Chronic Kidney Disease Symptoms, Causes, and Treatment

Understanding Chronic Kidney Disease: An Overview

Chronic kidney disease is a long-term progressive disease in which the kidneys lose their ability to function over time. Kidneys are vital organs that filter body waste and excess fluid excreted in urine. When they fail to perform their function, they accumulate waste and harmful substances in the body. 

The progression of CKD worsens over time and eventually leads to kidney failure. Many people with CKD are still able to live long lives with the condition. It is irreversible and has no cure, but early detection and treatment help to preserve its function as long as possible. 

The National Health Service (NHS) reported that chronic kidney disease (CKD) can affect individuals of any age, and people with diabetes and hypertension are at higher risk. It's more common in people who are black or of South Asian origin. In the U.S., kidney diseases are among the leading causes of death. 

In the United States, diabetes and high blood pressure are the leading causes of kidney failure, accounting for 2 out of 3 new cases. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) highlighted that 15% of adults in the U.S. have chronic kidney disease. Moreover, about 37 million people in total are living with chronic kidney disease (CKD), and 35.5 million U.S. adults are undiagnosed.

According to an Australian Institute of Health and Welfare (AIHW) review of the Australian Bureau of Statistics (ABS) most recent National Health Measures Survey (NHMS), 11% of Australians (1.7 million) aged 18 and over had shown biological symptoms of chronic kidney disease (CKD). It also highlighted that about one in twenty (4.9%) people aged 75 years and over had kidney disease in 2022. 

Chronic kidney disease does not affect only kidneys but also worsens overall health. The severity of chronic kidney disease is linked with other complications like cardiovascular diseases. People with CKD are more prone to develop heart disease, which is a leading cause of death. 

Chronic kidney disease also leads to renal failure, termed End Stage Renal Disease (ESRD). The other complications of CKD also include anaemia, bone loss, and electrolyte imbalances that poorly affect the quality of life. The treatment for end-stage renal disease involves dialysis and kidney transplant surgery.

What is Chronic Kidney Disease?

Kidneys do not filter blood only but are also responsible for maintaining the whole balance in the body. They are also involved in 

• Removing natural waste products and extra water from the body
• Plays a role in the production of red blood cells
• Maintaining electrolyte balance in the body
• Maintaining blood pressure
• Keeping the bones healthy

When the kidneys become damaged and cannot perform their functions for at least 3 months, this leads to chronic kidney disease. The development of chronic diseases is slow and shows fewer symptoms at early stages. It becomes severe over time and also increases the risk of other health problems like heart disease and stroke. 

In many cases, kidney disease may not show apparent symptoms early, but some symptoms, like fatigue and changes in urine colour, show kidney damage. Kidney disease is divided into five stages. According to NIDDK, 1 in 3 American adults is at higher risk for developing kidney disease, and one in nine American adults has kidney disease but is unaware.

Discover detailed insights into kidney anatomy and structure—explore more!

How CKD Affects Kidney Function

Kidneys play an essential role in filtering blood and removing waste in the form of urine. This filtering process involves a complex network of functional units known as nephrons. Each kidney consists of one million nephrons.

Nephrons filter, resorb, and secrete urine, essential for maintaining overall kidney health, homeostasis, and acid-base balance. 

When chronic kidney disease progresses, the number of functioning nephrons decreases, leading to lower blood filtration capability due to nephron damage and glomerulosclerosis. 

• Nephron Damage: CKD is often caused by other complications like diabetes and hypertension, which damage nephrons over time.
• Glomerulosclerosis involves the scarring of the glomeruli (the filtering units), which lowers the kidneys' filtration capacity to filter blood effectively.

The kidneys' inability to function appropriately leads to toxins and waste products accumulating over time. These waste products and harmful toxins, including urea and creatinine, result in electrolyte imbalances and other complications like cardiovascular disease, anaemia, and bone disorders.

