Living well with Chronic Kidney Disease

Living Well with Chronic Kidney Disease A Guide for Patients and Caregivers

How to use this book?

This booklet is designed to be simple for all readers.

It focuses on guides for Chronic Kidney Disease (CKD).

These involve the understanding of the disease, from early detection, dietary modification, lifestyle changes and treatment to delay the disease progression.

Additional references National Kidney Foundation (NKF): www.nkfs.org Kidney Dialysis Foundation (KDF): www.kdf.org.sg Advance Care Planning (ACP): www.livingmatters.sg

Disclaimer: This booklet only serves as an educational material.

It does not replace or represent any medical professional advice for any individual patient. Please consult the medical professional if in doubt.

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Contents About Kidneys and Chronic Kidney Disease (CKD) What is chronic kidney disease?............................................................. 1 Understand the kidney and its function............................................... 2 How to detect kidney disease?............................................................... 3 Stages of chronic kidney disease............................................................ 4 Symptoms of chronic kidney disease................................................... 5 Are you at risk?............................................................................................. 6

Disease Prevention and Management Ways to slow down kidney damage...................................................... 7 Medications.................................................................................................. 9 Nutrition and your kidneys ...................................................................... 11 Home monitoring....................................................................................... 16

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What is chronic kidney disease?

Chronic kidney disease (CKD) is a condition of a gradual loss of kidney function over time.

When your kidney function fails / deteriorates to end stage, these are the treatment options available: • Kidney transplant • Dialysis • Conservative care (no dialysis) CKD also increases your risk of having heart disease.

CKD is NOT reversible However, early detection and treatment can slow down the progression of kidney disease

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Understand the kidney and its function

CLEAN

Remove waste products in blood e.g. urea, creatinine.

Remove excess water FILTER

BALANCE

Balance chemicals in the body, e.g. potassium

Regulate blood pressure

CONTROL

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Produce hormones for red blood cells and vitamin D

How to detect kidney disease?

Urine Test

Urine test is performed to detect protein (e.g. albumin) in the urine. Damaged kidneys leak protein such as albumin from blood into the urine.

Normal kidney

Damaged kidney

Blood Test

Blood test is performed to check the blood creatinine and estimate glomerular filtration rate (eGFR in ml/min/1.73m2). eGFR measures the efficiency of kidneys to clean your blood.

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Stages of chronic kidney disease

Start monitoring your kidney health by keeping track of your eGFR! Date Creatinine eGFR Date Creatinine eGFR

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Symptoms of chronic kidney disease Early stage of CKD may not have any symptoms.

Everyone is unique, the symptoms may vary from person to person.

As kidney disease progresses, you may experience some of the following: 1) Waste buildup

Poor appetite Nausea / Vomiting

Itchy skin

2) Anaemia

Pale-looking

Feel tired easily

3) Water retention

Swollen feet and ankles

Difficulty in breathing

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Are you at risk?

Please tick if YES

Self assessment Do you have high blood pressure?

Do you have diabetes?

Do you have family history of kidney disease?

Are you overweight?

Do you smoke?

Are you above 60 years old?

Please get your kidney function checked if you have one or more of the risk factors above.

Note:

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Ways to slow down kidney damage Target

Action Exercise at least 3 times per week, about 30 minutes per session.

Keep fit and active Monitor and control blood pressure. You are encouraged to record your blood pressure in page 16.

Less than 140/90mmHg

Before meal: 6.1-8mmol/L 2 hrs after meal: 7.1-10mmol/L HbA1c ≤ 7%

Monitor and control blood sugar.

(If you have diabetes)

Please refer to the section on “nutrition and kidneys” (page 11).

Well balanced and healthy diet 7

Ways to slow down kidney damage Target

Action Discuss with your healthcare professional on smoking cessation program or useful tips to quit smoking.

Quit smoking

Please have checkup if you are at risk.

Have regular check ups Please refer to the “medication section� (page 9).

Adhere to your medication regime

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Medications You may be prescribed medicines to control diabetes, high blood pressure and cholesterol.

Take your medicines as prescribed by doctor If you have difficulty following the instructions or are concerned about side effects, consult your pharmacist.

GET IT RIGHT

If you miss a dose, take as soon as you remember. If it is nearly time for the next dose, skip the missed dose. Do not double the dose.

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Medications Keep the latest medicine list

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Avoid unwanted kidney damage Do not take traditional medicine or health supplements from dubious sources. They may lead to health problems, including kidney damage.

If you have kidney disease, avoid taking pain-killers such as Diclofenac (Voltaren), Naproxen (Synflex), Etoricoxib (Arcoxia) as they may worsen existing kidney function.

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Nutrition and your kidneys Dietary Control is Important for Managing Chronic Kidney Disease: • Maintain a Healthy Weight • Helps to prevent chronic diseases • Improves the control of chronic kidney disease.

• Maintain Good Blood Pressure Control • Limit the intake of sodium • Maintain Good Blood Sugar Control • Maintain Good Cholesterol Control • Maintain Appropriate Intake of Protein • Appropriate intake of high quality protein is important to keep your body nourished and strong • Delay the deterioration of your kidney function • Maintain a Healthy and Balanced Diet • Consists of a variety of foods that include fruits, vegetables, good quality protein and carbohydrate food in appropriate amount • Combine with moderate intake of salt, sugar and fat

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Nutrition and your kidneys Eat Well Tips: 1. Choose fresh over processed or preserved foods, which are often high in salt.

2. Substitute salt and sauces with fresh herbs and spices.

3. Use less dipping sauces and leave behind soup stock and gravy. Limit the amount of gravy.

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Nutrition and your kidneys 4. Choose plain rice instead of flavoured rice such as chicken rice, nasi briyani and nasi lemak.

5. Choose products lower in salt by reading food labels.

• Look out for ingredients list that contain salt/sodium • Ingredients that contain sodium include monosodium glutamate (MSG), sodium nitrite, and sodium benzoate.

• Choose “Reduced Salt”, “Low Salt”, or “No Added Salt” products.

• Look out for the Healthier Choice Symbol.

No Added Sodium

Lower in Sodium

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Nutrition and your kidneys 6. Avoid or limit sweetened drinks and food.

7. Take a variety of good quality carbohydrates, such as brown rice, wholemeal bread, root vegetables, and legumes.

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Nutrition and your kidneys 8. Limit high fat food, especially those high in saturated fats and trans fats Limit deep-fried food to not more than 2 times per week

9. Limit cholesterol-rich food Food high in cholesterol are often high saturated fats

10. Eat the appropriate amount of protein for you Too little • Muscle loss • Higher risk of infection • Slower wound healing

Too much • Burden the kidneys • High waste products • Nausea, vomiting • Poor appetite

Under-nutrition

Faster decline in kidney function

For more specific dietary advice, kindly consult your dietitian.

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Home monitoring

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Yishun Health is a network of medical institutions and health facilities of the National Healthcare Group.

Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.

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