Summary:
- Chronic kidney disease is common, especially with age
- Do not panic if you are told you have chronic kidney disease, the majority of patients with chronic kidney disease are well and won’t suffer any problems in the future
- It is important to monitor patients who have CKD more closely and we will do this with blood tests and urine checks
- It is important to control possible causes of CKD to prevent progression (for example high blood pressure and diabetes) and we will work with you to control these conditions if you have them
- It is also important to lead a healthy lifestyle to reduce the risk of the chronic kidney disease worsening
We have included more detailed information below to read about chronic kidney disease. However if you’d prefer to watch a short informative video on chronic kidney disease this is a good video produced by a hospital in the UK:
What is CKD?
“Kidney disease” is a term used by doctors to describe when your kidneys do not work as well as they should. “Chronic” means a long-term condition that does not get completely better.
Some people think that “chronic” means severe. This is not always true.
Some patients with CKD have more severe disease, but most patients with CKD have only a very slight kidney problem.
How common is CKD?
Mild to moderate CKD is very common. Recent research suggests that 1 in 10 people may have CKD. However, CKD is less common in young adults, being present in 1 in 50 people.
In people aged over 75 years old, CKD is present in 1 in 2 people.
However, many of these people with CKD may not have diseased kidneys.
CKD may be due to normal ageing of their kidneys. Severe kidney failure will not happen with normal ageing of your kidneys.
There is an increased risk of kidney disease progressing to cause problems if you have high blood pressure, heart disease or a stroke. We review patients with these conditions to minimise the risk of CKD progressing.
What causes CKD?
There are many causes of CKD. The most common causes are ageing of your kidneys, high blood pressure and diabetes. Very few of the causes of CKD are curable but they may be controlled.
How do you know if you have CKD?
Usually, CKD does not cause any symptoms. It is only detected through tests. These is usually a urine tests for blood or protein, or a blood test to measure kidney function.
Symptoms develop slowly and do not appear until most of your kidney tissue has been damaged. The rate at which kidney failure worsens can vary from person to person. Do not think that not having symptoms means that CKD has not gotten worse. This is why monitoring blood tests are very important.
What are the symptoms of advanced CKD?
Very occasionally CKD can advance to significant levels. Symptoms which can come from this are fairly non-specific and include:
- fatigue and general weakness
- lack of concentration
- restless legs and muscle cramps
- itchy skin
- poor sleep
- nausea (feeling sick), vomiting
- unpleasant taste in the mouth
- loss of appetite and weight loss
- shortness of breath
- swollen ankles
How is advanced CKD diagnosed and monitored?
CKD is diagnosed and monitored by either your GP or nephrologist (kidney specialist) if you are under them.
In the early stages of CKD, people may be unaware that they have it and a blood or urine test may be the only way it is found.
Your urine will be tested for certain substances, such as albumin (a type of protein) and blood. Extra albumin in the urine is due to chronic damage to your kidneys. It is measured using a urine dipstick or albumin creatinine ratio (ACR).
A blood test called the eGFR (estimated glomerular filtration rate) is used to measure kidney function. The eGFR is calculated by measuring the level of a substance called creatinine in your blood.
A normal eGFR is about 90 to120 ml/min in adults. The eGFR is sometimes referred to as the percentage of normal kidney function as the number is about the same.
If a 40 year old adult with normal kidneys has a GFR of 100 ml/min, and this falls by about 1 ml/min per year from that age (as it is thought to), many healthy people aged 75 will have an eGFR of 50 to 60 ml/min.
Other substances in the blood like urea, potassium and phosphate are also measured; high levels and can cause illness. Other blood tests, such as haemoglobin and PTH, are carried out to detect anaemia and renal (kidney) bone disease which may happen in advanced CKD.
Cardiovascular risk
People with CKD are at an increased risk of heart disease, stroke, and poor circulation (peripheral vascular disease). Cardiovascular risk factors like smoking, cholesterol and blood pressure will be monitored closely and you will be given medicine where needed.
What are the stages of CKD?
CKD is divided into 5 stages
CKD stage 1: this is where eGFR is greater than 90 mls/min, with some sign of kidney damage on other tests. If all the other kidney tests are normal, there is no CKD.
