Infographic Cards & 60-sec Scripts · 33 cards

Cartões informativos e roteiros para vídeos curtos

Uma imagem, uma ideia bem explicada. Cada card indica as fontes das diretrizes e, depois de baixar, você já pode mandar direto no grupo de pacientes. Também vem com um roteiro de vídeo curto de 60 segundos: é só seguir para gravar e fazer a narração.

O conteúdo dos cards está disponível em 中文, English e 日本語; para este idioma, está sendo exibida a versão em inglês.

YOUR LAB REPORT IN 3 MINUTESWhat does eGFR on my report mean?1eGFR = estimated glomerular filtration rate: roughly howmuch blood your kidneys filter per minute (mL/min/1.73 m²).2Stages: ≥90 G1 | 60–89 G2 | 45–59 G3a | 30–44 G3b | 15–29G4 | <15 G5.3One low value is not kidney disease. CKD means eGFR <60 formore than 3 months, or evidence of kidney damage such asalbuminuria.4The trend matters more than a single point: a drop of morethan 5 per year is what guidelines call rapid progression.5Look at it together with urine albumin (UACR) — thatcompletes the risk picture.Not sure how to read it? Bring the report to a nephrologist, or plot your trendwith the free eGFR tracker on this site.BBeyond CKDbeyondckd.com/pt/cards/egfr-in-3-minutesSources: KDIGO 2024 CKD Guideline · Inker LA et al. CKD-EPI 2021 · 2026-10-16Compiled from public clinical guidelines · General education, not individual medical advice

Your lab report in 3 minutes

What does eGFR on my report mean?

That eGFR number on your health check — what counts as OK? Here it is in 3 minutes.

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KIDNEY DIET5 diet traps in chronic kidneydisease1Salt substitutes and "low-sodium" soy sauce: sodium is oftenreplaced with potassium chloride, which can raise blood potassiumwhen kidneys are weak.2Phosphate additives in processed food: watch for "phosphate" or"phosphoric acid" on the label — absorption is close to 100%, farhigher than natural foods.3Star fruit: contains a neurotoxin; people with reduced kidneyfunction may get intractable hiccups, confusion or seizures, whichcan be fatal.4High-sodium takeaway and pickled food: guidelines advise less than2.3 g sodium a day (about 6 g salt).5Protein powder on your own: non-dialysis CKD stages 3–5 areadvised 0.55–0.6 g/kg/day; dialysis patients actually need more —ask a dietitian first.Limits differ from person to person — follow the targets set by your doctor and renaldietitian. Try the free diet calculator on this site.BBeyond CKDbeyondckd.com/pt/cards/five-diet-trapsSources: KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update · NKF ·…Compiled from public clinical guidelines · General education, not individual medical advice

Kidney diet

5 diet traps in chronic kidney disease

Some "healthy" foods are traps for kidney patients — the first one is in many kitchens every day.

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THE KIDNEY'S SECOND NUMBERWhat is urine albumin (UACR) andwhy test it?1UACR = urine albumin-to-creatinine ratio. One random urinesample is enough — no 24-hour collection.2Categories: A1 <30 | A2 30–300 | A3 >300 mg/g.3At the same eGFR, higher albuminuria means higher risk ofkidney failure and cardiovascular events — the second axisof the KDIGO risk heat map.4It can be changed: blood pressure and glucose control, andmedicines such as RAS blockers and SGLT2 inhibitors —discuss with your doctor.5If you have diabetes, hypertension or known CKD, guidelinesadvise testing at least yearly — more often at higher risk.Next visit, ask: "Should I have a UACR test?" Log the result in this site'seGFR tracker and watch both trends.BBeyond CKDbeyondckd.com/pt/cards/uacr-albuminuriaSources: KDIGO 2024 CKD Guideline · 2026-10-16Compiled from public clinical guidelines · General education, not individual medical advice

The kidney's second number

What is urine albumin (UACR) and why test it?

A normal eGFR doesn't mean your kidneys are fine — many people have never had the second number, UACR, checked.

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AFTER TRANSPLANTWhy no grapefruit withanti-rejection drugs?1Tacrolimus, cyclosporine, sirolimus and everolimus aremetabolised by the gut enzyme CYP3A4; grapefruit blocks it, soblood levels of the drug rise.2The effect can last 24–72 hours — so spacing it "a few hoursapart" does not help.3Same risk: pomelo and Seville (bitter) orange, includingmarmalade. Regular sweet oranges, lemons and limes are not aproblem.4Ate some by accident? Do not reduce your dose yourself —contact your transplant team; an earlier drug-level test may beneeded.5Also: star fruit is neurotoxic in people with reduced kidneyfunction — avoid it after transplant too.Drugs and doses differ from person to person — ask your transplant team orpharmacist if in doubt.BBeyond CKDbeyondckd.com/pt/cards/grapefruit-and-transplant-drugsSources: FDA · Bailey DG et al. Grapefruit–medication interactions · 2026-10-16Compiled from public clinical guidelines · General education, not individual medical advice

After transplant

Why no grapefruit with anti-rejection drugs?

