The therapeutic objectives of referral to a nephrologist in Delhi are aimed at reducing and treating the associated complications of CKD, and preparing adequately and sufficiently in advance, the replacement treatment for renal function. Early detection and appropriate referral to Nephrology of patients with CKD reduces complications and improves long-term survival, since it allows early identification of reversible causes, decrease the rate of progression, decrease associated cardiovascular morbidity and mortality, and prepare the patient adequately for dialysis if necessary.
The improvement of the care and the prognosis of CKD must be made through early detection plans in the population at risk, which implies close coordination and collaboration between Primary Care and Nephrology, says the nephrologist in Noida.
According to the nephrologist in Delhi, the treatment of Chronic Kidney Disease aims to avoid or reduce risk factors for disease progression, prevent the onset of symptoms and minimize complications.
The low protein diet delays the appearance of excess urea symptoms (pruritus, insomnia, neurological, neuromuscular, gastrointestinal and other disorders), by reducing its generation. Although controversial, it is suggested that protein restriction slows the progression of CKD. This concept is not applicable to patients with polycystic kidney disease, but protein restriction is especially beneficial in diabetic nephropathy, says the nephrologist in Gurgaon.
Before prescribing the diet, the patient must undergo a nutritional evaluation. Also, the diet must include an adequate energy supply. There is a favourable circumstance that phosphorus restriction is proportional to protein restriction, so both guidelines are consistent.
In addition, the low protein diet prevents part of metabolic acidosis, by reducing the generation of acids in the body. A low protein diet is especially useful in patients with CKD grade 4 and 5, although it is less important if the patient has very well controlled blood pressure. The low protein diet can cause malnutrition, so it should be provided between 0.6 and 0.8 g / kg / person / day, in those with moderate-severe or severe kidney failure, and some parameters should be evaluated periodically corporal like the index of corporal mass, the triceps fold or the circumference of the arm, and biochemicals (in the analytical ones) like albumin and serum cholesterol, or lymphocyte levels. On the other hand, the diet must contain 35-40 kilocalories per kilogram of weight per day, suggests the kidney specialist in Delhi.
With a low protein diet, acid production is reduced, but despite this, in an advanced CKD situation, the kidney is not capable of producing the bicarbonate necessary to replace what is lost, and it is necessary to replace it as a supplement (3 -4 grams daily in the form of oral stamps or bicarbonated water). This amount depends on kidney function and the animal protein content of the diet, explains the kidney specialist in Noida.
The water intake depends on the diuresis that is conserved. Diet salt is often limited to control excess fluids and high blood pressure. However, the loss of the ability to dilute urine associated with CRF implies that a minimum intake of salt is necessary to guarantee that the patient can eliminate, for example, 2 liters of water; otherwise water is retained, and sodium in the blood drops too low (hyponatremia). This process is frequent during hospitalization, in which very restrictive diets can be indicated in salt and liquids are provided in the form of glucose serum.
Salt restriction reduces the sodium load reaching the end places of the nephron where sodium is exchanged for potassium (the tubule reabsorbs sodium and expels potassium), thus favouring the dangerous increase in potassium in the blood (hyperkalemia), says the kidney specialist in Gurgaon.
The different alterations in bone-mineral metabolism (hyperphosphoremia, hypocalcaemia, hyperparathyroidism, osteoporosis, etc.) are secondary to the progressive loss of mass and kidney function. As glomerular filtration decreases, a discrete but significant decrease in calcitriol can be seen secondary to the loss of renal mass, and to phosphate retention, which in turn decreases the renal synthesis of calcitriol. Furthermore, with this deficit of calcitriol synthesis, intestinal calcium absorption decreases, producing hypocalcemia. The positive balance of phosphorus, the deficit of calcitriol and the hypocalcemia, lead to an increase in PTH and trigger a situation of secondary hyperparathyroidism. Control of the phosphocalcium balance is essential to prevent it, and its values must be kept in range according to the degree of renal failure of the patient. The basic treatment is with phosphorus chelating drugs, which manage to “catch” it from the diet and eliminate it with the faeces. A normal diet provides about 1,200 mg of phosphorus a day; When urinary phosphorous excretion is less than 700 mg / day, hyperphosphoremia and stimulation of PTH secretion begin to occur. At this time, emphasis should be placed on restricting foods rich in phosphorus, and if necessary, combining chelators and vitamin D, suggests the doctor for kidney in Delhi.
People with Chronic Kidney Disease have a much higher cardiovascular risk than the general population, and it is essential to fight all the factors that increase that risk. It is as important to try to slow down the progression of CKD as to combat factors such as high blood pressure, excess cholesterol, obesity, which multiply the complications in these vulnerable patients. Most patients with CRF have anemia, due to the relative deficit of renal synthesis of erythropoietin. Specific treatment improves survival, decreases morbidity, and increases quality of life in both dialysis and pre-dialysis patients, says the nephrologist in Delhi.
Tobacco use is the most common cause of preventable cardiovascular mortality worldwide. The immediate deleterious effects of smoking are related to activation of the sympathetic nervous system, which increases myocardial oxygen consumption through an increase in blood pressure, heart rate, and myocardial contractility.
Furthermore, smoking induces a progressive increase in arterial stiffness and is a major risk factor for cardiovascular disease, coronary heart disease and cerebrovascular disease. Furthermore, tobacco induces and accelerates the progression of CKD. In patients with advanced CKD, smoking is a cardiovascular risk factor and is associated with an increased risk of developing heart attacks, peripheral vascular disease, heart failure, and mortality. Quitting smoking is an essential therapeutic goal in CKD patients.
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