Is living a normal life with kidney disease possible? Millions of people live with this question on their minds every day. While it is hard to answer this question with a definite “Yes,” to say “No” is not true, either. Let me explain. What Do Our Kidneys Do The human body carries two kidneys located in your back, just where your rib cage ends. These two kidneys possess enough functioning power to outlast a normal human life. But what is their function? Kidneys do two main jobs. First is filtration-cleaning up the blood. Filtration doesn’t mean just the removal of the waste products, such as nitrogenous molecules and other acids. The filtration process also involves removing unwanted amounts of salts like sodium, potassium, calcium, phosphorus, and more. Using its filtration power, kidneys maintain a healthy level of many chemicals in our blood. The other major function, and less know to kidney disease patients, is the secretion of hormones. Let’s start the list with Renin. This hormone fine-tunes the blood pressure within its normal range. When your blood pressure drops, kidneys rave up the renin secretion, which, in turn, raises your blood pressure by making changes through a chain reaction. Have you ever wondered why kidney disease patients are so pale? Another hormone is erythropoietin. Have you ever wondered why kidney disease patients are so pale? This is because healthy kidneys produce erythropoietin, the hormone that induces bone marrow to make blood. However, with a worsening disease, kidneys fail to produce the required amount. As a result, blood production falls, and the patient becomes anaemic. Kidneys also regulate the calcium, phosphorus, and vitamin D axis. In this case, the kidney doesn’t directly produce any hormone, yet it plays the primary role in regulating this trio, basically by guiding four glands far up in the neck. These glands are called parathyroid glands, and they produce parathyroid hormone. When kidneys can no longer keep the calcium and phosphorus level within normal range, it kick-starts a cascade that makes the bone weak and blood vessels hard. Put in Perspective To put the importance of kidneys into perspective, remember that roughly 112 to 144 litres of blood pass through our kidneys in one day. During this passage, unwanted substances are removed, and the clear blood returns to the main circulation again to bring more toxins to be cleared. The whole blood circulates through the kidney about forty-eight times daily. What is Chronic Kidney Disease? Kidney disease is more common in the general population than we care to believe. Kidney disease is labelled as chronic if it lasts longer than three months. In chronic kidney disease, kidneys fail to meet the body’s demand for toxin clearance. Their production of hormones diminishes, too. Hundreds of millions of people live with chronic kidney disease, many of whom live a normal life until the late stages of kidney disease. But to maintain this level of health despite less-than-normal functioning kidneys, the patient has to follow the instructions of the healthcare professionals. People with kidney disease can live long and normal lives with proper diet, medication, exercise, and due diligence. Treatment of Chronic Kidney Disease There are various treatment options for kidney disease. Keep in mind, however, that almost all kidney disease treatment is the management of the conditions that lead to kidney disease. Thus, the best way to keep your kidney disease from worsening is the optimal management of underlying medical conditions, like blood pressure, diabetes, and heart disease, among others. In addition, doctors use a few medications to control the symptoms of kidney disease, like itching, bone pains, and loss of appetite. Such optimal treatment not only allows the patient to live a healthy life but also significantly delays the progression of kidney disease. Occasionally, inherent illness of the kidney can cause kidney damage and call for focused treatments with specific drugs. Treatment in the early stages includes: 1. Always start with a healthy lifestyle-nutrition, exercise, sleep, and meditation 2. Medication for high blood pressure 3. Medication for diabetes 4. Medication to control harmful cholesterol levels in the blood 5. Anemia medication 6. Sometimes, a low-protein diet to reduce the wastage produced by the body 7. Swelling medication Renal Replacement Therapy When a patient’s kidney function falls below five per cent, the kidneys cannot keep up with the body’s demands. At this stage, CKD patient needs replacement therapy. Two main options for replacement therapy are dialysis and transplant. But before diving into their details, it is essential to know that, if managed carefully, a tiny proportion of CKD patients would ever need replacement therapy. Dialysis is a process of cleaning blood without kidneys. Hemodialysis uses a machine for this process, while peritoneal dialysis can be done with either a machine or manually. On the other hand, a CKD patient has the option of a kidney transplant, meaning planting a donated human kidney in the recipient’s abdomen. After a kidney transplant, patients can again live normal life. The Take Home Most kidney disease patients can and should live healthy life throughout kidney disease. Adopting a healthy lifestyle is the best protection against worsening kidney disease. That’s why only a minority of CKD patients in affluent countries ever reach the stage of replacement therapy. The writer is an Internist and Nephrologist. He has won Top Internist Award in 2021 and Top Nephrologist Award in 2022 from Michigan, USA. He can be reached on Twitter @awaiszaka.