The most-asked question after a transplant — and the answer is not just "eat it a few hours apart".

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MEDICATION SAFETYPain relief with kidney disease:avoid NSAIDs1Common NSAIDs: ibuprofen, diclofenac, naproxen, mefenamicacid, celecoxib, and aspirin at pain-relief doses. Manycombination cold remedies contain them too.2KDIGO guidance: avoid NSAIDs when eGFR is below 30; noprolonged use when eGFR is below 60.3The "triple whammy": an NSAID plus an ACE inhibitor/ARB plus adiuretic clearly raises the risk of acute kidney injury.4Risk is higher when you are ill and dehydrated (vomiting,diarrhoea, fever) — ask your doctor which medicines to pause onsick days.5For occasional pain, acetaminophen (paracetamol) within therecommended dose is usually the safer choice — but still askfirst; patches and gels are absorbed too.Before buying any painkiller, ask the pharmacist one question: "I have kidneydisease — is this safe for me?"BBeyond CKDbeyondckd.com/pt/cards/painkillers-and-kidneysSources: KDIGO 2024 CKD Guideline · KDIGO 2012 CKD Guideline · 2026-10-16Compiled from public clinical guidelines · General education, not individual medical advice

Medication safety

Pain relief with kidney disease: avoid NSAIDs

Headache — grab any painkiller? With kidney disease, check which kind first.

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POTASSIUMHigh potassium: no symptoms, but itcan affect your heartbeat1Potassium leaves the body through the kidneys. As kidney functionfalls it builds up; very high levels disturb heart rhythm, can befatal, and often cause no symptoms.2Common high-potassium sources: banana, kiwi, orange juice,potato, tomato, dried fruit, nuts, chocolate, concentrated juices.3"Salt substitutes" and "low-sodium" soy sauce usually replacesodium with potassium chloride — a hidden high-potassium sourcefor kidney patients.4Cutting vegetables and root crops small, soaking and boiling inplenty of water, then discarding the water removes part of thepotassium; soups, stews and hot-pot broth keep it in the liquid.5There is no one-size-fits-all potassium limit — guidelines sayadjust to your blood level. Some kidney-protective medicines raisepotassium; do not stop them yourself, ask your doctor to adjust.If "K" is high on your report, ask your doctor first: is it diet, medication orconstipation? Don't guess, and don't stop medicines on your own.BBeyond CKDbeyondckd.com/pt/cards/high-potassiumSources: KDIGO 2024 CKD Guideline · KDOQI Nutrition in CKD: 2020 Update · 2026-10-16Compiled from public clinical guidelines · General education, not individual medical advice

Potassium

High potassium: no symptoms, but it can affect your heartbeat

High potassium usually has no symptoms — by the time you feel it, it is often very high. 5 things every kidney patient should know.

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BLOOD PRESSUREMeasure it wrong and the number is wrong1High blood pressure is both a cause and a consequence of kidney disease;controlling it is one of the most important ways to protect kidneyfunction.2KDIGO 2021 suggests a systolic target below 120 mmHg withstandardized measurement, when tolerated. That target applies only toa correctly taken reading.3How to measure: sit quietly 5 minutes, back supported, feet flat, armat heart level, no smoking/coffee/exercise in the previous 30 minutes,no talking; take two or more readings and average them.4Home readings reflect real life better than clinic readings; measure atfixed times morning and evening and bring the log to your visit.5Sodium under 2 g a day (about 5 g salt). For kidney patients withalbuminuria, guidelines recommend an ACE inhibitor or ARB — don'tstop it yourself because one reading looked normal.Bring your home log to the next visit and ask: "What is my target, and am I measuringcorrectly?"BBeyond CKDbeyondckd.com/pt/cards/blood-pressure-and-kidneysSources: KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in…Compiled from public clinical guidelines · General education, not individual medical advice

Blood pressure

Measure it wrong and the number is wrong

Kidney patients have a stricter blood-pressure target than most people — but most of us measure incorrectly at home. 5 things.

