Chronic Kidney Disease

The session Chronic Kidney Disease covers

• CKD: Fibrosis and Extracellular Matrix CKD
• Chronic Kidney Disease–Mesoamerican Nephropathy
• Anemia
• Bone and Mineral Metabolism
• Epidemiology, Outcomes and Health Service Research in CKD
• Chronic Kidney Disease Diagnosis, Classification and Progression
• Cardiovascular Complications of CKD 3-5
• Acid Base and Electrolyte Abnormalities
• CKD Mineral and Bone Disorder
• Chronic Kidney Disease–Diseases and Drugs

Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in your body.

In the early stages of chronic kidney disease, you may have few signs or symptoms. Chronic kidney disease may not become apparent until your kidney function is significantly impaired.

Treatment for chronic kidney disease focuses on slowing the progression of the kidney damage, usually by controlling the underlying cause. Chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant.

Symptoms

Chronic kidney failure, as opposed to acute kidney failure, is a slow and gradually progressive disease. Even if one kidney stops functioning, the other can carry out normal functions. It is not usually until the disease is fairly well advanced and the condition has become severe that signs and symptoms are noticeable; by which time most of the damage is irreversible.

It is important that people who are at high risk of developing kidney disease have their kidney functions regularly checked. Early detection can significantly help prevent serious kidney damage.

The most common signs and symptoms of chronic kidney disease include:

Anemia

Blood in urine

Dark urine

Decreased mental alertness

Decreased urine output

Edema - swollen feet, hands, and ankles (face if edema is severe)

Fatigue (tiredness)

Hypertension (high blood pressure)

Insomnia

Itchy skin, can become persistent

Loss of appetite

Male inability to get or maintain an erection (erectile dysfunction)

More frequent urination, especially at night

Muscle cramps

Muscle twitches

Nausea

Pain on the side or mid to lower back

Panting (shortness of breath)

Protein in urine

Sudden change in bodyweight

Unexplained headaches

Stages

Changes in the GFR rate can assess how advanced the kidney disease is. In the UK, and many other countries, kidney disease stages are classified as follows:

Stage 1 - GFR rate is normal. However, evidence of kidney disease has been detected.

Stage 2 - GFR rate is lower than 90 milliliters, and evidence of kidney disease has been detected.

Stage 3 - GFR rate is lower than 60 milliliters, regardless of whether evidence of kidney disease has been detected.

Stage 4 - GRF rate is lower than 30 milliliters, regardless of whether evidence of kidney disease has been detected.

Stage 5 - GFR rate is lower than 15 milliliters. Renal failure has occurred.

The majority of patients with chronic kidney disease rarely progress beyond Stage 2. It is important for kidney disease to be diagnosed and treated early for serious damage to be prevented.

Patients with diabetes should have an annual test, which measures microalbuminuria (small amounts of protein) in urine. This test can detect early diabetic nephropathy (early kidney damage linked to diabetes).

What causes chronic kidney disease (CKD)?

Anyone can get CKD. Some people are more at risk than others. Some things that increase your risk for CKD include:

Diabetes

High blood pressure (hypertension)

Heart disease

Having a family member with kidney disease

Being African-American, Hispanic, Native American or Asian

Being over 60 years old

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Symptoms of chronic kidney disease

Chronic kidney disease (CKD) usually gets worse slowly, and symptoms may not appear until your kidneys are badly damaged. In the late stages of CKD, as you are nearing kidney failure (ESRD), you may notice symptoms that are caused by waste and extra fluid building up in your body.

You may notice one or more of the following symptoms if your kidneys are beginning to fail:

Itching

Muscle cramps

Nausea and vomiting

Not feeling hungry

Swelling in your feet and ankles

Too much urine (pee) or not enough urine

Trouble catching your breath

Trouble sleeping

If your kidneys stop working suddenly (acute kidney failure), you may notice one or more of the following symptoms:

Abdominal (belly) pain

Back pain

Diarrhea

Fever

Nosebleeds

Rash

Vomiting

Having one or more of any of the symptoms above may be a sign of serious kidney problems. If you notice any of these symptoms, you should contact your doctor right away.

Complications of CKD

Your kidneys help your whole body work properly. When you have CKD, you can also have problems with how the rest of your body is working. Some of the common complications of CKD include anemia, bone disease, heart disease, high potassium, high calcium and fluid buildup. Learn more about the complications of CKD.