As CKD progresses and nephrons become damaged, these vital functions become compromised, leading to the symptoms and complications related to kidney failure.

Stages of Chronic Kidney Disease

Chronic kidney disease is divided into five stages based on the glomerular filtration rate (GFR). This division is globally accepted by healthcare organisations, including the National Kidney Foundation (NKF). This division helps to diagnose kidney disease more efficiently, and each stage requires different tests and treatments.

Table 01: Stages of Chronic Kidney Disease

Complications of Chronic Kidney Disease

• Hypertension (Increased blood pressure)
• Arteriosclerosis and cardiovascular diseases.
• Nerve damage.
• Hyperkalemia (high potassium in the blood) 
• Hyperphosphatemia (high phosphorus in the blood)
• Weaken immune system.
• Oedema (due to fluid buildup) causes swelling in the feet and ankles.

The development of cardiovascular diseases (heart-related) is most common in chronic kidney patients. The American Heart Association (AHA) reports that people with CKD are significantly more likely to die from cardiovascular causes compared to progressing to kidney failure.

The National Kidney Foundation reported that heart disease is the primary cause of death in the U.S. among people with CKD. It also highlighted that about 50% of those who die from CKD also suffer from cardiovascular disease.

According to Kidney International, hypertension (increased blood pressure) affects over 85% of patients in the advanced stages of CKD.

The National Institutes of Health (NIH) reports that anaemia is a common complication affecting up to 50% of CKD patients in the early stages and nearly 100% of those with end-stage renal disease (ESRD).

Risk Factors of Chronic Kidney Disease 

Risk factors for chronic kidney disease increase the chance of developing diseases. There are two types of risk factors: modifiable and non-modifiable factors. 

• Modifiable factors are those individuals who can change or manage themselves to reduce the risk of developing chronic kidney diseases. It includes

Table 2: Modifiable Risk Factors for CKD

• Non-modifiable factors: Non-modifiable factors are those individuals who can not change independently. However, early screening and preventive measures help to overcome CKD. These include age, family history, autoimmune disease, and kidney infections.

Table 3: Non-Modifiable Risk Factors for CKD

Common Causes of Chronic Kidney Disease

Kidney diseases occur when the kidneys are damaged and cannot filter the blood. With chronic kidney disease, the damage progresses over many years. 

The two common causes of chronic kidney disease are diabetes and hypertension. Diabetes is among the top leading causes that account for 44% of total cases of CKD. Hypertension is the second leading cause of CKD, which contributes to about 28% of cases of renal patients. Other conditions of chronic kidney disease include.

• Glomerulonephritis: This is inflammation of the kidney's filtration unit, the glomerulus, which can contribute to the development of CKD.
• Polycystic Kidney Disease: A genetic disease that leads to the formation of cysts in the kidneys.
• Recurrent Kidney Infections: Chronic kidney infections or obstructions that cause CKD over time are called pyelonephritis. 
• Membranous nephropathy. This is a disorder where your body’s immune system attacks the waste-filtering membranes in your kidney.
• Obstructions: Any blockage in the urinary tract due to kidney stones also contributes to CKD. 
• Vesicoureteral reflux: A condition in which urine flows backwards back up through the ureters to the kidneys.
• Nephrotic syndrome. Multiple collections of symptoms indicate kidney damage.
• Lupus and other immune system diseases that cause kidney problems.

Signs and Symptoms Of Chronic Kidney Disease

Many people with chronic kidney disease do not show any symptoms until the severity and development of more advanced stages. If symptoms show, it usually includes 

• Nausea 
• Loss of appetite
• Tiredness
• Foamy urine
• Itchy or dry skin
• Unintentional Weight loss 

People with more advanced stages of CKD may also face:

• Trouble concentrating
• Numbness or swelling in arms, legs, ankles, or feet
• Muscle cramps or aching 
• Shortness of breath
• Vomiting
• Trouble in sleeping
• Ammonia-like breath and metallic taste due to waste buildup in the blood

The symptoms may be due to 

Foamy Urine: Changes in urine are the most common symptom of CKD. The urine may become foamy or bubbly more or less often, in amounts more significant or less than usual, or the colour may be darker or paler. There may also be blood in the urine, or a person may face difficulty urinating.

