Chronic Kidney Insufficiency: Therapy

General measures

  • Blood pressure should be optimally adjusted.
  • Blood lipids (blood fats) should be controlled and brought to a low level if necessary.
  • Any concomitant medical conditions should be carefully monitored and treated.
  • Aim to maintain normal weight!Determination of BMI (body mass index, body mass index) or body composition using electrical impedance analysis.
    • Falling below the BMI lower limit (from the age of 19: 19; from the age of 25: 20; from the age of 35: 21; from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.
  • Nicotine restriction (refrain from tobacco use), as harmful to the kidneys!
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Review of permanent medication due topossible impact on the existing disease (nephrotoxic drugs?).
  • Avoidance of environmental stress:
    • Metals (cadmium, lead, mercury, nickel, chromium, uranium).
    • Halogenated hydrocarbons (HFCs; trichloroethene, tetrachloroethene, hexachlorobutadiene, chloroform).
    • Herbicides (paraquat, diquat, chlorinated phenoxyacetic acids).
    • Mycotoxins (ochratoxin A, citrinin, aflatoxin B1).
    • Aliphatic hydrocarbons (2,2,4-trimethylpentane, decalin, unleaded gasoline, mitomycin C).
    • Melamine

Conventional non-surgical therapy methods

Vaccinations

The following vaccinations are advised:

  • Flu vaccination
  • Hepatitis B
  • Pneumococcal vaccination: immunocompromised individuals should be vaccinated sequentially with the 13-valent conjugate vaccine PCV13 and six to 12 months later with the 23-valent polysaccharide vaccine PPSV23 against pneumococcus.

Regular checkups

  • Regular medical checkups

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Observance of the following specific nutritional recommendations:
    • Daily energy intake: about 30-35 kcal per kg body weight (stage CNI-3 to 5).
    • In general, the diet should be low in protein (low protein), but due to the risk of malnutrition, protein intake should not be reduced too drastically. In addition, the daily protein intake (per kg body weight) depends on the stage of renal insufficiency (renal dysfunction) (as recommended by the doctor)!
    • Avoidance or reduction of monosaccharides (simple sugars) and disaccharides (double sugars) and high intake of complex carbohydrates.
    • Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • Low cholesterol diet
    • Diet rich in fruits and vegetables
    • Renunciation of the consumption of star fruit. This contains a dangerous neurotoxin (nerve toxin), which is excreted by the kidneys without problems in healthy people, but accumulates in kidney patients and can enter the brain. This causes, among other things, epileptic seizures and even coma and death.
    • Oxalate-containing foods: moderate consumption of nuts (peanuts, pine nuts, hazelnuts, cashews), cocoa, spinach, chard, rhubarb; high excretion of oxalic acid is associated with an increased risk of developing chronic renal failure in subsequent years.
    • A low-salt diet, i.e., 5-7.5 g table salt (2-3 g sodium), should also be followed. Table salt is considered an important risk factor for the progression of chronic renal failure.
    • Avoid purine (uric acid) excesses, ie, prefer vegetarian sources of protein; avoid meat, offal, shellfish.
    • Treat vitamin D deficiency (dietary supplements: 20 ug/d).
    • In advanced renal insufficiency (kidney weakness) should not consume more than 1 g of phosphate per day to mitigate the effects of disturbances on vitamin D and bone metabolism. Foods rich in phosphate are cheese, especially processed cheese, nuts, dried vegetables and wheat bran.
    • In the stage of (pre)end-stage renal failure, potassium levels may be elevated.Then potassium-rich foods such as dried fruits, dried vegetables, dishes from dried potatoes should be urgently avoided and wheat bran, stockfish, spinach, tomato paste, ketchup, pistachios, roasted peanuts, chocolate, wine, fruit and fruit juices should be consumed in a limited way.
    • Stage-specific recommendations in chronic renal failure:
      • CKD stages 1 and 2: Restriction of daily drinking is not required. Note: High oral fluid volumes should not be used to improve renal function or “flush kidneys.”
      • Pre-dialysis (CKD stages* 3-4): 1.5 liters.
      • For hemodialysis (CKD stage 5): urine volume + 500 ml.
      • With peritoneal dialysis (CKD stage 5): amount of urine + 800 ml.
  • Selection of appropriate food based on the nutritional analysis
  • The European Renal Nutrition Working Group of the European Renal Association-European Dialysis Transplant Association (ERA-EDTA) recommends a Mediterranean diet (Mediterranean cuisine) for patients with kidney disease. Since this diet is also richer in potassium, however, the serum potassium levels must be checked regularly.
  • Flavanols, contained in dark chocolate or green tea, improved endothelial function (function of the inner wall of blood vessels) in dialysis patients, lowered diastolic blood pressure (from an average of 74 mmHg to 70) and increased heart rate (from an average of 70/min to 74).
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement-.
  • Detailed information on nutritional medicine you will receive from us.

* CKD = chronic kidney disease

Sports medicine