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DIABETES & KIDNEYSDiabetes damages kidneys — but nowthere are drugs that help1Diabetes is the leading cause of new dialysis in the US and manyother countries; long-term high glucose damages the kidneyfilters, usually silently at first.2If you have diabetes, guidelines advise checking eGFR and urinealbumin (UACR) at least once a year to catch damage early.3Glucose targets are individual: an HbA1c target anywhere from<6.5% to <8.0% may be appropriate, depending on age, hypoglycaemiarisk and other conditions.4SGLT2 inhibitors: recommended for type 2 diabetes with CKD andeGFR ≥20 — they slow kidney decline and protect the heart.5Metformin can be used at eGFR ≥30 (reduce the dose at 30–44); notadvised below 30. Medicines must be adjusted as kidney functionchanges — ask your doctor to review regularly.With diabetes, ask at your next visit: "Have I had a UACR this year? Am I a candidatefor an SGLT2 inhibitor?"BBeyond CKDbeyondckd.com/pt/cards/diabetes-and-kidneysSources: KDIGO 2022 Clinical Practice Guideline for Diabetes Management in CKD · USRDS…Compiled from public clinical guidelines · General education, not individual medical advice

Diabetes & kidneys

Diabetes damages kidneys — but now there are drugs that help

Diabetes is the leading cause of dialysis in many countries — but the last few years brought medicines that protect the kidneys.

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HEMODIALYSISWhy fluid matters between dialysissessions1When the kidneys can't remove water, extra fluid between sessions staysin the body: swelling, breathlessness, high blood pressure; removingit too fast on dialysis causes cramps and low blood pressure.2Studies link larger interdialytic weight gain to higher cardiovascularmortality. A common unit target is no more than 4% of dry weight (about2–2.5 kg); your own target is set by your dialysis team.3Thirst is mainly driven by salt: the more sodium you eat, the thirstieryou get. Cutting salt works better — and hurts less — than forcingyourself not to drink.4"Fluid" is not just water: soup, congee, ice, jelly, watermelon anddrinks all count; fruit and vegetables contain water too.5Thirst tips: suck a small ice cube or lemon slice, use a small cup, chewsugar-free gum, and pour the day's allowance into one fixed bottle.Your pre-dialysis weight is the best feedback. Ask the nurse: "What is my dry weight, andhow much did I gain this time?"BBeyond CKDbeyondckd.com/pt/cards/fluid-between-dialysisSources: KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update ·…Compiled from public clinical guidelines · General education, not individual medical advice

Hemodialysis

Why fluid matters between dialysis sessions

The real cause of thirst isn't water — it's salt. 5 keys to fluid control on dialysis.

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VACCINESVaccines for kidney patients andtransplant recipients: which are OK?1Kidney disease and dialysis weaken immunity, and infection is a leadingcause of hospitalisation; guidelines advise influenza (yearly),pneumococcal, hepatitis B and COVID-19 vaccination.2After transplant, live attenuated vaccines are contraindicated: MMR,varicella, the older live zoster vaccine, yellow fever, nasal-sprayinfluenza.3Inactivated vaccines can and should be given: injectable influenza,pneumococcal, hepatitis B, COVID-19, tetanus — usually starting 3–6months after transplant.4Shingles: the recombinant (non-live) zoster vaccine can be used inimmunocompromised adults; CDC recommends it for immunocompromisedpeople aged ≥19 — ask your transplant team about timing.5Best to complete vaccines before transplant or dialysis (the weaker thekidneys, the weaker the response); vaccinating household members addsanother layer of protection.Bring your vaccination record and ask: "What am I missing, and which ones must I avoid?"BBeyond CKDbeyondckd.com/pt/cards/vaccines-ckd-transplantSources: Danziger-Isakov L, Kumar D; AST ID Community of Practice. Vaccination of solid…Compiled from public clinical guidelines · General education, not individual medical advice

Vaccines

Vaccines for kidney patients and transplant recipients: which are OK?

"No vaccines after transplant" is a myth — only live vaccines are off-limits; the rest matter even more.

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ANEMIAWhy kidney patients get anemic — ironfirst, or injections?1The kidneys make erythropoietin (EPO); as function falls, EPO dropsand red cells decline. Definition: hemoglobin <13 g/dL in men, <12 inwomen.2Symptoms: fatigue, breathlessness, feeling cold, dizziness, poorconcentration, fast heartbeat — often dismissed as "just age" or"overwork".3Check iron first: transferrin saturation (TSAT) and ferritin. If ironis low, replace it (oral or IV) — many people improve on iron alone.4Erythropoiesis-stimulating agents (ESAs) are not meant to normaliseHb: guidelines advise not deliberately exceeding 11.5 g/dL andavoiding >13, because higher targets raise stroke and clot risk.5Anemia may have another cause: stomach ulcer or bowel bleeding,B12/folate deficiency, inflammation — guidelines say rule these outrather than blaming the kidneys for everything.Ask at your visit: "Is my iron sufficient? What is my Hb target? Should we rule out otherbleeding?"BBeyond CKDbeyondckd.com/pt/cards/anemia-in-ckdSources: KDIGO 2012 Clinical Practice Guideline for Anemia in CKD · KDIGO 2024 CKD…Compiled from public clinical guidelines · General education, not individual medical advice

Anemia

Why kidney patients get anemic — iron first, or injections?