Swelling or oedema: It is also a common symptom in CKD patients. When the kidneys fail to filter blood and excess fluid, it builds up in the body, causing swelling in the legs, ankles, feet, or face.

Fatigue: Kidneys are responsible for producing red blood cells. When kidneys fail to perform their function in CKD, they cannot make sufficient red blood cells to carry oxygen. This causes anaemia and results in fatigue and tiredness. 

Skin Rash/Itching: When the kidneys can't remove wastes from the body, they build up in the blood and can cause severe itching.

Ammonia Breath or Metallic Taste in Mouth: When waste builds up in the blood, food tastes different and causes bad breath. It is not uncommon for people to stop liking to eat meat or to lose weight because they do not feel like eating.

Nausea and Vomiting: Uraemia (the buildup of urea and waste products in the blood) can cause nausea and vomiting.

Shortness of Breath: Extra bodily fluid can build up in the lungs. When this fluid is combined with anaemia, it causes shortness of breath.

Feeling Cold: Anaemia can make the body feel cold even in a warm room.

Dizziness and Trouble Concentrating: Anaemia caused by kidney failure means that the brain is not getting enough oxygen. This leads to memory problems, trouble concentrating, and dizziness.

Diagnosis of Chronic Kidney Disease

A medical history, physical exam, and medication intake are usually taken to diagnose a renal problem. Urine and blood tests are the most common tests for diagnosing kidney-related issues.

Blood Test: Blood tests usually observe the glomerular filtration rate. The history of age, size, and gender is used to calculate how many millilitres of waste the kidneys should be able to filter in a minute, which is known as the estimated glomerular filtration rate (eGFR). An eGFR below 60 mL/min/1.73 m² for three months or more, along with evidence of kidney damage, indicates chronic kidney disease The patient may have CKD if the rate is lower than this.  

GFR values are used to determine the stage of kidney disease, and serum creatinine levels indicate how well the kidneys remove waste.

Urine Test: Creatinine is a waste product of muscle metabolism and is excreted through urine. An increase in creatinine level shows that the kidneys cannot filter it properly. However,The presence of albumin (protein) in the urine usually indicates kidney damage and is assessed using the urine albumin-creatinine ratio (uACR).

Both tests provide a clear picture of kidney health. An eGFR under 60 or a uACR over 30 for three months or more indicate that the patient suffers from kidney disease.

Other tests include ultrasound, magnetic resonance imaging (MRI), and computerised tomography (C.T.) scans, which help indicate kidney size and improper functioning. A kidney biopsy also determines the specific kidney disease or damage type. 

Imaging: Imaging tests also help diagnose kidney-related problems. Ultrasounds, MRIs, and C.T. scans provide images of the kidneys and urinary tract, helping to identify the central issue of kidney failure.

Kidney Biopsy: A kidney biopsy involves removing a small piece of kidney tissue to examine under a microscope. It helps doctors investigate the cause of kidney damage and failure.

Treatment

Diagnosing kidney disease early and treating it according to conditions is essential. Managing CKD is focused on four goals. It includes

• Managing the cause of disease that leads to CKD. (for example, diabetes, high blood pressure, or nephropathy)
• Taking steps to slow down the progression of CKD disease directly (also termed as "slowing CKD progression")
• Lowers the risk of cardiovascular disease (heart attack or stroke)
• Treating any complications that lead to CKD

Treatment for chronic kidney disease usually requires measures to control signs and symptoms with medicines. This reduces complications and slows the progression of the disease. If the kidneys become severely damaged, renal patients can benefit from proper treatment and management strategies. With appropriate management, CKD progression can be slowed and quality of life improved. This includes dialysis and kidney transplants for end-stage renal disease (ESRD). 

