Lesson 2:
Managing your kidney disease

Tell participants that you are going to make a statement for which you want to learn their reaction. Give each participant small cards on which you've written the following: SA (means Strongly agree); A (Agree); D (Disagree); SD (Strongly disagree). State the following and ask participants to hold up the card that shows his/her answer: “There are steps you can take to keep your kidney working”. As an assessment strategy: Repeat at the end of the lesson to see if their responses have changed.

• There are steps you can take to keep your kidneys working. (See session starter.)
• Weight management
• Blood pressure management
  • Blood pressure goal: individualized
  • Medications – ACEs/ARBs, diuretics
    • ACEs/ARBS and risk of hyperkalemia (too much potassium in the blood, but help lower urine albumin)
  • Sodium reduction (<2,300 mg)
  • Physical activity
• Diabetes management
  • A1C target (Note to educator: should become more individualized as CKD/CVD progresses)
  • Diabetes medications may change because of kidney disease (often takes less medication to control glucose in the later stages of CKD)
  • How to treat hypoglycemia appropriately (risk of high potassium with ACEi and ARB use) glucose tablets are preferred [May need to avoid juices with high potassium levels if hyperkalemic]
  • Hyperglycemia
• Cardiovascular disease (CVD)
  • Physical activity
  • CVD is major cause of mortality
  • LDL goal
  • Medications
• Nutritional health
  • Choose and prepare foods with less salt and sodium
  • Eat the right amount and kind of protein
  • Choose foods that are healthy for your heart
  • Choose foods based on phosphorus and potassium content (if restricted)
  • Make choices that help with diabetes management
  • Dietitian referral/nutrition therapy is covered benefit
• Medication safety
  • Prescription
  • Over-the-counter (pain relief)
• Tobacco cessation

• Questions And Answers About High Blood Pressure (NKDEP)
• Eating Right (NKDEP)
• Your Kidney Test Results (NKDEP)
• CKD: What Does it Mean for Me? (NKDEP)
• CKD and Medicines (NKDEP)
• Your Guide to Lowering Blood Pressure (NHLBI)
• Four Steps to Controlling Your Diabetes. For Life. (NIDDK, 10/06)
  (Note to educator: Some diet recommendations will be inconsistent with changes needed due to patient's level of kidney function.)
• Enjoy Living Smoke Free (English/Spanish) (NHLBI, 6/08)

• Key Concepts for KDE (NKDEP)
• NKDEP videos:
  • What changes do I need to make because I have kidney disease?
  • Are there medications for kidney disease?
  • Can kidney disease get better?
  • Is there a connection between heart disease and kidney disease?
• Nutrition for Early Chronic Kidney Disease in Adults (NIDDK, 1/06)
• Nutrition for Later Chronic Kidney Disease in Adults (NIDDK, 1/06)
• Analgesic Nephropathy (Painkillers and the Kidneys) (NIDDK, 9/07)

• True or False: Managing blood pressure is one of the most important ways to keep kidney disease from getting worse.
• True or False: People with kidney disease should limit the amount of salt/sodium in the diet.

Other outcomes:

• Patient states that managing blood pressure is the most important way to manage his/her KD.
• Patient states one way to change his/her eating to protect the kidneys.
• Patient tells one way he/she will approach use of OTC medications in the future.
• Smoking patient states that he/she is aware that smoking can worsen KD.
• Patient states what he/she will do with information from today's session.

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