Patient Education

What is CKD?
CKD means your kidneys are damaged and can’t filter blood properly. This can lead to waste build-up, fluid retention, and increased risk of heart disease, anaemia, and bone problems. It often develops slowly and may have no symptoms early on—early detection is vital.

How is CKD Diagnosed?

• Blood tests: Kidney function (eGFR)

• Urine tests: Protein (albuminuria)

• Blood pressure: High BP can worsen CKD

Stages of CKD

• Stage 1: Normal function with damage (eGFR ≥90)

• Stage 2: Mild decrease (60–89)

• Stage 3: Moderate decrease (30–59)

• Stage 4: Severe decrease (15–29)

• Stage 5: Kidney failure (<15, may need dialysis or transplant)

Managing CKD

• Control blood pressure & diabetes

• Eat a kidney-friendly diet (low salt, moderate protein, manage potassium & phosphorus)

• Stay active, quit smoking

• Avoid NSAIDs

Diet Tips

• Low Potassium: Limit bananas, oranges, potatoes; choose apples, berries, rice, pasta

• Low Phosphate: Limit processed meats, cheese, nuts; choose fresh fruits, white rice, plain pasta

Medications

May include blood pressure drugs, diuretics, potassium or phosphate binders, and anaemia treatments.

When to See a Specialist

Referral is recommended if:

• eGFR <45

• Persistent protein in urine

• Resistant high blood pressure

• Rapid decline in kidney function

• Electrolyte imbalances

Your Care Team: We work with you and your GP to monitor kidney health, adjust medications, provide dietary advice, and prepare for advanced care if needed.
Learn More: Visit Kidney Health Australia

When kidney function drops below 10%, it’s time to consider treatment options with your healthcare team. This is a personal decision and can be revisited over time.

Available Treatments

1. Dialysis
   
   

   • Home Dialysis:

     • Peritoneal Dialysis (PD): Uses the lining of your abdomen to filter waste. Can be manual (CAPD) or machine-assisted overnight (APD).

     • Home Haemodialysis: Blood filtered at home using a machine.

   • Hospital Dialysis:

     • Haemodialysis: Blood cleaned through a machine, usually 3 times a week for 4–6 hours.

2. Kidney Transplant
   
   

   • May be suitable depending on your health and circumstances.

3. Conservative (Non-Dialysis) Management
   
   

   • Focuses on symptom control and quality of life without dialysis.

Understanding Dialysis

• Peritoneal Dialysis: Permanent tube in abdomen, special fluid removes waste. Risks include infection and catheter issues.

• Haemodialysis: Requires a fistula or temporary tube; risks include fatigue, blood pressure changes, and infection.

Dialysis may not always relieve symptoms. Home dialysis offers flexibility, while hospital dialysis can involve travel and scheduling challenges. Dietary and fluid restrictions apply.

Conservative or Supportive Care

For patients who may not benefit from dialysis, this approach focuses on:

• Symptom management (nausea, fatigue, fluid retention)

• Comfort and dignity

• Emotional and social support

Renal Supportive Care teams include doctors, nurses, social workers, and dietitians.

Choosing Not to Have Dialysis

Dialysis may not extend life for some groups, such as:

• People aged 75+ with multiple serious health conditions

• People aged 80+

• Those with dementia, frailty, or poor day-to-day functioning

In these cases, dialysis may increase dependence and reduce quality of life.

Can Dialysis Be Stopped?

Yes, if health declines or treatment becomes too burdensome. This is a difficult but valid decision, supported by your healthcare team.

Making Your Decision:
Discuss openly with your doctors, nurses, and family. Your choice should reflect your health, lifestyle, and personal values.

More Info: Visit Kidney Health Australia for detailed resources.

Potassium is an essential mineral that helps regulate heart and muscle function. Healthy kidneys remove excess potassium, but when kidney function is impaired, potassium can build up to dangerous levels (hyperkalemia).

Normal blood potassium: 3.5–5.0 mmol/L
High levels (>5.5 mmol/L): May require dietary changes and medical care.

Tips to Manage Potassium

• Limit high-potassium foods (bananas, oranges, potatoes, tomatoes).

• Choose low-potassium alternatives (apples, berries, rice, pasta).

• Boil vegetables and discard water to reduce potassium.

• Avoid salt substitutes with potassium chloride.

• Check food labels for potassium additives.

• Watch portion sizes—even low-potassium foods can add up.