It is necessary to treat the cause of CKD. The treatment options vary depending on the cause. However, kidney damage continues to worsen even when underlying conditions, such as diabetes mellitus or high blood pressure, have been controlled.

The following medicines are usually prescribed to treat the cause of CKD, depending on the conditions. It involves

Increased blood pressure: People with kidney disease are more prone to high blood pressure. Doctors usually prescribe medications to lower blood pressure, commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers, to preserve kidney function.

Certain high blood pressure medications, such as ACE inhibitors or angiotensin II receptor blockers, may cause an initial slight decrease in kidney function and affect electrolyte levels. However, they are essential for preserving kidney function in the long term. Therefore, it is important to monitor the condition with regular blood tests.

The doctor also recommends diuretics and a low-salt diet to maintain blood pressure. 

Medications for oedema: People with renal failure often retain fluids. This results in fluid accumulation and increased blood pressure, leading to leg swelling. Diuretics help maintain the balance of fluids in the body.

Medications to treat anaemia: People with chronic kidney disease usually suffer from anaemia due to decreased production of red blood cells. Erythropoietin medications, with added iron, are generally prescribed to treat anaemia. They not only help in the production of red blood cells but also relieve fatigue and weakness linked with anaemia.

Medications for lowering cholesterol levels: Statins are usually prescribed to lower blood cholesterol levels. People with chronic kidney disease mostly have high levels of bad cholesterol, which increases the risk of heart disease.

Medications for bone protection: Calcium and vitamin D supplements are usually prescribed, which help prevent bone weakness and lower the fracture risk. Phosphate binders are also prescribed to lower the amount of phosphate in the blood and protect blood vessels from damage by calcium deposits (calcification).

Low protein diet: A diet low in protein helps to minimise waste products in the blood. It reduces the burden on kidneys by eating less protein. A registered dietitian also helps to lower the protein intake while still eating a healthy diet. The doctor requires regular follow-up testing to see whether the kidney disease progresses or remains stable.

When medications and lifestyle changes are no longer effective, more advanced treatments like dialysis or kidney transplants become necessary. The treatment of renal patients depends on the stage of CKD and other health conditions (including any CKD complications). Some types of kidney disease can be treated, depending on the cause. 

Often, though, chronic kidney disease has no cure. There are two standard methods of treating chronic kidney disease: dialysis and kidney transplant.

Dialysis. Dialysis is recommended when kidneys fail to filter waste products in renal failure. It artificially removes waste products and extra fluid from the blood. There are two types of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, the blood is entered into the dialysis machine, which filters waste and excess fluids from the blood. The filtered and cleaned blood is then returned to the body. 

In peritoneal dialysis, a thin tube is inserted into the abdomen, filling the abdomen with a dialysis solution. The solution absorbs waste and excess fluids, which are drained from the body, carrying the waste.

Kidney transplant. A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors.

After a transplant, the patient needs to take medications for the rest of life to keep the body from rejecting the new organ. A patient does not require dialysis to have a kidney transplant.

Lifestyle Recommendations

ons (CKD). Renal patients are advised to follow these instructions for better recovery.

• Stop using tobacco products, including smoking. Smoking enhances the kidney disease process and increases the risk of renal failure. It also causes other health complications like high blood pressure, cardiovascular diseases and stroke.
• Limit sodium intake (less than 2300 mg daily) and adjust the diet's potassium, phosphorus, and calcium intake.
• Doctors recommend exercise to renal patients, and starting with a short walk is a great way to begin.
• Getting sufficient sleep is essential for a healthy routine.
• Maintaining a healthy weight and following a balanced diet with physical activity helps improve the health condition of obese people. 
• Find ways to manage and reduce stress in your daily life.
• Avoid excessive use of NSAIDs, as they can be harmful to the kidneys.
• If the renal patient suffers from metabolic acidosis, increase the intake of fruits and vegetables such as apples, pears, and leafy greens. This helps lower the acid levels in the blood, slowing down CKD progression (worsening).