Stages of CKD

Chronic kidney disease (CKD) refers to all 5 stages of kidney damage, from very mild damage in Stage 1 to complete kidney failure in Stage 5. The stages of kidney disease are based on how well the kidneys can do their job – to filter waste and extra fluid out of the blood. Learn more about the stages of CKD.

How can I prevent CKD?

Diabetes and high blood pressure are the most common causes of CKD. If you have diabetes or high blood pressure, working with your doctor to keep your blood sugar and blood pressure under control is the best way to prevent kidney disease.

Living a healthy lifestyle can help prevent diabetes, high blood pressure and kidney disease, or help keep them under control. Follow these tips to lower your risk for kidney disease and the problems that cause it:

Follow a low-salt, low-fat diet

Exercise at least 30 minutes on most days of the week

Have regular check-ups with your doctor

Do not smoke or use tobacco

Limit alcohol

   How do I know if I have CKD?

CKD usually does not have any symptoms until your kidneys are badly damaged. The only way to know how well your kidneys are working is to get tested. Being tested for kidney disease is simple. Ask your doctor about these tests for kidney health:

eGFR (estimated glomerular filtration rate)

The eGFR is a sign of how well your kidneys are cleaning your blood.

Your body makes waste all the time. This waste goes into your blood. Healthy kidneys take the waste out of your blood. One type of waste is called creatinine. If you have too much creatinine in your blood, it might be a sign that your kidneys are having trouble filtering your blood.

You will have a blood test to find out how much creatinine is in your blood. Your doctor will use this information to figure out your eGFR. If your eGFR is less than 60 for three months or more, you might have kidney disease.

Urine test

This test is done to see if there is blood or protein in your urine (pee).

Your kidneys make your urine. If you have blood or protein in your urine, it may be a sign that your kidneys are not working well.

Your doctor may ask you for a sample of your urine in the clinic or ask you to collect your urine at home and bring it to your appointment.

Blood pressure

This test is done to see how hard your heart is working to pump your blood.

High blood pressure can cause kidney disease, but kidney disease can also cause high blood pressure. Sometimes high blood pressure is a sign that your kidneys are not working well.

For most people a normal blood pressure is less than 120/80 (120 over 80). Ask your doctor what your blood pressure should be.

How is CKD treated?

Damage to your kidneys is usually permanent. Although the damage cannot be fixed, you can take steps to keep your kidneys as healthy as possible for as long as possible. You may even be able to stop the damage from getting worse.

Control your blood sugar if you have diabetes.

Keep a healthy blood pressure.

Follow a low-salt, low-fat diet.

Exercise at least 30 minutes on most days of the week.

Keep a healthy weight.

Do not smoke or use tobacco.

Limit alcohol.

Talk to your doctor about medicines that can help protect your kidneys.

If you catch kidney disease early, you may be able to prevent kidney failure. If your kidneys fail, you will need dialysis or a kidney transplant to survive.

Kidney-friendly diet for CKD

You need to have a kidney-friendly meal plan when you have chronic kidney disease (CKD). Watching what you eat and drink will help you stay healthier. A kidney-friendly diet may also help protect your kidney from further damage by limiting certain foods to prevent the minerals in those foods from building up in your body. Learn more about the kidney-friendly diet for CKD.

