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My doctor has told me I have Chronic Kidney Disease. What treatments should I follow?

It is very important to control blood pressure. This will decrease kidney damage and may delay the progression of your kidney disease. For that we must consider:
  • Use of medications to control blood pressure
  • The goal is to maintain blood pressure at 130/80 mm Hg or less
There are other recommendations to improve control of chronic kidney disease and avoid heart problems. They are between them:
  • No Smoking
  • Follow a diet low in fat and cholesterol
  • Exercise regularly (with prior medical authorization)
  • Use the medicines as prescribed by your doctor
  • Maintain good control of your blood sugar levels
  • Use your diabetes medications as ordered
  • Avoid foods high in sugars
  • Doing physical activity regularly
  • Monitor your glucose levels at home.
  • Decrease your intake of foods high in sodium
Notify your health care team (primary care nurse, dietitian, social worker, or nephrologist) before you start using any vitamin or natural supplement or medication. Also, let the other doctors know that you visit that you have chronic kidney disease. Sometimes it may be necessary to use other treatments such as:
  • Special medications called phosphorus traps to help keep phosphorus levels in the blood from rising too much.
  • To improve your anemia – iron supplements in pills or by vein and sometimes special injections of a drug that will help improve your hemoglobin levels and avoid blood transfusions.
  • Calcium and extra vitamin D (in amounts prescribed by your doctor.Never use supplements without first talking to your nephrologist)
In addition to using medications, part of your treatment includes making changes in your eating habits. These include:
  • Decrease your sodium intake
  • Control your fluid intake
  • You may need to decrease the amount of protein you eat
  • Reduce the amount of foods high in potassium and phosphorus
  • Consume the calories needed to stay at a healthy weight for you.
At CKD clinics we can help you manage your chronic kidney disease as we have expert renal health professionals.
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What is Chronic Kidney Disease?

Chronic kidney disease occurs when the kidneys are losing their ability to function properly over time. The main function of the kidneys is to remove wastes and excess water and minerals from the body. Chronic kidney disease has five (5) stages (stages) and each defines a greater decrease in kidney function. Why does chronic kidney disease occur? The main causes of chronic kidney disease are diabetes and high blood pressure. However, there are other factors that can affect the proper functioning of the kidneys. These are:
  • Autoimmune diseases (such as lupus, scleroderma, HIV)
  • Congenital problems (polycystic kidneys)
  • Infections of the kidneys (Glomerulonephritis)
  • Recurrent urinary tract infections
  • Injury or trauma to the kidney
  • Kidney stones (stones in the kidneys)
  • Problems in the arteries that carry the blood flow to the kidneys
  • Abuse of analgesics for pain
  • Use of contrasts for certain medical studies.
Chronic kidney disease worsens over time. However, early stages (stages 1-3) of kidney disease usually do not produce any symptoms. The function of the kidneys may decrease over a period of months or years. In many cases the loss of kidney function is so slow that the condition is not detected until the person is already in more advanced stages of the disease and begins to feel some symptoms. The last stage (stage 5) is known as Permanent Renal Failure or Terminal Renal Disease. At this stage, the kidneys have already lost the ability to remove enough waste or fluid from the body so that the patient can live properly. At this time, it will be necessary to resort to a treatment that is known as dialysis or to a kidney transplant. What symptoms can someone with chronic kidney disease have? Because chronic kidney disease usually does not produce symptoms during the first stages, any symptom that the patient feels may be mistaken for a symptom of another condition. This is why in many cases, the diagnosis of chronic kidney disease is made in more advanced stages. Some of the symptoms you may notice are:
  • Lack of appetite
  • Feeling of general weakness and malaise
  • Headaches
  • Itching and dry skin
  • Sickness
  • Unintentional weight loss (unwanted)
Some other symptoms you may notice, especially in more advanced stages (such as 4 or 5) are:
  • Darkening or lightening of the skin
  • Bone pain
  • Changes in the nervous system and brain:
  • Much sleep and confusion
  • Difficulty concentrating and thinking
  • Numbness of the hands or feet
  • Cramps
  • Bad breath
  • Excessive thirst
  • Decreased sexual interest or impotence
  • Decrease or stoppage in menstrual periods (amenorrhea)
  • Difficulty sleeping (insomnia) or restless legs syndrome
  • Swelling of feet and hands (from accumulation of fluids)
  • Vomiting, usually in the morning
What tests can I take to find out if I have chronic kidney disease? A simple urine test called urinalysis can detect if there is a protein in the urine. This can begin to detect from 6 months to 10 years before kidney disease begins to produce symptoms. Some blood tests help to check how kidney function works. These are:
  • Creatinine levels
  • Nitrogenated Blood Urea (BUN)
Other laboratories may also be affected by chronic kidney disease. For this reason it is important that the patient perform regular laboratory tests to continue monitoring kidney function.
  • Albumin – a blood protein
  • Calcium
  • Cholesterol
  • Hemoglobin / Hematocrits
  • Magnesium
  • Match
  • Potassium
  • Sodium
  • Acidity of blood (CO2)
  • Vitamin D
For more information, you can visit our clinics or call 787-710-2532. We are here to help!
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Simple diagnosis of incipient chronic kidney disease in diabetes patients

