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ABOUT CHRONIC KIDNEY DISEASE (CKD)
What is Chronic Kidney Disease (CKD)
Chronic kidney disease (CKD) is a progressive loss of kidney function over a period of months or years. The symptoms of worsening kidney function are might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a family history of kidney disease.
Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a falling glomerular filtration rate (rate at which the kidneys filter blood) and as a result, a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into the urine. To fully investigate the underlying cause of kidney damage, various forms of medical imaging, blood tests and sometimes kidney biopsy (sampling a small piece of kidney tissue) are employed to find out if there is a reversible cause for the kidney malfunction. Recent professional guidelines classify the severity of chronic kidney disease in five stages, with stage 1 being the mildest and usually causing few symptoms and stage 5 being a severe illness with poor life expectancy if untreated.
There is no specific treatment unequivocally shown to slow the worsening of chronic kidney disease. If there is an underlying cause to CKD, such as vasculitis, this may be treated directly with treatments aimed to slow the damage. In more advanced stages, treatments may be required for anemia and bone disease. Severe CKD requires one of the forms of renal replacement therapy; this may be a form of dialysis, but ideally constitutes a kidney transplant.
NxStage System One helps make home dialysis possible.
CHRONIC KIDNEY DISEASE - STAGES
More than 25 million Americans suffer from Chronic kidney disease (CKD). CKD is when one suffers loss of kidney function. This happens gradually over time, usually over months to years.
Chronic kidney disease is divided into five stages of increasing severity with Stage 1 representing the mildest form of kidney damage. Moderate decreases in eGFR (30 to 59) represent stage 3 chronic kidney disease. At this stage of CKD, hormonal and mineral imbalances can lead to anemia, acidosis, and weak bones. Stage 5 is the most advanced stage of kidney damage and by this time most patients have been prepared for dialysis or are on the kidney transplant list. Your kidney doctor (nephrologist) can provide guidance and treatment to help preserve kidney function and prevent eventual need for dialysis.
All individuals with a Glomerular filtration rate (GFR) <60 mL/min/1.73 m2 for 3 months are classified as having chronic kidney disease, irrespective of the presence or absence of kidney damage. The rationale for including these individuals is that reduction in kidney function to this level or lower represents loss of half or more of the adult level of normal kidney function, which may be associated with a number of complications.
List of Services
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Stage 1 CKDList Item 1
Slightly diminished function; Kidney damage with normal or relatively high GFR (>90 mL/min/1.73 m2). Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine test or imaging studies.
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Stage 2 CKDList Item 2
Mild reduction in GFR (60-89 mL/min/1.73 m2) with kidney damage. Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine test or imaging studies.
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Stage 3 CKDList Item 3
Moderate reduction in GFR (30-59 mL/min/1.73 m2).
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Stage 4 CKDList Item 4
Severe reduction in GFR (15-29 mL/min/1.73 m2) Preparation for renal replacement therapy
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Stage 5 CKD
Established kidney failure (GFR <15 mL/min/1.73 m2)
*eGFR is estimated glomerular filtration rate, a measurement of the kidney's function.
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STAGES OF CKD
CHRONIC KIDNEY DISEASE - SIGNS & SYMPTOMS
Initially it is without specific symptoms and can only be detected as an increase in serum creatinine or protein in the urine.
As the kidney function decreases:
Blood pressure is increased due to fluid overload and production of vasoactive hormones, increasing one's risk of developing hypertension and/or suffering from congestive heart failure
Potassium accumulates in the blood (known as hyperkalemia with a range of symptoms including malaise and potentially fatal cardiac arrhythmias)
Erythropoietin synthesis is decreased (potentially leading to anemia, which causes fatigue)
Fluid volume overload - symptoms may range from mild edema to life-threatening pulmonary edema
Hyperphosphatemia - due to reduced phosphate excretion, associated with hypocalcemia (due to vitamin D3 deficiency).
Metabolic acidosis, due to accumulation of sulfates, phosphates, uric acid etc. This may lead to hyperkalemia due to excess acid (acidemia)
People with chronic kidney disease suffer from accelerated atherosclerosis and are more likely to develop cardiovascular disease than the general population. Patients afflicted with chronic kidney disease and cardiovascular disease tend to have significantly worse prognoses than those suffering only from the latter.
DIALYSIS TREATMENTS
Dialysis
Dialysis is primarily used to provide an artificial replacement for lost kidney function (renal replacement therapy) due to renal failure. Dialysis may be used for very sick patients who have suddenly, but temporarily, lost their kidney function (acute renal failure) or for quite stable patients who have permanently lost their kidney function (stage 5 chronic kidney disease). When healthy, the kidneys maintain the body's equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, sulfate) and remove waste products from the blood. The kidneys also function as a part of the endocrine system producing erythropoietin and 1,25-dihydroxycholecalciferol (calcitriol). Dialysis is an imperfect treatment to replace kidney function because it does not correct the endocrine functions of the kidney. Dialysis treatments replace some of these functions through diffusion (waste removal) and ultrafiltration (fluid removal).
Hemodialysis
This pressure gradient causes water and dissolved solutes to move from blood to dialysate, and allows the removal of several liters of excess fluid during a typical 3 to 5 hour treatment. Hemodialysis treatments are typically given in a dialysis center three times per week; however, as of 2007 over 2,000 people in the US are dialyzing at home more frequently for various treatment lengths.
In hemodialysis, the patient's blood is pumped through the blood compartment of a dialyzer, exposing it to a semipermeable membrane. The cleansed blood is then returned via the circuit back to the body. Ultrafiltration occurs by increasing the hydrostatic pressure across the dialyzer membrane. This usually is done by applying a negative pressure to the dialysate compartment of the dialyzer.
