A new diagnosis of chronic kidney disease can bring a lot of questions.
Who should I see? What happens next? Will my kidneys get worse? What can I do to protect the kidney function I still have?
These questions are normal—and you do not have to answer them alone.
Chronic kidney disease, or CKD, requires ongoing attention because your health needs can change over time. The good news is that there are steps you and your healthcare providers can take to protect your health, manage conditions that can affect your kidneys, and in many cases slow the progression of kidney disease. Current kidney care guidelines emphasize individualized treatment, regular monitoring, and working together with healthcare professionals.
Kidney disease is also more common than many people realize. The CDC estimates that about 37 million U.S. adults, or 14% of adults, have CKD.
If you have already been diagnosed, however, the most important question is not how common kidney disease is. It is: What can we do now?
That is where your kidney care team can make a difference.
Quick Answer: How Does a Care Team Help Manage Kidney Disease?
A kidney care team helps manage kidney disease by monitoring kidney function, managing blood pressure and diabetes, reviewing medicines, helping with nutrition, watching for complications, and adjusting treatment as your needs change. Your team may include a nephrologist, primary care provider, nurse, renal dietitian, pharmacist, social worker, and other specialists. You and your caregiver are also important members of that team.
Why Managing Kidney Disease Is a Team Effort
Kidney disease does not exist separately from the rest of your health.
Many people with CKD are also managing high blood pressure, diabetes, heart disease, medication changes, nutrition needs, or other medical conditions. Each of these areas can affect your kidney health and your overall treatment plan.
That is why CKD care often involves several healthcare professionals working together.
The American Kidney Fund describes CKD care as multidisciplinary care, meaning different healthcare professionals contribute their expertise as a patient’s needs change. Early in kidney disease, patients may work most often with their nephrologist, nurse, primary care provider, and dietitian. If CKD becomes more advanced, additional professionals may become involved.
The goal is not to give you more appointments or make your care more complicated. The goal is to make sure important parts of your health are not overlooked.
Who Is on Your Kidney Care Team?
Your exact team will depend on your kidney disease, other medical conditions, and treatment needs.
Your nephrologist
A nephrologist is a doctor who specializes in kidney disease.
Your nephrologist may monitor your kidney function, review laboratory results, manage kidney-related medications, watch for complications, and make changes to your treatment plan when needed. Nephrologists also help patients prepare for more advanced treatment if kidney disease progresses.
For many people with CKD, the nephrologist becomes an important long-term partner.
Your primary care provider
Your primary care provider remains an important part of your health team even after you begin seeing a kidney specialist.
Primary care providers help manage your overall health, including common conditions that can affect kidney disease, such as high blood pressure and diabetes. They may also coordinate referrals and make sure other health concerns are addressed.
Nurses, nurse practitioners, and physician assistants
Nurses and advanced practice providers can help you understand your treatment plan, monitor symptoms, review test results, answer questions, and identify changes that may need attention.
Kidney care can involve a great deal of new information. Having someone who can explain instructions in clear language can make it easier to understand what you should do between appointments.
Your renal dietitian
Food advice for kidney disease should be personal.
A renal dietitian has special training in nutrition for people with kidney disease. Your dietitian may help you make decisions about sodium, protein, potassium, phosphorus, fluids, and other parts of your diet based on your kidney function, laboratory results, medications, and other health conditions.
This matters because there is no single “kidney diet” that is right for every patient.
A person with early CKD may have different nutrition needs from someone with advanced disease or someone receiving dialysis. Your needs may also change as your laboratory results change.
Your pharmacist
Kidney disease can affect how certain medicines are used, and some over-the-counter medicines can be risky for people with CKD.
A pharmacist can review prescription medicines, over-the-counter products, vitamins, and supplements for possible interactions or safety concerns. Making sure your healthcare providers and pharmacist know about everything you take, including nonprescription medicines and supplements.
Before starting a new medicine or supplement, ask whether it is safe for your level of kidney function.
Your social worker
Living with a long-term condition can affect more than your physical health.
Social workers may help patients and families deal with insurance, transportation, financial concerns, access to community resources, emotional stress, and changes related to kidney treatment.
This support can become especially important when appointments, work, caregiving responsibilities, transportation, or treatment costs make it harder to follow a care plan.
Can a Care Team Help Slow Kidney Damage?
For many patients, slowing the progression of CKD is an important treatment goal.
Chronic kidney damage is often not reversible, but that does not mean nothing can be done. Patients and healthcare professionals can take steps to slow CKD progression and reduce complications. These steps may include controlling blood pressure, managing blood sugar when diabetes is present, taking appropriate medications, following an individualized eating plan, and monitoring kidney health over time.
Your team may look at several pieces of information together rather than relying on one number.
For example, they may follow your estimated glomerular filtration rate, or eGFR, along with urine albumin, blood pressure, blood sugar if you have diabetes, medication use, and other health factors. Looking at changes over time helps the team understand whether your treatment plan is working or needs to be adjusted.
Research also supports the value of team-based CKD care. A study of people with stage 3 CKD who also had diabetes and/or high blood pressure found that a multidisciplinary team approach may help slow the rate of decline in kidney function. The study does not mean team care can guarantee a certain result for every patient, but it supports the value of coordinated care for people managing several related health conditions.
What Does Collaborative Kidney Care Look Like Over Time?
Good kidney care is not one appointment followed by the same plan forever.
Your plan may change.
A medication that was right for you last year may need adjustment. A change in blood pressure may require closer monitoring. New laboratory results may affect what your dietitian recommends. An illness may change your fluid needs.
