In this column, we will look at treatment for early-stage CKD, which can lead ultimately to end-stage renal (kidney) disease, requiring dialysis and potentially a kidney transplant.
One of the problems with early-stage CKD is that it tends to be asymptomatic. However, there are simple tests, such as a basic metabolic panel and a urinalysis, that will indicate whether a patient may have mild CKD.
These indices for kidney function include an estimated glomerular filtration rate (eGFR), creatinine level and protein in the urine. The eGFR and kidney function are inversely related, meaning as eGFR declines, the more severe the chronic kidney disease.
What can be done to stem early-stage CKD, before complications occur? There are several studies that have looked at medications and lifestyle modifications and their impacts on its prevention, treatment and reversal.
Allopurinol is usually thought of as a medication to prevent gout. However, in a randomized controlled trial of 113 patients, results show that allopurinol may help to slow the progression of CKD.
The group using 100 mg of allopurinol showed significant improvement in eGFR levels compared to the control group over a two-year period. The researchers concluded that allopurinol slowed CKD progression, while also decreasing cardiovascular risk.
Fibrates are a class of drug usually used to boost HDL (“good”) cholesterol levels and reduce triglyceride levels, another cholesterol marker. Fibrates have gotten negative press for not showing improvement in cardiovascular outcomes.
However, in patients with mild to moderate CKD, a meta-analysis of 10 studies showed a 30 percent reduction in major cardiovascular events and a 40 percent reduction in the risk of cardiovascular mortality with the use of fibrates.
This is important, since patients with CKD are mostly likely to die of cardiovascular disease.
Fruits and vegetables may play a role in helping patients with CKD. In a small, one-year study, results showed that fruits and vegetables work as well as sodium bicarbonate in improving kidney function by reducing metabolic acidosis levels.
With metabolic acidosis, body fluids become acidic, and it is associated with chronic kidney disease. The authors concluded that both sodium bicarbonate and a diet including fruits and vegetables were renoprotective, helping to protect the kidneys from further damage in CKD patients.
Alkali diets are primarily plant-based, although not necessarily vegetarian or vegan diets, while animal products tend to cause an acidic environment.
In the Nurses’ Health Study, results show that animal fat, red meat and sodium all negatively impact kidney function. The risk of protein in the urine, a potential indicator of CKD, increased by 72 percent in participants who consumed the highest amounts of animal fat compared to the lowest, and by 51 percent in those who ate red meat at least twice a week.
With higher amounts of sodium, there was a 52 percent increased risk of having lower levels of eGFR.
The most interesting part with sodium was that the difference between higher mean consumption and the lower mean consumption was not that large, 2.4 grams compared to 1.7 grams.
In other words, the difference between approximately a teaspoon of sodium and three quarters of a teaspoon was responsible for the decrease in kidney function.
Therefore, it is important to have your kidney function checked with mainstream tests. If the levels are low, you should address the issue through medications and/or lifestyle modifications to manage and reverse early-stage CKD.
Don’t wait until symptoms and complications occur. In my experience, it is much easier to treat and reverse a disease in its earlier stages, and CKD is no exception.