CKD care at home that slows the disease and plans the next step.

CKD is staged by eGFR, a figure on the kidney function blood test. Stage 1 and 2 are mild and usually managed by the GP with lifestyle changes. Stage 3 is moderate loss, stage 4 severe loss, and stage 5 is kidney failure. Home care starts to matter from stage 3, because that is where blood pressure, diabetes and diet decide how fast the patient reaches stage 5, and it becomes a daily job at stage 4, when injections, the fistula and the dialysis plan enter the picture.

It can slow the decline, though it cannot reverse it. The two things that most affect the speed are blood pressure control and, in diabetics, sugar control, and both are day-to-day work at home. Salt reduction, avoiding NSAID painkillers and herbal products, and taking the prescribed ACE inhibitor or ARB without gaps also matter. What a caregiver adds is consistency: readings taken every day, meals cooked to the plan every day, and a log the nephrologist can act on. A patient whose numbers are only seen at a three-monthly visit is being treated on a fraction of the information.

Ask her nephrologist, and follow that instruction exactly. “Drink more water” is common advice and is wrong for many CKD patients, especially at stage 4 and 5 or where there is swelling, because the kidneys can no longer clear the extra fluid and it ends up in the legs and lungs. Some patients are told to keep fluids normal, some are restricted, and a few with specific conditions are told to drink more. Our caregivers are briefed to follow the doctor’s number and to ignore advice from relatives, however well meant.

The dietitian’s sheet decides, but the usual problem foods are salt (pickle, papad, sambar and rasam powders, packaged snacks), high-potassium items (banana, coconut water, tomato, potato, drumstick leaves, dried fruit), and high-phosphorus items (dairy, dal in large amounts, cola, processed cheese). Protein is often restricted before dialysis and the target changes once dialysis starts, so the sheet should be dated and updated. The caregiver’s job is to translate the sheet into what the household actually cooks, so the patient eats and the numbers still hold.

Yes. Anaemia is common in CKD because the kidneys make less of the hormone that drives red cell production, and the nephrologist often prescribes erythropoietin injections weekly or fortnightly, sometimes with iron. A GNM or B.Sc nurse gives the injection at home on the prescribed day, checks blood pressure before and after because erythropoietin can raise it, and records the dose. Visits are booked for the next day and then on the prescribed schedule. The haemoglobin tests the doctor orders can be arranged at home too.

Three things are usually arranged months ahead. A fistula is created, because it needs six to twelve weeks to mature and the family has to learn to protect the arm from then on. Hepatitis B vaccination is completed, since dialysis units require it and the course takes months. And the family decides with the nephrologist between haemodialysis at a centre, peritoneal dialysis at home and, where a donor exists, a pre-emptive transplant. Doing this at stage 4 means dialysis starts from a clinic chair rather than an emergency bed with a neck catheter.

It depends on whether you need a day attendant, a live-in attendant or nurse visits for injections, and on what else the patient carries, since a diabetic patient at stage five with a new fistula is a different job from a patient at stage three who needs readings and a cook. We quote after a free assessment that looks at the latest blood report, the medicine list and who is at home. Our dialysis care cost guide explains how the levels compare.