What is chronic kidney disease (CKD)?
The kidney acts like a filter. It sifts waste from the bloodstream, maintaining the body's internal balance. When kidney function declines, waste and toxins accumulate in the body, which can lead to serious health complications such as fluid retention, electrolyte imbalances, and, ultimately, chronic kidney disease.
Chronic kidney disease (CKD), also a chronic renal failure, denotes kidney damage or an estimated glomerular filtration rate (eGFR) lower than 60 ml/min/1.73 square meters. It lasts at least three months or longer (Vaidya & Aeddula, 2024). Over time, renal replacement therapy is often required to maintain patient health and quality of life.
CKD, a leading cause of death in the United States, affects about 35.5 million adults, with many unaware of their condition. At the same time, 360 individuals begin dialysis treatment for kidney failure daily (Centers for Disease Control and Prevention, 2024).
This chronic renal disease represents a considerable public health disadvantage due to its high prevalence, underdiagnosis, and the significant demand for dialysis treatment. Thus, early detection and prevention efforts are of critical importance.
Symptoms of chronic kidney disease
During the early stages, CKD's symptoms aren't usually apparent and only tend to show in the later stages (4 or 5). However, here are the chronic kidney disease symptoms that you need to look out for (NHS, 2023; National Kidney Foundation, 2023):
- Weight loss and poor appetite
- Swollen ankles, feet, or hands
- Shortness of breath
- Tiredness
- Blood in urine
- Increased or urination frequency
- Difficulty sleeping
- Itchy skin
- Muscle cramps
- Nausea
- Headaches
- Erectile dysfunction (in men)
- Foamy urine
- Itchy or dry skin
Note that some of these appear in the late stages. Encourage your patients to seek medical advice if they suspect signs and symptoms of CKD.
Causes of chronic kidney disease
Understanding what causes CKD helps diagnose and treat it. The top causes are diabetes and high blood pressure. Other causes of kidney disease include genetic disorders (like polycystic kidney disease), infections, nephrotoxic drugs, lupus, and more (National Institute of Diabetes and Digestive and Kidney Diseases, 2016).
If you have a patient with diabetes and high blood pressure, you have to ensure that they manage these conditions because they also affect CKD progression. Aside from these, individuals should also be mindful of other risk factors such as obesity, being over 60, having a family history of CKD or kidney failure, experiencing past acute kidney injury (AKI), and using tobacco products.
Stages of chronic kidney disease
CKD has five stages, assessed through the estimated glomerular filtration rate (eGFR) and the urine albumin-creatinine ratio (uACR) test, measured in ml/min per 1.73 meters squared. The glomerular filtration rate (eGFR) tells us how well the kidneys clean the blood, while the urine albumin-creatinine ratio (uACR) test checks for protein in the urine, which can indicate kidney damage.
Here are the stages and the essential information you need to know about them (American Kidney Fund, 2024; National Kidney Foundation, n.d.):
- Stage 1 (eGFR 90 ml/min per 1.73 m squared or higher): Mild kidney damage, with normal kidney function.
- Stage 2 (eGFR 60-89): Mild kidney damage, noticeable through either the presence of protein in the urine or physical damage, yet kidney function is relatively normal.
- Stage 3a (eGFR 45-59): Mild to moderate loss of kidney function, leading to impaired waste and fluid filtration, potentially causing additional health issues like high blood pressure and bone disease, along with symptoms like fatigue and swelling.
- Stage 3b (eGFR 30-44): Much like in Stage 3a, but with proper treatment and a healthy lifestyle, numerous individuals in Stage 3 avoid progressing to further stages.
- Stage 4 (eGFR 15-29): In this stage, severe kidney damage occurs, and kidney function is significantly impaired. This marks the final stage before kidney failure.
- Stage 5 (eGFR less than 15): Severe kidney damage or kidney failure, where accumulated waste leads to severe illness and complications. This stage necessitates dialysis or kidney transplant for survival.
As a healthcare provider, you must conduct repeat tests to confirm which chronic kidney disease stage your patient can be categorized into.
