Lesson 2: Managing Your Kidney Disease

The content of this lesson, Managing Your Kidney Disease, meets the needs of qualified providers seeking to deliver the Kidney Disease Education (KDE) Services benefit, 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 managing diabetes is a key part of managing kidney disease
• State at least one step to eating right for kidney health
• Recognize the importance of being cautious about over-the-counter medicines
• Recognize that smoking can worsen kidney disease
• Identify which lab values are used to keep track of diabetes, high blood pressure, and other conditions

Session Starter

Tell participants that you are going to make a statement for which you want to learn their reaction. Give each participant small cards on which you've written the following: SA (means Strongly agree); A (Agree); D (Disagree); SD (Strongly disagree). State the following and ask participants to hold up the card that shows his/her answer: “There are steps you can take to keep your kidney working”. As an assessment strategy: Repeat at the end of the lesson to see if their responses have changed.

Topics & Points to Cover

• There are steps you can take to keep your kidneys working. (See session starter.)
• Weight management
• Blood pressure management
  • Blood pressure goal: < 140/90 mm Hg
  • Medications – ACEs/ARBs, diuretics
    • ACEs/ARBS and risk of hyperkalemia (too much potassium in the blood, but help lower urine albumin)
  • Sodium reduction (<2,300 mg)
  • Physical activity
• Diabetes management
  • A1C target (Note to educator: should become more individualized as CKD/CVD progresses)
  • Diabetes medications may change because of kidney disease (often takes less medication to control glucose in the later stages of CKD)
  • How to treat hypoglycemia appropriately (risk of high potassium with ACEi and ARB use) glucose tablets are preferred [May need to avoid juices with high potassium levels if hyperkalemic]
  • Hyperglycemia
• Cardiovascular disease (CVD)
  • Physical activity
  • CVD is major cause of mortality
  • LDL goal
  • Medications
• Nutritional health
  • Choose and prepare foods with less salt and sodium
  • Eat the right amount and kind of protein
  • Choose foods that are healthy for your heart
  • Choose foods based on phosphorus and potassium content (if restricted)
  • Make choices that help with diabetes management
  • Dietitian referral/nutrition therapy is covered benefit
• Medication safety
  • Prescription
  • Over-the-counter (pain relief)
• Tobacco cessation

Materials/Content for Learners

• Eating Right for Chronic Kidney Disease
• Your Kidney Test Results (PDF, 244.53 KB)
• Chronic Kidney Disease
• Managing Chronic Kidney Disease
• Your Guide to Lowering Blood Pressure (NHLBI)
• 4 Steps to Manage Your Diabetes for Life
  (Note to educator: Some diet recommendations will be inconsistent with changes needed due to patient's level of kidney function.)
• Enjoy Living Smoke Free (English/Spanish) (NHLBI) (PDF, 4.1 MB)

Background/Clinical Information for Educators

• NIDDK videos:
  • What changes do I need to make because I have kidney disease?
  • Are there medications for kidney disease?
  • Can kidney disease get better?
  • Is there a connection between heart disease and kidney disease?
• Eating Right for Chronic Kidney Disease
• Nutrition for Advanced Chronic Kidney Disease in Adults
• Pain Medicine and Kidney Damage

Sample Outcome Assessment Questions

• True or False: Managing blood pressure is one of the most important ways to keep kidney disease from getting worse?
• True or False: People with kidney disease should limit the amount of salt/sodium in the diet?

Other outcomes:

• Patient states that managing blood pressure is the most important way to manage his/her KD.
• Patient states one way to change his/her eating to protect the kidneys.
• Patient tells one way he/she will approach use of OTC medications in the future.
• Smoking patient states that he/she is aware that smoking can worsen KD.
• Patient states what he/she will do with information from today's session.

Additional Resources for Download

These images are available free of charge to download and include in your patient education materials.