Hearing the words hemodialysis alone sounds terrible. No one would enjoy receiving dialysis at the hospital three times a week for four hours each time. Once the kidneys are damaged, it cannot be reversed, so it is more important to take good care of your health to avoid dialysis. What are the essential rules to protect your precious kidneys? Also known as the bean, the kidney filters waste products from the body, maintains the body in a stable condition, produces various necessary hormones and enzymes. When the kidneys deteriorate, many problems occur throughout the body, such as dry skin, itching, swelling, shortness of breath, indigestion, fatigue, weakness, frequent urination, and the formation of blood clots. There are two main reasons for kidney damage: the development of kidney diseases itself and external diseases attacking the kidneys.

In the case of kidney diseases, the most representative ones that occur in the kidneys themselves are glomerular diseases that damage the glomeruli, which are tissues inside the kidneys, and genetic kidney diseases such as polycystic kidney disease. As for diseases attacking the kidneys from the outside, diabetes and hypertension are the most common. Even healthy individuals may age by 1% each year. If the symptoms mentioned earlier are present, the kidneys will lose their function much faster. Moreover, if there are chronic kidney disease patients among your parents or family members, the likelihood increases significantly. The progression of chronic kidney disease can be divided into five stages based on the glomerular filtration rate, which is the kidney's ability to filter blood. As the disease progresses, all organs in the body start to deteriorate slowly. The problem is that until the kidneys deteriorate severely, there are hardly any symptoms. That's why when symptoms appear and you visit the hospital, it is likely that the disease has already progressed significantly.

Many cases involve severely damaged kidneys. Also, since the kidneys gradually deteriorate over a period of 5 to 10 years, individuals may not be aware of the changes in their physical condition. Instead, they may come to the hospital when a long-unseen acquaintance looks sick or when they say that the moon looks dark. Typically, in stages 1 and 2, there are almost no symptoms, but from stage 3 or 4, which is the middle stage, various symptoms such as gradually appearing headaches, decreased memory, reduced cognitive function, edema, hematuria, fatigue, and diarrhea, overlapping with complications, can be felt. As it progresses to stage 5, the waste products accumulate in the body due to uremic poisoning, a very fatal symptom that occurs when waste products are not excreted through urine and cannot be maintained without dialysis. What's even scarier is that once the kidneys deteriorate, there is no way to restore them to health.

Currently, it doesn't exist, so the best thing is to manage it before the kidney function deteriorates. If the kidney function has already deteriorated, it is important to detect it early and manage it so that it does not progress to the next stage. You may wonder how to detect it if there are no symptoms at the beginning. Therefore, it is very important to receive regular health check-ups. Monitoring kidney function through urine and blood tests is crucial. Just because the related values are not good does not necessarily mean that the kidneys are in poor condition, but it should be considered as a useful guideline. If there are issues with the values, visit a hospital to determine whether it is indeed a kidney problem or if it is a secondary issue caused by a cold or other reasons. If it is indeed a kidney problem, it is important to start managing it promptly. Kidney management can be divided into primary prevention, secondary prevention, and tertiary prevention. Primary prevention involves maintaining a healthy state.

Prevention of kidney disease is important. Secondary prevention is a method to prevent patients in stages 1 to 4 from progressing to the next stage, ultimately avoiding dialysis. Tertiary prevention, on the other hand, is the management for patients in stage 5, requiring dialysis for chronic kidney disease. Since the rules to be followed vary by stage, I will categorize and explain them. In the absence of kidney disease, managing risk factors is crucial. Actually, managing risk factors should be done not only when there is no kidney disease but even more diligently if you have kidney disease. Representative factors include managing blood pressure, blood sugar, cholesterol, avoiding alcohol and smoking, controlling salt intake, and dietary management. Each time you manage one factor, the risk of delaying dialysis increases threefold. Conversely, failing to manage each factor increases the risk of needing dialysis threefold.

In cases of high blood pressure, blood sugar, and cholesterol, consistent exercise, weight management, and most importantly, not skipping the medication prescribed and currently being taken at the hospital are important. Exercise is also very helpful. Regardless of the type of exercise, it is good to sweat for at least 30 minutes a day, more than 5 times a week, until you breathe a little heavily. Dietary management is a situation that many patients are most concerned about. Some may hear that protein intake is not good for the kidneys and may avoid meat or fish, but doing so may actually be bad for the kidneys. You should consume about 0.6 to 0.8 grams of protein per 1 kg of body weight to supply the necessary nutrients to the body and prevent muscle loss. For example, in actual meals, you should choose one type among meat, fish, tofu, and eggs for each meal. Meat should be about the size of a ping-pong ball.

You should eat about 1 piece of fish and 1/5 block of tofu. Consuming too much protein for a long time can cause an excess burden on the kidneys, so it is not recommended to exceed 2g of protein per 1kg of body weight. The recommended daily intake of sodium is about 2,000mg, which is about 5g of salt. According to 2019 data, the average daily salt intake in South Korea is 8.3g, which has decreased significantly compared to the past, but still, many people consume more than 3g. Consuming a lot of sodium can lead to an increase in body fluid, edema, hypertension, proteinuria, renal arteriosclerosis, and impair kidney function. As the amount of salt in a ramen package is 4.5g, consuming ramen with kimchi will exceed 5g. A bowl of cold noodles contains 6.7g, and knife-cut noodles contain 7.3g, which easily surpass the daily salt intake in one meal.