That ongoing communication is one of the benefits of collaborative care.
A coordinated kidney team can help connect these different pieces instead of treating each issue by itself. The patient and caregiver can then understand not only what needs to change but also why the change matters.
You Are an Important Member of Your Kidney Care Team
Your doctors and nurses bring medical training to the team.
You bring information no laboratory test can provide.
You know how you feel day to day. You know which changes are realistic for your family. You know when a medication is causing problems, when following a meal plan is difficult, or when transportation, cost, work, or caregiving responsibilities are getting in the way.
Sharing that information helps your team build a plan you can actually follow.
Here are several ways you can take an active role:
- Keep an updated list of your prescription medicines, over-the-counter medicines, vitamins, and supplements.
- Write down questions before your appointments.
- Ask what your kidney numbers mean and whether they have changed.
- Know your personal blood pressure goal.
- If you have diabetes, ask how your blood sugar goals relate to your kidney health.
- Follow laboratory testing and appointments recommended by your care team.
- Tell the team when you have new symptoms or side effects.
- Ask before making major changes to fluids, supplements, diet, or medicines.
- Bring a caregiver or trusted family member when another set of ears would help.
Preparing questions before your appointment can help you make the most of your time with your kidney care team. You may also want to bring a trusted friend, family member, or caregiver who can take notes, help remember important information, and make sure your questions are answered.
How Caregivers Can Help Without Taking Over
Caregivers are often an important part of managing kidney disease.
You may help a loved one organize appointments, remember medications, prepare meals, arrange transportation, track blood pressure, or keep a list of questions for the doctor.
You may also notice changes the patient does not notice.
The goal, however, is partnership.
When possible, allow the person with kidney disease to remain involved in decisions about their health. Ask what type of help would be most useful. At appointments, help the patient remember questions but also give them room to speak for themselves.
Kidney care works best when patients, caregivers, and healthcare professionals can communicate openly.
Your Kidney Plan May Need to Change During Heat or Illness
Managing kidney disease also means planning for situations outside the clinic.
This can be especially important in New Mexico.
Hot weather, heavy sweating, vomiting, diarrhea, poor appetite, illness, and changes in fluid intake can affect blood pressure, hydration, medications, and kidney health. At the same time, some people with CKD need fluid restrictions, so simply telling every kidney patient to “drink more water” may not be safe.
Ask your care team what you should do if you become sick or are exposed to extreme heat.
For more information, Renal Medicine Associates’ “How Heat and Dehydration Can Impact Kidney Health” explains why people with CKD may need an individualized plan for fluids, medications, blood pressure, and warning signs during New Mexico’s hotter months.
Questions to Ask Your Kidney Care Team
You do not have to remember every medical term. Start with questions that help you understand what to do next:
What stage of kidney disease do I have?
Are my kidney numbers stable, improving, or getting worse?
What are we doing to help slow further kidney damage?
What should my blood pressure goal be?
Do I need to change what I eat or drink?
Should I meet with a renal dietitian?
Are all my medicines and supplements safe for my kidney function?
What symptoms should make me call your office?
What should I do if I become dehydrated, sick, or unable to eat and drink normally?
When should my kidney function be checked again?
Writing down the answers can give both patients and caregivers a clearer plan to follow at home.
FAQ: Managing Kidney Disease With a Care Team
Who should be on my kidney care team?
Your team may include a nephrologist, primary care provider, nurse or advanced practice provider, renal dietitian, pharmacist, social worker, and other specialists depending on your health. The members of the team may change as your kidney disease and treatment needs change.
Can kidney disease be stopped from getting worse?
CKD cannot always be stopped or reversed, but treatment and lifestyle changes can often help slow progression and reduce complications. Managing blood pressure, diabetes when present, medications, nutrition, and regular monitoring are important parts of CKD management.
How often should I see my kidney doctor?
There is no single schedule for every CKD patient. How often you need appointments and laboratory tests depends on your stage of kidney disease, how quickly your kidney function is changing, other medical conditions, medications, and your treatment plan. Your nephrologist can tell you what follow-up schedule is appropriate for you.
Should I see a renal dietitian if I have kidney disease?
Many people with CKD can benefit from individualized nutrition guidance. A renal dietitian can adjust recommendations according to your kidney function, laboratory results, medications, health conditions, and treatment.
What is the patient’s role in managing kidney disease?
The patient is an active member of the care team. Taking medicines as directed, attending follow-up visits, completing recommended laboratory tests, asking questions, reporting symptoms, and discussing challenges with the team can all help make the treatment plan more effective.
Key Takeaway: You Do Not Have to Manage Kidney Disease Alone
Managing kidney disease is a long-term partnership.
Your kidney care team can monitor changes, help manage blood pressure and diabetes, review medications, guide nutrition, identify complications, and adjust your treatment as your health changes. Just as importantly, your team can help you understand what is happening so you can make informed decisions about your care.
Your role matters, too.
Ask questions. Know your numbers. Bring your medication list. Tell your team when something does not feel right or when the care plan is difficult to follow. Encourage your caregiver to participate when you need support.
Small decisions made consistently over time can become an important part of protecting your health.
At Renal Medicine Associates, our mission is to provide the highest quality care in the prevention and treatment of kidney disease and the maintenance of kidney health. If you have recently been diagnosed with kidney disease or need help managing CKD, our kidney care team can help you understand your condition, your treatment options, and the steps you can take moving forward.
This article is intended for general education and is not a substitute for individualized medical advice. Kidney failure treatment decisions should be made with a nephrologist and the patient’s healthcare team.
Medically reviewed by: Renal Medicine Associates Clinical Review Team