Lesson 3:
What happens when kidney disease gets worse?

What are your ideas about how you may feel or what you may notice when your kidney function worsens?

• Kidneys have other jobs besides making urine. At this stage, they can't function as well.
• Gradual/adaptationto symptoms ; you may feel fine
• Different foreveryone – important to know your lab test results, including eGFR and urine albumin values
• Possible symptoms of decreasing kidney function and why they occur later
  • There is no change in urine volume or kidney pain (lower back)
  • Fatigue or weakness
  • Swelling
  • Bad taste in the mouth/food doesn't taste good (especially red meat)
  • Feel cold
  • Poor concentration
  • Shortness of breath
  • Itching skin
  • Cramping in hands and legs
  • Nausea andvomiting
• Complications (*May require additional medications) – basic explanation and treatment
  • Anemia*
    • May feel tired or weak
    • Erythropoietin deficiency
    • May need iron
    • May need erythropoiesis stimulating agent (injection)
    • LABS: hemoglobin
  • Mineral and bone disorder*
    • May get itchy skin
    • Inadequate active Vitamin D
    • May take special supplement
    • Too much phosphorus in the blood
    • May need phosphorus binding med with meals
    • LABS: Phosphorus, calcium, VitaminD, iPTH
  • Malnutrition
    • May have bad taste in mouth
    • Poor appetite
    • May add to swelling
    • Need adequate calories
    • LABS: albumin
  • Changes in functional status
    • Difficulty walking
    • Harder to care for self
  • Fluid overload
    • May be seen as weight gain, swelling, or shortness of breath
    • Kidneys may not remove fluid well
    • Rarely need fluid restriction
    • Use less salt, take water pills
  • Metabolic acidosis
    • Kidneys not removing acid in the blood
    • May need medication with bicarbonate
    • LABS: bicarbonate
  • Depression
    • Diabetes can contribute
    • Fear, grieving with loss of body function
    • It is OK to talk about it
  • Sexual complications
    • Discuss concerns with your doctor
• Know how your medications work. Know which medications you can continue taking (including OTC medications). Talk with your pharmacist and provider about:
  • The more medications you take, the more you need to know about: medication interactions, medication-disease interactions, medication-food interactions, medication-herbal supplement interactions.
• Timing of medication use (ie., qAC, etc.)
• Cultural consideration: Be sensitive to your target audience's use of traditional remedies and healers.
• Symptoms and complications may increase as kidney function declines to kidney failure (State directly)

• Kidney Failure: What to Expect (NIDDK)
• Your Kidney Test Results (NKDEP)

• AMT (NKDEP)
  • Anemia (page 9)
  • CKD-MBD (pages 7-9)
  • Malnutrition (page 5)
• NKDEP videos:
  • What are the symptoms of CKD?
• Kidney Failure: What to Expect (NIDDK, 7/06)
• Anemia in Kidney Disease and Dialysis (NIDDK, 10/08)
• Chronic Kidney Disease—Bone and Mineral Disorder (NIDDK, 2/09)

• What symptoms may people with CKD experience as their kidney function worsens?
• What can you do to deal with the symptoms/complications of CKD?

Other outcomes:

• Patient states that managing blood pressure is the most important way to manage his/her KD.
• Patient states that he/she knows future health problems may require additional medications.

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