors and Affiliations

  1. UCL Department of Nephrology, Royal Free London NHS Foundation Trust, London, United Kingdom

    Mark Harber

Appendix

Appendix

My Kidney Care Plan

Name ……………………………….

Hospital number …………………..

Welcome to the Chronic Kidney Disease (CKD) Service (designed by Katy Gerrard)

This is your care plan; it will help all members of your healthcare team (including your GP) to care for you. Hopefully it will also help you understand and get involved in your kidney problems and plans for treatment.

Please bring it with you to every appointment and also if you get admitted to hospital or go to your GP.

The chronic kidney disease team is a group of renal specialists who help manage people with kidney problems. As well as running clinics at the Royal Free Hospital, we also run clinics at Barnet Hospital, Mary Rankin (St. Pancras) and North Middlesex Hospital.

Your nurses are: ………………………………………………………..

Your consultant is: ………………………………………………………………………………………………….

The specialist nurses and doctors in this team work alongside dieticians, social workers, psychologists, your primary care team (GP surgery) and of course you and your family/carers to manage your kidney problems.

We can help with many aspects of kidney problems in our clinic, including:

  • Further monitoring and stabilisation of your kidney function

  • Management of any associated symptoms or complications you may have

  • Anaemia (blood count) management

  • General health and wellbeing promotion

  • Preparation for dialysis

  • Assessing whether you are physically fit enough for a kidney transplant

  • Conservative management if you choose not to have dialysis

We are happy to discuss any/all of the above issues with you and also any other matters you are concerned about. You will still continue to see a renal doctor (specialist) regularly.

All your other day-to-day health problems will still be managed by your general practitioner (GP). We recommend that you take this care plan with you when you attend your GP surgery.

If you need to contact us about any kidney-related problems then you can call us on ………… (office hours). We might not be able to answer your call straight away as we run clinics every day, but we will return your call as soon as we can. If the problem is urgent, then please contact your GP or go straight to your nearest Accident and Emergency.

Lifestyle

There are many things you can do to try and keep yourself healthy:

  • We recommend that you follow a balanced healthy diet and do not eat salty foods or add extra salt to your food.

  • Some patients need to follow specific diets like low potassium or low phosphate; we will advise you, if you are one of these patients – you can use this section of your folder to insert relevant diet sheets. We also have dieticians who you will be able to see. If you want to contact the dieticians, please call ext 31719.

  • It is beneficial to take regular exercise as your condition allows.

  • If you smoke, we strongly advise that you stop as it will damage your kidneys further. Your GP will be able to provide help for you to stop smoking.

  • We recommend that you do not drink too much alcohol; this is no more than 14 units for women and 21 for men per week.

  • It is advisable to be a healthy weight; we will recommend what weight is ideal for you.

  • High blood pressure (BP) damages kidneys further, so it is very important that you make sure your BP is well controlled. We will advise you what your BP should be.

  • If you are diabetic, it is vital that your diabetes is well controlled as high blood sugars will damage the kidneys further; your healthcare team can help you with this.

  • It is advisable that blood is taken from the veins in your hands; if this is not possible, then your dominant arm can be used; this is in case we need to make a fistula for dialysis.

My medication list

Medication

Dose

Frequency

Function

My Test Results

If you would like to know your blood test results, they can be included here.

 

Target range

__/__/__

__/__/__

__/__/__

__/__/__

__/__/__

__/__/__

eGFR

       

Urea

       

Creatinine

       

Calcium

       

Potassium

       

Phosphate

       

Haemoglobin

       

Blood pressure

       

Weight

       

Results Key

eGFR

Roughly the percentage of normal kidney functionI have left (on average people need to consider dialysis treatment with a level below 15 %)

Urea

Waste level

Creatinine

Waste level

Calcium

Important for bone strength

Potassium

A mineral, which if high can cause heart rhythm problems

Phosphate

Important for bone strength and can cause itching if high

Haemoglobin

Blood count

Treatment Options

When/if your kidney function deteriorates, we will need to discuss treatment options. This is in order for us to make plans for your future care. You will be very central to the decision-making process, and so we will need to explain to you in detail about the options. You may wish to make notes about all of the options here.

You can change your decision at any time, but please discuss this with your nurse as soon as possible.

We also suggest that you discuss this with you family/carers.

Peritoneal Dialysis

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Haemodialysis/Home Haemodialysis

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Kidney Transplant

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Conservative Management

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Dates These Options Were Discussed

……………………………………………………..

Decision on Preferred Treatment Option

……………………………………………………….

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Tomson, C.R.V., Methven, S. (2014). Chronic Kidney Disease: Management. In: Harber, M. (eds) Practical Nephrology. Springer, London. https://doi.org/10.1007/978-1-4471-5547-8_48

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  • DOI: https://doi.org/10.1007/978-1-4471-5547-8_48

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  • Online ISBN: 978-1-4471-5547-8

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