Always tired, breathless on the stairs? Anemia is common in kidney disease, but the order of treatment matters.

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AFTER TRANSPLANTThe most common cancer after transplantis skin cancer1Immunosuppression weakens immune surveillance; skin-cancer risk risessteeply after transplant. Squamous cell carcinoma is the most common,with risk 65–250 times the general population (NEJM review).2Ultraviolet light is the main driver: more sun, more years sincetransplant and fairer skin all raise the risk.3Daily protection: broad-spectrum SPF 30+ sunscreen applied beforegoing out and every 2 hours; hat, long sleeves, sunglasses; avoidstrong sun between 10 am and 4 pm.4Protect lips and ears too (lip cancer risk also rises); choose a lipbalm with SPF.5KDIGO advises an annual full-skin and lip examination by a qualifiedprofessional. Check yourself monthly: any new spot, or one that grows,changes colour, won't heal or keeps scabbing — see a doctor promptly.Sun protection is something you can do for your new kidney every single day. Ask your team:"How often should I see dermatology?"BBeyond CKDbeyondckd.com/pt/cards/sun-and-skin-after-transplantSources: KDIGO 2009 Clinical Practice Guideline for the Care of Kidney Transplant…Compiled from public clinical guidelines · General education, not individual medical advice

After transplant

The most common cancer after transplant is skin cancer

Anti-rejection drugs sharply raise skin-cancer risk — but it is also the easiest to prevent and to catch early.

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BEFORE YOUR SCANContrast dye? 5 things kidney patientsshould say before the scan1Iodinated contrast (CT, cardiac cath, angiography) can cause acutekidney injury; the lower the eGFR the higher the risk, and eGFR <30 isthe main risk factor.2Tell them first: "I have chronic kidney disease, my eGFR is __", andbring your latest blood results; the doctor will weigh whether the testis necessary or another test can be used.3Prevention (KDIGO): IV fluids before and after, the lowest necessarydose, and no NSAIDs or other kidney-toxic drugs around the time of thescan.4On metformin? Whether to pause and when to restart depends on kidneyfunction and the type of exam — ask beforehand; don't stop or continueon your own.5Gadolinium for MRI: at eGFR <30 some older (group I) agents carry arisk of nephrogenic systemic fibrosis; the group II agents nowcommonly used carry very low risk. If urine output falls or you swell orget breathless in the days after, go back.One sentence that protects your kidneys: "I have kidney disease — does this test needcontrast?"BBeyond CKDbeyondckd.com/pt/cards/contrast-and-kidneysSources: KDIGO 2012 Clinical Practice Guideline for Acute Kidney Injury · ACR Manual on…Compiled from public clinical guidelines · General education, not individual medical advice

Before your scan

Contrast dye? 5 things kidney patients should say before the scan

CT scans and cardiac catheterisation may use contrast — if your kidneys are weak, speak up before the test.

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EXERCISECan kidney patients exercise?Guidelines say: 150 minutes a week1KDIGO 2024 recommends that people with CKD do moderate-intensityphysical activity for at least 150 minutes a week, or to a level theirheart and body can tolerate.2What is "moderate"? You can talk but not sing (the CDC talk test):brisk walking, cycling, swimming and dancing all count.3It doesn't have to be in one go: 20–30 minutes a day, or three 10-minutebouts, all count; simply sitting less has benefits of its own (WHO).4Strength training on 2 or more days a week (resistance bands, squats,lifting water bottles) helps keep muscle — kidney patients lose muscleunusually fast.5Light activity is fine on dialysis days (some units offer cyclingduring dialysis). After transplant the kidney sits in the lower abdomen— ask your team before contact sports. If you have heart disease, highpotassium or unstable blood pressure, check with your doctor first.Start today: a brisk 10-minute walk after a meal is a beginning. Ask your doctor: "Whichtype of exercise suits my condition best?"BBeyond CKDbeyondckd.com/pt/cards/exercise-with-ckdSources: KDIGO 2024 CKD Guideline · WHO 2020 guidelines on physical activity and…Compiled from public clinical guidelines · General education, not individual medical advice

Exercise

Can kidney patients exercise? Guidelines say: 150 minutes a week

"Weak kidneys, more rest" is outdated — KDIGO 2024 explicitly recommends regular physical activity.

