Lesson 3: What Happens when Kidney Disease Gets Worse

The content of this lesson, What Happens when Kidney Disease Gets Worse, meets the needs of qualified providers seeking to deliver the Kidney Disease Education (KDE) Services benefit (PDF, 206 KB), as defined by the Centers for Medicare & Medicaid Services (beneficiaries must have an eGFR of 29 or lower).

Lesson Objectives

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

  • Recognize that managing blood pressure is a key part of managing kidney disease
  • 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)

Materials/Content for Learners

Background/Clinical Information for Educators

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.
March 2012