Diabetes mellitus ( DM) is the most common diagnosis of patients on dialysis in Puerto Rico. Avoid or reduce the possibility that DM patients are candidates for dialysis is one of the most urgent priorities in Puerto Rican medicine. So why do so many people living with diabetes in Puerto Rico? There are several factors to consider. First, is the hereditary factor . Many Puerto Rican families, both father and mother, suffered or suffering from DM . The possibility of developing DM is high in the members of these families. The harmful lifestyles of patients with DM is alarming. The high incidence of obesity and comes from a high -calorie, salt, lack of exercise more inadequate diet. Another important factor is that , although there is evidence of simple laboratories that detect changes in renal function in patients with DM, they are referred late to the nephrologist. The diagnosis of incipient chronic kidney disease in patients with DM is simple. Only two laboratory tests are needed to make an early diagnosis. The two tests used to assess kidney function are serum creatinine, which measures kidney function, and albumin in the urine. This way, you can know if your kidneys are functioning mild, moderate or severe or if you need dialysis. Also, it is important to ask the patient if urination DM observes a lot of foam in the urine. This may be an important signal because it can be associated with amounts of protein / albumin in urine increased. The presence of protein / albumin in the urine is a sign of kidney or heart disease in patients with DM. However, at present, there are scientific knowledge for early detection of kidney disease in patients with DM and establish a systematic treatment to prevent or slow the progression of kidney disease in this.
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Education and teamwork as key factors in treating diabetes

When discussing diabetes, we are talking about how one of the major epidemics of the 21st century spreads over the population. How to treat and stop it? The main tool for the prevention of complications and the development of diabetes lies in education, not only for the general population, but also for the different health professionals who, in one way or another, participate in the care of the Patients. This will allow for better interaction at each encounter between the individual and the health care provider, maximizing adherence to treatment and achieving better metabolic control to reduce diabetes progression, progression, and associated complications. Today, innovation and technology offer new and different treatment options for diabetes. There are many oral medications that work on different physiological defects identified in this condition. Similarly, there have been new injectable drugs, which are not insulin and help maintain proper control of blood sugar levels and maintain or reduce body weight. There are also new insulins and methods of administration of this that allow a better simulation of the insulin secretion that occurs in a person who has diabetes. All this, in addition to the emergence of new methods to control blood sugar levels to individualize therapy helps each person with diabetes to achieve and maintain adequate control, slow the progression of the disease and its complications. Despite all these advances have not been able to reduce new cases of diabetes, stop the progression of the disease or the development of chronic complications of this. At that time, there is no data on diabetes control in Puerto Rico. Data from the Department of Health show that US diabetes control in the nation, as measured by the percentage of people achieving A1C below 7.0%, has improved to 55.7% in the period 2003 And 2004. How much more can the situation improve? What can be done to achieve this? There is still a long way to go. There are enough tools to get proper control of diabetes and associated conditions. In order to stop this epidemic, joint efforts are needed between health professionals, professional and non-professional organizations related to diabetes, the insurance industry, the pharmaceutical industry, government and the general population. We must learn to work together. Therefore, it would achieve greater awareness of how to prevent and control diabetes and how to individualize therapy to achieve maximum benefit with the lowest risk and probably the best cost for each individual. Only then will it stop diabetes mellitus in Puerto Rico and thus contribute to a better quality of life for our people.
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Advice for good kidney health

