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Chronic Kidney Disease (C.K.D)
• Chronic kidney disease can affect anyone—young or old!
• Chronic kidney disease doesn’t happen overnight! It happens slowly, and in stages.
Chronic kidney disease is a highly prevalent type of kidney disease that affects 10-13% of the population worldwide. It is irreversible, progressive and slow damage to your kidney functions and associated with higher cardiovascular risk.
Patients with this remain asymptomatic most of the time, presenting the complications typical of kidney damage only in more advanced stages and are always at higher risk of complications and morbidity.
Chronic kidney disease can’t be cured, but it can be treated.
Available treatments for CKD:
- For Stage 1-3 CKD:
These stages are mostly treated through Medicines. Your doctor will prescribe you medicines on the basis of your kidney condition. Each stage of CKD has different medicines.
The main purpose of this treatment is to slow down the progression of kidney dysfunction, treat complications like anemia, bone diseases, cardiovascular diseases and prepare for kidney replacement therapy.
- End Stage CKD – Dialysis and Transplant are the preferred treatment options for stage 4 and 5 CKD.
- Your treatment can be conservative (patients without indication for dialysis, usually those with glomerular filtration rate above 15 ml/minute) or replacement therapy (hemodialysis, peritoneal dialysis, and kidney transplantation).
For those who don’t want Dialysis or a Kidney Transplant:
For some who do not want dialysis or a kidney transplant, a third option is to treat kidney failure with conservative measures. Precautions will likely include proper management of symptoms, controlling the high levels of blood pressure, preventive care planning, and care that makes you comfortable can help in treating the disease.
The only way people can know if they have CKD is through simple blood and urine tests.
A blood test checks the level of creatinine (a waste product) in the blood to see how well the kidneys are working. A urinalysis checks for protein in the urine (an early sign of kidney damage).
Chronic kidney disease doesn’t happen overnight! It happens slowly, and in stages.
Chronic kidney disease (CKD) is divided into five stages. The stages are based on the eGFR test result and how well your kidneys work to filter waste and extra fluid out of your blood.
In the early stages (Stages 1–3), your kidneys are still able to filter waste out of your blood. In the later stages (Stages 4–5), your kidneys must work harder to filter your blood and may stop working altogether.
As the stages go up, kidney disease gets worse and your kidneys work less well.
At each stage, it is important to take steps to slow down the damage to your kidneys. Your goal at each stage of CKD is to take steps to slow down the damage to your kidneys and keep your kidneys working as long as possible.
As much as anything else, life expectancy for kidney disease depends on a person’s age and sex.
For a 60-year-old man, stage 1 kidney disease life expectancy will be approximately 15 years. That figure falls to 13 years, 8 years, and 6 years in the second, third, and fourth stages of kidney disease respectively.
For a 60-year-old woman, stage 1 life expectancy is 18 years, while stage 2 is only one year less. For stage 3 kidney disease, her life expectancy would be 11 years.
You can understand, women have a slightly greater life expectancy at all ages. But during stages 4 and 5, those advantages slip away, and life expectancy becomes essentially identical between the sexes.
Age changes everything.
Consider the life expectancy of 70-year-old men and women.
For a 70-year-old man, his life expectancy is 9 years for Stage 1 CKD, 8 years for Stage 2 CKD, 6 years for Stage 3 and 4 years for stage 4.
For a 70-year-old woman, life expectancy is 11 years for Stage 1, 8 years for Stage 2, and 4 years for Stage 3.
Once again, women start with a greater life expectancy, but the differences disappear in later stages of the disease.
Stage 5 kidney disease means total kidney failure and the necessity of dialysis. Five decades ago, a failed kidney meant death was likely. These days, things are quite a bit different. The average life expectancy for a patient on dialysis is 5-10 years. Though for someone between the ages of 70 and 74, life expectancy is closer to four years on dialysis.
If you have kidney disease, you can still have a productive home and work life and enjoy spending time with family and friends. For the best possible outcome, it is important that you become an active member of your treatment team. Early detection and appropriate treatment are important to slow the progression of the disease to prevent or delay kidney failure.
