Hemodialysis 

Peritoneal dialysis (PD) 

In peritoneal dialysis, wastes are filtered through a cleansing fluid that flows through a tube (catheter) into part of your stomach. The lining of your belly serves as a filter and removes waste products from your blood. After the filtering process is done, the fluid gets out of the body through the catheter. There are two kinds of peritoneal dialysis - Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD). Basically, these two treatments are the same, however, the number of treatments and the method differ.

CAPD is a great way to rid your body of toxins while you go about the day. It's done by placing two quarts (or enough for eight treatments) in an enclosed bag and later draining it through a tube inside yourself. The fluid is drained from the abdomen after the exchange of fluid is done. This process is usually done three, four, or five times in a 24-hour period while you do your usual activities. Every exchange takes an average of 30 minutes. Some CKD patients like to do their exchanges at mealtimes and at bedtime.

Automated Peritoneal Dialysis (APD), also known as Continuous cycling peritoneal dialysis (CCPD), uses a machine that does multiple exchanges at night while you sleep. The machine automatically fills your stomach with dialysate. You must remain attached to the machine for about 10 to 12 hours at night, and then dialysate is drained into a sterile bag that you empty in the morning. With APD, you might have a lower risk of peritonitis (inflammation of the peritoneum) because you connect and disconnect to the dialysis equipment less frequently compared to CAPD.

Kidney Transplant

This surgical procedure is done to replace a damaged or diseased kidney with a healthy kidney from a living or deceased donor. Typically, a kidney transplant is chosen for people with kidney failure than a lifetime on dialysis. It can treat CKD or end-stage renal disease to improve your quality of life and lower the risk of death. While a kidney transplant is a lower treatment cost, it may be riskier for some people. These are people of older age, with severe heart disease, or have other factors that could affect their ability to undergo the procedure safely.

You can slow down the progression of your CKD by monitoring and managing condition including bone disease, diabetes, edema, hypertension, and high cholesterol. You must take all your medications as advised by your nephrologist to help prevent kidney failure and heart disease.

CKD 4 Diet

If you are living with CKD stage 4 and aren't on dialysis yet, your diet will be focused on limiting or avoiding certain foods that can cause further damage to your kidneys. Stage 4 CKD diet depends on other conditions including hypertension and diabetes. Generally speaking, a diet for CKD should be:

Protein

According to Kidney Disease Outcome Quality Initiatives (K/DOQI) Nutrition, a CKD patient may benefit from a protein intake of 0.6 grams per kilogram of body weight when GFR is below 25, or approximately 25% remaining kidney function. Your protein source should be from high protein sources. Consider avoiding processed foods as they are rich in sodium and phosphorus that can be harmful to the kidneys. Including a plant-based diet can be gentle to your kidneys while providing your protein requirements. Following a low-protein diet may protect your kidney, but increase the risk of protein malnutrition. It also decreases the buildup of protein waste in the blood. Always check in with your renal dietitian or nephrologist for your recommended protein intake. Click here to learn more about a plant-based diet.

Phosphorus

Limiting phosphorus in your diet can help prevent bone disease, preserve existing kidney function and manage PTH (parathyroid hormone) levels. At Stage 4, the PTH production increase, causing the release of calcium and phosphorus from the bones.

As a result, bones are weakened and the spike of phosphorus and calcium in the body can cause calcification in your heart, blood vessels, and other soft tissues within your body. Your nephrologist will suggest your phosphorus restriction based on your lab results, calcium, and PTH. 

Potassium

You may need to limit high-potassium foods if your kidneys couldn't remove enough potassium to manage normal blood levels in stage 4 CKD. If your potassium level is too high, consider cutting down on foods such as bananas, oranges, dried fruits, potatoes, avocados, brown and wild rice, dairy foods, beans, peas, nuts, meat, pork, fish, poultry and salt substitute. Your doctor may suggest limiting your potassium intake to 3,000 mg a day. Always check in with your renal dietitian for a custom meal plan and talk to your nephrologist about your potassium restriction.

Sodium

Other conditions such as fluid balance and blood pressure may affect sodium requirements. Your nephrologist may suggest limiting your intake from 1000 mg to 4,000 mg per day. To lower sodium intake, you must cut out processed and pre-packaged foods.