Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a progressive condition characterized by the gradual loss of kidney function over time. The kidneys play a crucial role in filtering waste and excess fluids from the blood, which are then excreted in the urine. When kidney function declines, waste products can accumulate, leading to various health complications.

CKD is a significant public health concern worldwide, often remaining undetected until it reaches advanced stages. Early detection and management are vital to slow progression and prevent complications.

Chronic Kidney Disease refers to the persistent damage or decrease in kidney function lasting for three months or more. It's typically identified through blood tests measuring glomerular filtration rate (GFR) and urine tests detecting proteinuria.

CKD progresses through five stages:

• Stage 1: Normal or high GFR (≥90 mL/min) with evidence of kidney damage.
• Stage 2: Mild reduction in GFR (60–89 mL/min) with kidney damage.
• Stage 3: Moderate reduction in GFR (30–59 mL/min).
• Stage 4: Severe reduction in GFR (15–29 mL/min).
• Stage 5: Kidney failure (GFR <15 mL/min), often requiring dialysis or transplantation.

CKD can be categorized based on its underlying causes:

• Diabetic Nephropathy: Kidney damage resulting from long-standing diabetes.
• Hypertensive Nephrosclerosis: Damage due to chronic high blood pressure.
• Glomerulonephritis: Inflammation of the kidney's filtering units.
• Polycystic Kidney Disease: A genetic disorder causing cyst formation in kidneys.
• Chronic Kidney Disease of Unknown Etiology (CKDu): CKD without identifiable traditional risk factors, observed in certain regions.

Chronic Kidney Disease develops gradually over months or years, often without noticeable symptoms until significant damage has occurred. A variety of underlying conditions and lifestyle factors can contribute to CKD. Here’s a breakdown of the most common causes:

1. Diabetes (Type 1 and Type 2)

Diabetic nephropathy is the leading cause of CKD worldwide. Persistently high blood sugar levels damage the blood vessels in the kidneys over time, reducing their ability to filter waste.

2. Hypertension (High Blood Pressure)

High blood pressure puts strain on the delicate filtering units of the kidneys (glomeruli), eventually impairing their function. It also accelerates existing kidney damage.

3. Glomerulonephritis

This refers to inflammation of the kidney’s filtering units. It may result from infections, autoimmune diseases, or unknown causes. It can be acute or chronic and is one of the more common non-diabetic causes of CKD.

4. Polycystic Kidney Disease (PKD)

A genetic disorder, PKD causes numerous fluid-filled cysts to grow in the kidneys, interfering with their function over time. It is the most common inherited kidney condition.

5. Prolonged Use of Certain Medications

Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), some antibiotics, and certain heartburn medications (like proton pump inhibitors) can harm the kidneys.

6. Urinary Tract Obstruction

Chronic obstruction caused by kidney stones, an enlarged prostate, or certain cancers can cause backflow of urine into the kidneys, leading to damage and scarring.

7. Recurrent Kidney Infections (Pyelonephritis)

Frequent or chronic infections can inflame and scar the kidneys, reducing their filtering capacity over time.

8. Autoimmune Disorders

Conditions like lupus and vasculitis can directly affect kidney tissues, damaging their filtering ability and causing long-term deterioration.

9. Congenital Malformations

Some people are born with abnormally developed kidneys or urinary systems, making them more susceptible to CKD later in life.

10. Heavy Metal Exposure and Toxins

Chronic exposure to toxic substances such as lead, mercury, and certain herbal remedies can negatively affect kidney function.

CKD often progresses silently, with symptoms appearing in later stages:

• Fatigue and Weakness: Due to anemia or toxin buildup.
• Swelling (Edema): In feet, ankles, or hands from fluid retention.
• Shortness of Breath: Fluid accumulation in lungs.
• Nausea and Vomiting: Resulting from waste accumulation.
• Loss of Appetite: Changes in taste or uremia.
• Sleep Disturbances: Due to muscle cramps or restless legs.
• Itchy Skin: Phosphate buildup can cause itching.
• Frequent Urination: Especially at night.

Early diagnosis of CKD is critical because symptoms often appear only in later stages. Regular screening is especially important for people with risk factors like diabetes or hypertension.

1. Blood Tests

• Serum Creatinine Test: Measures the level of creatinine, a waste product, in your blood. Elevated levels may indicate impaired kidney function.
• Estimated Glomerular Filtration Rate (eGFR): This is a calculated value derived from serum creatinine, age, sex, and body size. An eGFR below 60 mL/min/1.73 m² for more than 3 months indicates CKD.
   

2. Urine Tests

• Urine Albumin-to-Creatinine Ratio (UACR): This detects the presence of albumin (a type of protein) in the urine. Even small amounts (microalbuminuria) can be an early indicator of kidney damage.
• Dipstick Test: A simple test to detect blood, protein, glucose, and infection indicators in the urine.
   

3. Imaging Tests

• Ultrasound: Non-invasive imaging helps assess kidney size, structure, and detect obstructions or abnormalities like cysts or tumours.
• CT or MRI Scan: Used for more detailed imaging in complex cases or when evaluating masses, tumours, or vascular issues.

4. Kidney Biopsy

A small sample of kidney tissue may be taken using a needle to examine under a microscope. This helps in diagnosing specific kidney diseases (e.g., glomerulonephritis or autoimmune nephritis).

