10/26/21, 8:53 PM Chronic Kidney Disease Treatment Guide | Cleveland Clinic

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Chronic Kidney Disease

Overview

Your Guide to Chronic Kidney Disease

Chronic kidney disease (CKD) is an umbrella

term for conditions that weaken your
kidneys’ ability to filter waste and water from
your blood. Over time, several conditions,
including diabetes and high blood pressure as
well as some autoimmune and congenital
diseases, can damage the kidneys. At the
damage progresses, your kidneys fail and you
may require a kidney transplant or dialysis.

At the Glickman Urologic & Kidney Institute,

our approach is to manage your disease for as
long as possible with medications and a special diet. Early detection and appropriate

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treatment are important in slowing the disease progression, with the goal of preventing or
delaying kidney failure.

This guide provides an overview of treatment options for CKD offered at Cleveland Clinic,
as well as information you need to become an active participant in your care.

What is CKD?

What Are Symptoms of CKD?

If you have CKD, you may notice you feel tired and have less energy, urinate less often,
have trouble concentrating or sleeping, have little appetite, muscle cramps at night, swollen
feet and ankles, puffy eyes, and skin that feels dry and itchy.

Diagnosis

How CKD is diagnosed

Clinicians perform two blood tests to diagnose CKD:

Glomerulofiltration rate (GFR), to determine how well your kidneys are filtering blood.
Serum creatinine measurement, to indicate how well your kidneys are removing waste
products.

We assess the result of these tests along with your age, race, gender and other factors to
determine your kidney function. There are five stages of CKD.

Stages of Chronic Kidney Disease

Stage 1

GFR 120-90: Normal kidney function

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Stages of Chronic Kidney Disease

Stage 2

GFR 90-60: Mildly decreased kidney function

Stage 3

GFR 60-30: Moderately decreased kidney function

Stage 4

GFR 30-15: Poor kidney function

Stage 5

GFR less than 15: Kidney failure

Treatment Options
Treatment is designed to delay the
progression of the disease to kidney failure.

Most patients benefit from a combination of

medications and dietary changes. If your
kidney function drops below a glomerular
filtration rate (GFR) of 20, you will be
evaluated for a kidney transplant. If you are
not considered a candidate for
transplantation, dialysis will be started once
your kidney function reaches 10, or possibly
sooner.

Medical therapy

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You will likely be given an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin

receptor blocker (ARB) to lower the blood pressure in their kidneys. You may also need a
diuretic to help your body eliminate extra fluid.

If you have glomerulonephritis, you may be given steroids and an immunosuppressant

medication such as cyclosporine. Certain patients with CKD require other medications.
These may include:

A phosphate binder, if your kidneys are unable to eliminate phosphate

Vitamin D and calcitrol to prevent bone loss
Erythropoetin to build red blood cells, if you are anemic.

Dietary guidelines

A CKD diet is as important as taking medications in maintaining your kidney function.

Cleveland Clinic dietitians are experts in balancing the dietary needs of patients with CKD
to support kidney function while minimizing the impact of diabetes, high blood pressure or
cardiovascular disease.

A CKD diet limits sodium to prevent swelling and high blood pressure, and in certain
patients, restricts protein intake to prevent disease progression. It also balances calcium
and phosphorus to prevent bone loss and helps maintain proper potassium levels to
prevent a potentially fatal arrhythmia. Because there are many foods you will not be able to
eat, nutritional supplements may be added to ensure you get enough calories.

If you have diabetes, your primary source of calories will become simple carbohydrates. If
appropriate, the option of early kidney/pancreas transplantation will be discussed.

A CKD diet is not always easy to follow. If you stick to the diet faithfully, keep your blood
sugar and blood pressure under control, and take your medications as instructed, you
should feel better, retain less fluid and be less itchy. You will also be less likely to lose bone
density.

Kidney transplantation

If your kidney function drops to a GFR less than 20, you will be evaluated for a kidney
transplant, even before you actually need to start dialysis. A new, healthy kidney can

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improve your strength, stamina and energy. After transplantation, you should be able to
return to a more normal lifestyle. You will be allowed to eat a normal diet and drink fluids
normally. Any anemia may resolve, and if you have high blood pressure, you might need
fewer blood pressure medications. Because kidney transplantation is so beneficial,
Cleveland Clinic nephrologists prefer to transplant patients’ kidneys before they need
dialysis.

If you have diabetic nephropathy, you may be able to receive a new pancreas along with a
kidney, eliminating the need for insulin or other diabetes medication.

Donor WIn

Cleveland Clinic’s Transplant Center offers a unique program of wellness assessment and
maintenance designed to ensure the continued good health of our kidney donor patients.
Called the ‘Donor Wellness Initiative,’ or ‘Donor WIn,’ the program consists of:

A detailed physical examination

Sophisticated measurement of cardiovascular health
Dietary and fitness evaluations
Evaluation of kidney function

For more information about DonorWIn, visit ccf.org/donorwin.

Dialysis

When kidney function drops dramatically, dialysis is required to purge the body of waste
and fluid.

Several different types of dialysis are available, with the most common forms being
hemodialysis and peritoneal dialysis. In hemodialysis, the blood is circulated through a
machine that extracts fluid and waste before returning the cleansed blood to the body.
Hemodialysis generally requires patients to spend several hours several times a week at a
dialysis center.

In peritoneal dialysis, a solution is run directly into the abdomen, where it absorbs waste
products. The waste products are then filtered out naturally by the abdominal membrane
(peritoneum), and the solution drained out of the body at scheduled intervals. Based on

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clinical trials suggesting that slow dialysis may be better, Cleveland Clinic nephrologists
provide arrangements for some patients to have overnight hemodialysis and peritoneal
dialysis at home.

