Life Modifications For Chronic Kidney Disease

Introduction

Chronic kidney disease is an incurable illness affecting the renal system (also known as the urinary system) that must be managed throughout your life. It is important that, when diagnosed, patients implement lifestyle changes and self-management plans that will work alongside their medication to prevent the progression of the disease. Modifications range from small changes in diet and exercise to potentially major lifestyle changes.

What is chronic kidney disease?

Chronic kidney disease (CKD) is the deterioration of the kidneys and renal system. There are five stages of the disease:

• Stage 1 is associated with biomarkers of CKD in the blood
• Stages 2-4 are attributed to mild to severely decreased kidney function.¹
• Stage 5 or end-stage kidney disease means that the kidneys are failing, which can be fatal, so patients start dialysis therapy or receive a kidney transplant.

CKD was reported to affect 500 million people worldwide by 2018, significantly contributing to morbidity and mortality.² This is projected to continue increasing due to rising rates of type II diabetes, obesity, and hypertension that are associated with CKD.^2,3

Reducing chronic kidney disease from developing

CKD increases your risk of death, cardiovascular disease (heart and circulation problems), stroke, anxiety, depression, and especially your quality of life.^1,2,4 This is why it is important to not only take medication and adhere to treatment plans prescribed by your healthcare team but also make lifestyle changes such as:

• Implementing a healthy diet
• Engaging in physical activity
• Reducing smoking and alcohol consumption.^3,4 

Research has shown that making these changes can improve outcomes and reduce the progression of CKD.^3,4 However, it is also essential to be confident in your ability to self-manage these lifestyle changes to optimise your quality of life.³

Physical activity

Physical activity can reduce the risk of CKD progression or prevent complications like cardiovascular disease.^1,5 Patients with CKD often feel that physical activity will worsen their condition.^1,5 However, this common misconception often causes a cycle involving a lack of physical activity, which contributes negatively to their CKD and overall health, and then a further reduction in physical activity, and so on.^1,2,5 Physiotherapists and exercise physiologists can create a suitable exercise plan tailored to the physical abilities that will help you gain the confidence to participate in physical activity.¹

It is generally recommended that people with chronic diseases like CKD should exercise between 2.5 and 5 hours per week, gradually building up from their current level.^1,6

Aerobic exercise alone or combined with resistance exercise is particularly beneficial to improve your overall health and can contribute to a better outcome of CKD.^1,5,6 Aerobic exercise includes things like walking, cycling, and swimming.¹ Resistance exercise (also known as strength exercise) involves targeting specific muscle groups by lifting free weights or using weight machines and repeating exercises between 10 and 15 times.1 These recommendations also apply to people with stage 5 CKD who are receiving dialysis or a kidney transplant but should be discussed with professionals.⁶

If you are too unwell to participate in specifically structured aerobic or resistance exercises, it is important that you still move your body as much as possible and reduce the amount of time spent sedentary.^1,6 As someone with CKD, it is also important to know your limits. Listening to your body and taking note of pain when undertaking certain movements or activities is very important.² For example, heavy lifting should be avoided if it causes pain.²

Dietary adjustments

Making dietary adjustments is essential in controlling the progression of CKD, and doing so can replace the need to add more medication to your regime.^7,8 The kidneys maintain the right levels of electrolytes in your bloodstream, so when they aren't functioning correctly, these levels can be off, causing you further issues. Several dietary factors need to be closely monitored or controlled; these include:

• Sodium (salt): should be reduced where possible.⁷
• Potassium should be regularly checked, as people with CKD can often have high levels.⁷
• Phosphorus: should be regularly checked, as high levels can be a risk factor for cardiovascular problems in people with CKD.^7,8
• Protein: should be reduced and kept track of, as low-protein diets are suggested for people with CKD; however, studies suggest that plant-based protein breaks down more effectively than animal proteins and may be a better option as it allows for higher food intake.^7,8 
• Saturated fat: should be reduced where possible, as high fat is associated with inflammation in the renal system, which can cause progression of CKD, high blood pressure, and an increased risk of cardiovascular disease.^8,9
• Fibre: your diet should be rich in fibre, as this balances healthy gut bacteria and the breakdown of carbohydrates and protein and is good for digestion.⁷ 

