Introduction: 

Chronic Kidney Disease (CKD) is a significant global health concern, affecting approximately 10% of the worldwide population. Chronic Kidney Disease (CKD) has emerged as a significant health concern in India, with recent studies indicating a rising prevalence among the adult population. A systematic review and meta-analysis of community-based studies conducted between 2011 and 2023 revealed that CKD affects approximately 13.24% of adults in India. Notably, the prevalence increased from 11.12% during 2011–2017 to 16.38% between 2018–2023 among individuals aged 15 years and above. This upward trend underscores the urgent need for early detection and effective management strategies to address the growing burden of CKD in the country. 

https://pubmed.ncbi.nlm.nih.gov/39763170/

In this blog, Dr. Nikhil Bhasin, a leading nephrologist in Mumbai, will provide an in-depth exploration of CKD, discussing its causes, symptoms, stages, and available treatment options. With extensive experience in nephrology and kidney transplantation, Dr. Bhasin is dedicated to enhancing kidney health and improving patient outcomes. 

What is Chronic Kidney Disease (CKD) and Why is it Important?

CKD refers to the progressive deterioration of kidney function over a period of months or years. The kidneys play vital roles, including filtering waste from the blood, regulating blood pressure, balancing electrolytes, and producing hormones essential for red blood cell production and bone health. When kidney function declines, these processes are disrupted, leading to various health complications.

How Do the Kidneys Function and Why Are They Essential?

The kidneys are two bean-shaped organs located on either side of the spine, just below the rib cage. Each day, they filter about 120 to 150 quarts of blood to produce 1 to 2 quarts of urine, composed of wastes and extra fluid. Beyond waste removal, kidneys maintain a balance of salts and minerals—such as sodium, calcium, phosphorus, and potassium—in the blood, ensuring the proper functioning of nerves, muscles, and other tissues. They also release hormones like erythropoietin, which stimulates red blood cell production, and renin, which regulates blood pressure.

What Are the Stages of Chronic Kidney Disease?

CKD progresses through five stages, determined by the glomerular filtration rate (GFR), a measure of how well the kidneys filter blood:

• Stage 1: Normal kidney function with some signs of damage. Individuals may have normal GFR but show other markers of kidney damage.

• Stage 2: Mild loss of kidney function. GFR is slightly reduced, and there may be subtle signs indicating kidney issues.

• Stage 3: Moderate loss of kidney function. GFR continues to decline, and symptoms such as fatigue, swelling, and changes in urination patterns may become noticeable.

• Stage 4: Severe loss of kidney function. GFR is significantly reduced, leading to more pronounced symptoms and the need for planning potential treatments like dialysis or transplantation.

• Stage 5: Kidney failure. GFR falls to a critical level, and the kidneys can no longer maintain the body’s balance, necessitating dialysis or a kidney transplant.

What Are the Early and Advanced Symptoms of CKD?

In the initial stages, CKD often presents no symptoms. As the disease progresses, individuals may experience:

• Early Symptoms:

• Fatigue and weakness
• Loss of appetite
• Difficulty concentrating
• Trouble sleeping
• Dry, itchy skin

• Advanced Symptoms:

• Swelling in the feet and ankles
• Increased or decreased urination
• Muscle cramps
• Shortness of breath
• Chest pain
• Nausea and vomiting

These symptoms result from the kidneys’ diminished ability to eliminate waste and maintain fluid and electrolyte balance.

What Causes Chronic Kidney Disease and Who is at Risk?

Several factors can lead to CKD:

• Diabetes: High blood sugar levels can damage the blood vessels in the kidneys over time.

• High Blood Pressure (Hypertension): Increased pressure can harm kidney tissues, impairing their filtering ability.

• Other Contributing Factors:

• Heart disease
• Obesity
• Family history of kidney disease
• Age over 60
• Chronic urinary tract infections
• Autoimmune diseases like lupus

What Complications Can Arise from CKD?

If left untreated, CKD can lead to:

• Anemia: Reduced red blood cell count, causing fatigue and weakness.

• Bone Disease: Imbalances in calcium and phosphorus can weaken bones.

• Cardiovascular Disease: Increased risk of heart attacks and strokes.

• Fluid Retention: Leading to swelling, high blood pressure, and fluid in the lungs.