Advantages and Disadvantages of Dialysis and Kidney Transplant 

Table 04: Advantages and Disadvantages of dialysis and kidney transplant

In addition to medical treatments, lifestyle changes also play an essential role in managing CKD and improving overall health

Managing and Living with Chronic Kidney Disease

It is difficult to manage CKD conditions, but with the right strategies, a person can still manage complications. Chronic kidney disease is more than a diagnosis. It requires changes in daily routine with the mindset that you are the only one who can manage it. Here are some tips beneficial for managing chronic kidney disease. 

Daily Tips to Manage CKD

Managing CKD conditions seems complicated. However, small, consistent actions can make a big difference. These tips help manage chronic kidney disease much better.

• Take proper medicines on time: Remember to take the medicines your doctor has prescribed. Other complications, like diabetes and high blood pressure, worsen CKD, so it is essential to take medication on time. 
• Notice any additional symptoms: Observe any additional symptoms, such as feeling low, changes in urine colour, and lower energy levels. It is essential to highlight them with the nephrologist.
• Celebrate small wins: Living a stress-free life helps ensure better management of chronic kidney disease. To keep yourself motivated, try celebrating little wins like lab improvement results. 

Stories from CKD Patients

Here are some highlighted stories of renal patients suffering from CKD and successful management of kidney disease.

• John's Story: When I was first diagnosed, I didn't know how I'd keep living my life the way I wanted. But over time, I found my routine. I stick to my meds, I manage my diet, and I make sure to get out and see friends. It's not easy, but I've learned to live with CKD instead of fighting against it all the time.
• Maria's Journey: My family was everything to me. They reminded me to stay strong, especially when I wanted to give up. Although it was painful, I still tried to keep fighting and managing. My daughter also comes during my appointments to help me remember the doctor's advice.

These stories motivate other CKD patients to manage CKD, although it is hard but not impossible. Each journey is different, but people always learn motivation from others.

Managing Mental Health

Mental health is equally important in managing CKD, as emotional well-being significantly impacts physical health. People with chronic kidney diseases usually face mental stress. These tips help manage stress and chronic kidney disease (CKD).

• Dealing with stress: Managing stress is essential, whether through medication, taking a calming walk, or engaging in a favourite hobby. Small moments of calmness help recharge mental and physical health. 
• Seek help when needed: You should seek help from therapists or counsellors to deal with your emotions. 
• Acknowledge feelings: Dealing with a chronic illness is tough. So, it is acceptable to acknowledge emotions and deal with feelings.
• Take motivation from other CKD patients: Motivate yourself from other renal patients who successfully manage CKD complications. Recovery is difficult but not impossible. 

Prevention

Chronic kidney disease can be prevented by following methods. 

• Avoid using over-the-counter medicines. Limit the use of over-the-counter (OTC) painkillers like aspirin and ibuprofen, which can damage the kidneys when used excessively. Consult a doctor before using painkillers like aspirin, ibuprofen (Advil, Motrin I.B., others), and acetaminophen (Tylenol, others). Excessive usage of OTC medications can damage kidneys. Taking too many pain relievers for a long time leads to kidney damage.
• Maintain a healthy weight: Eat a well-balanced diet. Maintain a healthy weight by doing exercise and physical activity. Keep yourself busy in games or any physical games. Obese people are at more risk of renal failure, so it is recommended to lose a healthy weight. Be active for 30 minutes at least five days a week.
• Quit alcohol use and smoking. Limit alcohol-containing beverages. Cigarette smoking also damages kidneys and makes the disease worse. Avoid smoking and tobacco products for healthy kidneys.   
• Manage other medical complications: It is essential to manage other complications with CKD, such as diabetes, hypertension, and cardiovascular disease. Maintaining an average glucose level and blood pressure leads to better management of chronic kidney disease. 

