Understanding Chronic Kidney Disease

By Asanga Abeyaratne

Today is World Kidney Day, a global campaign to enhance awareness of chronic kidney disease (CKD). This a significant global health burden, with around 10 per cent of the worldwide population affected.

CKD results in a gradual loss of kidney function over time. The term CKD describes a range of kidney illnesses, from early kidney disease to more advanced. Kidneys do not regenerate, and CKD results in chronic, permanent loss of kidney function. While there is no cure for CKD, its progression can be slowed down or stopped with the right treatment. CKD is frequently managed in conjunction with diabetes, hypertension, and cardiac disease.

CKD can be screened for by measuring blood creatinine (to estimate how much blood is being filtered by the kidneys) and a urine sample (to check whether there is a protein called albumin). 

People with diabetes, high blood pressure, heart disease or a family history of kidney issues should speak to their GP to get screened for CKD. The screening involves a single blood and urine test and does not require fasting. If there is an abnormal result, your GP may repeat the tests.

The terms stage 1 & 2 are used to describe early mild kidney disease. It is essential to recognise and act on the early disease to avoid progression to later stages. Treatment will involve controlling your blood pressure, sugar, and medication to reduce protein loss through urine. Another reasonably important aspect is stopping a smoking habit and a healthy diet.

Stage 3 suggests moderate disease, this is the stage you are likely to see a kidney specialist. It is vital to adhere to medications and advice aiming to slow down the progression or even halt it. Monitoring kidney functions through regular blood tests crucial.
Stage 4 and 5 denote severe disease with likely progression to end-stage renal failure (ESRF). Close engagement with a kidney specialist is crucial at this stage, and a fair amount of planning for dialysis therapy occurs in these stages. Treatment of ESRF will be with hemodialysis, peritoneal dialysis, kidney transplantation, or palliation. Dialysis does not improve sick kidneys but replaces the function of now essential functionless kidneys. It is also necessary to manage co-existent cardiovascular disease. People with CKD are more susceptible to cardiovascular disease, including heart attack and stroke. This year's theme, "Living well with kidney disease", acknowledges the challenges of living with kidney disease, emphasising those on dialysis and transplantation—the steering committee advocates patient-centeredness in research, practice and policy.

In Summary, CKD is an often under-recognized chronic health condition which may remain asymptomatic until the last stages. The earlier the recognition, the more likelihood of avoiding more severe ill health later.