You must keep your doctor’s appointment, take your medication as directed, eat a healthy diet, and monitor your blood pressure and blood sugar.
Learn about the stages of CKD you are in (?):
Stage 1: Normal or High GFR (GFR & gt; 90mL/min)
In Stage 1, you will have a glomerular filtration rate (GFR) of normal or high 90 mL/min. There are usually no symptoms, your kidneys will be working well.
Sometimes you will find out about CKD STAGE 1 when Doctors test you for Diabetes or High blood pressure which are the leading causes of kidney diseases. Other tests like Urine test, eGFR test may also be helpful to identify about your CKD Stage 1.
The most common symptoms to know about stage 1 CKD include:
Higher than normal levels of creatinine or urea in the blood
Abnormal Urine Test (Blood or protein in your urine)
High blood pressure.
Evidence of kidney damage in an MRI, CT scan, ultrasound or contrast X-ray
A family history of polycystic kidney disease (PKD)
Swelling in your hands or feet.
Urinary tract infections.
At Stage 1 CKD, doctors mostly focus on the following points to slow down the kidney damage and keeping your kidneys working well for as long as possible.
- Lifestyle modifications are the initial components of treatment and secondary prevention. You can do dietary management, weight management and stay physically active.
- Try to control your Blood pressure (less than 120/80 millimeters of mercury) as it reduces renal disease progression and cardiovascular morbidity/ mortality.
- Monitor for other common complications of CKD including: anemia, electrolyte abnormalities, abnormal fluid balance, mineral bone disease, and malnutrition.
You can discuss with your doctor and get a proper treatment plan according to your health complications.
Can I recover from Stage 1 kidney diseases?
Yes, you can cure Stage 1 CKD. you can stop its progress or at least slow down the damage by the correct early treatment and lifestyle changes to help your help kidneys stay healthier longer.
Stage 2 Mild CKD (GFR = 60-89 mL/min)
You will have a mild decrease in glomerular filtration rate (GFR) of 60-89 ml/min in Stage 2 CKD. There are usually no symptoms, your kidneys will be working well.
Many people do not experience symptoms of kidney disease until the later stages of CKD.
Possible Stage 2 kidney disease symptoms and signs include:
Your blood pressure levels will be high.
Your legs or hands may swell.
Infections in Urinary tract.
Abnormal urine test (protein in urine)
Higher than normal levels of Creatinine or Urea in the blood.
Darker urine color between yellow, red and orange.
Blood in your urine (Hematuria)
Early-stage kidney disease may not have any noticeable symptoms. Even with mild damage, your kidneys may still be able to function well enough to do their job (mostly) well.
The most common causes of kidney diseases are:
- Diabetes
- High blood pressure
- Urinary tract infections (UTI)
- Kidney stones
- Tumors or cysts in the kidneys and nearby areas
- Protein in your urine
- Lupus (inflammation in joint,)
The longer the above diseases are left, the more the kidneys are left untreated. If you try to cure the above causes, you can treat your damaged kidney.
The treatment of Stage 2 CKD is quite similar to that of Stage 1 CKD.
Your doctor will:
- Check (to) your blood sugar if you have diabetes.
- Keep your blood pressure in the normal range (less than 120/80 millimeters of mercury or mm HG is best).
- Decide whether to start or stop taking medicines that protect your kidneys.
The following home remedies can help you manage stage 2 CKD:
- You can take Iron supplements if you have Anemia and improve fatigue.
- Try to drink lots of water
- Eat smaller meals throughout the day
- Practice stress management
- Do exercise on a daily basis.
Patients diagnosed with stage 2 kidney disease are considered to have healthy kidney function. Thus, the prognosis is much better compared to advanced stages of CKD.
The main aim is therefore to prevent further progression to other stages.
You can slow the progression of the disease by regular check-ups, medicines and diet. Keep you healthy as long as possible treatment and management of kidney disease can vary as noted below, especially as your condition progresses. When CKD worsens, it can also lead to potentially life-threatening complications, such as heart disease.
