Authored by

DR. PALLAVI PATRIMD (Nephrology), ABIM (Internal Medicine Residency), ABIM (Nephrology)Consultant Nephrologist, Hypertension and Transplantation Specialist.

Chronic Kidney Disease (CKD)

+ What is Chronic Kidney Disease?

The Kidneys are the organs that filter waste and excess fluid from the blood. Any longstanding disease may result in kidney failure leading to waste building up in the body.

+ What do the Kidneys Do?

- Filter Waste Products in The Blood- Remove Extra Fluid from The Body- Help Balance Various Chemicals in The Body- Help Maintain Blood Pressure- Keep the Bones Healthy- Make Hormones That Stimulate the Bone Marrow to make Blood Cells

+ What does the term Chronic Kidney Disease (CKD) mean?

CKD is irreversible Kidney Damage that usually occurs slowly with gradual loss of Kidney Function over time affecting the Kidneys’ ability to perform its normal functions. Once diagnosed with CKD, the goal of treatment is to slow the progression of CKD and preserve remaining Kidney function.

+ What are the Causes of CKD?

1. Diabetes Mellitus - Most common cause2. High Blood Pressure - Hypertension3. Glomerulonephritis - A group of diseases that cause inflammation and damage to the kidneys4. Heart or Liver Disease 5. Inherited diseases - Polycystic Kidney Disease which causes cyst formation and damage to the kidneys6. Kidney Malformations - Birth Defects7. Use of Drugs that are harmful to the Kidneys - Pain-killers such as the Non-steroidal Anti-inflammatory Drugs including Brufen, Voveron, Hifenac etc.8. Exposure to certain Toxins Lead (from exposure to Lead based paints), Illegal Drug Use (Cocaine, Heroin)9. Obstruction of Urine Flow - Enlarged Prostate or Cancers of the Urinary Tract or Prostate10. Direct Injury to the Kidneys - Road Traffic Accidents

+ What are the Tests my Kidney Doctor (Nephrologist) will advise to diagnose CKD?

1. Blood Tests

  • Serum Creatinine

- A measure of how well the kidneys are cleaning the blood of the body’s waste products- The Normal value of Creatinine is generally around 0.5 - 1.2 mg/dL

  • Serum Electrolytes

2. Urine Tests

  • Urine Routine

- Tests for presence of Sugar, Protein, Blood Cells in the Urine

  • 24 Hour Urine

- Collection for Protein3. Imaging Studies

  • Kidney Ultrasound Scan

To check for- Size of the Kidneys- Presence of scarring in the Kidneys- Malformations- Presence of Cysts, Tumors, Stones- Obstruction of Urine Outflow

  • Kidney Biopsy

- A simple, outpatient procedure in which a small sample of kidney tissue is taken from the patient and sent to the lab. This test can help diagnose the cause of Kidney disease and direct treatment.

+ What are the Symptoms of CKD?

Patients may not have obvious symptoms when CKD is mild, but at more severe stages of CKD, patients may show the following-- Decrease in Urine Output- Blood in Urine, Frothiness of Urine (This may be noted in certain diseases in milder level of CKD)- Decrease in Energy Level- Trouble Concentrating/Confusion- Poor Appetite, Nausea/Vomiting- Trouble with Sleep- Swollen Legs, Puffiness Around Eyes- Shortness of Breath, Difficulty Breathing while sleeping flat- Dry, Itchy Skin

+ If I am diagnosed with CKD, what can I do to preserve remaining Kidney Function?

- Maintain good control over Blood Pressure.- Maintain good control of your Blood Sugar levels if Diabetic.- Adhere to the Diet outlined by the Kidney doctor- Avoid Painkillers (specifically Non-Steroidal Anti-inflammatory Drugs as above)- Ensure that all your physicians are aware of your Kidney function before any medication changes or any tests/procedures are planned- Follow up with your Kidney doctor and take medications as prescribed- Avoid Smoking

+ What are the Diet Changes I should make?

In general individuals with CKD will be required to make some changes to their diet especially involving - - Restriction of Fluid and Salt.- Restriction of potassium and/or phosphorus containing foodsEach individual should consult their Nephrologist and Clinical Nutritionist for personalized recommendations on what foods should be consumed and what avoided.

+ What are my Treatment options once my Kidneys Fail?

CKD progression can be managed with medications as prescribed by your Nephrologist.However, once the CKD progresses to being severe, which is also called as End Stage Renal Disease, or ESRD , individuals will require Kidney Replacement Therapies such as Dialysis or Kidney Transplantation.1. Dialysis

  • Hemodialysis (Blood based Dialysis)

This is blood-based dialysis which requires a surgical connection of an artery and vein called an Arteriovenous fistula (AVF) or Graft (AVG) in the arm. Needles are inserted into the AVF or AVG and are hooked up to the Dialysis Machine. A less ideal type of access to the blood is via a catheter that is placed typically in the neck of the patient. Hemodialysis typically requires the patient to come into a Dialysis center Three times a Week and for 3-4 hours every time.

  • Peritoneal Dialysis (Non-Blood based Dialysis)

This type of dialysis requires placement of a catheter into the patient’s abdomen. The patient or a friend/family member performs this type of dialysis at home. Special fluid bags are required; Fluid is filled through the catheter into the abdomen and then drained after several hours. This process is repeated several times in a day – it can be done manually (CAPD) or with the use of a machine (APD). This has to be done very day in a clean way so as to avoid infections. Patients and family members will require training to learn how to do this on their own in a safe way.2. TransplantationThis is the preferred form of kidney replacement therapy for patients with End Stage Kidney Disease. It offers a healthier and better quality of life than Dialysis. All patients who are deemed fit by their kidney Doctor should strongly consider transplantation. The transplanted kidney can come from a patient who has died (Deceased Donor Transplant) or from a family member (Living Donor Transplant). Deceased Donor Transplantation requires registration with the state government while the Living Donor Transplantation requires the patient and the donor to both be screened to ensure they are a good match (based on blood type matching) and that they are both fit to undergo their respective surgeries. After kidney transplantation, patients will need to take certain medications to prevent rejection of the kidney for life and routinely visit their Nephrologist on a regular basis.


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