Chronic Kidney Disease: A Home Care Guide

What the tests mean

• eGFR (estimated glomerular filtration rate): estimates kidney filtering from a blood creatinine test, age and sex. Stages 1 to 5; stage 3 (about 30 to 59) is common in older adults; stage 5 (below 15) is kidney failure.
• Urine albumin or protein: leaking protein signals kidney damage and increased risk for heart disease.
• Blood pressure, blood sugar, haemoglobin, salts (potassium, sodium, calcium, phosphate), vitamin D and bone health are checked.
• Ultrasound looks at kidney size and blockage.

Single results can vary with dehydration, illness and medicines; a doctor interprets the trend. Keep reports together; see keeping a health record at home and monitoring kidney disease at home.

Common causes and what worsens CKD

• Diabetes, the leading cause; see diabetes at home after 60.
• High blood pressure; see hypertension home care guide.
• Heart disease and heart failure.
• Kidney stones, enlarged prostate and urinary obstruction; see prostate problems and urinary symptoms.
• Repeated infections.
• Long-term painkillers, especially anti-inflammatory tablets.
• Some herbal, ayurvedic and traditional products with heavy metals or toxins; dehydration; contrast dyes for scans; some other medicines.
• Inherited kidney disease.
• Smoking and obesity.

Protecting the kidneys at home

### Blood pressure and sugar

These are the most powerful steps. Take blood pressure and diabetes medicines exactly as prescribed; keep home readings in a log; attend check-ups. See how to measure blood pressure at home, how to test blood sugar at home and daily weights in heart failure if heart failure coexists. Never stop or change medicines without the doctor.

### Medicines and remedies

Many medicines are cleared by the kidneys, and doses may need adjusting as kidney function falls. Some harm the kidneys.

• Always tell every doctor, dentist and pharmacist that your parent has CKD, and carry a card.
• Avoid over-the-counter painkillers (especially anti-inflammatory tablets and gels in large amounts), some cold remedies, herbal and traditional products, and "kidney tonics" unless the nephrologist approves; see painkillers and older adults and supplements and medicine interactions.
• Never stop or reduce prescribed medicines because you fear kidney harm; ask the doctor.
• Review medicines regularly with the doctor and pharmacist, especially after hospital stays; see polypharmacy and deprescribing.
• Be careful with contrast dye for scans: tell the radiology staff about CKD.
• Sick-day rules: if your parent has vomiting, diarrhoea, fever or is unable to drink, call the doctor the same day, since some medicines may need to be paused temporarily; do not pause or change them yourself.

### Food, salt and fluids

Advice varies by stage, other illnesses and blood test results, so see a renal dietician if possible; see nutrition for kidney disease. General principles:

• Salt: reduce, since it raises blood pressure and fluid retention: avoid pickles, papad, packaged and fast foods; cook with less salt.
• Protein: needs are individual. In early CKD, avoid very high protein diets; in advanced CKD, protein may be moderately limited; in frail, underweight older adults, adequate protein is important. Do not restrict protein without advice; see how much protein do seniors need.
• Potassium: in more advanced CKD, high potassium can be dangerous to the heart. The dietician may advise limiting foods high in potassium (such as bananas, oranges, coconut water, potatoes, tomatoes, spinach and dried fruit), depending on blood results. Do not use salt substitutes, which contain potassium.
• Phosphate: advanced CKD may require limits on cola, processed foods and dairy; the dietician advises.
• Fluids: some people need no limit, others need restriction (especially with swelling, heart failure or dialysis). Follow the doctor's advice; do not drink excessively or restrict on your own; see hydration for older adults.
• Diabetes and weight: continue balanced eating; avoid crash diets and sweet drinks.
• Avoid herbal juices and "detox" remedies.
• Keep weight and nutrition adequate; poor appetite is common in advanced CKD; see malnutrition in older adults.

### Activity and lifestyle

Regular gentle exercise helps blood pressure, sugar, mood and fitness; see exercise at home for seniors: a safe starter guide and walking programme for older adults. Stop smoking. Limit alcohol. Manage cholesterol as advised. Sleep well; see sleep problems in older adults. Keep vaccines up to date, including hepatitis B, flu and pneumonia vaccines, as advised; see vaccines for older adults in India.

### Heat and dehydration

Dehydration can injure the kidneys. In hot weather, drink adequately unless restricted, avoid heavy exertion in the heat and seek help for vomiting or diarrhoea; see heat stroke and dehydration in seniors and diarrhoea and dehydration in seniors.

Symptoms of advancing CKD

As kidney function falls: tiredness, weakness, poor appetite, nausea, itching, swelling of legs and face, breathlessness, muscle cramps, poor sleep, restless legs, difficulty concentrating, changes in urine (foamy, less or more, dark, night-time urination), anaemia, bone pain, metallic taste. These are not specific, and they need a doctor. See anaemia and fatigue in older adults and swollen legs in older adults.

Emergency and urgent signs

Call 112 for: severe breathlessness; chest pain; collapse or fainting; very slow or irregular heartbeat with weakness (possible high potassium); confusion or drowsiness; seizures; signs of stroke; vomiting blood. Call the doctor the same day for: passing very little or no urine; marked swelling or rapid weight gain; vomiting or diarrhoea preventing fluids or medicines; fever with urinary symptoms; severe itching or persistent nausea; muscle weakness or palpitations; blood in urine; severe back or flank pain; or a sudden worsening of tiredness.

Planning ahead

If CKD advances, the nephrologist will discuss options: dialysis (haemodialysis or peritoneal dialysis), kidney transplant, or conservative kidney care that avoids dialysis and focuses on symptoms and quality of life, often appropriate for frail, older people with other illnesses. These decisions are personal and should be made early, with the person and family; see living with dialysis: routines, travel and support, advance care planning in India and palliative care at home guide. Consider also costs and insurance; see health insurance for senior citizens in India and government schemes for senior citizens.

A simple weekly routine

• Daily: take medicines at the same times, note blood pressure and, if advised, weight; offer fluids as the doctor allows; keep meals low in salt.
• Weekly: refill the pill organiser, check supplies and the date of the next test, and look for new swelling in the feet or face.
• Before any new medicine, remedy or scan: ask the doctor or pharmacist whether it is safe with kidney disease and say clearly that your parent has CKD.
• Keep a folder with all blood and urine reports in date order so any doctor can see the trend at a glance.
• Plan for monsoon, heat and travel: carry medicines, the report folder and a card stating the kidney diagnosis, and know the nearest hospital with a kidney team.

Emotional health

CKD brings worry, tiredness and changes to diet and life. Depression and anxiety are common; see depression in older adults. Encourage questions, support groups and open conversation.

Family and carers

Keep a medicine list; ensure tests are done on schedule; help with low-salt cooking; learn the warning signs; attend appointments; check medicines before buying anything over the counter; look after yourself; see preparing for a doctor's visit with a parent and caregiver burnout signs and prevention.

When to ask a professional

A doctor or nephrologist diagnoses, monitors and treats CKD. A renal dietician designs a diet. A pharmacist reviews medicines. A dialysis nurse can explain options. A diabetologist or cardiologist manages related conditions. For senior services, call Elderline 14567. In an emergency, call 112.