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Chronic Kidney Disease (CKD) may arise due to a multitude of

different insults to renal function. However despite the wide

range of pathological processes that may induce renal injury,
substantial loss of nephrons provokes a common syndrome
characterized clinically by systemic hypertension, proteinuria
and a progressive decline in glomerular filtration rate (GFR)
and patho-physiologically by progressive interstitial fibrosis,
peritubular capillary loss with hypoxia and destruction of
functioning nephrons because of tubular atrophy .Some of
these factors such as age and race are not open to
intervention. The majority, however, provide at least a potential
for intervention in order to slow or halt the progression of early
CKD. Serum Creatinine: Creatinine is a waste product in your
blood that comes from muscle activity. It is normally removed
from your blood by your kidneys, but when kidney function
slows down, the creatinine level rises. Your doctor should use
the results of your serum creatinine test to calculate your
GFR.Glomerular Filtration Rate (GFR): Your GFR tells how
much kidney function you have. It may be estimated from your
blood level of creatinine. If your GFR falls below 30 you will
need to see a kidney disease specialist (called a nephrologist),
Your kidney doctor will speak to you about treatments for
kidney failure like dialysis or kidney transplant. A GFR below 15
indicates that you need to start one of these treatments.Blood
Urea Nitrogen (BUN): Urea nitrogen is a normal waste product
in your blood that comes from the breakdown of protein from
the foods you eat and from your body metabolism. It is normally
removed from your blood by your kidneys, but when kidney
function slows down, the BUN level rises. BUN can also rise if
you eat more protein, and it can fall if you eat less protein.

Serum Creatinine

Purpose: To determine how much creatinine is in the

Normal range: .8 to 1.4 milligrams per deciliter (mg/dl).
How this test is conducted: A blood sample is taken and sent
for analysis.
When this test is performed: Throughout the early stages of
chronic kidney disease and the later stages, including end
stage renal disease (ESRD).
GFR Glomerular Filtration Rate
Purpose: To determine how much kidney function a person
Normal range: 90+, with little or no protein or albumin in urine.
How the test is conducted: This test is a calculation based on
your creatinine level, age, race, gender and other factors.
When this test is performed: Throughout the early stages
of CKD and the later stages, including ESRD.
BUN Blood Urea Nitrogen
Purpose: To detect elevated waste levels in the bloodstream,
which is an early sign of reduced kidney function.
Normal range: 7 to 20 milligrams per deciliter (mg/dl)
How this test is conducted: A blood sample is taken and sent
for analysis.
When this test is performed: In the diagnostic stage, the
early stages of chronic kidney disease and the later stages,
including end stage renal disease (ESRD), to measure
effectiveness of treatment.
The blood urea nitrogen (BUN) test is an important diagnostic
tool. Chronic kidney disease happens over time, but many
people do not know they have it. This is because symptoms in
the early stages of the disease may go unnoticed. An early
diagnosis is important so that treatment can begin. Waste in

the blood can be the first signal that your kidneys arent
working as well as they should. The BUN test measures the
amount of urea in your bloodstream. Urea is a waste product
left over from the protein you eat, which is normally eliminated
through the kidneys. High levels of urea mean your kidneys are
not getting rid of waste and it remains in the body. This could
make you feel tired and ill.

Stage 5 final stage of Chronic Kidney Disease

A person with stage 5 chronic kidney disease has end stage
renal disease (ESRD) with a glomerular filtration rate (GFR) of
15 ml/min or less. At this advanced stage of kidney disease,
the kidneys have lost nearly all their ability to do their job
effectively, and eventually dialysis or a kidney transplant is
needed to live.
Symptoms of stage 5 CKD
Symptoms that can occur in stage 5 CKD include:
Loss of appetite
Nausea or vomiting
Being tired
Being unable to concentrate

Making little or no urine

Swelling, especially around the eyes and ankles
Muscle cramps
Tingling in hands or feet
Changes in skin color
Increased skin pigmentation
Because the kidneys are no longer able to remove waste and
fluids from the body, toxins build up in the blood, causing an
overall ill feeling. Kidneys also have other functions they are no
longer able to perform such as regulating blood pressure,
producing the hormone that helps make red blood cells and
activating vitamin D for healthy bones

Low-protein diets may be helpful before you start dialysis. Your

doctor or dietitian may recommend a moderate-protein diet (1
gram of protein per kilogram of body weight per day).
Once you start dialysis, you will need to eat more protein. A
high-protein diet with fish, poultry, pork, or eggs at every meal
may be recommended. This will help you replace muscles and
other tissues that you lose.
People on dialysis should eat 8 - 10 ounces of high-protein
foods each day. Your doctor, dietitian, or nurse may suggest
adding egg whites, egg white powder, or protein powder.


