Chronic Kidney Disease (CKD) affects millions of people worldwide, yet many are unaware of the seriousness of this condition. Renal failure is a medical condition where the kidneys gradually lose their ability to filter waste products, extra fluid and electrolytes from the blood. This results in fluid buildup and waste products accumulation which can adversely affect our health.The article provides information on Chronic Kidney Disease, including its causes, symptoms, and treatment options. Raising awareness about this condition can help you maintain your kidney health.
How healthy kidneys function and the impact of CKD
Understanding how healthy kidneys work is important to see how Chronic Kidney Disease affects us. Our kidneys do a lot to keep our bodies healthy:
They remove waste and extra water from our blood.
They help control the number of red blood cells we have.
They balance important minerals in our blood like sodium, potassium, calcium, and phosphorus.
They keep our blood pressure at a healthy level.
They help keep our bones strong.
Chronic Kidney Disease (CKD) occurs when the kidneys are damaged over time, typically taking at least 3 months to develop.
All the organ systems in our body are connected. When the kidneys don't work well, extra stress is put on the heart and the blood vessels and over time this may result in other health issues like heart disease and stroke.
Renal insufficiency usually progresses slowly and may give few symptoms early on. There are 5 stages of kidney disease and you can learn more about them here.
What symptoms do people with kidney disease experience?
Symptoms of kidney disease may be subtle initially and sometimes they go unnoticed for a long time.
When symptoms do appear, they can include:
Foamy urine (this results from losing protein in the urine)
Changes in how often you urinate
Dry or itchy skin
Feeling tired
Nausea
Loss of appetite
Unplanned weight loss
In later stages of CKD, signs of kidney damage may include:
Trouble concentrating
Numbness or swelling in hands and feet
Muscle aches or cramps
Shortness of breath
Vomiting
Poor sleep
Breath that smells like ammonia
Metallic taste and lack of appetite
Below is a figure depicting CKD symptoms from the 2024 KDIGO guidelines:
What causes Chronic Kidney Disease?
There are multiple factors that may increase the risk of kidney disease. A detailed medical history and physical examination is essential for identifying the underlying reason of loss of kidney function because everyone's situation is unique.
Understanding what puts you at risk can help in selecting proper testing and treatment with the goal of preventing further kidney damage.
Here is a list of risk factors that may affect kidney health:
Uncontrolled diabetes
High blood pressure
Inherited conditions such as polycystic kidney disease or Alport's syndrome
Unhealthy weight
Smoking
Heart Failure
Prior episodes of acute kidney injury
Older age
Presence of protein in the urine
Autoimmune diseases like lupus, IgA nephropathy or other
Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs)
Family history of kidney disease. Some people have genetic conditions that predispose them to developing renal disease
Infections such as Sepsis or Hemolytic Uremic Syndrome (HUS)
Other causes such as kidney cancer, kidney stones, frequent untreated urinary tract infections (UTIs), and kidney and urinary tract abnormalities before birth (KAKUT).
Some over the counter medications and supplements
Common problems resulting from Chronic Kidney Disease
People with advanced kidney disease may experience health conditions such as:
Heart Problems: CKD significantly increases the risk of cardiovascular diseases, including hypertension, heart attacks, and heart failure. This is due to factors such as fluid overload, electrolyte imbalances, and the buildup of uremic toxins.
High Blood Pressure: Your kidneys help control your blood pressure, but when they're not working well, it can cause your blood pressure to go up, which in turn can damage your kidneys even more.
Complications from renal failure itself such as: anemia, bone and joint problems, mineral imbalances, metabolic acidosis, a buildup of waste products and poor nutrition.
How to diagnose Chronic Kidney Disease?
For a long while, this can be a silent disease, therefore diagnostics are essential! We typically rely on physical exam and routine blood and urine tests. Occasionally, imaging and tissue biopsy are required to obtain additional information and guide treatment. Below are the main tests we utilize:
The Estimated Glomerular Filtration Rate (eGFR) is a blood test that estimates how well your kidneys are removing waste products from the blood. It takes into account your serum creatinine level, age, and sex. A newer formula includes "Cystatin C", which is a small protein produced by most cells in our body, for a more accurate estimation of eGFR. A higher eGFR number is better, and it is used to determine the stage of CKD.
