Discussions between people with chronic kidney disease (CKD) and their healthcare team can help patients better understand their condition and the different treatment options available.
General discussion
- Comorbidities (other health issues such as weight, diabetes, cardiovascular disease, cancer, frailty)
- Lifestyle (smoking or vaping, drinking, recreational drug use)
- Diet, including salt intake
- Physical activity and exercise, including reducing prolonged sedentary time
Immunisations
Chronic kidney disease (CKD) reduces the body's ability to fight infectious diseases. Vaccines are effective and safe in reducing the risk of complications and death from many infectious diseases. Although live virus vaccines should not be given to transplant patients or the severely immunosuppressed, there may be inactivated vaccines which can be used instead.
The need for vaccination at various stages of CKD and treatment should be discussed by the general practitioner (GP) and renal team with the patient. Information and recommendations can be found in the Australian Immunisation Handbook for health professionals.
Medications
What patients may expect to know:
- What different medications are used for
- How medications may affect the kidneys or react with other medicines
- When to take medication, e.g. time of day, with or without food
- When medications will be reviewed by the treating team
Patients can ask for a medication card to record medication, indication and doses. This card can be shown to other health practitioners.
Medications that may help to slow progression of disease:
- ACE inhibitors (ACEI), angiotensin receptor blockers (ARBs), SGLT2 inhibitors
- Antihypertensives
- Mineralocorticoid receptor antagonists, nonsteroidal mineralocorticoid receptor antagonists (MRA), which also reduce inflammation in the kidneys
- Glucagon-like peptide-1 (GLP-1) receptor agonists, for people with diabetes and CKD
- Statins to lower cholesterol
Supplements that can be given to support bone health:
- Vitamin D
Medications that may cause ongoing kidney damage and may need to be stopped or have the dose adjusted:
- Pain medications, nonsteroidal anti-inflammatory drugs (NSAIDs) used for arthritis and in some cold preparations, e.g. ibuprofen, naproxen, COX-2 inhibitors
- Reflux medications, e.g. proton pump inhibitors (PPI)
- Cholesterol and triglyceride medications dose adjustment
- Antacids
- Herbal medications and vitamin supplements, including alternative, complementary and traditional medications
- Diabetic medications
- Contrast dye (used for certain x-rays and imaging, such as MRIs)
- Antimicrobial medications (antibiotics, antifungal, antiviral)
- Blood thinners
- Others – always ask whether they cause kidney damage
Resources
Resources for general practitioners
Prescribing and deprescribing in chronic kidney disease
Patients with chronic kidney disease are often taking a variety of medications. This article contains more detail about medications and CKD, including a useful table about commonly prescribed medications that people with CKD may need to adjust or stop taking.
Source: Australian Journal of General Practice
Referring to chronic disease allied health services under Medicare
Following a healthy diet and exercising regularly is one of the best ways to slow down the progression of kidney disease.6,7 Refer people with CKD for allied health services (such as a dietitian and exercise physiologist), as required. Stop smoking programs are also recommended, if required.8
Source: Australian Government Department of Health and Aged Care
Chronic kidney disease management in primary care
A handbook for GPs with advice on detecting CKD, tests, staging, action plans, medication advice, treatment targets and nephrology referral.
Source: Kidney Health Australia
Kidney Failure Risk: The Equation
GPs can use the Kidney Failure Risk Equation (KFRE) for people with advanced chronic kidney disease (eGFR < 60) to calculate the probability of progression to kidney failure in 2 and 5 years. The model has been validated for the Australian population. The model should not be the only method GPs use to manage the progression of CKD.
Source: Seven Oaks Hospital Chronic Disease Innovation Centre
Resources for patients
Medicines and kidney disease
A useful webpage about how kidney disease can impact the way your body reacts to medicines.
Source: Kidney Health Australia
Sick day action plan
For people with CKD, it is important to have a plan for what medications to stop on days of illness such as vomiting and diarrhoea (unless minor) causing dehydration, fevers, sweats and shaking. Patients can complete their sick day action plan with advice from their GP or kidney care team.
Source: Kidney Health Australia
Managing chronic conditions
General information about chronic conditions – prevention, diagnosis, treatment and management.
Source: Australian Government Department of Health, Disability and Ageing
Managing diet to improve CKD
Patient education sheet about the importance of nutrition in managing kidney disease.
Source: Kidney Health Australia
Exercise and kidney disease
Patient education sheet about the importance of exercise in managing kidney disease.
Source: Kidney Health Australia
References
- Ikizler TA, Burrowes JD, Byham-Gray LD, et al; KDOQI Nutrition in CKD Guideline Work Group. KDOQI clinical practice guideline for nutrition in CKD: 2020 update. Am J Kidney Dis. 2020;76(3) (suppl 1):S1-S107. Accessed 10 Nov 2023.
- Lambert K, Bahceci S, Harrison H, et al. Caring for Australians and New Zealanders with Kidney Impairment (CARI) Guideline Group. Commentary on the 2020 update of the KDOQI clinical practice guideline for nutrition in chronic kidney disease. Nephrology (Carlton) 2022. un;27(6):537-540. DOI: 10.1111/nep.14025.
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024 Apr;105(4S):S117-S314. DOI: 10.1016/j.kint.2023.10.018.