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AFTER TRANSPLANTWhy you must never miss ananti-rejection dose1A study of why kidney transplants fail found that about half ofrejection-related losses involved non-adherence — the mostpreventable cause of all.2Anti-rejection drug levels must stay steady: take them at the sametimes every day and keep the timing relative to food consistent (alwaysfasting or always after meals) so levels don't swing.3Never reduce, stop or switch brands on your own; switching brand orformulation (immediate ↔ extended release) requires new drug-levelchecks arranged by your transplant team.4Missed a dose? Don't double up. Rules differ by drug (some can be takenwithin a few hours, otherwise skipped) — ask in advance and write themdown.5On trough-level day, have blood drawn before the morning dose, or thenumber is meaningless. Use a pill organiser, phone alarms and atime-zone converter when travelling.Nobody gets told off for asking "What do I do if I miss a dose?" Ask first, write it down, setthe alarm.BBeyond CKDbeyondckd.com/pt/cards/never-skip-antirejectionSources: Sellarés J et al. Understanding the causes of kidney transplant failure: the…Compiled from public clinical guidelines · General education, not individual medical advice

After transplant

Why you must never miss an anti-rejection dose

Among the reasons a transplanted kidney fails, one is entirely avoidable: not taking the medicines properly.

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DENTAL & ORAL HEALTH7 warning signs of gumdisease1Bleeding when brushing or flossing2Red, swollen, tender gums3Persistent bad breath4Receding gums — teeth look longer5Wider gaps, food trapping6Loose teeth, bite feels different7Pus at the gum line — see a dentist soonGingivitis is reversible; bone loss from periodontitis is not.Treating gum disease lowers HbA1c by about 0.43% in people withdiabetes.BBeyond CKDbeyondckd.com/pt/cards/gum-disease-7-warning-signsSources: WHO · Sanz M et al. EFP S3 guideline, periodontitis stage I–III ·…Compiled from public clinical guidelines · General education, not individual medical advice

Dental & oral health

7 warning signs of gum disease

Bleeding when you brush is not “heatiness”. Any one of these 7 signs means your gum pockets should be measured.

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DENTAL & ORAL HEALTHFluoride toothpaste: check theppm, spit don’t rinse1Adults and children 6+: 1,350–1,500 ppm;1,450–1,500 beats 1,000–1,2502Under 3: a smear; 3–6: pea-size; at least 1,000 ppm3Spit, don’t rinse — keep fluoride on the teeth4Twice a day; the bedtime brush matters most5Fluoride varnish at the dentist cuts newpermanent-tooth decay by about 43%6Free sugars under 10% of energy; frequency mattersmore than amountTaiwan’s tap water is not fluoridated — toothpaste is the main source.Dry mouth on dialysis? Ask about high-fluoride toothpaste.BBeyond CKDbeyondckd.com/pt/cards/fluoride-toothpaste-how-muchSources: Walsh T et al. Fluoride toothpastes of different concentrations · Marinho…Compiled from public clinical guidelines · General education, not individual medical advice

Dental & oral health

Fluoride toothpaste: check the ppm, spit don’t rinse

What does the ppm on the tube mean, and should you rinse after brushing?

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DENTAL & ORAL HEALTHThe 48 hours after scaling1Bigger gaps = the space tartar and swollen gums werefilling2Sensitivity usually fades in 1–2 weeks; use asensitivity toothpaste3Brush as normal the same day — soft brush, go easy on sorespots4Skip coffee, tea, red wine and other dark foods for 24hours5Light oozing for 1–2 days is normal; bleeding beyond 24 h— call the dentist6Healthy gums don’t need a fixed 6-monthly clean;periodontitis needs 3–6-monthly maintenanceOn dialysis: book the day after dialysis, once heparin has cleared.Anticoagulants are not usually stopped for routine scaling.BBeyond CKDbeyondckd.com/pt/cards/after-scaling-48-hoursSources: Lamont T et al. Routine scale and polish · Sanz M et al. EFP S3 guideline,…Compiled from public clinical guidelines · General education, not individual medical advice

Dental & oral health

The 48 hours after scaling

Bigger gaps and sensitive teeth after a clean? That’s not damage. Here’s what to do.

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HEART & VESSELSDaily aspirin is not for everyone1Had a heart attack, stroke or stent? Keep taking it(secondary prevention)2No cardiovascular disease and aged 60+: USPSTF 2022 saysdo not start3Aged 40–59 with 10-year risk ≥10%: individual decision,net benefit small4Bleeding risk (gut, brain) rises with age and offsets thebenefit5CKD raises bleeding risk further — don’t start on your own6Never stop prescribed aspirin without asking“Prevention” means you don’t have the disease yet. If you do, it’s treatment —and the answer is different.BBeyond CKDbeyondckd.com/pt/cards/aspirin-not-for-everyoneSources: USPSTF 2022 · 2026-10-17Compiled from public clinical guidelines · General education, not individual medical advice

Heart & vessels

Daily aspirin is not for everyone

Low-dose aspirin to prevent a first heart attack? The 2022 guidance changed.