CKD stage 2: this is where eGFR is between 60 to 89 with some sign of kidney damage. If all the other kidney tests are normal, there is no CKD.
CKD stage 3: a mild-moderate degree of impairment in kidney function occurs in this stage. This is subdivided in to 3a (eGFR 45 to 59) and 3b (eGFR 30 to 44) because we now know that patients in 3b have increased rate of cardiovascular diseases (heart attacks, strokes, narrowing of other arteries). Despite the mild impairment, only a minority of patients progress to end stage kidney failure. Most patients with stage 3 CKD can be treated by the GP.
CKD stage 4: this is where eGFR is between15 to 29 ml/min, a severe reduction in kidney function.
CKD stage 5: this is where eGFR is less than 15 ml/min, when dialysis or a kidney transplant may be needed.
What is the treatment for CKD?
Although there is no cure for CKD, treatment is important to try and stop what has caused CKD and to reduce the rate of decline in kidney function.
There are some things that everyone with CKD should try to do.
- Lose weight (if overweight) and take regular exercise.
- Stop smoking
- Reduce the amount of salt in your diet to help control your blood pressure
- Eat a healthy balanced diet
- Drink about 2 litres of fluid a day. 2 litres are about 10 cups or 6 mugs. There is no benefit in drinking large amounts of fluid, except in people who get lots of urine infections or in other special cases.
- You should not binge drink and be cautious in replacing extra fluid losses in hot weather and during times of diarrhoea or vomiting.
- Buy an automatic blood pressure monitor to check your blood pressure at home.
- Have an annual “flu jab” (influenza vaccination) and have the pneumonia (pneumococcal) vaccine once. Talk to your GP about this.
- Avoid some types of painkillers: non-steroidal inflammatory medications (NSAIDS) such as ibuprofen should be avoided. Ask your doctor if you are unsure.
- Seek early treatment with antibiotics if you are prone to urine infection. Symptoms of urine infections can include frequent need to urinate, burning sensation on urinating, aches in the bladder or loin, smelly urine.
Treatment for early CKD stages 1, 2 and 3
Blood pressure should be treated carefully. If it is above 140/85, tablets are usually needed. The aim is to get your blood pressure down to 130/80 or lower.
Your cholesterol should be checked, and some people will be advised to take a daily aspirin tablet. A blood test to check eGFR should be performed once a year. CKD stage 3 requires more careful monitoring for declining kidney function. You should have a 6 month (then 12 monthly if stable) monitoring check of blood creatinine, potassium, and haemoglobin (Hb), urinary albumin (protein), blood pressure and assessment of cardiovascular risk.
If your urine tests show a lot of protein in the urine, or your kidney function is declining fast over time, a referral may be made to a kidney specialist.
If someone with CKD also has diabetes, extra care to control blood pressure, blood sugar levels and cholesterol levels is required. This will
need intensive monitoring, including extra urine tests to look for albumin in the urine. This is because CKD can be a complication of diabetes. However, CKD does not cause diabetes.
Treatment for advanced CKD stages 4 and 5
Treatment should be as for CKD stages 1-3. All medicines should be reviewed as their doses may need to be altered. Some medicines may need to be avoided as they can damage the kidneys further. This review should include prescribed medicines, any medicines bought at the chemist and complementary therapies.
Advice from a kidney specialist may be necessary, especially in stage 5.
What if the kidney function continues getting worse?
In the few people with declining kidney function that are progressing to CKD stage 5, a treatment plan should be made with the kidney specialist team.
Patients need information, time, and counselling to help them decide on the most appropriate option for them and to help prepare for any dialysis and transplantation. Elderly or very frail patients may choose not to have dialysis. This is a reasonable decision and is called supportive care.
Who cares for patients with CKD?
Most patients in CKD stage 1, 2 and 3 will be checked yearly and sometimes twice a year by their GP.
On each visit, you should expect blood pressure measurement, urine and blood tests and a review of your medicines. Any point of concern may lead to a referral to a kidney specialist (nephrologist) for a review.