Chronic Kidney Disease Treatment in India

Overview

What is chronic kidney disease?

Chronic kidney disease (CKD), also known as chronic renal disease, is characterised by damage to the kidneys, due to which they are unable to function properly. Wastes, toxins, and excess water are normally filtered from the blood by the kidneys. Other important functions, such as maintenance of bone health and red blood cell production, are also supported by the kidneys. When kidney function begins to decline, waste products are no longer filtered efficiently, leading to their accumulation in the blood.

The term “chronic” is used because kidney function is gradually reduced over time. CKD can eventually progress to kidney failure, which is also referred to as end-stage kidney disease.

What are the 5 stages of chronic kidney disease?

CKD is classified into five stages based on the kidneys’ ability to remove waste products from the blood. The stage of CKD is identified through blood and urine tests.

These stages range from mild kidney impairment (stage 1) to complete kidney failure (stage 5). The stage is determined by healthcare providers using the glomerular filtration rate (GFR), which is calculated based on the level of creatinine, a waste product, present in the blood.

Stage	GFR (mL/min)	What It Means
Stage 1	90 and higher	Signs of mild kidney damage are present, although kidney function is maintained well.
Stage 2	60 to 89	More signs of mild kidney damage are present, although kidney function is maintained well.
Stage 3a	45 to 59	Mild to moderate kidney damage is observed, and kidney function is reduced. This stage is most commonly seen. Symptoms may be noticed at this stage.
Stage 3b	30 to 44	Moderate kidney damage is present, and kidney function is reduced. With appropriate treatment, progression to stage 4 can often be prevented..
Stage 4	15 to 29	Kidney function is severely reduced, and severe kidney damage is present, with the kidneys approaching complete failure
Stage 5	Less than 15	Kidney failure is imminent or has already occurred. Kidney dialysis or kidney transplantation may be required at this stage.

Causes

CKD develops when kidney function is impaired by an underlying disease or medical condition. In many cases, more than one factor may contribute to the development of CKD.

Common causes of chronic kidney disease include:

Type 1 or type 2 diabetes
High blood pressure
Autoimmune disorders such as lupus, sarcoidosis, and Sjögren syndrome
Polycystic kidney disease and other hereditary kidney disorders
Long-term blockage of the urinary tract caused by conditions such as enlarged prostate or urinary tract tumours
Vesicoureteral reflux, a condition in which urine flows backward into the kidneys
Certain medications, including lithium, high doses of ibuprofen or other nonsteroidal anti-inflammatory drugs
(NSAIDs), and immunosuppressive drugs

Symptoms of CKD

In the initial stages of kidney disease, noticeable symptoms are often absent. As the condition progresses, various symptoms may begin to appear.

Increased frequency of urination
Fatigue, weakness, or reduced energy levels
Decreased appetite
Swelling in the hands, feet, or ankles
Difficulty in breathing or shortness of breath
Frothy or foamy urine
Puffiness around the eyes
Dryness and itching of the skin
Difficulty with concentration
Sleep disturbances
Numbness or tingling sensations
Nausea and vomiting
Muscle spasms or cramps
Elevated blood pressure
Darkening or discoloration of the skin

Diagnosis

Tests

Screening for CKD can be performed using two simple tests:

A blood test called the estimated glomerular filtration rate (eGFR)
A urine test called the urine albumin-to-creatinine ratio (uACR)

Both tests are important for obtaining a comprehensive assessment of kidney health. An eGFR below 60 and/or a uACR above 30 persisting for three months or longer may indicate the presence of kidney disease.

The eGFR provides an estimate of how effectively the kidneys are filtering waste products from the blood. It is calculated using factors such as serum creatinine level, age, and sex, and may also be estimated using cystatin C levels. Normal eGFR values vary with age and generally decline as a person grows older. For this test, higher values indicate better kidney function. The eGFR value is also used to determine the stage of CKD.