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HEART & VESSELSWhat 5 g of salt a day lookslike15 g salt ≈ 1 level teaspoon ≈ 2,000 mg sodium2Global average intake is about 10.8 g — more thantwice the recommendation3Roughly 70–80% of sodium comes from processed andrestaurant food, not the shaker4Read labels: over 600 mg sodium per 100 g is high5Cutting sodium is one of the cheapest ways to lowerblood pressure6On dialysis it also reduces thirst and fluid gainPotassium limits clash with “low-sodium salt” — it is mostlypotassium chloride. Dialysis patients should avoid it.BBeyond CKDbeyondckd.com/pt/cards/salt-5g-a-daySources: WHO · 2026-10-17Compiled from public clinical guidelines · General education, not individual medical advice

Heart & vessels

What 5 g of salt a day looks like

WHO: under 5 g salt (2 g sodium) a day — about one teaspoon. Most people eat double.

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HEART & VESSELSFish-oil capsules vs eating fish1VITAL (NEJM 2019): 1 g/day fish oil vs placebo, 5.3years2Major cardiovascular events: no significant difference(HR 0.92, 0.80–1.06)3Secondary analyses: fewer heart attacks, but the primaryendpoint was negative4People eating little fish (<1.5 servings/week) may havebenefited more5Eating fish itself tracks with lower risk — it’s morethan omega-36High-dose prescription fish oil (4 g) is a separatequestion with separate trialsTwo servings of fish a week has steadier evidence than capsules. Kidneypatients: fish contains phosphorus — ask your dietitian.BBeyond CKDbeyondckd.com/pt/cards/fish-oil-pills-vs-fishSources: Manson JE et al. VITAL: marine n-3 fatty acids · 2026-10-17Compiled from public clinical guidelines · General education, not individual medical advice

Heart & vessels

Fish-oil capsules vs eating fish

A daily fish-oil pill to prevent heart disease? The 25,871-person VITAL trial disappointed.

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LIVER & DIGESTIVEFatty liver: how much weightloss actually helps1Lose 3–5%: liver fat starts to fall2Lose 7–10%: liver inflammation (MASH) improves3Lose ≥10%: fibrosis can regress4Mediterranean-style diet + 150+ min/week exercise isfirst-line5Cutting sugary drinks and fructose has a clear effect6The leading cause of death in fatty liver iscardiovascular disease, not the liverKidney patients: balance weight loss with protein, potassium andphosphorus — set targets with a dietitian.BBeyond CKDbeyondckd.com/pt/cards/fatty-liver-weight-loss-targetsSources: EASL–EASD–EASO Clinical Practice Guidelines on MASLD · 2026-10-17Compiled from public clinical guidelines · General education, not individual medical advice

Liver & digestive

Fatty liver: how much weight loss actually helps

Fatty liver isn’t “nothing”, but it isn’t untreatable either — the weight-loss thresholds are clear.

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LIVER & DIGESTIVEIs a little alcohol good for you?1GBD 2016 (Lancet 2018): the level of consumption withlowest risk is 0 drinks/day2About 2.8 million deaths in 2016 were attributable toalcohol3For ages 15–49, alcohol is the leading risk factor for earlydeath and disability4Observational “red wine protects the heart” studies sufferfrom sick-quitter bias5Alcohol is a Group 1 carcinogen: mouth, oesophagus, liver,breast, bowel6One drink a day raises cancer risk only slightly — but thereis no safe thresholdKidney patients: alcohol affects blood pressure, glucose, triglycerides andmany drugs. Transplant recipients — ask your team.BBeyond CKDbeyondckd.com/pt/cards/no-safe-level-of-alcoholSources: GBD 2016 Alcohol Collaborators · 2026-10-17Compiled from public clinical guidelines · General education, not individual medical advice

Liver & digestive

Is a little alcohol good for you?

A 2018 analysis of 195 countries found the amount of alcohol that minimises overall health risk is — zero.

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LIVER & DIGESTIVELiver supplements: ask threethings first1Is there a randomised trial showing better liver outcomes(not just enzyme numbers)?2Are ingredients and doses disclosed, with third-partytesting?3Will it interact with my medicines?4EASL 2024 guideline: no supplement is currentlyrecommended for fatty liver5Herbal and dietary supplements are themselves a commoncause of drug-induced liver injury6What works: weight loss, stopping alcohol, controllingglucose and lipids, treating hepatitis B/CTransplant recipients: many “liver” herbs alter tacrolimus levels — alwaysask a pharmacist first.BBeyond CKDbeyondckd.com/pt/cards/liver-supplements-can-hurtSources: EASL–EASD–EASO Clinical Practice Guidelines on MASLD · WHO · 2026-10-17Compiled from public clinical guidelines · General education, not individual medical advice

Liver & digestive

Liver supplements: ask three things first

“Liver support” has no legal definition. Ask before you buy.