However, there are people who insist on a salt-free diet all at once after hearing that sodium is not good for the kidneys. If you suddenly remove all salt and eat, you may lose your appetite, reduce the amount you eat, experience muscle loss, dehydration, and even depression, so caution is needed. If I may give you a tip on managing sodium without difficulty, gradually reduce salt intake. Try removing one salty food item from your diet at a time, such as eating soup in a bowl instead of a soup bowl, or eating only the solid parts without the broth. Nowadays, if you search online, you can find the sodium content of each food, so I recommend choosing your food based on that information. If you want to know for sure whether you are consuming salt properly, you can check it through a urine test, so please consult with your doctor.

Practicing a low-sodium diet can quickly show effects such as reduced edema and blood pressure. As these effects accumulate, the difference between those who practice a low-salt diet and those who do not becomes clear in terms of the occurrence of chronic kidney disease after 10 to 20 years. Can you imagine 10 to 20 years ahead? In 10 to 20 years, patients' children will become college students, get married, start families, and even have grandchildren. I want to emphasize that practicing a low-salt diet is the most certain way to maintain a healthy kidney status without the need for dialysis treatment at that time. Secondly, efforts are needed to prevent progression to severe stages at the second stage where the disease has already occurred. Stage 1-2 of chronic kidney disease is relatively early, and through treatment of the underlying conditions, it is a stage where kidney deterioration can be prevented. If you have diabetes or hypertension, it is essential to actively manage your blood sugar and blood pressure.

If you have a tendency to develop accidents, you can try correcting proteinuria or hematuria through drug therapy like immunosuppressants. In the case of polycystic kidney disease, you can also try drug therapy to prevent cysts from growing larger, which can delay the progression of the disease. In addition to treating the underlying disease, it is recommended to manage lifestyle habits more strictly than when healthy. You should strictly control your intake of protein and sodium. As mentioned earlier, do not consume more than 1.2g of protein per 1kg of body weight per day, and sodium should be consumed separately at 2,000mg per day. Regarding potassium, many people mistakenly think it is harmful to the kidneys, but contrary to popular belief, potassium intake is actually recommended in stages 1 and 2. WHO recommends a minimum intake of about 3,500mg of potassium.

Potassium has vasodilating and sodium excreting effects. Foods rich in potassium such as sweet potatoes, bananas, spinach, green leafy vegetables, avocados, and yogurt are helpful when consumed appropriately as meals or snacks. Many people wonder whether they should drink a lot of water or a little. In cases of various stones or urinary tract infections, it is recommended to consume plenty of fluids. On the contrary, in cases of hyponatremia, we advise restricting fluid intake. Generally, unless the patient cannot urinate, there is no need to force more or less water intake. Drink appropriately whenever you feel thirsty. In stages 3 and 4 of chronic kidney disease, it is essential to check and manage complications. Starting from stage 3, it is necessary to regulate fluid and electrolyte balance, manage waste excretion, and address hormonal abnormalities.

Especially from stage 4 onwards, the symptoms worsen. Due to these complications of kidney disease, anemia occurs, and osteoporosis and vascular calcification can develop. Therefore, it is necessary to maintain the body's homeostasis through appropriate medication intake and injections. Dietary habits should be managed even more strictly. Particularly when kidney disease progresses to stage 4 or above, it is necessary to reduce foods rich in potassium. We recommend white rice over mixed grains. Vegetables should be soaked in water or blanched before consumption to reduce potassium intake. Please avoid tomatoes, bananas, watermelons, and melons, which are high in potassium. In the final stage, stage 5 of kidney disease, preparation for dialysis or transplantation is required. In most cases where transplantation is not an option, once dialysis starts, it needs to be continued for a lifetime. It's not an easy thing, right? The stress for those who need dialysis.

There are research results showing that the level of stress from cancer or the loss of family members can affect the progress of the disease. However, dialysis is not the end but the beginning of a new lifestyle. Although dialysis treatment may be uncomfortable, if you understand it and follow the treatment well, you can overcome the symptoms of uremia. Therefore, it would be great if you could receive treatment with a positive mindset. If there is an opportunity for a kidney or organ transplant, it is a very fortunate chance. Transplanted kidneys can perform all the functions of the original kidneys, so it is essential to maintain kidney disease management consistently. I hope you will adhere to the guidelines for kidney management and enjoy a healthy and happy life for a long time.

신장이 안 좋으면 나타나는 증상 및 만성신부전을 막기 위한 팁 [숫자로 보는 건강]

세계 의료의 표준을 선도하는 국민의 병원, 분당서울대학교병원입니다.
Lead the Standard, Build the Trust, Seoul National University Bundang Hospital!