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    Friday, 15 March 2019

    What is Chronic Kidney Disease?

    Chronic Kidney Disease (CKD) is a progressive loss in kidney function over a period of months or years. Each of your kidneys has about a million tiny filters, called nephrons. If nephrons are damaged, they stop working. For a while, healthy nephrons can take on the extra work. But if the damage continues, more and more nephrons shut down. After a certain point, the nephrons that are left cannot filter your blood well enough to keep you healthy.
    When kidney function falls below a certain point, it is called kidney failure. Kidney failure affects your whole body, and can make you feel very ill. Untreated kidney failure can be life-threatening.
    What you should not forget:
    •    Early chronic kidney disease has no signs or symptoms.
    •    Chronic kidney disease usually does not go away.
    •    Kidney disease can be treated. The earlier you know you have it, the better your chances of receiving effective treatment.
    •    Blood and urine tests are used to check for kidney disease.
    •    Kidney disease can progress to kidney failure.
    •    Kidney Diseases are Common, Harmful and often Treatable
    •    Common: Between 8 and 10% of the adult population have some form of kidney damage, and every year millions die prematurely of complications related to Chronic Kidney Diseases (CKD).
    •    The first consequence of undetected CKD is the risk of developing progressive loss of kidney function that can lead to kidney failure (also called end-stage renal disease, ESRD) which means regular dialysis treatment or a kidney transplant is needed to survive.
    •    The second consequence of CKD is that it increases the risk of premature death from associated cardiovascular disease (i.e. heart attacks and strokes). Individuals who appear to be healthy who are then found to have CKD have an increased risk of dying prematurely from cardiovascular disease regardless of whether they ever develop kidney failure.
    •    Treatable: If CKD is detected early and managed appropriately, the deterioration in kidney function can be slowed or even stopped, and the risk of associated cardiovascular complications can be reduced.
    How is kidney function measured?
    •    The main indicator of kidney function is your blood level of creatinine, a waste product of the body produced by muscles and excreted by the kidneys. If kidney function is reduced, creatinine accumulates in the blood leading to an elevated level when a blood test is checked.
    •    Kidney function is best measured by an indicator called GFR (Glomerular Filtration Rate) which measures the blood filtration rate by kidneys.
    •    This indicator allows doctors to determine if the kidney function is normal, and if not, to what level the reduced kidney function has deteriorated. In everyday practice, GFR can easily be estimated (eGFR), from measurement of the blood creatinine level, and taking into account, age, ethnicity and gender.
    Stages of Chronic Kidney Disease (CKD)
    Usually, kidney disease starts slowly and silently, and progresses over a number of years. Not everyone progresses from Stage 1 to Stage 5. Stage 5 is also known as End-Stage Renal Disease (ESRD).
    Stage    Description        GFR Level
    Healthy Kidneys    Normal Kidney Function    90mL/min or more
    Stage 1    Kidney damage with normal or high GFR    90ml/min or more
    Stage 2    Kidney damage and mild decrease in GFR    60 to 89mL/min
    Stage 3    Moderate decrease in GFR    30 to 59mL/min
    Stage 4    Severe decrease in GFR    15 to 29 mL/min
    Stage 5 (ESKD)    Established kidney failure    Less than 15mL/min or on dialysis
    Causes of CKD
    •    High blood pressure (hypertension) and diabetes are the most common causes of kidney disease.
    •    The high blood pressure causes just over a quarter of all cases of kidney failure.
    •    Diabetes has been established as the cause of around one-third of all cases and is the commonest cause of ESRD in most developed countries.
    •    Other less common conditions include inflammation (glomerulonephritis)
    •    Or infections (pyelonephritis).
    •    Sometimes CKD is inherited (such as polycystic disease)
    •    Or the result of longstanding blockage to the urinary system (such as enlarged prostate or kidney stones).
    •    Some drugs can cause CKD, especially some pain-killing drugs (analgesics) if taken over a long time.
    •    A person can lose up to 90% of their kidney functions before experiencing any symptoms.
    •    Most people have no symptoms until CKD is advanced. Signs of advancing CKD include swollen ankles, fatigue, difficulty concentrating, decreased appetite, blood in the urine and foamy urine.
    The majority of individuals with early stages of CKD go undiagnosed.
    We are calling on everyone to check if they are at risk for kidney disease and encouraging people with any risk factors to take a simple kidney function test.
    Kidney disease usually progresses silently, often destroying most of the kidney function before causing any symptoms. The early detection of failing kidney function is crucial because it allows suitable treatment before kidney damage or deterioration manifests itself through other complications.
    •    Simple laboratory tests are done on small samples of blood (to measure creatinine content and estimate GFR) and on urine (to measure creatinine and albumin excretion).
    •    Serum Creatinine is measured in the blood to estimate your overall kidney function, or Glomerular Filtration Rate (GFR)
    •    A simple “dipstick” test may be used to detect excess protein in the urine.
    •    Urine albumin. The presence of excess protein in the urine is also a marker of CKD
    Treating CKD
    There is no cure for chronic kidney disease, although treatment can slow or halt the progression of the disease and can prevent other serious conditions developing.
    •    In the early stages of kidney disease, a proper diet and medications may help to maintain the critical balances in the body that your kidneys would normally control.
    •    However, when you have kidney failure, wastes and fluids accumulate in your body and you need dialysis treatments to remove these wastes and excess fluid from your blood, dialysis can be done either by machine (haemodialysis) or by using fluid in your abdomen (peritoneal dialysis).
    •     In suitable patients a kidney transplant combined with medications and a healthy diet can restore normal kidney function.
    Prevalence of CKD
    About 1 in 10 people have some degree of CKD. It can develop at any age and various conditions can lead to CKD.
    •    Kidney disease can affect people of all ages and races.
    •     African Americans, Hispanics, American Indians and people of South Asian origin (those from India, Bangladesh, Sri Lanka or Pakistan) have a higher risk of CKD.
    •    This risk is due in part to high rates of diabetes and high blood pressure in these communities.
    •    It is more common in women. Although about half of people aged 75 or more have some degree of CKD.

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