Renal Impairment and Role of InHome Care

Renal impairment means when kidneys stop functioning normally. If not taken care of ends up into acute kidney failure also called renal failure. eGFR(estimated glomerular filtration rate) is a test performed to check the level of creatinine(a waste) found in blood. The eGRF number shows how well the kidneys are working. The five stages of Renal impairment and eGFR for each stage are :

  • Stage 1 with normal or high GFR (GFR > 90 mL/min)
  • Stage 2 Mild CKD (GFR = 60-89 mL/min)
  • Stage 3A Moderate CKD (GFR = 45-59 mL/min)
  • Stage 3B Moderate CKD (GFR = 30-44 mL/min)
  • Stage 4 Severe CKD (GFR = 15-29 mL/min)
  • Stage 5 End Stage CKD (GFR <15 mL/min)


Renal impairment is incurable but the progress and damage to the kidneys can be controlled with healthy lifestyle regime and following a proper treatment plan. For stage 1 intake of medication advised by the doctor, maintaining a healthy weight, exercising, no smoking, eating healthy food as advised by a nutritionist and keeping a track of your blood pressure, sugar level and creatinine levels will help in leading a healthy life.

People with stage 2 will need to follow the advice of renal dietician and take medication as advised by doctor. Choose a diet that is low in saturated fat and cholesterol and moderate in total fats. Limit intake of refined and processed foods high in sugar and sodium. Choose and prepare foods with less salt or high-sodium ingredients.

In stage 3 as kidney function decreases waste products increase in the blood causing a condition known as “uremia.” The symptoms might include fatigue, urination discoloration, fluid retention and swelling. There can be pain in back due to kidney and sleep disturbances because of restless legs. Here the role of nephrologist is important. They help the patient in keeping their kidneys working as long as possible also diet is planned specially keeping in mind and eating habits are encouraged to change to save time for kidneys. Consuming high quality protein and potassium, some grains, fruits and vegetables if potassium and phosphorus are at normal levels, prevent bone disease and even preserve existing kidney function. Lowering calcium consumption. Cutting back carbohydrates for those with diabetes.

Decreasing saturated fats to help lower cholesterol. Lowering sodium for people with high blood pressure or fluid retention by cutting out processed and pre-packaged foods. Limiting calcium if blood levels are too high. Completely avoiding over-the-counter dietary supplements unless approved by the nephrologist.

In stage 4, a person might develop complications of kidney disease such as high blood pressure, anemea (a shortage of red blood cells), bone diseases, heart disease and other cardiovascular diseases. Symptoms may include Nausea and/or vomiting. Taste changes to a metallic taste in the mouth. Bad breath due to urea buildup in the blood. Loss of appetite. Difficulty in concentrating e.g, focusing on reading the newspaper can occur. Nerve problems e.g. numbness or tingling in the toes or fingers. People in stage 4 should visit their doctor at least every three months. The doctor will also help prepare the patient for dialysis or a kidney transplant. Diet is such an important part of treatment, the dietitian will review a person’s lab work results and design a meal plan individualized for their needs. Kidney functions and overall health can be preserved by intake of designed diet. The main concern of specialists and all is to putt off kidneys dialysis and transplant as long as possible. With a kidney function as low as 15% or less dialysis is recommended.

With stage 5 chronic kidney disease patients kidneys lose almost fully their working ability and at this time patients are advised to start dialysis or chose transplant as the next option to live happily. Symptoms that can occur in stage 5 include along with previously mentioned are Headaches Itching Making little or no urine Swelling around the eyes and ankles. Muscle cramps. Changes in skin color. Increased skin pigmentation. If you are diagnosed with stage 5 CKD, you will need to a nephrologist who is trained in kidney disease, kidney dialysis and transplant. Your nephrologist will develop your overall care plan and manage your healthcare team.

At this stage after selecting one of the wayout from dialysis or transplant most of the patients feel better than before and they know how important is this to keep them living.

Changes in the diet for people with stage 5 CKD

First thing a patient starting dialysis will experience is limiting the water intake. Along with this the diet will be planned by the nutritionist according to the patients body’s requirements after going through a dialysis and his/her test reports results. All this be designed to keep the patient feeling best. All this include the list of restricted foods and the recommended foods along with the quantities to be taken daily. After analyzing the lab reports Protein intake is increased to replace the lost one during the dialysis treatment. All of this is to be done individually for each patient. Doses of vitamin B C D and Iron are all settled accordingly.

Find a doctor when you have stage 5 CKD

Nephrologist is the right specialist to see and get guidance from after the stage 5 kidney malfunction is revealed. These specialists are the right tool to control and treat this disease.

Life At Home

A warm relationship is required between family to fight the stress of renal impairment. Sometimes it becomes hard to accept and feels the world is crashing especially a feeling of helplessness and anger develops against the disease and a fear that patient may die. There are times patient need counseling especially when depressed for long time. Patients become moody because of buildup of waste products in blood and stress. It is helpful to talk openly and confide in some friend and sometimes to make patient realize that family is affected by his behavioral changes.

In case of elderly person it becomes even more difficult. In many families slowly the next generation realize and offer help treating parents with dignity and respect and taking more responsibility for their care. It requires balance of patience, sensitivity and home following the medications, fluid intake and diet should be carefully monitored without bringing into notice so that sense of independency remains intact and food which is not included in diet should not be offered. Also they have to be involved in all activities planned in family. Low blood pressure is the most common side effect of dialysis, affecting one out of four patients at some point over the course of dialysis treatments. The two main causes are gaining excess fluid weight between sessions and having a weak heart. In order to avoid excess fluid weight gain, patient should maintain a healthy fluid level by drinking no more than quart (32 ounces) daily and avoid excessive salt diet which may enhance desire to drink more water. If patient gain excess fluid weight, discuss the issue with dialysis team who can adjust dialyzing time accordingly.

A common side effect found in patients with old age health problem and multiple health issues is a drop of blood pressure and can cause death. Doctors and staff at dialysis clinic manage these affects by adjusting sodium levels and reclining in specific position to provide adequate blood flow to brain. Same measures are advised to be taken at home.


In total a kidney patient can lead a happy, nearly healthy and perfect life with the support and cooperation of family or by the use of proper inhome care services.