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LUNGS & BREATHINGNever too late to quit: yearsregained by age1Lifelong smokers lose about 10 years on average2Quit at 60: regain about 3 years3Quit at 50: about 6 years4Quit at 40: about 9 years5Quit before 30: almost the same as never smoking6US study of 200,000 people: quitting at 25–34brings death risk close to never-smokersIn COPD, quitting is the only thing proven to slow lung-functiondecline. For kidney patients it also protects the kidney andtransplant vessels.BBeyond CKDbeyondckd.com/pt/cards/quit-smoking-never-too-lateSources: Doll R et al. Mortality in relation to smoking: 50 years · Jha P et al.…Compiled from public clinical guidelines · General education, not individual medical advice

Lungs & breathing

Never too late to quit: years regained by age

“Thirty years of smoking — quitting now is pointless.” Fifty years of British doctors say otherwise.

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LUNGS & BREATHINGLow-dose CT: who should andshouldn’t1USPSTF 2021: aged 50–80, ≥20 pack-years, current smokeror quit <15 years → yearly2NLST: in heavy smokers, LDCT cut lung-cancer mortality by20% (relative)3The cost: 24% of scans positive, 96% of those turn out not tobe cancer4Overdiagnosis is about 18% of detected cancers5Never-smokers without family history: no randomised trialshows lower mortality6LDCT uses no contrast — no direct effect on kidney functionTaiwan’s public programme also covers family history — check the HealthPromotion Administration for criteria. Quitting beats any screening.BBeyond CKDbeyondckd.com/pt/cards/who-should-get-ldctSources: NLST · USPSTF 2021 · 2026-10-17Compiled from public clinical guidelines · General education, not individual medical advice

Lungs & breathing

Low-dose CT: who should and shouldn’t

Annual LDCT lung-cancer screening for everyone? The evidence only supports high-risk groups.

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LUNGS & BREATHINGE-cigarettes: two things that areboth true1Cochrane 2026 (90 studies): nicotine e-cigs vs NRT, quitrate RR 1.59, high certainty2About 4 more quitters per 100 people3But most successful quitters are still vaping a year later4WHO: e-cigarettes contain harmful substances, are not safe,long-term effects unknown5They nearly triple the risk that non-smoking teens startsmoking6Taiwan Tobacco Hazards Prevention Act, Art. 15: making,selling and using them is prohibitedKidney patients have legal, well-studied options (patches, varenicline —doses adjusted for kidney function). Use a cessation clinic.BBeyond CKDbeyondckd.com/pt/cards/e-cigarettes-two-truthsSources: Lindson N et al. Electronic cigarettes for smoking cessation · WHO · 2026-10-17Compiled from public clinical guidelines · General education, not individual medical advice

Lungs & breathing

E-cigarettes: two things that are both true

“Better than patches for quitting” and “not safe” can both be true — and in Taiwan they are illegal.

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BONES, JOINTS & MUSCLESGlucosamine: what the big trialsfound1GAIT (NEJM 2006): pain response placebo 60%, glucosamine64%, chondroitin 65%, both 67% — none significant2BMJ 2010 (3,803 people): pain improved 0.3–0.5 cm on a10-cm scale, below the 0.9 cm that matters clinically3Joint-space change on X-ray same as placebo — no “cartilagerepair”4Industry-funded trials showed 0.5 cm more effect thanindependent ones5ACR 2019, OARSI 2019 and NICE 2022 all recommend against6What works: exercise therapy and weight loss (each kg lostcuts knee load by about 4 kg)Kidney patients: some products carry potassium or sodium; possibleinteraction with warfarin. Fairly safe — just don’t skip the exercise.BBeyond CKDbeyondckd.com/pt/cards/glucosamine-what-trials-foundSources: Clegg DO et al. GAIT · Wandel S et al. Glucosamine/chondroitin network…Compiled from public clinical guidelines · General education, not individual medical advice

Bones, joints & muscles

Glucosamine: what the big trials found

Ten years on glucosamine? Here’s the NIH 1,583-person trial and the BMJ meta-analysis.

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BONES, JOINTS & MUSCLESPrevent fractures: prevent fallsfirst, not calcium first1JAMA 2017 (33 RCTs): calcium, vitamin D or both — nosignificant reduction in hip or total fractures2The cost of calcium pills: kidney stones, gut symptoms3Cochrane 2019 (108 RCTs): exercise cuts fall rate by 23%,high certainty4Balance and functional training works best; tai chi may cutfalls 19%5WHO: about 684,000 fall deaths a year worldwide, most inpeople 60+6Diagnosed osteoporosis on treatment: calcium and D asprescribed alongside your medicationKidney patients: calcium is decided by your nephrologist from blood calcium,phosphate and PTH — self-supplementing can speed vascular calcification.BBeyond CKDbeyondckd.com/pt/cards/falls-not-calciumSources: Zhao JG et al. Calcium/vitamin D and fracture · Sherrington C et al. Exercise for…Compiled from public clinical guidelines · General education, not individual medical advice

Bones, joints & muscles

Prevent fractures: prevent falls first, not calcium first

A meta-analysis of 51,145 people: calcium pills didn’t reduce fractures in community-dwelling older adults. Something else did.