CKD Clinic
Patients with a GFR of less than 45 may
benefit from visiting one of our CKD Clinics.
Cleveland Clinic CKD Clinics are held at
mulitiple locations, including the main
campus.

At the CKD Clinic, you will undergo thorough

kidney function testing, and a comprehensive
cardiovascular risk assessment that includes
innovative approaches to blood pressure
measurement (BP Tru, central BP
assessment) and a cholesterol test. The
results will determine the stage of your
kidney disease and extent of your
cardiovascular risk. The nephrologist will use
this information to make an individualized treatment plan.

At follow-up visits, a registered dietitian will provide you with nutritional and dietary
interventions for CKD, as well as for cardiovascular disease and/or diabetes, if needed. A
nurse practitioner will follow your progress. If you are likely to need future dialysis, you will
be assessed on a regular basis.

It is important that you become an active part of your treatment team. The goal is to help
you gain an understanding of the risks of kidney failure, the goals of management and the
benefits of your treatment options. It is hard work that requires you keep your medical
appointments, take your medications as prescribed, stick to your diet and pay close
attention to your blood pressure and blood sugar. By working closely with the CKD team,
you may be able to delay the need for transplantation or dialysis.

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We encourage you to bring a family member or friend with you to your appointments.
Bringing a “patient advocate” with you may help you ask the right questions to get the
information you need to be a partner in your disease management

Looking Ahead
There is no cure for CKD, and there are many
questions about the disease that remain
unanswered. For example, although it is
known that high blood pressure, high blood
lipid levels, high phosphorus levels and
uncontrolled diabetes accelerate kidney
function decline, it is unclear whether
correcting these issues affects the rate of
CKD progression.

Cleveland Clinic physicians are dedicated to

finding answers to these and other issues
affecting patients with CKD through clinical
studies. An important aid in this effort is the
CKD Registry, which contains demographic
and treatment information on more than
100,000 patients with CKD treated at
Cleveland Clinic. The information is vitally
important in helping pinpoint which factors
cause CKD and regulate its progression,
which tests are most useful in diagnosing the disease and monitoring it progression, and
which medications are most effective at decreasing complications and slowing the
deterioration of kidney function. To date, Cleveland Clinic physicians have used the
information in the CKD Registry to identify markers of all-cause and CKD-related deaths
and to verify the accuracy of new diagnostic test for CKD. 

Cleveland Clinic nephrologists also conduct clinical trials of promising medications and
procedures for patients with CKD. Projects currently underway include an investigation of
the role of stem cells in protecting the kidney during coronary artery bypass surgery, an

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examination of alternative biomarkers to creatinine for predicting early kidney damage,

and a clinical trial of a medication that may decrease the need for dialysis in patients with
diabetes. Near term studies will examine the role of kidney nerve denervation for
controlling blood pressure in patients with CKD.

Patient Services

Medical Concierge

If you are traveling from out of state and need any assistance, call the complimentary
Medical Concierge at 800.223.2273, ext. 55580, or email medicalconcierge@ccf.org

Global Patient Services

Complimentary assistance for national and international patients and families is available
at 001.216.444.8184.

MyChart

Cleveland Clinic MyChart® is a secure, online personal healthcare management tool that
connects patients to portions of their medical record at any time, day or night. Patients can
view test results, renew prescriptions, review past appointments and request new ones.
Our latest feature, Schedule My Appointment, allows patients to view their primary care
physician’s open schedule and make appointments online in real time. Patients register for
MyChart through their physician’s office or online.

Appointments

Contacting Cleveland Clinic

To make an appointment at one of our CKD Clinics, please contact our appointment
scheduling office at 216.444.6771. Same-day appointments available.

Virtual Second Opinion

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If you cannot travel to Cleveland Clinic, help is available. You can connect with Cleveland
Clinic specialists from any location in the world via a phone, tablet, or computer,
eliminating the burden of travel time and other obstacles. If you’re facing a significant
medical condition or treatment such as surgery, this program provides virtual access to a
Cleveland Clinic physician who will review the diagnosis and treatment plan. Following a
comprehensive evaluation of medical records and labs, you’ll receive an educational second
opinion from an expert in their medical condition covering diagnosis, treatment options or
alternatives as well as recommendations regarding future therapeutic considerations.
You’ll also have the unique opportunity to speak with the physician expert directly to
address questions or concerns.

Learn more

Why Choose Us?

Kidney specialists (nephrologists) in Cleveland Clinic’s Department of Nephrology &
Hypertension are experts in the evaluation and management of CKD. Cleveland Clinic is
ranked as one of the nation's top hospitals by U.S. News & World Report. Our CKD Clinic
uses an innovative team approach, in which the nephrologists are supported by nurse
practitioners, physician assistants, nutritionists and educators. The team focuses on
educating and involving patients in the daily management of their disease and in decisions
about dialysis and kidney transplant options. The goal is to manage the disease so that
patients can enjoy a better quality of life.

Cleveland Clinic’s electronic medical record is critically important for monitoring chronic
disease status over time and interacting with a number of different Cleveland Clinic
specialists, like cardiologists and endocrinologists, involved in the ”total care“ of the
patient.

Despite best efforts, kidney function can decline to a level that requires more than medical
and dietary intervention. When kidney transplantation becomes an option, patients can
feel comfortable knowing that Cleveland Clinic has one of the most experienced kidney
transplant programs in the world. When dialysis is needed, several leading-edge forms are
offered, including overnight dialysis at home.

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Related Institutes & Services

Glickman Urological & Kidney Institute

The Glickman Urological & Kidney Institute offers innovative treatments in urology and nephrology,
including minimally invasive, scarless options for urologic procedures and medical management of
kidney disease.

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