Everything I need to know about Chronic Kidney Disease (CKD)

What is CKD?

Kidney disease is a term used by doctors to include any abnormality of the kidneys, even if there is only very slight damage. ‘Chronic’ means a condition that is long-term and does not get completely better. Some people think 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 abnormality in the kidneys.

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. Although severe kidney failure will not occur with normal ageing of the kidneys, there is an increased risk if it is combined with high blood pressure and heart disease or stroke. Medical checks can monitor this.

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 do not appear until later stages. The rate at which CKD worsens varies from patient to patient. Regular monitoring tests by your doctor are therefore vital.

At a more advanced stage, symptoms of CKD are:

• 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 Nephrologist (kidney specialist) in advanced cases. Results of the blood and urine tests can be used to tell the stage of your disease. If someone has markedly reduced kidney function, high blood pressure, and protein leak in the urine or associated problems such as kidney pain, a scan or other investigation like biopsy may be performed.

Who looks after patients with CKD?

Most patients with early CKD will be monitored yearly and sometimes twice yearly by their GP. On each visit, expect a blood pressure measurement, urine and blood tests and your GP will regularly 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 regular follow-up.

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
• Medicine to control associated problems such as high blood pressure and high cholesterol.
• In very advanced cases, Dialysis and kidney transplant may be considered.

Leading a normal life with CKD

Most people with CKD should 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 serious problems, such as cardiovascular disease. This 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 water tablets e.g. furosemide, anti-inflammatories e.g. ibuprofen/naproxen, or blood pressure tablets e.g. ramipril).

You can usually restart these when you are well, after 24-48 hours of eating and drinking normally.

Speak to your GP if you are unwell, and on these kinds of medications with CKD.