Chronic Kidney Disease and its complications
Our kidneys play an important role in removing toxins and excess water from the body through the formation of urine. Kidneys are also involved in maintaining haemoglobin levels and bone health. When the normal function of the kidney is gradually lost irreversibly over a period of time, they are no longer able to remove harmful toxins and excess fluid effectively, leading to various complications in the body affecting almost all organ systems, and even leading to death if not treated on time. This condition is known as chronic kidney disease (CKD) or chronic kidney failure.
The most common complications of CKD include:
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Fluid retention leading to high blood pressure, fluid build-up in the lungs and swelling in the arms and legs
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Heart diseases leading to heart failure
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Bone weakness leading to increased risk of fractures
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Anaemia
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Reduced immunity
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Pregnancy complications
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Loss of memory or seizures
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Death
CKD is a progressive condition and there is no cure for the condition. As the condition worsens, and the glomerular filtration rate falls, patients will require renal replacement therapy i.e. dialysis or a kidney transplant for survival:
CKD Burden
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The prevalence of CKD was estimated to be about 9.1% globally in 2017, accounting for about 1.2 million deaths annually. The condition is reported to be more common in the female gender as compared to their male counterparts (9.5% vs. 7.3%)
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The prevalence has increased by about 29% between 1990 and 2017 and is thought to be rising steeply due to the ageing population worldwide.
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China (132.3 million) and India (115.1 million) accounts for about one-third of the global cases.
Stages of Chronic Kidney Disease
CKD can be medically classified through Stage 1 to 5 depending on the severity of the condition.
Stage 1-3: Mild to moderate kidney damage
Stage 4: Severe kidney damage
Stage 5: Complete kidney failure requiring dialysis or transplant
Signs and Symptoms of Chronic Kidney Disease
The most common chronic kidney disease symptoms may include:
Risk Factors of Chronic Kidney Disease
The most common cause of CKD includes:
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Diabetes mellitus
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Hypertension
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Polycystic kidney disease
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Chronic Glomerulonephritis
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Recurrent urinary tract infection and obstruction
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Cardiovascular disease
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Elderly age
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Smoking
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Obesity
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Family history of kidney disease
Prevention and lifestyle modification
Lifestyle plays an important role in the development and progression of CKD to the end stages. Some of the most effective ways of preventing CKD progression includes:
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Controlling diabetes and hypertension
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Quitting smoking
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Maintaining ideal weight through a healthy diet and regular exercising
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Avoiding the use of over-the-counter drugs especially pain killers without a doctor’s prescription
Diagnosis and Management of Chronic Kidney Disease
Your doctor will take down a detailed history of the signs and symptoms, family history and carry out a thorough physical examination during the first visit. He will additionally request certain blood tests, urine tests and ultrasonography to detect any abnormality. A biopsy may be done to understand the cause of the kidney problem.
The aim of overall management should be to manage signs and symptoms, treat complications and slow down the progression of the condition. Chronic kidney disease treatment is generally individualised as per the patient’s conditions and needs. Kidney disease treatment in Delhi may include medical management of hypertension, anaemia, swelling, improving bone strength and a kidney-friendly diet to minimize the kidneys’ workload.
Patients with stage 5 CKD need regular dialysis or a renal transplant for survival. Consult the best kidney doctor in Delhi if you or your loved one is suffering from chronic kidney disease.
Living with CKD
If you have been diagnosed with CKD, it is important to take good care of yourself every day. Apart from following a healthy lifestyle, you must keep the following things in mind.
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Get an appointment from a dietician who can help you plan a kidney-friendly diet.
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Do not skip on a regular doctor visit and prescribed medications to prevent worsening of conditions
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If you are suffering from stage 4 CKD, it is important to discuss the prospect of dialysis and kidney transplant, in case your condition further deteriorates to improve survival.
FAQs
1. What is GFR?
GFR refers to glomerular filtration rate and signifies how well the kidneys are functioning to remove the toxin waste product creatinine from the blood. A GFR value of less than 60 ml/min denotes significant kidney damage.
2. How is GFR related to CKD staging?
Estimated GFR or eGFR is used for staging CKD. eGFR is inversely proportional to CKD staging.
Stage 1: eGFR ≥90 ml/min
Stage 2: 60-89 ml/min
Stage 3: 30-59 ml/min
Stage 4: 15-29 ml/min
Stage 5: <15 ml/min
3. What is the role of diet in CKD?
A kidney friendly-diet will help to protect the kidney from further damage. Visit Manipal, the best kidney hospital in Delhi NCR for diet-related queries. Some of the most common dietary changes recommended in CKD include
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Cutting down sodium in the form of table salt, packaged and tinned food
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Limiting phosphorus by eating more fruits and vegetables and cutting down on dairy and meat
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Reducing potassium intake found in high amount in citrus fruits, bananas, oranges, tomatoes, etc
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Limiting fluid intake
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Limiting high protein diet
4. Are patients with CKD at higher risk of COVID-19?
Our kidneys play a crucial role in maintaining good immunity. Any conditions of the kidney are thus associated with lower immunity.
Yes, patients with CKD especially patients on Dialysis and transplant recipients on immunosuppressive drugs, are at higher risk of infections including COVID 19 due to low immunity.
5. Why are patients with CKD at increased risk of fracture?
Kidneys produce an active form of Vit D ( calcitriol) which helps to absorb calcium from food to maintain strong bones and skeletal system. In CKD, the kidney stops synthesizing calcitriol. To maintain blood calcium level, the body starts removing it from the bone, thus making it brittle and prone to fracture.
6. Why are patients with CKD at increased risk of developing anaemia?
Kidneys produce a hormone- Erythropoietin which is required in the process of formation of red blood cells. Thus deficiency of this hormone in CKD patient makes them prone to develop anaemia.
Dr Ashish Nandwani
Consultant - Nephrology And Renal Transplant
Manipal Hospitals, Dwarka, Delhi
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