High-Potassium Foods to Limit

• Bananas, oranges, mangoes, avocados

• Potatoes, sweet potatoes, pumpkin

• Tomato products, spinach, mushrooms

• Chocolate, nuts, coconut water

• Milk (limit to 1 cup/day)

Low-Potassium Alternatives

• Apples, pears, berries, watermelon

• Boiled carrots, green beans, cucumber, lettuce

• Rice, pasta, white bread

• Plain crackers, popcorn

Leaching Vegetables

To reduce potassium:

1. Peel and cut vegetables into small pieces.

2. Soak in warm water for 2+ hours.

3. Rinse and boil in fresh water.

4. Discard boiling water before serving.

When kidneys can no longer filter waste and excess fluid effectively, dialysis is a treatment that helps perform this vital function. It can be life-saving and improve quality of life for people with advanced kidney disease.

What is Dialysis?

Dialysis is a process that removes waste products and extra fluid from your blood when your kidneys are not working properly. It helps maintain balance in your body by controlling:

• Fluid levels

• Electrolytes (such as potassium and sodium)

• Waste products

Types of Dialysis

1. Haemodialysis (HD)
   
   

   • Blood is filtered through a machine called a dialyser.

   • Usually performed 3 times a week, each session lasting 4–6 hours.

   • Can be done in hospital or at home.

   • Requires a vascular access (fistula or catheter).

2. Peritoneal Dialysis (PD)
   
   

   • Uses the lining of your abdomen (peritoneum) to filter waste.

   • Dialysis fluid is introduced into your abdomen and later drained.

   • Can be done manually during the day (CAPD) or overnight using a machine (APD).

   • Usually performed at home, offering flexibility.

Benefits of Dialysis

• Removes toxins and excess fluid

• Helps control blood pressure

• Reduces symptoms like nausea, fatigue, and swelling

Risks and Challenges

• Infection at access site

• Fatigue and blood pressure changes

• Dietary and fluid restrictions

• Time commitment for regular sessions

Lifestyle Considerations

• Diet: Low salt, controlled potassium and phosphate intake

• Fluid: Limited daily intake to prevent overload

• Exercise: Light physical activity is encouraged

• Travel: Planning ahead for dialysis sessions is essential

Alternatives to Dialysis

• Kidney Transplant: Offers the best long-term outcome for suitable patients.

• Conservative Care: Focuses on symptom management and quality of life without dialysis.

Making the Decision

Starting dialysis is a major decision. Discuss your options with your nephrologist, nurses, and family. Your choice should reflect your health, lifestyle, and personal goals.

Need More Information?
Visit Kidney Health Australia for resources and support.
Book an Appointment: Contact Kidney Care Clinic

Why Blood Pressure Matters

High blood pressure (hypertension) is like a garden hose with too much pressure; over time, it damages the delicate "filters" in your kidneys. Managing your blood pressure is the most important thing you can do to protect your kidney function and prevent heart disease.

1. Know Your Numbers

• The Goal: For most people, we aim for a reading below 130/80.

• Check at Home: Use a reliable arm-cuff monitor. Sit quietly for 5 minutes before taking a reading.

• Keep a Log: Track your numbers in a diary to show your specialist during your Telehealth appointment.

2. The "Salt-Smart" Diet

Salt (sodium) acts like a sponge, pulling water into your blood vessels and increasing pressure.

• The Limit: Aim for less than 2,000mg of sodium per day (about 1 teaspoon of salt).

• Read Labels: Look for "Low Salt" or "No Added Salt" on packaging. Aim for less than 120mg of sodium per 100g of food.

• Ditch the Shaker: Use herbs, lemon juice, garlic, or ginger to flavor your food instead of salt.

• Beware of Hidden Salt: Bread, sauces, and processed meats (bacon, deli meats) are often very high in salt.

3. Lifestyle Changes That Work

• Move Your Body: Aim for 30 minutes of moderate activity (like a brisk walk) most days. This helps your blood vessels stay flexible.

• Manage Weight: Even losing a few kilograms can significantly lower your blood pressure.

• Limit Alcohol: Stick to no more than 1–2 standard drinks per day, with several alcohol-free days each week.

• Quit Smoking: Smoking damages the lining of your arteries and makes high blood pressure much more dangerous for your kidneys.

4. Your Medications

If lifestyle changes aren't enough, we use medications to help your kidneys.

• Consistency is Key: Take your tablets at the same time every day.

