Dr. Vinod Valluri, MD, is a nephrologist with the Mid-Atlantic Permanente Medical Group. He sees patients at the Kaiser Permanente Capitol Hill and Largo medical centers.
Chronic kidney disease (CKD) is a growing global health concern, affecting millions of people worldwide. Despite its prevalence, CKD often remains underrecognized compared to other chronic conditions like obesity, diabetes, hypertension, and heart disease. Yet, the kidneys play a vital role in maintaining overall health, and understanding CKD is essential for preventing and managing the illness.
The Role of the Kidneys
Our two kidneys are responsible for filtering waste and excess fluid from the body, maintaining electrolyte balance and regulating blood pressure. They also help sustain the bone health, acid-base equilibrium and produce hormones such as erythropoietin, which stimulates red blood cell production. Basically, healthy kidneys are essential for survival and to function optimally.
When kidney function declines, toxins and fluids accumulate along with disruption of above-mentioned processes, leading to serious health complications. This decline is measured by the glomerular filtration rate (GFR). This refers to the amount of blood the kidneys filter per minute. A normal GFR ranges from 90 to 120.
CKD is defined as a persistent reduction in kidney function, often categorized into stages based on GFR:
- Stage 1: Normal or high function (GFR ≥90)
- Stage 2: Mild reduction (GFR 60–89)
- Stage 3: Moderate reduction (GFR 30–59)
- Stage 4: Severe reduction (GFR 15–29)
- Stage 5: Kidney failure (GFR <15)
Who Is at Risk for Chronic Kidney Disease?
CKD risk increases with age. Around age 40, kidney function naturally declines by about 0.8 percent per year. However, age is only one factor. The leading causes of CKD include:
- Diabetes: Poorly controlled blood sugar damages kidney tissue.
- High blood pressure: Increased blood pressure strains kidney filtration.
- Obesity: Excess weight increases filtration workload and contributes to diabetes and high blood pressure.
- NSAID use: Frequent use of non-steroidal anti-inflammatory drugs, such as ibuprofen, can harm kidneys.
- Dehydration: Chronic low fluid intake stresses kidney function.
- Prostate issues: Obstruction can lead to kidney damage.
- Family history: People with a family history of CKD are at higher risk.
Globally, CKD affects approximately 14 percent of adults, and its prevalence is rising. In fact, a recent Lancet study reported that 788 million adults were living with CKD in 2023, up from 378 million in 1990. CKD is now the ninth leading cause of death worldwide, driven by rising rates of diabetes, hypertension and obesity. In the United States, an estimated 1 in 7 adults has CKD.
Why CKD Is Called a Silent Disease
One of the most challenging aspects of CKD is its lack of early symptoms. In fact, approximately 9 in 10 adults with CKD don’t know they have it.
Kidneys are highly resilient. Even when function drops significantly, patients often feel fine. Unfortunately, CKD can progress unnoticed until advanced stages. Symptoms of advanced chronic kidney disease include:
- Nausea and vomiting
- Confusion
- Restlessness
- Fatigue and insomnia
- Loss of appetite
- Decreased urine output
- Swelling in the feet
- Shortness of breath
- Increased bleeding tendency
Anemia is a common complication of CKD, as damaged kidneys produce less erythropoietin. Symptoms of anemia include palpitations, shortness of breath and fatigue.
Can CKD Be Reversed?
Unfortunately, CKD cannot be reversed. Unlike acute kidney injury, which may improve with treatment, CKD involves permanent damage to the organ. Current treatments aim to slow progression of chronic kidney disease.
How Is CKD Managed?
Management focuses on preserving remaining kidney function and preventing complications. Key strategies include:
- Blood pressure control: Medications such as Angiotensin converting enzyme inhibitors and angiotensin receptor blockers reduce pressure within the kidneys and offer protective benefits.
- Blood sugar control: For patients with diabetes, medications like SGLT2 inhibitors and GLP-1 receptor agonists help manage glucose, help with weight loss and protect kidney health.
- Lifestyle changes: Maintaining a healthy weight, exercising regularly (at least 150 minutes of moderate aerobic activity per week), and avoiding NSAIDs are critical.
- Dietary adjustments: Limit salt intake, eat balanced meals with colorful fruits and vegetables, and practice portion control to prevent obesity. A nutritionist can offer helpful guidance on what to eat and what to limit.
- Hydration: Drink water regularly throughout the day.
Prevention: What You Can Do
Many risk factors for chronic kidney disease are under our control. Here’s what you can do to reduce your risk:
- Monitor blood pressure regularly, not just during annual checkups.
- Keep blood sugar within target ranges if you have diabetes.
- Maintain a healthy weight through diet and exercise.
- Stay hydrated and avoid excessive salt.
- Limit or avoid NSAID use unless prescribed.
- Seek prompt treatment for urinary tract or prostate issues.
Living with CKD
Receiving a CKD diagnosis can be anxiety provoking, especially for patients who associate kidney disease with dialysis. Education and empowerment are key. Understanding your stage of CKD, its causes, and your treatment goals can make a significant difference. Many patients live for decades with CKD by following medical advice and adopting healthy habits.
Learn more from the Mid-Atlantic Permanente Medical Group about how to live well with chronic kidney disease.
Feature image, stock.adobe.com
