Chronic Kidney Disease

Introduction:  Kidneys are a pair of organs in our abdomen. They are responsible for removing impurities from blood and excrete in urine. They also maintain balance of electrolytes like sodium, potassium, phosphorus and acid-base equilibrium in our body. In a healthy individual these functions are maintained through a urine output of 2-3 L a day. When kidney function declines due to common health conditions like high blood pressure and diabetes, we call it Chronic (long term) kidney failure or disease (CKD). It is estimated that about 14% of the world population has chronic kidney disease causing a great burden on the families and health system of the countries. 

Estimating Kidney Function:  Kidney function of an individual can be estimated by simple blood tests, like testing for serum creatinine, BUN (Blood urea nitrogen) and eGFR (estimated Glomerular function rate). Normal serum creatinine is 1 mg/dl, and we see higher numbers depending on the degree of kidney damage. Also, normal BUN is about 20 and can be elevated in people with kidney disease. eGFR is used to classify kidney disease into stages. It is also used to adjust medications and make decisions regarding kidney dialysis and transplantation. 

Stages of Chronic Kidney Disease:  

How to Slow down progression of kidney damage:

    • control your blood pressure. Keeping your blood pressure within a healthy range may help slow the progression of kidney disease. 

    • Monitor your blood glucose and keep diabetes well controlled. 

    • Eat a kidney-friendly diet and exercise regularly. 

    • Maintain an ideal body weight. 

    • Drink at least 2-3 L of fluids daily and mostly water. This will change as kidney disease advances and people in stage 4/5 kidney disease may be placed on a fluid restriction. 

    • Use caution when taking over-the-counter supplements and medicines especially NSAIDs like ibuprofen, Naprosyn, etc. 

    • Avoid certain types of IV contrast if you have CKD.

    • See a Nephrologist on a regular basis and have blood urine tests done and monitored. 

    • Avoid smoking and alcohol. 

    • Maintain good blood cholesterol levels. 

Symptoms of stage 5 kidney disease (ESRD):

Many people do not experience symptoms of kidney disease until the later stages when kidney damage has occurred. Possible stage 5 kidney disease symptoms and signs include:

    • Uremia (waste buildup in your blood)

    • Fatigue—possibly caused by anemia

    • Shortness of breath

    • Nausea or vomiting

    • Swelling in your hands/legs/eyes/lower back

    • Lower back pain

Treatment Options when Kidneys fail: 

When eGFR if less than 15ml/min we call it stage 5 kidney disease. At this point an individual may need to prepare for a kidney transplant or kidney dialysis. In some countries these preparations are started earlier. Dialysis decisions are not made strictly on numbers but looking at overall picture of the individual, like electrolytes, fluid balance and general health and activity status.  There are two types of kidney transplant. Living donation from a friend or family member or from a cadaver (from a dead person ).

 Dialysis is available in two forms. 

    • Peritoneal dialysis—Uses the blood vessels in the lining of abdomen—the body's natural filter—along with a solution called dialysate to filter and clean blood. With this method, blood never leaves the body. Can be done with a machine or manually at home, at work, or while traveling. Usually done on a daily basis. 
    • Hemodialysis—Filters out blood through a dialysis machine to remove toxins, waste, and excess fluid. Blood flows into the machine, gets filtered, and is returned to the body. Hemodialysis can be performed at home or a dialysis center and usually done three times a week.

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