• Don't Stop Suddenly: Even if you "feel fine," high blood pressure is a silent condition. Never stop your medication without speaking to your specialist first.

• Side Effects: If you feel dizzy or notice a cough, let us know! We can often adjust the dose or find a better alternative for you.

5. Questions for Your Next Telehealth Visit

• What is my target blood pressure?

• Are my latest kidney function (eGFR) and protein (ACR) levels improving?

• Should I be tracking my weight daily?

Tip for Rural Patients: Use your local pharmacy to help you! Most pharmacies can check your blood pressure for free and help you organize your medications into "webster packs" if you have many tablets to manage.

What is an SGLT-2 Inhibitor?

Common brands include Forxiga (Dapagliflozin) and Jardiance (Empagliflozin). These medications were originally for diabetes but are now a primary treatment for Chronic Kidney Disease (CKD) and Heart Failure, even if you don't have diabetes.

How They Work

They help your kidneys "flush out" extra salt and sugar through your urine. This reduces the pressure inside the kidney's filters, allowing them to rest and slowing down the progression of kidney disease.

The "Sick Day Rules"

This is the most important part of your treatment. If you become unwell with an illness that causes dehydration, you must temporarily stop taking your SGLT-2 inhibitor.

When to STOP (The "SADMANS" Rule)

Stop your medication if you experience:

• S – Severe diarrhea (more than 2-3 watery stools).

• A – Abdominal pain or severe nausea.

• D – Dehydration (feeling very thirsty, dizzy, or dry mouth).

• M – Many vomits (unable to keep fluids down).

• A – Acute fever, sweats, or shakes.

• N – No appetite (unable to eat or drink normally).

• S – Surgery or procedures (Stop 2-3 days before any planned surgery).

When to RESTART

Only restart your medication when you have been feeling well and eating/drinking normally for at least 24 to 48 hours. If you are unsure, contact our clinic or your GP.

What to Watch Out For

1. Diabetic Ketoacidosis (DKA) – Rare but Serious

In rare cases, these drugs can cause the blood to become too acidic. Emergency Warning Signs:

• Nausea, vomiting, or stomach pain.

• Difficulty breathing or rapid breathing.

• A "fruity" or "nail polish remover" smell on your breath.

• Feeling very drowsy or confused.

Note: If you have diabetes, your blood sugar may still look normal even if you have DKA. If you feel very unwell, go to the Emergency Department and tell them you take an SGLT-2 inhibitor.

2. Hygiene and Infections

Because there is more sugar in your urine, there is a higher risk of fungal infections (thrush).

• Prevention: Keep the genital area clean and dry. Use cotton underwear.

• Action: If you notice itching, redness, or pain, see your GP or pharmacist. You usually do not need to stop the medication for mild thrush.

Tips for Daily Life

• Hydration: Drink plenty of water throughout the day.

• Foot Care: If you have diabetes, check your feet daily for any new cuts or sores.

• Creatinine Levels: It is normal for your kidney blood test (creatinine) to rise slightly when you first start this drug. This is actually a sign the drug is reducing pressure in the kidney.

What is Phosphate?

Phosphate is a mineral found in many foods. It works with calcium to keep your bones strong. However, when kidneys aren't working at 100%, phosphate builds up in the blood.

High phosphate acts like "poison" for the body:

• It pulls calcium out of your bones, making them weak and brittle.

• It combines with calcium to create "chalky" deposits in your blood vessels, increasing the risk of heart attacks and strokes.

• It can cause your skin to feel very itchy and your joints to ache.

1. For Non-Dialysis Patients (CKD Stages 3-5)

Your goal is to slow the buildup of phosphate by choosing "natural" sources over "added" sources.

• Focus on "Additives": Manufacturers add phosphate to processed foods because it acts as a preservative. Your body absorbs 100% of these chemical additives.

• Read the Label: Avoid ingredients containing the letters "PHOS" (e.g., Sodium Phosphate, Calicium Phosphate).

• Limit "Brown" Drinks: Cola and some bottled iced teas are very high in phosphoric acid.

• Swap Processed Meats: Move away from deli meats, sausages, and ham toward fresh chicken, fish, or lean meats.

2. For Dialysis Patients

Dialysis helps remove some phosphate, but it is not as efficient as healthy kidneys. You must be more strict with your intake.

• Protein Paradox: You need more protein on dialysis, but protein contains phosphate. Focus on high-quality proteins (egg whites, fresh meats) and avoid plant proteins that are also high in phosphate (like large amounts of beans or lentils).