The kidneys are two organs in the body whose proper functioning is vital for human life. In each kidney there are thousands of small microfilters (glomeruli) that are responsible for maintaining the proper balance of water, minerals, acids, bases, toxic substances and nutrients necessary for a good functioning of our body. In addition, the kidneys produce hormones that help in the production of red blood cells and maintain hemoglobin (Hgb) and other substances that strengthen our bones to acceptable levels. These microfilters act as “strainers” where, depending on the holes or pores of each, normal or excessive amounts of albumin or red blood cells in the urine are retained or leaked. The presence of small amounts of albumin in the urine (microalbuminuria) may be indicative of an initial kidney disease. Among the diseases that can affect these microfilters are diabetes mellitus type 1 and type 2, and hypertension. These conditions can affect the performance of microfilters and, depending on the damage they cause to these structures, the filters or pores are enlarged, allowing large amounts of albumin and red blood cells to pass into the urine. Progressively, the microfilters and their pores are clogged, and can not perform the functions of the kidneys to normal levels. According to the loss of the microfilters, toxic substances can be retained that can do damage in our body. In addition, anemia (under Hgb) and possible weakening of the bones can occur. The overall functioning of microfilters is well known, such as renal function. There are clinical laboratory tests that can, in a simple way, detect whether your microfilters are working properly. The two tests used to evaluate kidney function are serum creatinine, which measures the function of the kidney and albumin in the urine. If we know the value of these tests, we can detect the overall functioning of microfilters or, in other words, the total renal function of both kidneys. This way, you can know if your kidneys are functioning normally, mild, moderate or severe and if you need dialysis. It is vital that you know the functioning of your kidneys. Ask your doctor to tell you which stage of function your kidneys are in. In short, early detection of problems in the functioning of your kidneys can help you avoid, in many cases, the progressive deterioration of your kidney function and the possibility that you need dialysis. Prevention now or pay later: that is the slogan. To protect the functioning of your kidneys, the following is recommended:
  • Controlled blood pressure.
  • Decreased microalbumin, if detected.
  • Normalization of blood sugars.
  • Maintain the ideal weight for your height.
  • Decreased consumption of salt.
Suitable cholesterol levels, especially bad cholesterol, known as LDL. Acceptable protein intake (levels acceptable for a healthy adult are: 1 gram for each kilogram of weight). Avoid using medications to control pain (such as naproxen-related medications). Proper use of natural medicines, as some of these can cause damage to the kidneys. The author is chief medical director of P.R. RENAL HEALTH & amp; RESEARCH, in Carolina, Guaynabo, Ponce and Toa Baja. For information, call 787-710-CKDC (2532).
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Diabetes is a common life-long health condition. There are 3.2 million people diagnosed with diabetes in the UK and an estimated 630,000 people who have the condition, but don’t know it.
Diabetes is a condition where the amount of glucose in your blood is too high because the body cannot use it properly.
This is because your pancreas doesn’t produce any insulin, or not enough insulin, to help glucose enter your body’s cells – or the insulin that is produced does not work properly (known as insulin resistance).
  • Insulin is the hormone produced by the pancreas that allows glucose to enter the body’s cells, where it is used as fuel for energy so we can work, play and generally live our lives. It is vital for life.
  • Glucose comes from digesting carbohydrate and is also produced by the liver.
  • If you have diabetes, your body cannot make proper use of this glucose so it builds up in the blood and can’t be used as fuel.
  • There are two main types of diabetes: Type 1 diabetes and Type 2 diabetes.
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What is Diabetes?