Stage 3A Moderate CKD
Stage 3 of chronic kidney disease (CKD) is called “middle stage” of kidney disease, it occurs when your estimated glomerular filtration rate (eGFR) falls between 30-59 mL/min, indicating moderate kidney damage and noticeable loss of kidney function.
This stage is separated into 2 sub-stages:
- Stage 3A Moderate (GFR = 45-59 mL/min)
- Stage 3B Moderate (GFR = 30-44 mL/min)
Many people do not experience symptoms of kidney disease until the later stages when kidney failure has occurred.
Possible stage 3 kidney disease symptoms and signs include:
- Fatigue (feeling weak and tired)
- Fluid retention, swelling (edema) of extremities and shortness of breath:
- Urination changes (foamy; dark orange, brown, tea-colored or red if it contains blood; and urinating more or less than normal)
- Kidney pain felt in your back
- Your skin may be dry or itchy
- Sleep problems due to muscle cramps or restless legs syndrome (an uncomfortable feeling in your leg)
You can easily find out about the Stage 3 CKD, doctors will suggest two tests, such as:
eGFR test
Urine test
The results of these tests will be carefully examined by your Nephrologist.
As stage 3 progresses, you should consult a Nephrologist. Nephrologists will examine you carefully and suggest some lab tests to gather information about your condition to offer the best advice for treatment. The nephrologist’s goal is to help you to keep your kidneys working as long as possible.
You don’t require Dialysis or a kidney transplant in Stage 3. Instead, you will be prescribed certain medications to treat underlying medical conditions that may be contributing to kidney damage. You must inform your doctor.
- Medicines for High Blood pressure & Glucose– To control your high blood pressure levels, Doctors will prescribe ACE Inhibitors (Angiotensin converting enzyme) and ARB (Angiotensin II receptor blockers) and also for Glucose management.
- Medications to lower cholesterol levels– Your doctor might recommend medications like Statins to lower your cholesterol.
Your doctor may also prescribe medications to help minimize the side effects of CKD, such as:
- Iron supplements for Anemia (Lack of RBC)
- Calcium/Vitamin D supplements to protect your bones
- cholesterol-lowering drugs
- Diuretics to treat Edema (Swelling)
You may also need to stop taking certain medicines that can worsen the damage to your kidneys, such as pain medicines called NSAIDs (nonsteroidal anti-inflammatory drugs) and some arthritis medicines.
In stage 3 you may also be referred to a Renal dietitian. As a balanced diet is such an important part of the treatment, the dietitian will review a person’s lab work results and recommend a meal plan individualized for their needs.
For stage 3 CKD, you must take a healthy balanced diet is likely to consist of:
- Eating high-quality protein and potassium (if blood levels are above normal)
- Consuming some grains, fruits and vegetables (potassium and phosphorus are at normal levels)
- Limiting phosphorus to help PTH levels remain normal, prevent bone disease and even preserve existing kidney function.
- Lowering calcium consumption.
- Cutting back carbohydrate for those with
- Decreasing saturated fats to help lower cholesterol.
- Lowering Sodium for people with high blood pressure or fluid retention by cutting out processed and pre-packaged foods.
- Limiting calcium if blood levels are too high.
- Taking water soluble vitamins such as C (100 mg per day) and B complex, or completely avoiding over-the-counter dietary supplements (unless approved by the nephrologist)
It’s helpful to work with a registered renal dietitian because as the stages of CKD change, so will the diet.
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 4 kidney disease occurs when your estimated glomerular filtration rate (eGFR) falls between 15–29, indicating a severe loss of kidney function. At this stage of chronic kidney disease (CKD), it’s important to manage your health as best you can to preserve kidney function and start planning ahead for potential treatments like a kidney transplant or dialysis.
Seeing a kidney doctor (nephrologist) can help you learn about and compare options, so you can make treatment choices that are right for you.
What are the Symptoms of stage 4 CKD?
Many people do not experience symptoms of kidney disease until the later stages when kidney damage has occurred.