• Phosphate Binders: If your specialist has prescribed "binders" (like Sevlamer, Renagel, or Calcium Carbonate), you must take them with your first bite of food. They act like a magnet, soaking up the phosphate in your stomach before it enters your blood.

The Traffic Light Guide to Phosphate

This guide helps you identify which foods are safest for your kidneys and which ones you should stop or limit.

🟢 GREEN LIGHT: GO! (Safest Choices)

These foods are naturally lower in phosphate and are the best choices for your daily meals.

• Beverages: Water, sparkling water, ginger ale, lemon-lime soda, and home-brewed light teas.

• Protein: Freshly cooked chicken (skinless), turkey, fresh fish, and egg whites.

• Dairy Alternatives: Rice milk (unfortified), almond milk (check for no "phos" additives), and small amounts of cream cheese or brie.

• Grains: White rice, white bread, sourdough, pasta, couscous, and corn-based cereals.

• Fruits & Veggies: Most fresh fruits and vegetables (though your specialist may advise on potassium levels separately).

🟡 YELLOW LIGHT: CAUTION (Limit These)

These foods contain moderate amounts of phosphate. Enjoy them in small portions or less frequently.

• Protein: Lean cuts of red meat (beef, lamb, pork) and salmon.

• Dairy: Small servings of milk (half a cup) or one small tub of yogurt.

• Grains: Whole-wheat bread, brown rice, and oatmeal.

• Vegetables: Legumes, lentils, and chickpeas (if using canned, rinse them thoroughly under water first).

• Nuts: Small handfuls of macadamias, walnuts, or pecans.

🔴 RED LIGHT: STOP & THINK (Avoid These)

These foods are very high in phosphate, especially "added" chemicals that are dangerous for kidney patients.

• Beverages: Dark colas, bottled iced teas, and beer.

• Processed Meats: Bacon, sausages, ham, deli meats, and "nuggets" or pre-marinated meats.

• Fast Food: Most "chain" burgers, fried chicken, and pizza.

• Dairy: Hard cheeses (Cheddar, Parmesan), processed cheese slices, and ice cream.

• Additives: Any food listing "PHOS" in the ingredient list (e.g., Sodium Phosphate, Phosphoric Acid).

• Snacks: Chocolate, caramels, and heavily salted nuts.

Top Tips for Success

1. Boil Your Veggies: Boiling vegetables in water and discarding the liquid can help reduce the phosphate content.

2. The 90/10 Rule: Focus on eating fresh, whole foods 90% of the time. This naturally eliminates almost all hidden phosphate additives.

3. Don't Forget the Binders: If you are on dialysis, a binder taken after a meal is much less effective than one taken during a meal.

Important Note

Phosphate management is very personal. These are general guidelines; always consult with your renal dietitian to create a plan that fits your specific blood results and lifestyle.

How Does Diabetes Affect the Kidneys?

Your kidneys are filled with millions of tiny blood vessels that act as filters. Over time, high blood sugar levels (glucose) can damage these vessels. When they are damaged, they can't filter your blood properly, causing waste to build up and important proteins to leak into your urine.

This condition is often called Diabetic Nephropathy or Chronic Kidney Disease (CKD).

The 5 Pillars of Management

Managing diabetic kidney disease requires a "whole-body" approach. Here is how we work together to protect your function:

1. Blood Sugar Control

Keeping your glucose levels stable prevents further "scarring" of the kidney filters.

• HbA1c Target: Usually 7% or less (though we may adjust this based on your age and other health factors).

• Monitoring: Regular checks help us see if your current medications are working.

2. Blood Pressure Management

High blood pressure is the "silent partner" of diabetes that speeds up kidney damage.

• Target: Aim for under 130/80.

• Medication: We often use specific blood pressure pills (ACE inhibitors or ARBs) because they have a "shielding" effect on the kidneys.

3. Newer "Kidney-Protective" Medications

Recent medical breakthroughs have given us powerful tools to slow down kidney decline:

• SGLT-2 Inhibitors: These tablets (like Forxiga or Jardiance) help the kidneys clear glucose and reduce internal pressure.

• GLP-1 Receptor Agonists: These (like Ozempic or Trulicity) help control sugar and weight, which eases the load on the kidneys.

4. Diet and Nutrition

What you eat directly impacts how hard your kidneys have to work.

• Reduce Salt: High salt intake raises blood pressure and causes fluid retention.