Frequently Asked Questions about Chronic Kidney Disease (CKD)

1. What is Chronic Kidney Disease (CKD)?

Chronic Kidney Disease (CKD) is a progressive renal disease caused by a gradual loss of kidney function. When it progresses, it results in kidney failure. Chronic kidney disease is commonly caused by diabetes, hypertension, or glomerulonephritis. Early-stage CKD can be managed, and its progression slowed, but it cannot be cured or reversed. This needs clarification.

2. What are the early signs of CKD?

CKD does not show symptoms at the initial stage and usually remains unnoticed. Some symptoms that people typically experience include swelling of extremities, excessive tiredness, fatigue, and a frequent urge to urinate during the night. Others face increased blood pressure, lack of appetite, and sudden weight loss. However, these symptoms are also associated with other conditions, so the person should consult a doctor to confirm.

3. Who is at risk of developing CKD?

The majority of people are at higher risk of developing CKD due to other health complications. It increases the pressure on the kidneys due to diabetes or hypertension. People who are at high risk include those 60+ and with a family history of diabetes or kidney disease, heart disease, or obesity. The minority populations involve African Americans, Hispanics, and Native Americans, who are more predisposed to CKD, genetics, and health histories.

4. How is CKD diagnosed?

CKD can be treated by lowering the progression of the disease and other associated complications. It is also treated by managing lifestyle changes, choosing healthy food, and controlling blood sugar and blood pressure. 

5. How is CKD treated?

CKD can be treated by lowering the progression of the disease and other associated complications. It is also treated by managing lifestyle changes, choosing healthy food, and controlling blood sugar and blood pressure. 

6. Can CKD be prevented?

Certain factors can prevent chronic kidney disease, which contributes to the development of CKD. These include other complications like controlling blood sugar levels, managing high blood pressure, exercising, adopting healthy lifestyle behaviours, limiting salt and protein intake, and avoiding smoking. 

7. How does CKD affect other parts of the body?

Chronic kidney disease affects various parts of the body. When the kidneys don't filter blood, it results in high blood pressure, which increases the chance of cardiovascular diseases and stroke. CKD also alters the levels of calcium and phosphorus, which weakens bones and causes osteoporosis. It also causes anaemia due to decreased production of red blood cells. 

8. What is the difference between CKD and acute kidney injury (AKI)?

Chronic kidney disease (CKD) is a progressive disease that takes years to develop. Acute Kidney Injury (AKI) is a sudden and temporary condition that occurs within hours or days. AKI is reversible and usually caused by severe infections, dehydration, medications, or obstructions to urine flow. If left untreated, AKI progresses to chronic kidney disease (CKD).

9. Can people with CKD live normal lives?

People with early-stage chronic kidney disease usually live an everyday life by managing symptoms and treatment accordingly. But in the advanced stage, people with CKD require proper treatment like dialysis and kidney transplants, which leads to compromised quality of life because it's not possible to repair the damage that has already happened to kidneys in the advanced stages of CKD. However, effective management also allows some patients to maintain a good quality of life.

10. What dietary changes are required in CKD?

Dietary changes for CKD patients may include limiting fluids and consuming little sodium, potassium, and phosphorus. People with renal failure also need to restrict calorie intake in obesity. The recommended diet patterns for CKD patients include low-carbohydrate diets, including the ketogenic diet, and higher-carbohydrate diets, like Mediterranean diets and other plant-based dietary patterns, depending on the individual requirements. 

Conclusion

Chronic kidney disease (CKD) is a degenerative illness that frequently remains undiagnosed until severe damage has been caused. The progression of CKD is slower, and complications can be prevented with early detection and treatment. People can enhance kidney function by managing risk factors like diabetes and hypertension and modifying their lifestyle through regular exercise and a kidney-friendly diet. Frequent check-ups are essential for detecting CKD early and enabling appropriate treatments that significantly enhance outcomes, especially for at-risk patients.