Andrew Kowalski, MD, FASN
Chronic Kidney Disease (CKD) is a progressive, life long condition in which the kidneys lose their ability to function properly. The kidneys are vital organs responsible for filtering waste, excess fluids, and toxins from the blood, which are then excreted through urine. CKD usually develops gradually over months or years, but rapid progression has been seen as well. This progression can lead to serious health complications, including end stage kidney disease (ESRD).
CKD is the 9th leading cause of death in America, and it accounts for close to 50,000 deaths annually. According to the Centers of Disease Control and Prevention (CDC) an estimated 10-15% of adults in the United States are thought to currently have kidney disease, which accounts to around 35-37 million people. Additionally, 660,000 people are living with kidney failure and are requiring dialysis and around 100,000 people are waiting for a kidney transplant.
To further expand, CKD does not discriminate among the various populations, ethnic backgrounds, or socioeconomic classes, but the data does suggest that it is often more prevalent among certain ethnicities (genetic reasons?), such as non-Hispanic Black and Hispanic individuals. It is also frequently seen and diagnosed at a much later stage among those with lower levels of income and educational achievement.
Looking at global statistics the National Institute of Health (NIH) estimates around 8 to 16% of the world population has CKD, which accounts for about 850 million and that number is projected to grow.
Office, E.E. Kidney Disease Facts. Encyclopedia. Available online: https://encyclopedia.pub/image/detail/961 (accessed on 08 November 2024).
How CKD Develops
CKD occurs when the kidneys are damaged, often due to underlying conditions like high blood pressure or diabetes. These conditions place extra strain on the kidneys, reducing their ability to filter blood efficiently. Over time, this impairment worsens, leading to scar tissue involvement of the kidney thereby leading to a buildup of waste and toxins in the body, which can affect the other organs and systems.
Stages of CKD
CKD is classified into five stages based on the glomerular filtration rate (GFR), which measures how well the kidneys are filtering the blood.
• Stage 1: Kidney damage with normal GFR (90+).
• Stage 2: Mild reduction in GFR (60–89).
• Stage 3: Moderate reduction in GFR (30–59).
• Stage 4: Severe reduction in GFR (15–29).
• Stage 5: Kidney failure (GFR < 15), often requiring dialysis or transplantation.
Causes of CKD
Supramanian, K., Sekar, M., & Safwan Hadi Nor Afendi, N. (2024). Chronic Kidney Disease: Etiology, Pathophysiology, and Management Strategies to Increase Quality of Life. IntechOpen. doi: 10.5772/intechopen.1005083
1. Diabetes: High blood sugar can damage the blood vessels in the kidneys, leading to CKD. Diabetic nephropathy is one of the most common causes.
Office, E.E. Kidney Disease Facts. Encyclopedia. Available online: https://encyclopedia.pub/image/detail/961 (accessed on 08 November 2024).
2. Hypertension (High Blood Pressure): Persistent high blood pressure damages the small blood vessels in the kidneys, reducing their function over time.
Approximately 29% of adults in the United States are affected by hypertension, with the prevalence of the condition rising as individuals age. Around 63% of individuals over 60 years old are impacted by this health issue.
3. Glomerulonephritis: This condition causes inflammation of the kidney’s filtering units, known as glomeruli, which can impair kidney function.
4. Polycystic Kidney Disease (PKD): A genetic disorder that causes fluid-filled cysts to grow in the kidneys, eventually leading to kidney damage.
Approximately 500,000 individuals in the United States are impacted by this condition.
5. Infections or Obstructions: Frequent urinary tract infections, kidney stones, or other blockages can contribute to CKD.
Symptoms of CKD
CKD is often referred to as a “silent” condition because early stages might not present noticeable symptoms. As the disease progresses, symptoms can include:
• Fatigue and weakness
• Swelling in the legs, ankles, or feet
• Shortness of breath
• Nausea and vomiting
• Loss of appetite
• High blood pressure
• Changes in urination frequency or color
Supramanian, K., Sekar, M., & Safwan Hadi Nor Afendi, N. (2024). Chronic Kidney Disease: Etiology, Pathophysiology, and Management Strategies to Increase Quality of Life. IntechOpen. doi: 10.5772/intechopen.1005083
Diagnosing CKD
CKD is usually diagnosed through blood and urine tests. The two main tests include:
• Blood Test (Serum Creatinine): Measures the level of creatinine, a waste product, in the blood. High levels may indicate reduced kidney function.
• Urine Test (Albumin-to-Creatinine Ratio): Checks for the presence of albumin, a protein that can leak into the urine if the kidneys are damaged.
Managing CKD
While CKD cannot be cured, early diagnosis and treatment can help slow its progression. The goal of CKD management is to control symptoms, reduce the risk of complications, and prevent further kidney damage.
1. Lifestyle Changes: Diet plays a key role in managing CKD. Reducing sodium, potassium, and phosphorus intake can help ease the workload on the kidneys. Staying active and maintaining a healthy weight also contributes to better overall health.
2. Blood Pressure and Blood Sugar Control: Keeping blood pressure and blood sugar within healthy ranges is critical in preventing further kidney damage, especially for those with diabetes or hypertension. In adults, a typical blood pressure reading is around 120/80 mmHg. High blood pressure is diagnosed when the reading is 130/80 mmHg or higher.
3. Medications: Doctors may prescribe medications to control high blood pressure (ACE inhibitors or ARBs), manage blood sugar levels, reduce cholesterol, and treat anemia, which is common in advanced CKD.
4. Dialysis or Transplant (Stage 5 CKD): In cases of end-stage renal disease (ESRD), when the kidneys can no longer function, dialysis or kidney transplant becomes necessary.
Prevention
Preventing CKD involves maintaining a healthy lifestyle, regular check-ups, and managing underlying conditions like diabetes and hypertension. Early detection of kidney disease can help slow its progression, so routine screening for those at risk is vital.
Conclusion
Chronic Kidney Disease is a serious and progressive condition, but with the right management and lifestyle choices, it is possible to slow its progression and maintain quality of life. Raising awareness about CKD is crucial, as early detection can make all the difference in outcomes. Whether you’re at risk or simply want to stay informed, understanding CKD empowers you to take proactive steps toward better kidney health.
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