Possible stage 4 kidney disease symptoms and signs include:
- Anaemia (Shortage of RBC)
- Decreased appetite leads to Fatigue like conditions
- Bone disease
- Fluid retention and Shortness of breath
- Kidney pain in your back
- Change in taste in mouth
- Bad breath due to urea build-up in the blood
- Urination changes – You may urinate less or more than normal and see change in colour of urine (foamy; dark orange, brown, tea-coloured or red if it contains blood)
- Abnormal blood levels of phosphorous, calcium, or vitamin D
How can I treat Stage 4 CKD?
Stage 4 kidney disease cannot be reversed, but you can do different things to help slow disease progression. It is crucial for you to control any other health issues you may have, treat any potential complications of kidney disease, and try to manage or prevent heart disease.
You can do lifestyle modifications
Here are 5 basic ways to start with:
- Reduce the intake of salt (Sodium) in your daily diet.
- Get a Kidney diet plan from any Renal Dietitian.
- Regularly monitor levels of blood sugar, blood pressure and cholesterol.
- Maintain a healthy body weight.
If you Smoke, then quit smoking as it slows down the blood flow to your important organs.
What are the treatment options available in Stage 4 CKD?
In stage 4 chronic kidney disease (CKD) has advanced kidney damage with a severe decrease in the glomerular filtration rate (GFR) to 15-30 ml/min.
Nephrologist will ask you about your choices, you can go for the dialysis or a kidney transplant in the near future:
- Dialysis –
- Haemodialysis: This is a treatment that can be done in a centre or in a patient’s home with assistance from a care partner. A dialysis machine removes a small amount of a patient’s blood through a man-made membrane called a dialyzer, or artificial kidney, to clean out toxins that the kidneys can no longer remove. The filtered blood is then returned to the body.
- Peritoneal dialysis (PD): Unlike haemodialysis, PD is a needle-free treatment and a care partner is not required to help assist during treatment. PD can be performed at home or at work.
- Kidney transplant: This is the preferred and best treatment for kidney patients in later stage of CKD and does not require as many diet restrictions as those who are on haemodialysis or Peritoneal dialysis (PD).
What are the other health complications in Stage 4 CKD?
As your kidney function worsens, more waste products will build up in your blood, which causes Uremia (high level of waste products in blood), one of the major signs of kidney failure.
Moreover, this stage of kidney disease predisposes you to related complications and conditions, which include:
- High blood pressure
- Diabetes
- Anaemia (shortage of red blood cells)
- Bone disease
- Heart disease
- Other cardiovascular diseases
Stage 5 End stage CKD (GFR < 15 mL/min)
Stage 5 kidney disease, or end Stage Renal disease (ESRD), occurs when your estimated glomerular filtration rate (eGFR) falls below 15, indicating that your kidneys are failing or close to failing. At this advanced stage, treatments like dialysis or a kidney transplant will likely be needed to prolong life and keep your body healthy and chemically balanced. At ESRD, it’s important to work with a kidney doctor (nephrologist) to determine which treatment option may best fit your lifestyle.
What are the symptoms in Stage 5 CKD?
Possible stage 5 kidney disease symptoms and signs include:
- Uremia (waste build-up in your blood)
- Fatigue (feeling weak and tired) caused by Anemia (lack of RBC)
- Shortness of breath
- Nausea or vomiting like feeling
- Less Urine formation
- Loss of appetite
- Your skin color may change.
- Abnormal thyroid levels
- Swelling in various parts of your body like hands, legs, eyes and lower back
- Frequent Headaches
- Lower back pain
The symptoms are similar to Stage 4 CKD, but they are more severe and quite often seen in patients.
As your kidney does not function properly in Stage 5 CKD, other health problems. Waste products may build up in your blood and cause other health problems, such as:
- Blood pressure levels will become high.
- Lack of Red Blood Cells may result in Anemia.
- Bone and Heart disease
- High potassium and phosphorus levels in blood
- Metabolic acidosis (a build-up of acid in your body)
As the stages go up, kidney disease gets worse and your kidneys work less well. At each stage, it is important to take steps to slow down the damage to your kidneys. Your goal at each stage of CKD is to take steps to slow down the damage to your kidneys and keep your kidneys working as long as possible.