• Protein Balance: While protein is important, excessive amounts can sometimes strain damaged kidneys. We will guide you on the right balance.

• Watch the "Hidden" Sugars: Avoid sugary drinks and highly processed snacks.

5. Regular Monitoring (The "Big Three" Tests)

Since kidney disease often has no symptoms until it is advanced, we rely on these tests:

1. eGFR (Blood Test): Measures how well your kidneys are filtering.

2. uACR (Urine Test): Checks for "Albumin" (protein) leaking into the urine.

3. Blood Pressure: Checked at every visit.

Practical Tips for Success

• Stay Hydrated: Water is the best choice. Avoid "energy drinks" or sodas.

• Be Active: Even a 20-minute walk helps your body use insulin more effectively.

• Avoid "NSAIDs": Common over-the-counter pain relievers like Ibuprofen (Nurofen) or Diclofenac (Voltaren)can be harmful to kidneys. Always ask your pharmacist for kidney-safe options like Paracetamol.

• Don't Smoke: Smoking narrows the blood vessels in the kidneys, making it much harder for them to function.

Questions to Ask at Your Telehealth Visit

• What was my last protein (uACR) result?

• Is my current dose of diabetes medication safe for my kidney level?

• Are there any "Sick Day Rules" I should follow for my specific medications?

What is Nephrotic Syndrome?

Nephrotic syndrome is a condition where your kidneys leak too much protein into the urine. Normally, your kidneys filter the blood and keep protein inside your body. When the filter becomes damaged, protein is lost into the urine, and this causes swelling and other health problems.

Key Features

People with nephrotic syndrome usually have:

• Protein in the urine (proteinuria)

• Swelling of the legs, ankles, around the eyes or the whole body

• Low levels of protein (albumin) in the blood

• High cholesterol levels

What Causes Nephrotic Syndrome?

There are many possible causes. Your doctor will work with you to find the reason.

1. Diseases affecting the kidney directly

• Minimal Change Disease

• Focal Segmental Glomerulosclerosis (FSGS)

• Membranous Nephropathy

2. Diseases affecting the body that then impact the kidney

• Diabetes

• Lupus

• Infections (such as hepatitis B or C)

• Certain medicines

• Allergies or immune system conditions

In some cases, the exact cause is not found.

What Symptoms Should I Look For?

• Swelling in legs, face, or abdomen

• Foamy or frothy urine

• Sudden weight gain (from fluid)

• Tiredness

• Loss of appetite

If swelling becomes sudden or severe, or if you notice reduced urine output, tell your doctor promptly.

How is Nephrotic Syndrome Diagnosed?

Your doctor may use:

• Urine tests – to check for protein

• Blood tests – to look at kidney function, albumin, cholesterol

• Ultrasound – to look at the kidneys

• Kidney biopsy – in some cases, to find the exact cause

Treatment

Treatment depends on the underlying cause, but usually includes:

1. Reducing Swelling

• Water tablets (diuretics)

• Salt restriction in diet

2. Protecting the Kidneys

• Blood pressure medicines (such as ACE inhibitors or ARBs)

• Good control of diabetes (if relevant)

3. Treating the Cause

• Steroid medication

• Medicines to calm the immune system (immunosuppressants)

• Treating infections or stopping certain medicines

4. Managing Cholesterol

• Cholesterol‑lowering tablets if needed

Your doctor will tailor treatment to your situation.

Possible Complications

Not all patients get complications, but nephrotic syndrome can sometimes lead to:

• Infections (due to low protein levels)

• Blood clots

• High cholesterol

• Kidney damage

• Fluid overload

Seek medical attention if you develop severe swelling, shortness of breath, fever, or pain in the legs/chest.

What Can I Do to Help?

• Reduce salt in your diet

• Take medicines as prescribed

• Weigh yourself daily and record any sudden changes

• Avoid NSAIDs (like ibuprofen) unless advised

• Stay up to date with vaccinations

• Keep follow‑up appointments

• Ask your doctor before taking over‑the‑counter or herbal supplements

Will I Get Better?

Many people improve with treatment, and some causes (like Minimal Change Disease) can go into full remission. Others may be long‑term conditions that need ongoing care. Early diagnosis and correct treatment make a big difference.

Where Can I Get More Information?

• Kidney Health Australia – kidney.org.au

• International Society of Nephrology – patient information

• Discuss questions directly with your kidney specialist (nephrologist) or GP