Some studies suggest that a balanced and diverse plant-based or Mediterranean diet is beneficial for people with CKD.^7,8 They are high-fibre, low-sodium, low-fat diets.^7,8 In a plant-based diet, phosphorus absorption is lower, but it can be higher in potassium.⁷ 

Some studies, however, suggest that plant potassium is absorbed more effectively than in a meaty diet.^7,8 Both plant-based and Mediterranean diets are good for cardiovascular health and could potentially slow the progression of CKD.^7,8 

It is important to consult your doctor or dietician if you are considering changing your diet and discuss with them a personalised diet that you will be able to follow and enjoy.⁷ 

Hydration practices

Hydrating with water is imperative for kidney function and people with CKD.¹⁰ Water prevents the secretion of a hormone called vasopressin.¹⁰ Too much vasopressin in the blood causes hypertension and scarring of the kidneys and renal system.¹⁰ Higher fluid intake (water) is associated with better survival of CKD; however, optimal fluid intake must be tailored to the individual as it depends on factors such as weight, age, and stage of CKD.¹⁰ You should pay attention to your body’s signals, such as thirst and the colour of your urine; darker yellow urine means less hydration.¹⁰

Alcohol consumption and smoking

The effects of alcohol on CKD are unclear in the current research.^11,12 Although heavy alcohol consumption can have detrimental effects on the kidneys and be a contributing factor to CKD.¹¹ People with CKD who regularly drink alcohol should reduce their consumption to a light amount, while people who are non-drinkers should not incorporate additional alcohol into their lifestyle.^6,11,12

Recreational drug use and smoking tobacco should be avoided altogether.^6,12 Smoking tobacco and regular recreational drug use are associated with an increased risk of mortality in people with CKD.^4,12 Abstinence from smoking cigarettes, recreational drugs, and heavy alcohol consumption can be extremely challenging. If you would like to quit but are struggling, resources and support groups that you may find helpful are listed below:

• Support near you for addition https://www.talktofrank.com/get-help/find-support-near-you 
• Support and tips to quit smoking: https://www.nhs.uk/conditions/stop-smoking-treatments/

Check-ups and medication management

Patients with CKD have extensive medication regimes.² It is important to make sure you are well informed and adhere to your prescribed medications, using dispensing aids and support from others.² To stay informed, you should regularly meet with your doctors and have them explain what you are taking and why. Regular monitoring and check-ups with your doctors allow them to ensure that you are on the optimal treatment plan. Blood pressure should be monitored regularly, as hypertension and other symptoms of cardiovascular disease are associated with CKD.⁷ Blood sugar levels should be checked regularly, as CKD is also associated with type II diabetes.^4,6,7

Stress management

Stress management has major effects on the body and your well-being, with or without chronic disease. A hormone called cortisol is released when you are stressed, and this causes inflammation in the body and can have negative effects on the kidneys.¹³ To manage stress, you can practice mindfulness and relaxation techniques and reduce stress-inducing activities.² Make sure that you have a work-life balance by maintaining clear communication with your employer so that your expected workload reflects your current condition.²

Social support

A strong support network from family, friends, neighbours, work, or other communities can significantly improve your quality of life, so these people must be educated on CKD and your treatment plan.² Support can be as simple as exercising or creating meal plans to eat together.

If you require ongoing treatment, it is a good idea to consider whether receiving it at home or in the hospital is the best option for you.² For some people, hospital visits allow for socialisation with staff and others with similar CKD experiences. On the other hand, receiving treatment at home can allow for more flexibility, time with family, maintaining employment, and some normalcy.²

Joining support groups for assistance or speaking to someone directly so that you feel heard and understood can significantly improve your mental well-being.

• NKF Peers: a support network that connects people who need support with trained mentors who have been there and understand their situation and struggles. To find out more, visit: https://www.kidney.org/peers
• For counselling and support services specific to kidney disease, visit: https://www.kidneycareuk.org/get-support/counselling-and-support-service/ 

Summary

Lifestyle modifications play a critical role in the outcome and progression of CKD. The global impact of CKD underscores the importance of integrating self-management plans with medication, dietary adjustments such as a mostly plant-based diet, regular physical activity, and hydration practices. Stress management, social support, and managing alcohol and tobacco habits are also essential factors in preventing the progression of CKD. Regular check-ups, medication adherence, and regular consultation with your healthcare team are critical for ensuring your treatment and self-management plans are optimal for your condition.