Diabetes, also known as diabetes mellitus, is the name given to a disease that causes a person to have high glucose levels in blood (high blood sugar).  This may happen either because the body’s production of insulin in insufficient or because the body does not respond adequately to the insulin that is produced.  In some cases, both factors contribute to high blood glucose levels. There are three types of diabetes: Type 1 Diabetes This type of diabetes is characterized by the body’s inability to produce insulin.  Insulin is a hormone produced by the pancreas that helps the body use up the glucose in blood for energy.  Some people call this type of diabetes “insulin-dependent diabetes” or “juvenile diabetes” because it usually affects people in their teenage years or early adulthood. Type 1 diabetes is less common than type 2 diabetes. Patients who are diagnosed with diabetes type 1 will need insulin injections for the rest of their life because their bodies have stopped producing it.  Along with insulin injections, they must follow a special diet and make sure to follow up on blood exams regularly. Type 2 Diabetes The body does not produce enough insulin for proper function, or the cells in the body do not react to insulin properly (also called insulin resistance). Most diabetes cases are diabetes type 2. Recommendations to control the symptoms of diabetes are losing weight (if necessary), following a healthy diet, exercising, and monitoring blood glucose levels. Who’s at risk? People who are overweight or obese have a higher risk of developing type 2 diabetes. Central obesity, or belly fat contributes greatly to insulin resistance. Along with being overweight, being sedentary and eating unhealthy foods also contribute to developing type 2 diabetes. What symptoms can a person with diabetes experience?
  • Frequent urination (polyuria)
  • Excessive thirst (polydipsia)
  • Hungry (polyphagia)
  • Tiredness
  • Weight loss
3) Gestational Diabetes  develops during pregnancy.  The diagnosis is made usually after the 24th week of gestation.  This type of diabetes may develop if insufficient insulin is produced by the mother’s body or it may also be associated with insulin resistance, possibly due to hormonal changes during pregnancy, which may result in elevated blood glucose levels. Gestational diabetes can usually be controlled with exercise and diet.  Some patients may need to use insulin injections to control blood glucose levels during their pregnancy.  If gestational diabetes goes undiagnosed or remains uncontrolled, there is a risk of complications during childbirth. Usually, gestational diabetes goes away after childbirth.  In many cases, women who have had gestational diabetes, go on to develop type 2 diabetes years later.  Lifestyle changes such as healthy eating and maintaining a healthy weight can reduce the risk of developing type 2 diabetes later on.  
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Taking good care of your kidneys

Diabetes Mellitus, either type I or II, is a health condition that affects the necessary kidney function essential for living.

In each kidney there are thousands of tiny microfilters that are responsible for keeping the balance between water, minerals, acids, bases, toxins and nutrients for proper body function.  Also, kidneys produce hormones that aid in the production of red blood cells to maintain hemoglobin levels and other substances that keep the bones in optimal conditions.

These microfilters act as strainers where, due to each one’s pores, they retain or filter normal or excessive quantities of red blood cells. The presence of small amounts of a type of protein called albumin in urine can be the start of kidney disease. When diabetes – and arterial hypertension – cause kidney damage, pores are enlarged and permit the passage or large quantities of red cells in urine. Progressively, the microfilters and pores get blocked and are unable to perform their required normal functions.

Due to this blockage of the microfilters, toxic substances can get retained and cause damage to the human body. Also, anemia can develop and bone deterioration could follow. The microfilter’s global functions are known as renal function. There are clinical laboratory tests that can detect if the microfilters are working well. The two tests that are used to evaluate renal function are serum creatinine, that measures the kidney’s function, and albumin found in urine.  After getting the results from these tests, the kidney’s filtering capacity can be detected and can show if further treatment may be needed.

It is always recommended to ask your doctor to inform you in which functional stage your kidneys are.  An early detection of kidney disease, in most cases, can help avoid deterioration of renal function and the chances of requiring dialysis.

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What is End-Stage Renal Disease?

End-Stage Renal Disease (ESRD) is defined as a stage where tissue is destroyed and the kidneys suffer permanent reduced function. At this stage, toxic substances accumulate in the body because they cannot be eliminated by the sick kidneys. The kidneys, in their normal state, produce a hormone known as erythropoietin which is responsible for stimulating the bone marrow to produce red blood cells.  In ESRD erythropoietin levels are low, resulting in low hemoglobin levels.  

After 30 years of age and as aging progresses, kidney function decreases.  Certain medical conditions such as diabetes mellitus, hypertension and abuse of pain relievers can accelerate the loss of kidney function and can eventually pose the need for receiving dialysisor a kidney transplant.

In Puerto Rico the leading cause of ESRD is diabetes mellitus (67.4%) followed by hypertension (12.8%).  In our country the majority of the people who begin dialysis are between 60 and 80 years old.  It should be clarified that most people who are in this age group will not develop permanent kidney disease and need dialysis.

However, it is important to emphasize that those who are between the ages of 60 and 80 years should be evaluated to determine renal function and whether any albumin or protein is present in urine.  Be aware of foam in urine, since this finding may suggest presence of albumin or protein in the urine, a marker of kidney damage and cardiovascular risk.

If we can detect kidney disease, we can also detect in what stage of the disease each person is.  More importantly, we may determine if the loss of kidney function is due solely to the aging process of the person and the kidneys.  

The greatest challenge is working on early prevention or dealing with the disease later.  Dr. Rafael Burgos Calderón Medical Director of Atlantis and PR Renal Health & Research, Inc

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