Functional Medicine for Kidney Health and Chronic Kidney Disease

What is chronic kidney disease?

Your kidneys do many important jobs. They remove waste and extra water from your body, help make red blood cells, balance important minerals, help control blood pressure and keep your bones healthy.⁵

Chronic kidney disease (CKD) means your kidneys have been damaged or have not worked well for at least 3 months. Damaged kidneys can't filter blood the way they should, so waste and extra fluid can build up in your body. CKD usually develops slowly, and in some people it can lead to kidney failure. CKD also raises the risk of heart disease and stroke.^{1, 5}

CKD is common in the United States. Researchers estimate that more than 35 million U.S. adults, or more than 1 in every 7, have it. African American, Hispanic, American Indian, Native Hawaiian and other Pacific Islander people are more likely to have advanced kidney disease, including kidney failure.¹

The most common causes of CKD in adults are diabetes and high blood pressure. High blood sugar can damage the kidneys' filters. High blood pressure can damage blood vessels in the kidneys. Other causes include autoimmune diseases such as lupus, where the immune system attacks the body by mistake. Polycystic kidney disease (an inherited condition), kidney stones with complications, infections, drugs that are toxic to the kidneys, metabolic syndrome and severe obesity can also cause CKD.^{2, 5}

Anyone can develop CKD at any age. For many people, CKD is not caused by only one thing. It may be linked to health, lifestyle, environment and access to care. The longer you've had diabetes, high blood pressure or heart disease, the more likely you are to develop CKD. Common risk factors for CKD include:^{1, 5}

• Diabetes^{1, 5}
• High blood pressure (hypertension)⁵
• Heart disease or heart failure⁵
• Obesity⁵
• Age over 60⁵
• A family history of CKD or kidney failure⁵
• A past acute kidney injury (AKI), which is a sudden loss of kidney function^{1, 5}
• Smoking or other tobacco use⁵
• Heavy alcohol use⁵

Signs and symptoms of chronic kidney disease

Most people in the early stages of CKD do not have symptoms, and many have no symptoms until their kidney disease is advanced. Symptoms alone cannot tell you if you have CKD. The only way to know is to get your kidneys checked with blood and urine tests.^{1, 5}

When symptoms do happen, often as CKD becomes more advanced, they may include:^{1, 5}

• Foamy urine^{1, 5}
• Urinating more often or less often than usual⁵
• Itchy or dry skin⁵
• Feeling tired, or trouble sleeping⁵
• Nausea, vomiting or loss of appetite¹
• Weight loss without trying⁵
• Swelling (edema) in the legs, feet or ankles, or less often in the hands or face¹
• Trouble concentrating⁵
• Muscle cramps¹
• Shortness of breath or chest pain¹

How chronic kidney disease is diagnosed and treated

Checking for CKD usually starts with two tests. A blood test gives your estimated glomerular filtration rate (eGFR), which shows how well your kidneys remove waste from your blood. A urine test called the urine albumin-creatinine ratio (uACR) checks for albumin, a protein that should usually stay in the blood. Albumin in the urine can be a sign of kidney damage. Both tests are needed to get a clear picture of your kidney health.⁵

An eGFR under 60, a uACR over 30, or both, for 3 months or more may be a sign of CKD. An eGFR of 15 or less is called kidney failure, and most people below this level need dialysis or a kidney transplant. CKD is divided into stages 1 through 5, based mostly on eGFR.^{3, 5}

Testing matters if you are at risk, because early kidney disease usually has no symptoms. If you have diabetes, NIDDK advises getting checked every year. If you have high blood pressure, heart disease or a family history of kidney failure, ask your provider how often you should be tested.³

Advanced, long-lasting CKD usually can't be undone. But the sooner you find out you have CKD, the sooner you can make changes to protect your kidneys. Treatment depends on your CKD stage, test results and other health conditions. It usually focuses on managing the likely cause, such as diabetes or high blood pressure, slowing CKD, lowering the risk of heart disease and stroke, and treating complications.^{1, 5}

Your doctor may prescribe medicines to help slow CKD, protect your kidneys, lower blood pressure or lower albumin in the urine. NIDDK calls controlling blood pressure the most important step you can take to treat kidney disease. A kidney dietitian can help you plan meals, because your nutrition needs may change with your CKD stage, lab results and other conditions. Other steps to manage CKD include regular physical activity, aiming for a healthy weight, getting enough sleep, quitting smoking and finding healthy ways to cope with stress.^{4, 5}

A nephrologist is a doctor who specializes in the kidneys. Your primary care doctor may check your kidney health and may refer you to a nephrologist if your kidney disease is complicated, getting worse quickly or advanced.⁴

How our care fits alongside your nephrologist

Avicenna Functional Medicine does not replace your nephrologist, your primary care doctor, or the treatment they prescribe. Our role is to add to your care, not to take its place.

In a functional medicine visit, we look at factors that may affect kidney health, such as diet, lifestyle and environmental exposures, alongside the care you already receive. Any guidance on diet is coordinated with your nephrologist, because kidney-friendly eating depends on your CKD stage and lab results. Our aim is to understand the whole picture of your health and to support your overall wellbeing.⁵

Please do not stop or change any prescribed medication without talking to the doctor who prescribed it. These cautions matter for people with kidney disease:

• Pain relievers called NSAIDs, such as ibuprofen and naproxen, lower blood flow to the kidneys. They can cause sudden kidney injury or make CKD worse. People with CKD should not treat themselves with NSAIDs and should talk with a healthcare professional first. NSAIDs are also in many cold medicines, so check labels and ask before using them.^{4, 6}
• For people with CKD, herbal supplements can make kidney disease worse, interact with prescription medicines, or raise the risk of CKD complications. Some contain ingredients known to damage the kidneys, or contaminants such as heavy metals. The FDA does not regulate herbal supplements for dose, content or purity, so talk with your healthcare team before starting any.⁷
• Tell your doctors and pharmacist about every medicine you take, including over-the-counter medicines, vitamins and supplements. Kidneys that don't filter as well can let some medicines build up in the blood, so your doctor may change a dose or a medicine.⁴

What to expect at Avicenna

All visits are by telehealth, for patients located in Florida and Texas. We are a cash-pay practice, and we accept HSA and FSA. Care usually follows these steps:

• A free, 30-minute discovery call to talk about your health and whether our approach is a good fit for you
• A full intake visit with our health coach, under clinician supervision, covering your history, symptoms, current treatment and goals
• Testing chosen for you, where it is likely to be useful
• A personalized plan, with follow-up visits to review how you are doing and adjust the plan as needed

When to get urgent care

Tell your nephrologist or primary care doctor promptly about new or worse swelling, a change in how often you urinate, foamy urine, or new nausea, vomiting or itching. These can be symptoms of more advanced CKD. People with CKD also have a higher risk of acute kidney injury (AKI), a sudden loss of kidney function caused by illness, injury or certain medicines.¹

Telehealth visits with our team are not for emergencies. Call 911 right away if you have warning signs of a medical emergency, such as:⁸

• Chest pain or pressure that lasts two minutes or more⁸
• Trouble breathing or shortness of breath⁸
• Sudden confusion, unusual behavior or trouble waking up⁸
• Fainting or passing out⁸
• Sudden dizziness, weakness or changes in vision⁸
• Being unable to speak⁸
• Severe belly pain, or sudden severe pain anywhere in the body⁸
• Coughing up or vomiting blood⁸
• Thoughts of suicide or of harming someone else (you can also call or text 988)⁸