In Stage 5 CKD, GFR rate is less than 15 ml. Your kidneys are very close to damage or may fail completely. You need kidney dialysis or a kidney transplant immediately.
If you have kidney disease, you can still have a productive home and work life and enjoy spending time with family and friends. For the best possible outcome, it is important that you become an active member of your treatment team. Early detection and appropriate treatment are important to slow the progression of the disease to prevent or delay kidney failure.
You must keep your doctor’s appointment, take your medication as directed, eat a healthy diet, and monitor your blood pressure and blood sugar.
Know how CKD affects your Mental health
How Chronic kidney disease (CKD) affects my Mental health?
You can experience mental health changes especially in the End Stage Renal Disease (ESRD). It is normal to experience sadness due to the several life-changes that you will encounter, a persistent very low mood combined with persistent negative thinking, lack of energy and motivation may be sign of depression.
Fear and anxiety are common emotions when you have been diagnosed with a kidney disease like CKD. As you are no longer in control of your renal process, you may worry about its impact on how you care for it. Taking regular Dialysis treatment may affect your daily life. Sometimes when you don’t get Kidney Donor timely, you face anxiety issues.
How can I cure my anxiety during CKD?
These simple steps can help you control anxiety:
- Self-talk – Sometimes talk to yourself and find out the reason behind your fear or anxiety.
- Meditation – It really helps you to calm down your mind and any kind of breathing exercise will help you slow down your heart rate and blood pressure.
Learn time management – If you learn how to manage your time properly, you can easily balance your work and give more time to your dialysis therapies.
Feelings of anger are common among CKD patients. Anger is a normal and healthy emotion everyone feels from time to time. Dealing with an illness like chronic kidney disease (CKD) can bring up anger problems. Some examples of things people with kidney disease often feel powerless to control are.
- dietary changes
- dialysis schedule
- employment/income
- medication regime
Getting angry can affect your kidney health, it raises your heartbeat and blood pressure levels.
5 ways to control your anger: –
- Try to stay calm and positive, avoid unnecessary work burdens.
- Do you remember the saying “Laughter is the best medicine”? You can watch funny movies and videos in your dialysis treatment to utilize the time properly.
- Surround yourself with positive people who encourage and motivate you.
- Practice Deep breathing exercises to calm down your mind or simply go for a walk.
- Share your concerns or problem with someone
If you are still not able to manage your anger and it is affecting your relationships with others, you can take the help of a certified counsellor.
Depression is the most common mental health problem in patients with chronic kidney disease.
It has a negative effect on the way you feel, think, and act. It can cause you to lose interest in activities you once enjoyed.
The cause of depression differs from person to person, there are many causes: –
- Persistent negative thinking or feelings of hopelessness
- Losing interest or enjoyment in things that used to be enjoyable or fun.
- Lacking motivation and energy to continue the treatment.
- Not wanting to be around others because of your bad health.
- Have changes in sleep (can be increased or decreased) and appetite.
- Poor concentration in daily activities.
Depression is a very treatable disease. You can treat it with medications or with psychotherapy, also known as “talk therapy” with the help of Psychiatrist.
You may experience mental health changes because of the stressors associated with CKD.
These are the common reasons: –
- The cost of your treatment can make you feel financially burdened.
- There are restrictions to your lifestyle or working life during the treatment for CKD.
- The need to rely on others most of the time to take care of you, makes you unhappy and you feel like burden on others.
- Living with CKD symptoms or complications is hard as it results in other health problems and affects your overall body.
- It is hard to treat kidney diseases completely so you can feel uncertain about your health or future.
- In Dialysis, you will have to take out time separately from your every week, this affects your day-to-day activities.
- Unable to have restful sleep can also result in mood disorders.
- As you cannot do hard labour work in CKD, you will have to change your job and adjusting to a new work environment can be stressful.
- You have to follow a healthy diet strictly to improve the health of kidneys. A sudden eating restriction may make you feel depressed.
- Sometimes when you are not able to get a suitable donor on time, you start to feel discouraged and hopeless.