The Urine Albumin-Creatinine Ratio (uACR) is a urine test that assesses the ratio between albumin (a protein) and creatinine levels in your urine. Healthy kidneys keep albumin in the blood while filtering out creatinine into the urine. A lower uACR number (<30 mg/g) is better. Loss of protein (albumin) in the urine indicates the kidney "filter" is damaged and is a significant risk factor for progression of kidney disease.
Imaging tests such as CT scans or ultrasounds can detect obstructions, stones, or other abnormal kidney structure, such as cysts.
A kidney biopsy is sometimes necessary. It involves taking a small sample of kidney tissue for microscopic examination, which helps to establish an accurate diagnosis and tailor the treatment plan.
Notably, genetic testing is becoming more commonly used, in particular in those patients in whom we do not understand the underlying cause of their kidney disease.
Treatment Options
One unique aspect of managing chronic kidney disease (CKD) is that we aim at treating the underlying cause of kidney disease plus we aim at lowering patient’s individual risk factors for CKD. An early referral to a kidney doctor, can help reduce complications and preserve kidney function.
There are medications known to slow down kidney disease progression. They do this mainly by reducing the pressure of blood flow through the tiny filters in your kidneys (called nephrons), and by lowering the amount of protein loss in the urine. Excess protein in the urine is known to be toxic to the kidneys.
These medications include an "ACE inhibitor" or "ARB", an "SGLT2 inhibitor" (like Dapagliflozin or Empagliflozin), and/or a "non steroidal MRA" (such as Finerinone). Recently, studies have shown that GLP-1 agonists like semaglutide (ozempic) can reduce protein loss in the urine for patients with advanced chronic kidney disease and diabetes.
A cholesterol-lowering drug called a statin is often recommended because the risk of cardiovascular events in patients who suffer from chronic kidney disease (CKD) is exponentially higher. Statins can help lower the risk of heart attacks and strokes, even if your cholesterol levels are normal. Here is a validated risk score by the American Heart Association to estimate your risk and determine if you would benefit from statin treatment: AHA PREVENT.
Managing your nutrition and lifestyle for Kidney Health
The special diet aimed at lowering the workload on the kidneys is simply a balanced diet rich in fruits (low-potassium ones if needed in advanced stages), vegetables, whole grains, and healthy fats. Ideally we should all stay away from processed foods and foods high in sugar and unhealthy fats. Here are some key components:
Sodium: Low-salt diet (less than 2 gm sodium per day) helps control blood pressure and reduce fluid retention and weight gain.
Protein: Depending on the stage of CKD and the degree of proteinuria, you may need to limit protein intake. Excessive protein can increase the kidneys' workload.
Potassium: For those with more advanced disease (CKD 4 or 5), limiting the potassium intake may be important as high levels can be dangerous. However, the foods that are high in potassium, are also foods that are considered healthy, such as fruits and vegetables and the new guidelines recommend a plant based diet for patients with CKD. A tailored advice from your doctor is essential as not everybody affected by CKD needs a low potassium diet.
Phosphorus: Limit phosphorus intake to avoid bone and heart problems. Foods high in phosphate include dairy products, nuts, seeds, beans, and certain sodas.
Calcium: Manage calcium intake according to your healthcare provider's advice. Balance is crucial because both too much and too little calcium can cause problems.
Fluids: Depending on your condition and treatment plan, you might need to monitor your fluid intake to prevent fluid overload.
Prior to making any changes in your diet, please speak with your doctor or dietitian to create a personalized eating plan that meets your specific needs.
When the battle is lost
For patients whose CKD progresses to end-stage kidney disease, planning for dialysis or a kidney transplant early is very important. There are two types of dialysis: hemodialysis and peritoneal dialysis. Patients should discuss these treatment choices with their healthcare providers well in advance. Kidney transplantation is also a viable treatment option and should be considered as part of the long-term management plan.
Conclusion:
Managing chronic kidney failure requires careful evaluation and management. Early diagnosis and treatment play a pivotal role in preserving quality of life and delaying the need for dialysis or transplantation. It is essential to address the risk factors associated with CKD to prevent its progression. Regular follow-up care and proactive health management are crucial components of ongoing treatment. By working closely with your doctor to develop a personalized treatment plan, you can effectively maintain kidney health and enhance your overall well-being.
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