5. Other Tests

• Blood pressure monitoring: Consistently high readings may suggest chronic kidney strain.
• Electrolyte panel: Imbalances in sodium, potassium, calcium, and phosphorus may indicate CKD.
• Parathyroid hormone (PTH) levels: Elevated in advanced CKD stages due to altered calcium/phosphorus metabolism.

There is no cure for CKD, but its progression can often be slowed or managed effectively with a combination of lifestyle changes, medications, and—at later stages—dialysis or transplant. Treatment plans are highly individual and depend on the stage of the disease, the underlying cause, and the presence of complications.

1. Lifestyle Modifications

• Dietary Changes: Patients are often advised to follow a low-sodium, low-potassium, and low-phosphorus diet. Protein intake may be moderated to reduce waste production.
• Fluid Balance: Depending on kidney function, patients may need to restrict fluid intake to prevent swelling and high blood pressure.
• Exercise: Regular physical activity helps control blood sugar, blood pressure, and weight.
• Smoking Cessation: Smoking accelerates CKD progression and increases cardiovascular risk.
• Alcohol Moderation: Limiting alcohol helps reduce strain on kidneys and control blood pressure.
   

2. Medications

• Blood Pressure Medications: ACE inhibitors or ARBs (angiotensin receptor blockers) not only control blood pressure but also reduce protein loss in urine and slow CKD progression.
• Diuretics: Help control swelling and high blood pressure by removing excess fluid.
• Phosphate Binders: Reduce phosphorus absorption from food to protect bones and prevent calcification.
• Erythropoietin-Stimulating Agents (ESAs): Used to treat anaemia by encouraging red blood cell production.
• Vitamin D Supplements: Help manage bone health, especially in later stages of CKD.
• Blood Sugar Control Drugs: For diabetic patients, maintaining optimal blood glucose levels is essential to slow kidney damage.
   

Besides these, medications containing alpha ketoanalogues (Brand: Renolog) and supplements (Brand: Ketosteril) may also be prescribed.

3. Dialysis

Used in end-stage renal disease (Stage 5 CKD), when kidney function drops below 10–15%.

• Haemodialysis: Blood is filtered outside the body through a dialyser machine, typically done 3 times a week.
• Peritoneal Dialysis: Uses the lining of the abdomen to filter blood inside the body, usually done daily at home.
   

4. Kidney Transplantation

For suitable candidates, a transplant offers the best long-term outcome. A healthy kidney from a living or deceased donor is surgically placed to take over filtering duties. Post-transplant, lifelong immunosuppressive medications are necessary to prevent organ rejection.

5. Monitoring and Regular Follow-Ups

CKD management is continuous. Regular check-ups are vital to:

• Monitor eGFR and protein levels
• Adjust medications
• Manage emerging complications
• Prepare for dialysis or transplantation if needed

• Diabetes
• Hypertension
• Family history of kidney disease
• Age over 60
• Obesity
• Smoking
• Cardiovascular disease
• Prolonged use of NSAIDs
• Exposure to toxins

• Anemia
• Bone disease
• Cardiovascular issues
• Fluid retention
• Electrolyte imbalances
• Decreased immune response
• Pericarditis
• Pregnancy complications

• Follow Medical Advice: Adhere to prescribed treatments and medications.
• Dietary Adjustments: Work with a dietitian to plan kidney-friendly meals.
• Stay Active: Engage in suitable physical activities.
• Monitor Health Parameters: Regularly check blood pressure and blood sugar.
• Seek Support: Join support groups or counseling sessions.

"CKD only affects the elderly": 

While risk increases with age, CKD can occur at any age.
 

"Symptoms are always noticeable": 

Early stages often lack noticeable symptoms.

 

"Dialysis is the only treatment": 

Many manage CKD with medications and lifestyle changes.

Consult a healthcare provider if you experience:

• Persistent fatigue
• Swelling in limbs
• Changes in urination patterns
• Shortness of breath
• Unexplained nausea or vomiting

• What stage of CKD am I in, and what does it mean for my health?
• What are the likely causes of my kidney disease?
• What lifestyle changes should I adopt to slow the progression?
• Are there specific foods or drinks I should avoid?
• How often do I need tests to monitor my kidney function?
• What treatment options are best suited for my condition?
• At what point should we consider dialysis or transplant?

• Educate Yourself
  Learn about CKD, its stages, symptoms, and treatment to offer informed support.
• Be a Part of Their Health Journey
  Accompany them to medical appointments when possible and help keep track of medications or dietary plans.
• Encourage Healthy Habits
  Support lifestyle changes like exercise, healthy eating, and quitting smoking—join them in these changes if you can.
• Offer Emotional Support
  Be empathetic. Living with CKD can be stressful; offering a listening ear and moral support can mean the world.

Chronic Kidney Disease is a serious yet manageable condition that affects millions across the globe, including a significant portion of India’s population. The key to living well with CKD lies in early detection, consistent medical care, lifestyle adjustments, and strong support systems.

Understanding CKD not only empowers patients but also caregivers and family members. Whether you’re managing the condition or helping someone who is, awareness, education, and proactive care are crucial.

Taking steps to maintain kidney health—like monitoring blood pressure, controlling diabetes, eating right, and staying active—can go a long way in preventing or delaying CKD. For those already diagnosed, the journey doesn’t end with the diagnosis—it begins with it.