Reducing sodium in your diet helps you control high blood

pressure. It also keeps you from being thirsty, and prevents
your body from holding onto extra fluid. It is likely that you will
need to cut down the sodium in your diet.
Look for these words on food labels:
No salt added
Check all labels to see how much salt or sodium foods contain
per serving. Also, avoid foods that list salt near the beginning of
the ingredients. Look for products with less than 100 mg of salt
per serving.
Do not use salt when cooking and take the salt shaker away
from the table. Most other herbs are safe, and you can use
them to flavor your food instead of salt.
DO NOT use salt substitutes because they contain potassium.
People with chronic kidney disease also need to limit their

If you do not have a problem eating carbohydrates, these foods
are a good source of energy. If your health care provider has
recommended a low-protein diet, you may replace the calories
from protein with:

Fruits, breads, grains, and vegetables. These foods provide

energy, as well as fiber, minerals, and vitamins.
Hard candies, sugar, honey, and jelly. If needed, you can even
eat high-calorie desserts such as pies, cakes, or cookies, as
long as you limit desserts made with dairy, chocolate, nuts, or

People with advanced kidney failure also have anemia and
usually need extra iron.
Many foods contain extra iron (liver, beef, pork, chicken, lima
and kidney beans, iron-fortified cereals). Talk to your doctor,
nurse, or dietitian which foods with iron you can eat because of
your kidney disease.

4. Dialysis treatments for people with stage 5 CKD

Most people report feeling much better once they begin dialysis.
As the toxins are removed from the blood medicines replace the
functions the kidneys can no longer perform, they find they can
enjoy a good quality of life. There are two types of dialysis
treatments for people with stage 5 kidney disease.
1. Hemodialysis: This treatment that can be done in a center or in
a patients home with assistance from a care partner. A dialysis
machine removes a small amount of a patients blood through a
man-made membrane called a dialyzer, or artificial kidney, to

clean out toxins that the kidneys can no longer remove. The
filtered blood is then returned to the body.

Changes in the diet for people with stage 5 CKD

Once you begin dialysis, you will need to make changes in what
you eat and drink. Your diet is a big part of your treatment, so you
will be working with a dietitian who will coach you on how you
should eat. Depending on the dialysis treatment you choose and
your lab test results, your dietitian will help create a meal plan
based on your individual requirements to keep you feeling your
best. Your dietitian will explain what foods are restricted and
which ones are recommended on the renal diet.
A healthy diet for stage 5 CKD may recommend:
Including grains, fruits and vegetables, but limiting or avoiding
whole grains and certain fruits and vegetables that are high
in phosphorus or potassium
A diet that is low in saturated fat and cholesterol and moderate
in total fats, especially if cholesterol is high or if you have
diabetes or heart disease
Limiting intake of refined and processed foods high
in sodium and prepare foods with less salt or high-sodium
Aiming for a healthy weight by consuming adequate calories
and including physical activity each day within your ability
Decreasing calcium intake if necessary
Limiting fluid intake
Increasing protein intake to the level determined by the
dietitians assessment of individual needs and to replace losses
in the dialysis treatment
Taking special renal vitamins high in water soluble B vitamins
and limited to 100 mg of vitamin C
Vitamin D and iron tailored to individual requirements

Other meal plan concerns

A kidney-friendly meal plan may make it hard to get all of the
vitamins and minerals you need. To help you get the right balance
of vitamins and minerals, your dietitian may suggest a special
supplement made for people with kidney disease.
Your doctor or dietitian might also suggest a special kind of
vitamin D, folic acid or iron pill, to help avoid some common side
effects of kidney disease, like bone disease and anemia.
Regular multi-vitamins may not be healthy for you if you have
kidney disease. They may have too much of some vitamins and
not enough of others. Talk to your doctor or dietitian to find
vitamins that are right for you.