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Chronic Kidney Disease (CKD)

Overview:

What is chronic kidney disease?

Chronic kidney disease describes the gradual and progressive loss of kidney function. It is a disease in which lasting irreversible damage reduces kidney function.

Chronic kidney disease (CKD) can also be described as a state of reduced GFR (glomerular filtration rate) to less than 60 mL/min/1.73 m2 for 3 months or more.

Patients with CKD tend to have an irreversible loss of the nephrons and thus an irreversible loss of kidney function. That’s because nephrons are the functional units of the kidneys, the loss of those functional units leads to the loss of kidney function which will eventually result in an overall toxic state.

If the damage gets worse it could lead to a state in which your kidneys will stop functioning. If your kidneys stop functioning you have kidney failure (or end-stage renal disease /ESRD).

progression of kidney damage to ckd and kidney failure

Symptoms:

When chronic kidney disease (CKD) is at its early stages (Stages 1&2) it usually doesn’t cause symptoms in patients, so it could be said CKD is asymptomatic at the very beginning and can only be diagnosed through testing.

However, after CKD gradually progresses into later stages, waste and extra fluid tend to build up in the body. Hence the individual will experience one or more of the following symptoms:

  1. Loss of appetite and not feeling hungry
  2. Swelling in feet and ankles due to fluid accumulation (also known as Oedema)
  3. Shortness of breath (if fluid accumulates in the lungs)
  4. Nausea & vomiting
  5. Sleeping problems & insomnia
  6. Muscle cramps
  7. Fatigue and tiredness
  8. Itching

Causes of chronic kidney disease CKD

CKD can result from any underlying kidney disease that is caused by either acute kidney injury or slowly progressive kidney disease.

Discussing all the causes of kidney disease is beyond the scope of this Article. Instead, we will focus on the most common causes of CKD.

1-) Diabetes
Diabetes is the leading cause of CKD and Kidney failure (ESRD) worldwide. Diabetic nephropathy occurs in both type I and type II diabetes, meaning both types of diabetes cause CKD.

2-) High blood pressure (hypertension)
is the second most common cause of CKD and kidney failure (ESRD).

3-) Glomerulonephritis
or the inflammation of the glomeruli could cause permanent damage to the glomeruli and initiate CKD; if the glomeruli are damaged the kidneys can’t function properly.

4-) Autosomal dominant polycystic kidney disease
This cause of CKD is a genetic disorder that results in the formation of cysts inside the kidneys.

5-) Kidney stones
Kidney stones rarely cause CKD, but when left untreated they could definitely lead to kidney damage hence causing CKD.

While those are the most common causes for the initiation of CKD, certain other factors increase the risk for progression of CKD into worse conditions, such as:

  • Heart disease/ cardiovascular disease
  • Family history of CKD: Having a family member with chronic kidney disease
  • Age: being over 60 years

Diagnosis:

A patient is diagnosed with chronic kidney disease CKD when they have either of these:

  1. Kidney damage for 3 months or more:
    kidney damage may occur as a result of disease (such as polycystic kidney disease), damage can also result from diabetes and hypertension.
  2. A state of reduced GFR (glomerular filtration rate) for 3 months or more:
    To be diagnosed with CKD, GFR must be below 60 mL/min/1.73 m2.

The stages of chronic kidney disease:

The following classification is based on the estimated glomerular filtration rate (eGFR).

classification and staging of chronic kidney disease ckd by the national kidney foundation

Read more about the stages of CKD.

Treatment

There is no permanent cure for CKD because the disease is irreversible and the damage is permanent, in severe cases when CKD progresses to stage 5 (in which the kidneys fail) dialysis and kidney transplantation may be required.

However certain steps could be taken to delay the progression of CKD to later stages; thus, the aim of treatment is to delay progression as much as possible.

Goals of treatment:

  1. Manage the underlying cause.
  2. Delay the progression of CKD into other stages and most importantly delay the progression into kidney failure.
  3. Delay and treat known cardiovascular disease comorbidities.
  4. Manage uremic complications that arise (such as anemia, mineral metabolism abnormalities and high blood pressure).
summary of goals of treatment ckd

Possible treatments of CKD include:

  1. Controlling blood sugar levels if you have diabetes
  2. Maintaining normal blood pressure in hypertensive patients
  3. Managing anemia, mineral metabolism abnormalities and high blood pressure that are caused by CKD
  4. Treating glomerulonephritis
  5. Dietary changes

Complications of CKD

Kidneys are the central control center for homeostasis, thus they are very important to maintain balance inside the human body, when they lose their ability to maintain balance a number of complications (including other diseases) tend to arise.

CKD could lead to the following health complications:

  • Hypertension and cardiovascular disease
  • Anemia
  • Hyperkalemia- high potassium
  • Hyperphosphatemia
  • Metabolic acidosis
  • Secondary hyperparathyroidism
  • Toxin build-up
  • Fluid build-up

Some of these complications arise as direct consequences of losing kidney function.

Many complications, however, result from treatment of the causes of CKD (such as the treatment for glomerulonephritis).

  • The worst complication of CKD is when CKD progresses to kidney failure (the almost complete loss of kidney function).

Prevention

To prevent CKD either from happening or from progressing further (if you are already diagnosed with it), here are some preventive actions that you could take:

  1. Prevent diabetes, or control your blood sugar if you have diabetes
  2. Prevent high blood pressure, or control it if you do happen to have high blood pressure
  3. Exercise for at least 30 mins a day, 4-5 days per week
  4. Have a healthy diet
  5. Quit smoking
  6. Get plenty of high-quality sleep

The complications and further progression of CKD will deny us the long health-span we all desire; Nevertheless, half of the causes of CKD are preventable, thus it’s best to take those preventions seriously in order to increase the likelihood of a CKD-free life.

References

1. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39(Suppl 1):S1-S266, 2002.

2. Karl Skorecki, Glenn M. Chertow et al., Brenner & Rector’s the Kidney, 10th edition, Philadelphia, United States of America, Elsevier, [2016]

3. Jonathan Himmelfarb et al., Chronic Kidney Disease, Dialysis, and Transplantation, 3rd edition, Philadelphia, United States of America, Saunders (an imprint of Elsevier Inc.), [2010]

4. John Feehally et al., Comprehensive Clinical Nephrology, 6th edition, Philadelphia, United States of America, Elsevier -Health Sciences Division, [2018]

5. Christopher S. Wilcom et al., Therapy in Nephrology and Hypertension- A Companion to Brenner & Rector's the Kidney, 3rd Edition, Philadelphia, United States of America, Saunders/an imprint of Elsevier, [2008]

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