Peritoneal Dialysis
In peritoneal dialysis, a sterile solution containing minerals and glucose is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a semipermeable membrane. The dialysate is left there for a period of time to absorb waste products, and then it is drained out through the tube and discarded. This cycle or "exchange" is normally repeated 4-5 times during the day, (sometimes more often overnight with an automated system). Ultrafiltration occurs via osmosis; the dialysis solution used contains a high concentration of glucose, and the resulting osmotic pressure causes fluid to move from the blood into the dialysate.
As a result, more fluid is drained than was instilled. It does free patients from the routine of having to go to a dialysis clinic on a fixed schedule multiple times per week, and it can be done while traveling with a minimum of specialized equipment.
ANEMIA
Anemia describes a condition in which the blood does not contain enough red blood cells. These cells are important because they deliver oxygen throughout the body.
A person who is anemic typically feels tired. Healthy kidneys make a hormone called EPO (erythropoietin), which stimulates the bone marrow to make red blood cells. Patients with kidney disease may not be able to make enough EPO and are thus prone to anemia.
When the blood count gets very low, a blood transfusion is sometimes needed. Patients with kidney disease and anemia can receive injections of EPO, and thus avoid blood transfusions.
KIDNEY TRANSPLANTATION
Kidney transplantation involves placing a functioning kidney from another person into your body; your own kidneys are not typically removed. The kidney can come from a relative, friend, or an anonymous donor who has recently died. Kidney transplantation is not a complete cure nor is it guaranteed to work, but many patients who receive a kidney transplant are able to live much healthier lives. People who receive a transplant must take anti-rejection medication and be monitored by a physician who specializes in kidney disease.
350,000
people have end stage kidney disease
65,000
people with end stage kidney disease die each year
95,000
people were on the waiting list for a kidney transplant in 2019
HYPERTENSION
High Blood Pressure
High blood pressure or hypertension is a major risk factor in the development of kidney disease. High blood pressure can cause injury to the blood vessels in the kidneys. Once damaged, the blood vessels are unable to help remove wastes from the blood which leads to kidney damage and eventually can lead to kidney failure.
Blood pressure readings consist of two measurements. The top number is called the systolic pressure and the bottom number is the diastolic pressure. Patients with reduced kidney function should set a goal blood pressure of least 130/80.
Hypertension is not only a risk factor for kidney disease but also accelerates damage to the kidney when kidney disease is already present. Early detection and treatment of high blood pressure is essential.
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DIABETES
The term diabetes, without qualification, usually refers to diabetes mellitus, which is associated with excessive sweet urine (known as "glycosuria") but there are several rarer conditions also named diabetes. The most common of these is diabetes insipidus in which the urine is not sweet (insipidus meaning "without taste" in Latin); it can be caused either by kidney (nephrogenic DI) or pituitary gland (central DI) damage. It is a noninfectious disease. Among the body systems affected are the nerve, digestive, circulatory, endocrine and urinary systems.
The term "type 1 diabetes" has universally replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Likewise, the term "type 2 diabetes" has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and non-insulin-dependent diabetes mellitus (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature. Various sources have defined "type 3 diabetes" as, among others, gestational diabetes, insulin-resistant type 1 diabetes (or "double diabetes"), type 2 diabetes which has progressed to require injected insulin, and latent autoimmune diabetes of adults (or LADA or "type 1.5" diabetes.)
KIDNEY STONES
Kidney stones (called renal calculi in medical terminology are solid concretions (crystal aggregations) formed in the kidneys from dissolved urinary minerals. The terms nephrolithiasis and urolithiasis refer to the condition of having calculi in the kidneys and urinary tract, respectively. Bladder stones can form or pass into the urinary bladder. Ureterolithiasis is the condition of having a calculus in the ureter (the tube connecting the kidneys and the bladder).
Kidney stones typically leave the body by passage in the urine stream, and many stones are formed and passed without causing symptoms. If stones grow to sufficient size before passage—on the order of at least 2-3 millimeters—they can cause obstruction of the ureter. The resulting obstruction causes dilation or stretching of the upper ureter and renal pelvis (the part of the kidney where the urine collects before entering the ureter) as well as muscle spasm of the ureter, trying to move the stone. This leads to pain, most commonly felt in the flank, lower abdomen and groin (a condition called renal colic). Renal colic can be associated with nausea and vomiting. There can be blood in the urine, visible with the naked eye or under the microscope (macroscopic or microscopic hematuria) due to damage to the lining of the urinary tract.
There are several types of kidney stones based on the type of crystals of which they consist. The majority are calcium oxalate stones. More rarely, struvite stones are produced by urea-splitting bacteria in people with urinary tract infections, and people with certain metabolic abnormalities may produce uric acid stones or cystine stones.
The diagnosis of a kidney stone can be confirmed by radiological studies or ultrasound examination; urine tests and blood tests are also commonly performed. When a stone causes no symptoms, watchful waiting is a valid option. In other cases, pain control is the first measure, using for example non-steroidal anti-inflammatory drugs or opioids. Using soundwaves, some stones can be shattered into smaller fragments (this is called extracorporeal shock wave lithotripsy). Sometimes a procedure is required, which can be through a tube into the urethra, bladder and ureter (ureteroscopy), or a keyhole or open surgical approach from the kidney's side. Sometimes, a metal tube may be left in the ureter (a ureteric stent) to prevent the recurrence of pain. Preventive measures are often advised such as drinking sufficient amounts of water.
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