Everything I need to know about Chronic Kidney Disease (CKD)
What is CKD?
Kidney disease is a term used by the medical profession to describe any abnormality of the kidney. These abnormalities can be graded from very mild to severe. ‘Chronic’ means a condition that is long-term and does not get completely better. Some people think incorrectly that ‘chronic’ means severe. This is not always the case. Although some patients with CKD have more severe disease, most patients with CKD have only a very slight changes in kidney function which will have minimal impact on their lives.
How common is CKD?
Mild to moderate CKD is very common. Recent research suggests that 1 in 10 of the population may have CKD, but it is less common in young adults. In those aged over 75 years, CKD is present in 1 out of 2 people. Many of the people with CKD may not have diseased kidneys but have normal ageing of their kidneys. Severe kidney failure does not occur with normal ageing of the kidneys, but there is an increased risk of heart disease or stroke, which is higher if it is combined with high blood pressure. Recent guidance is to reduce risk by using cholesterol medications (STATINS) and controlling blood pressure with medication.
What causes CKD?
There are many causes of CKD, and the most common causes are ageing of the kidneys, high blood pressure and diabetes. Other causes are kidney stones, enlarged prostate, medications, inherited kidney disease, high cholesterol, kidney infection or inflammation. Other tests may be needed if there is associated high BP or Diabetes, and these can be managed with medication by the GP.
How do I know if I have CKD?
In most cases CKD does not cause any symptoms and is only detected when tests results are abnormal. These are usually blood test to measure kidney function and urine tests for blood or protein. 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 discovered. Symptoms develop slowly and may not appear until later stages. The speed at which CKD worsens varies from patient to patient. Regular monitoring tests by your doctor are therefore vital and you will be invited at least yearly for monitoring.
At a more advanced stage, symptoms of CKD can include :
- Fatigue and general weakness
- Nausea (feeling sick)
- Shortness of breath
- Blood in urine
- Swollen ankles, feet, or hands
How is it monitored?
CKD is usually monitored by either your GP, or in advanced cases a Nephrologist (kidney specialist) Results of the blood and urine tests can be used to tell the stage of your disease. If someone has more severe kidney dysfunction, high blood pressure, and/or protein leak in the urine or associated problems such as kidney pain, a CT/US scan or biopsy may be required to help clarify the level of abnormality.
Who looks after patients with CKD?
Most patients with early CKD will be monitored by their GP and sometimes On each visit, expect to provide a series blood pressure measurements, urine and blood tests. Thereafter your GP will review your medications. Patients with advanced stage may still be reviewed by the GP twice yearly if they are well and the results stable. Otherwise, they are referred to the nephrology team of consultants, specialist nurses and dieticians for specialist management.
What is the treatment for CKD?
Although there is no cure for CKD, treatment can stop it from getting worse. It is beneficial to review diet and lifestyle to reduce the risk of stroke and heart attack. GPs and their patients may consider:
- Lifestyle changes
- Blood pressure and cholesterol medications.
- In very advanced cases, dialysis and even kidney transplant may be considered.
Leading a normal life with CKD
Most people with CKD will be able to lead normal lives with medications and regular check-ups. If you have CKD, even if it’s mild, you’re at an increased risk of developing other medical problems, such as cardiovascular disease. Prevention is always better than cure. This is why it’s important to always attend your regular CKD checks.
Sick day rules
If you’re unwell with any of the following:
- Vomiting or diarrhoea
- Fever, sweats and shaking.
then you may need to stop some of your regular medication (especially Diuretics e.g. furosemide, anti-inflammatories e.g. ibuprofen/naproxen, or blood pressure tablets e.g. ramipril and SGL12 medications e.g Dapagliflozin, Empagliflozin or Canagliflozin).
You can usually restart these when you are well, after 24-48 hours of eating and drinking normally.
Consult with your GP if you are unwell, or have questions about these kinds of medications with CKD.