DEAR MAYO CLINIC: I have high blood pressure and was just diagnosed as having chronic kidney disease. I am disheartened by this news, but I also am determined to do more to improve my health. I know I may not be able to reverse my condition, but I am hoping to avoid dialysis or a kidney transplant for as long as possible.

ANSWER: Your determination will help you manage your chronic kidney disease by following recommended treatments and making lifestyle changes.

As you know, kidneys remove waste and fluids from the body through urination. With chronic kidney disease, kidney function is gradually lost. End-stage renal failure is when dialysis or a kidney transplant is needed to stay alive.

Similar to how high blood pressure is called a silent killer, many people don't know they have chronic kidney disease until it is discovered during a lab test for another reason. Because kidney disease usually doesn't cause symptoms in earlier stages, it often is not discovered until later in the course of the disease process. In fact, one in nine people may not know they have chronic kidney disease, but it affects about 14% of the population. That's more than 30 million people in the U.S.

Your healthcare professional will discuss what's best to help slow progression of kidney disease in your situation, but some recommendations typically include:

Follow a kidney diet

One key dietary adjustment to prevent the development or progression of chronic kidney disease is sodium restriction. Some people cook with a lot of salt and often add more salt at the table. Many processed foods also have added salt.

Reduce sodium intake by limiting convenience foods, salty snacks and processed meats and cheeses. Overall, try to eat fresher foods rather than foods that come out of a can or a bag. You can still enjoy many foods.

Increase fluid intake as well. Lack of fluid can lead to disease progression and affect how well medications work.

Address underlying conditions

Treatments for chronic kidney disease usually involve tackling the underlying issue. One of the most common causes of chronic kidney disease is high blood pressure, also known as hypertension.

High blood pressure relates to the pressure inside of blood vessels when the heart is pumping and when it relaxes. That pressure can increase as we age. A number of medical problems are associated with increases in blood pressure over time, which can lead to cardiovascular disease and chronic kidney disease. Controlling those disease processes is extremely important.

High blood pressure responds to our lifestyle choices, including getting regular exercise, avoiding processed foods, reducing sodium intake and eating more fruits and vegetables. All of these things reduce high blood pressure without medications.

Sometimes those lifestyle changes aren't enough. These are the patients who need medications to help with blood pressure control. The patient with chronic kidney disease typically has a goal blood pressure of 130/80 mm Hg.

Some risk factors for kidney disease we can't control, such as our age and race. Being Black, Native American or Asian American, for example, increases the risk of kidney disease. But some risk factors can be controlled. Managing diabetes, quitting smoking or tobacco use and maintaining a healthy weight are important steps to help control kidney disease. — Ivan Porter II, M.D., Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida

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