• Electrolyte Imbalances: Such as elevated potassium levels, which can cause heart rhythm problems.

How is Chronic Kidney Disease Diagnosed?

Diagnosis involves:

• Blood Tests: To assess levels of waste products like creatinine and estimate GFR.

• Urine Tests: To detect abnormalities, including protein or blood in the urine.

• Imaging Tests: Such as ultrasound or CT scans to visualize kidney structure and size.

• Biopsy: In some cases, a small sample of kidney tissue is examined to determine the cause of damage.

What Are the Best Treatment Options for CKD?

Chronic Kidney Disease (CKD) management focuses on slowing its progression, addressing underlying causes, and mitigating complications. Treatment plans are tailored to individual needs, considering the disease stage and associated health conditions.

How Can You Slow Down CKD Progression?

To slow CKD progression, it’s essential to manage underlying conditions and adopt a kidney-friendly lifestyle:

• Control Blood Pressure and Blood Sugar: High blood pressure and diabetes are leading causes of CKD. Maintaining these within target ranges can prevent further kidney damage.
  CDC
• Adopt a Healthy Diet: Eating a balanced diet rich in fruits, vegetables, whole grains, and low-fat dairy products supports kidney health. Limiting salt and added sugars is also beneficial.
  NIDDK
• Engage in Regular Physical Activity: Aim for at least 30 minutes of moderate exercise most days to help control weight and blood pressure.
• Avoid Smoking and Limit Alcohol Intake: Smoking and excessive alcohol can worsen kidney damage. Quitting smoking and moderating alcohol consumption are crucial steps.
• Use Medications Wisely: Some over-the-counter pain relievers, like ibuprofen and naproxen, can harm the kidneys if used frequently. Consult your healthcare provider before taking any new medications.

When is Dialysis or a Kidney Transplant Needed?

In advanced stages of CKD, when kidneys can no longer filter blood effectively, renal replacement therapies become necessary:

• Dialysis: This treatment removes waste products and excess fluids from the blood. There are two main types:
  

• Hemodialysis: Blood is filtered through a machine outside the body.
• Peritoneal Dialysis: The lining of the abdomen filters blood inside the body.

• Kidney Transplant: Surgically placing a healthy kidney from a donor into the patient’s body. This option can offer a better quality of life compared to long-term dialysis.
  Wikipedia

The decision between dialysis and transplantation depends on various factors, including overall health, availability of a donor, and personal preferences.

When Should You See a Doctor for Kidney Disease?

Early detection of CKD can significantly impact its progression. Consult a healthcare professional if you experience:

• Persistent Fatigue or Weakness: Unusual tiredness that doesn’t improve with rest.
• Changes in Urination: Such as foamy urine, or urinating more or less frequently than usual.
• Swelling: Particularly in the ankles, feet, or hands, due to fluid retention.
• High Blood Pressure: Especially if it’s difficult to control.

Individuals with risk factors like diabetes, hypertension, heart disease, or a family history of kidney problems should have regular kidney function screenings. CDC

How Can You Prevent Chronic Kidney Disease?

Preventing CKD involves proactive health measures:

• Maintain a Healthy Weight: Achieving and sustaining a healthy weight reduces the risk of conditions that can lead to CKD.
• Stay Active: Regular physical activity helps control blood pressure and blood sugar levels.
• Eat a Balanced Diet: Focus on heart-healthy foods and limit salt and sugar intake.
• Monitor Blood Pressure and Blood Sugar: Regular checks can lead to early detection and management of potential issues.
• Avoid Smoking and Limit Alcohol: Both can contribute to kidney damage.
• Stay Hydrated: Drinking adequate water supports kidney function.

Implementing these lifestyle changes can significantly reduce the risk of developing CKD and support overall kidney health.

Conclusion: 

In conclusion, the rising prevalence of Chronic Kidney Disease (CKD) in India, escalating from 11.12% between 2011 and 2017 to 16.38% between 2018 and 2023 among individuals aged 15 and above, highlights an urgent need for early detection and effective management strategies. This trend underscores the importance of public health initiatives focused on prevention, timely diagnosis, and comprehensive treatment approaches to mitigate the growing burden of CKD in the country.