• Fort Myers
  • Cape Coral
  • Bonita Springs
  • Fort Myers
  • Cape Coral
  • Bonita Springs

Chronic Kidney Disease Program

Chronic Kidney Disease (CKD) means that the kidneys have become damaged. The common causes of CKD are diabetes mellitus, hypertension, inherited diseases, and nephritis.

The purpose of the CKD program is to slow the progression of damage to the kidneys and treat associated complications such as hypertension, anemia, and bone disease. If we are unable to arrest the disease process and the kidney damage progresses to end stage renal disease (ESRD), our plan is to manage these complications while preparing patients for renal (kidney) replacement therapy. This therapy can consist of peritoneal dialysis, hemodialysis, home hemodialysis, or kidney transplantation.

Managing these complications and preparing patients for renal replacement therapy is a complex process of visits, treatment, and teaching sessions. Our medical team consists of nephrologists (kidney doctors), nurse practitioners, registered dieticians, nurses, and medical assistants.

We hope that you will participate in this effort by keeping appointments and following treatment recommendations. Please assist us by bringing your medications and questions to each visit.

What Increases Your Risk of Having Chronic Kidney Disease?

  1. Diabetes Mellitus
  2. Hypertension
  3. Race: African-American, Hispanic, and Native Americans
  4. Age over 65
  5. A Relative with Chronic Kidney Disease

Symptoms of Kidney Disease

  1. Often none in the earlier stages (1-3)
  2. Feeling tired or weak
  3. Headaches
  4. Itching
  5. Nausea and Vomiting
  6. Loss of Appetite
  7. Swelling
  8. Shortness of Breath
  9. A metallic taste
  10. Darkening of the Skin
  11. Trouble with concentration
  12. Change in urination

Stages of Kidney Disease

Stage GFR Treatment Goals
1 >90 Diagnosis & Treatment
2 60-89 Estimating Progression
3 30-59 Treating Complications
4 15-29 Preparing for Dialysis/Transplant
5 <15 Dialysis/Transplant

How Can the Progression of Kidney Disease Be Delayed?

  1. Keeping blood pressure under 130/80 or if you have diabetes or protein in the urine, under 125/75.
  2. Taking certain types of medications called ACE-Inhibitors or angiotensin receptor blockers.
  3. If you are diabetic, keeping blood sugars tightly controlled (HbA1c less than 7.0).
  4. Avoiding medications that harm your kidneys such as non-steroidal anti-inflammatory drugs. (NSAIDs). Examples are Motrin, ibuprofen, Aleve, Advil, Naprosyn. A Cox-2 inhibitor called Celebrex is also harmful.
  5. Avoiding, if possible, IV contrast dye used for CT scans and heart catheterizations and gadolinium used in MRIs.
  6. Controlling your cholesterol.
  7. Quit smoking.
  8. If overweight, losing weight.
  9. Treating anemia, if present.
  10. Avoiding Fleet phospho-soda (oral) and Fleet enemas for patients in Stage 4 and 5 chronic kidney disease.

Goals of Treatment

eGFR stable or increasing
Blood Pressure 130/80 or 125/75
Urine protein/creatinine ratio <1
Anemia
Hgb 11-12
Iron Saturation >20
Ferritin >200
Bone Disease
Calcium 8.4 – 10.2
Phosphorus 2.7 – 4.6
PTH
Stage 3 35 – 70
Stage 4 70 – 110
Stage 5 150 – 300
Nutrition
Albumin >3.8
Diabetes Mellitus
HbA1C <7.0
Lipids
Cholesterol <200
HDL >45
LDL <100

Visit Schedule

Initial Consult and follow up MD
Two Interim Visits ARNP
Every 3rd visit MD