Other Kidney Organizations

• American Association of Kidney Patients
• UKD Foundation, Inc.
• The Nephron Information Center
• The Nephcure Foundation
• The Kidney Transplant Dialysis Association
• Renal Support Network
• Polycystic Kidney Disease Foundation
• National Kidney Disease Education Program
• National Kidney & Urologic Diseases Information Clearinghouse
• National Institute of Diabetes and Digestive and Kidney Diseases
• Kidney School
• Kidney Options
• Home Dialysis Central
• Fresenius Medical Care
• Dialysis Patient Citizens
• Davita
• American Transplant Foundation
• American Renal Associates
• American Kidney Fund
• Academy of Nutrition and Dietetics (AND)
• Agency for Healthcare Research and Quality (AHRQ)
• AHRQ Patient Safety Network (PSNet)
• American College of Nutrition (ACN)
• American Kidney Fund (AKF)
• American Nephrology Nurses' Association (ANNA)
• American Society for Artificial Internal Organs (ASAIO)
• American Society of Diagnostic & Interventional Nephrology (ASDIN)
• American Society of Nephrology (ASN)
• American Society for Parenteral and Enternal Nutrition (ASPEN)
• American Society of Pediatric Nephrology (ASPN)
• American Society of Transplantation (AST)
• American Society of Transplant Surgeons (ASTS)
• Arbor Research Collaborative for Health (formally the URREA)
• Association for the Advancement of Medical Instrumentation (AAMI)
• AV Fistula First Breakthrough Coalition (FFBI)
• Board of Nephrology Examiners, Inc. Nursing and Technology (BONENT)
• California Dialysis Council (CDC)
• Canadian Association of Nephrology Nurses and Technologists (CANNT)
• Canadian Institute for Health Information (CIHI)
• Center for Practical Bioethics
• Centers for Disease Control and Prevention (CDC)
• Dialysis Safety
• Division of Laboratory Systems (DLS)
• Healthcare-associated Infections (HAI)
• Morbidity and Mortality Weekly Report (MMWR)
• National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)
• National Institutes for Occupational Safety and Health (NIOSH)
• Viral Hepatitis
• Centers for Medicare and Medicaid Services (CMS)
• Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb)
• DialysisData.org
• ESRD Clinical Performance Measures Project (CPM)
• Centre for Health Evidence (CHE)
• Chronic Disease Research Group (CDRG)
• Department of Health - UK (DH)
• The Dialysis Outcomes and Practice Patterns Study (DOPPS)
• ECRI - (Healthcare Technology Assessment)
• eHealth Initiative
• End-Stage Renal Disease (ESRD) Networks
• ESRD Network Organizations Background from CMS
• Environmental Protection Agency (EPA)
• European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
• European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA)
• European Society for Paediatric Nephrology (ESPN)
• Food and Drug Administration (FDA)
• Vaccines, Blood & Biologics
• Center for Devices and Radiological Health
• Healthcare Information and Management Systems (HIMSS)
• Health Insurance Portability and Accountability Act (HIPPA)
• Understanding HIPAA Privacy
• International Health Care Worker Safety Center (also EPINet™)
• International Society for Hemodialysis (ISHD)
• International Society for Nephrology Technicians and Technologists (ISNTT)
• International Society of Nephrology (ISN)
• International Society for Peritoneal Dialysis (ISPD)
• Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
• Keeping Kidney Patients Safe
• The Kidney & Urology Foundation of America (KUFA)
• Kidney Disease: Improving Global Outcomes (KDIGO™)
• Kidney Disease Outcomes Quality Initiative (K/DOQI™)
• Kidney Disease Quality of Life Working Group (KDQOL)
• Kidney Foundation of Canada
• Lupus Foundation of America (LFA)
• Management Sciences for Health (MSH)
• Medicare
• Medicare and Kidney Disease Education
• Coverage of Kidney Dialysis and Kidney Transplant Services (Adobe Acrobat Reader required)
• Medicare Payment Advisory Commission (MedPAC)
• The National Anemia Action Council (NAAC)
• National Association for Nephrology Technicians/Technologists (NANT)
• National Center for Complementary and Alternative Medicine (NCCAM)
• National Foundation for Transplants
• National Guideline Clearinghouse  (evidence-based clinical practice guidelines)
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• National Institutes of Health (NIH)
• National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
• National Institutes for Occumpational Safety and Health (NIOSH)
• National Kidney Foundation (NKF)
• National Kidney Foundation (UK site)
• National Kidney Registry
• National Kidney Research Fund (UK site)
• National Patient Safety Agency (UK site)
• National Patient Safety Foundation
• National Quality Forum (NQF)
• National Renal Administrators Association (NRAA)
• National Vascular Access Improvement Initiative (Fistula First)
• Nephrology Nursing Certification Commission (NNCC)
• North American Transplant Coordinators Organization (NATCO)
• Occupational Safety and Health Administration (OSHA)
• Bloodborne Pathogens and Needlestick Prevention
• Workplace Violence
• OrganDonor.gov
• Organ Procurement and Transplantation Network (OPTN)
• Polycystic Kidney Disease Foundation
• Quackwatch
• Renal Physicians Association (RPA)
• Scientific Registry of Transplant Recipients (SRTR)
• Sepsis Alliance
• S.L.E. Lupus Foundation
• Spanish Society of Dialysis and Transplantation (Sociedad Española de Diálisis y Trasplante) (SEDYT)
• TransWeb (All about transplantation and donation) (opens new browser window)
• UK Renal Registry
• United Network for Organ Sharing (UNOS)
• U.S. Federal Government:  President,  Senate,  House of Representatives,  Thomas
• U.S. Department of Health and Human Services
• Senate Finance Committee, Subcommittee on Health
• House of Representatives Ways and Means Committee, Subcommittee on Health
• US Renal Data System (USRDS)
• Vascular Access Society