If you have chronic kidney disease (CKD) there is a stone simple way that you might save yourself from needing dialysis or a kidney transplant. CKD, a condition in which the kidneys struggle to filter waste from the blood, is a silent health threat that you can be completely unaware of until serious damage is done. One in three adults with diabetes and one in five with high blood pressure has CKD, and like so many illnesses, incidence increases after age 50. If left unchecked, end stage renal disease-kidney failure-occurs. That's when you'll need to be hooked up to a dialysis machine to filter your blood or will require a kidney transplant to stay alive.

Although there is no cure once CKD sets in, it can often be kept from advancing, and now doctors have confirmed that a certain simple exercise can not only help you avoid dialysis or transplantation but also add years to your life. And that exercise is... walking! Here's what to do...

A Proven Benefit

We all know that exercise improves cardiovascular fitness, and researchers had already confirmed that it improves fitness in people with CKD. But could walking actually help with the disease itself-and in a significant way? That question had never been tested by research... so a group of Taiwanese researchers decided to find out.

The study started out with 6,363 patients whose average age was 70. All had moderate to severe CKD, and 53% had CKD severe enough to need dialysis or a kidney transplant. The researchers recorded and monitored exercise activity and a range of other health and medical measurements in the group and identified 1,341 people who walked as their favorite form of exercise. These patients were compared with patients who did not walk nor exercise in any other way.

The results: Walkers were 33% less likely to die of kidney disease and 21% less likely to need dialysis or a kidney transplant than nonwalkers/nonexercisers. And the more a person walked, the more likely he or she was not on dialysis or in need of a kidney transplant and still alive when the study ended. So, for example, someone who walked once or twice a week for an average 30 minutes to an hour had a 17% lower risk of death and a 19% lower risk of needing dialysis or a kidney transplant compared with someone who didn't walk or exercise. And someone who walked for an average 30 minutes to an hour seven or more times a week had a 59% lower risk of death and a 44% lower risk of needing dialysis or a kidney transplant.

Now, when researchers see this kind of dramatic result, they always should explore whether there was some reason other than the activity that was studied (in this case, walking) that could explain things. These are called confounding factors-for example, could it be that walkers walked because they were healthier, as opposed to being healthier because they walked? But no confounding factors were found. The average age, average body size and degree of kidney disease was the same in the two groups, as was the prevalence of diabetes-associated coronary artery disease, cigarette smoking and use of medications for CKD.

The bottom line for people with CKD... walk! Walk everywhere! Walk often! Even a 30-minute walk once or twice a week can help. The more you walk, the greater the benefit.

Are you at risk?

If you have diabetes or high blood pressure, your doctor should give you a simple blood test to see whether CKD is developing. Otherwise, here are telltale signs to keep an eye out for-these may signal that you should be evaluated for CKD...

• Unexplained fatigue

• Trouble concentrating

• Poor appetite

• Trouble sleeping

• Nighttime muscle cramps

• Swollen feet and ankles

• Eye puffiness, especially in the morning

• Dry, itchy skin

• Frequent urination, especially at night

Be sure to tell your doctor what medications you're on when you are examined for CKD. Because the kidneys also filter medications out of your body, meds can build up to toxic levels in your system if the kidneys aren't doing their job. If you have CKD, your doctor may take you off some medications and lower the dose of others.

While there's no cure for CKD once it sets in, it need not advance to severe and deadly stages that require dialysis or a kidney transplant. Besides exercising and keeping the underlying cause (whether it be diabetes, high blood pressure or something else) in check, mild CKD is managed by diet. To do it right...

• Make walking a priority.

• Work with your doctor to manage the underlying cause, and work with a dietitian to manage your nutrition requirements. A dietitian will plan a regimen that controls the amount of protein, salt, potassium and phosphorus you consume, all of which can build up to toxic levels in people with CKD. A dietitian will also balance your CKD diet needs with those related to glucose control or whatever condition may be associated with your CKD.

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