The uACR measures the levels of albumin (a protein) and creatinine in the urine. Normally, healthy kidneys retain albumin in the bloodstream while filtering creatinine into the urine, resulting in little or no albumin being present in urine. The uACR is determined by calculating the ratio of urine albumin to urine creatinine. Lower uACR

values are considered favorable. This test is commonly used to detect albuminuria, an important risk factor for CKD-related complications.

In certain situations, additional investigations may be advised by healthcare professionals to obtain more detailed information about kidney health. These may include kidney biopsy or imaging studies such as computed tomography (CT) scan, ultrasound, or magnetic resonance imaging (MRI).

Treatment

Although CKD cannot be completely cured, several measures can help preserve kidney function and delay disease progression for as long as possible. If kidney function is reduced, the following steps are generally recommended:

Attend regular follow-up visits with a healthcare provider or nephrologist to monitor kidney health
Maintain proper blood glucose control in individuals with diabetes
Avoid painkillers and other medications that may further impair kidney function
Keep blood pressure under control
Follow a kidney-friendly diet, which may include limiting protein, sodium (salt), and potassium intake, along with foods that help manage blood cholesterol levels
Avoid smoking
Engage in regular physical activity or exercise on most days of the week
Maintain a healthy body weight

Medications

Depending on the underlying cause of kidney disease, one or more medications may be recommended by a nephrologist. These may include:

Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to help control blood pressure
Phosphate binders when the kidneys are unable to effectively remove phosphate
Diuretics to assist in eliminating excess fluid from the body
Medications to reduce cholesterol levels
Erythropoietin for the management of anemia by promoting red blood cell production
Vitamin D and calcitriol to help prevent bone loss.

Complications

As CKD progresses, the likelihood of developing complications increases. Some common complications include:

Cardiovascular disease, including heart disease and stroke
High blood pressure
Anemia due to reduced red blood cell levels
Metabolic acidosis caused by accumulation of acid in the blood
Mineral and bone disorders resulting from imbalance of calcium and phosphorus levels, which may affect the bones and heart
Hyperkalaemia, characterised by elevated potassium levels in the blood
Kidney failure

Certain conditions, such as cardiovascular disease and high blood pressure, may also contribute to the development or progression of CKD.

Prevention

Regular health check-ups with a healthcare provider throughout life can help in the prevention of kidney disease. People at higher risk may undergo routine screening tests for CKD to enable early detection.

Additional measures that may help prevent CKD include:

Controlling high blood pressure
Maintaining proper blood sugar levels in individuals with diabetes
Following a balanced and nutritious diet
Avoiding smoking and tobacco use
Engaging in physical activity for at least 30 minutes on most days of the week
Maintaining a healthy body weight
Using over-the-counter pain medications only as recommended, since excessive use may harm the kidneys
Limiting the intake of alcoholic beverages

Myths and Facts

Myth

If CKD were present, its effects would likely be recognised

Fact

CKD often progresses slowly, with symptoms appearing only after significant kidney damage

Myth

A cure for CKD may be possible

Fact

Unfortunately, CKD has no cure, and treatment primarily focuses on managing symptoms

Myth

As CKD is genetic, it cannot be prevented

Fact

Certain genetic variations may increase CKD risk, but not all carriers develop the disease, and some CKD patients lack these variants

Frequently asked questions

How can kidney dysfunction be identified?

Kidney problems often go unnoticed in the early stages due to lack of symptoms, making regular health check-ups important for managing conditions like diabetes and hypertension that may lead to kidney disease

Which foods can negatively affect kidney health?

In CKD, a kidney-friendly diet, low in salt, excess protein, phosphorus, and potassium, while emphasizing heart-healthy foods, may help preserve kidney function, and guidance from a dietitian is often beneficial.

What changes in urine appearance may indicate kidney failure?

Kidney failure may not change urine color, but foamy or frothy urine can indicate excess protein due to impaired kidney filtration.