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BONES, JOINTS & MUSCLESDoes running wear out your knees?1Hip/knee OA prevalence: recreational runners 3.5%,non-runners 10.2%, competitive runners 13.3%2Recreational runners OR 0.86; competitive runners OR 1.343Under 15 years of running: OR 0.64Real risk factors: obesity, joint injury, occupationalkneeling and squatting5Observational data — can’t rule out that people with badknees don’t run6With existing OA, still exercise (high-quality evidence) —choose the right kindKidney patients’ limits come from heart, anaemia and fistula protection —not “running hurts knees”. Weight-bearing exercise protects bone density.BBeyond CKDbeyondckd.com/pt/cards/running-and-your-kneesSources: Alentorn-Geli E et al. Running and hip/knee OA · 2026-10-17Compiled from public clinical guidelines · General education, not individual medical advice

Bones, joints & muscles

Does running wear out your knees?

A systematic review of 125,810 people: recreational runners had less osteoarthritis than non-runners.

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BRAIN, NERVES & MINDThe mini-stroke passed — why goto hospital now?1TIAregistry (4,789 people): stroke after TIA at 2 days1.5%, 7 days 2.1%, 90 days 3.7%, 1 year 5.1%2That’s with urgent specialist care; in the 1990s withoutit, 90-day risk was 12–20%3CHANCE trial: dual antiplatelets started within 24 h cut90-day stroke from 11.7% to 8.2%422% of recurrent strokes occurred in people with “low-risk”scores5At assessment 5% had new atrial fibrillation, 15.5% carotidstenosis — both treatable now6Remember FAST: Face, Arm, Speech, TimeStroke risk in CKD is 1.5–3× the general population. Even if symptoms aregone, call emergency services.BBeyond CKDbeyondckd.com/pt/cards/tia-first-week-riskSources: Amarenco P et al. TIAregistry.org · Wang Y et al. CHANCE · 2026-10-17Compiled from public clinical guidelines · General education, not individual medical advice

Brain, nerves & mind

The mini-stroke passed — why go to hospital now?

Symptoms vanishing in minutes doesn’t mean safety — the first week after a TIA carries the highest stroke risk.

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BRAIN, NERVES & MINDStroke: 4.5 hours and 24 hours1IV thrombolysis: within 3 h OR 1.75, 3–4.5 h OR 1.26,beyond 4.5 h no significant benefit (6,756-patientmeta-analysis)2Benefit holds regardless of age or severity — includingover 803Thrombectomy (large-vessel occlusion): independence46% vs 26.5%; treat 2.6 to reduce disability in 14Selected patients can be treated up to 24 h — but onlyimaging in hospital can tell5Every minute of delay costs about 1.9 million neurons6Don’t drive yourself, don’t take pills first, don’t waitfor familyKidney patients especially: emergency imaging tells ischaemic frombleed; thrombolysis and thrombectomy are not contraindicated in CKD.BBeyond CKDbeyondckd.com/pt/cards/stroke-time-is-brainSources: Emberson J et al. Alteplase IPD meta-analysis · Goyal M et al. HERMES…Compiled from public clinical guidelines · General education, not individual medical advice

Brain, nerves & mind

Stroke: 4.5 hours and 24 hours

“Nothing can be done, sleep on it” is a leading avoidable cause of stroke disability. Two time windows decide everything.

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BRAIN, NERVES & MINDPreventing dementia: 14 thingswith evidence (ginkgo isn’t one)1Education, hearing loss, high LDL, depression, head injury,inactivity, diabetes2Smoking, hypertension, obesity, excess alcohol, socialisolation, air pollution, untreated vision loss3New in 2024: high LDL and vision loss4Ginkgo: the 3,069-person, 6-year GEM trial — dementia HR1.12, no effect5Ginkgo has antiplatelet action — more bleeding withanticoagulants or dialysis heparin6Hearing and vision correction, blood pressure and glucosecontrol — all doable in clinicCognitive impairment is common in CKD but often has treatable causes (anaemia,uraemic toxins, vascular) — get assessed before buying supplements.BBeyond CKDbeyondckd.com/pt/cards/dementia-14-risk-factorsSources: Livingston G et al. Lancet standing Commission on dementia · DeKosky ST et al.…Compiled from public clinical guidelines · General education, not individual medical advice

Brain, nerves & mind

Preventing dementia: 14 things with evidence (ginkgo isn’t one)

Lancet 2024: around 45% of dementia may be preventable or delayed — through these 14 factors, not supplements.

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