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Improving the understanding, detection, and management of kidney disease.

Lesson 3:
What happens when kidney disease gets worse?


Learning Objectives »

By the end of each session, participants will be able to:

  • List three symptoms of worsening kidney function.
  • Recognize that additional medications may be needed to treat complications.

Session Starter: »

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


Topics & Points To Cover: »

  • Kidneys have other jobs besides making urine. At this stage, they can't function as well.
  • Gradual/adaptation into symptoms; you may feel fine
  • Different for everyone – 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 and vomiting
  • 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)

Sample Outcome Assessment Questions »

  • 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.

Additional Resources For Download »

None available at this time.

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Page last updated: March 1, 2012