Dear Dr Makis,
I’ve just been told by my doctor that I have chronic kidney disease. They didn’t really explain what that meant, it sounds really serious and I’m worried. What does this mean for me?
Christine.
Dear Christine,
I understand that you are very worried, the words chronic kidney disease sound terrifying. Please do not worry, I will try and explain what this means.
Chronic kidney disease (CKD) means that your kidneys are diseased or damaged in some way or are ageing. As a result, your kidneys may not work as well as they used to. A range of conditions can cause chronic kidney disease. Chronic means ongoing, persistent, and long-term. It does not mean severe as some people think. You can have a mild chronic disease. Many people have mild CKD. Chronic kidney disease used to be called chronic renal failure, but chronic kidney disease is a better term, as the word failure implies that the kidneys have totally stopped working. In most cases of chronic kidney disease this is not so. In most people who have chronic kidney disease there is only a mild or moderate drop in kidney function, which usually does not cause symptoms, and the kidneys have not 'failed'.
Kidney function is assessed using a combination of a blood test called the estimated glomerular filtration rate (eGFR); and a measure of the amount of protein in the urine (proteinuria). Increased protein in the urine and decreased eGFR are both associated with an increased risk of progressive chronic kidney disease.
You are unlikely to feel unwell or have symptoms with mild-to-moderate chronic kidney disease - that is, stages 1 to 3. Chronic kidney disease is usually diagnosed by the eGFR test before any symptoms develop. About 1 in 10 people have some degree of chronic kidney disease. It can develop at any age and various conditions can lead to CKD. It becomes more common with increasing age and is more common in women.
Although about half of people aged 75 or more have some degree of chronic kidney disease, most of these people do not actually have diseases of their kidneys; they have normal ageing of their kidneys. Most cases of CKD are mild or moderate (stages 1-3).
Symptoms tend to develop when chronic kidney disease becomes severe (stage 4) or worse. The symptoms at first tend to be vague and nonspecific, such as feeling tired, having less energy than usual and just not feeling well. With more severe chronic kidney disease, symptoms that may develop include difficulty thinking clearly, a poor appetite, weight loss, dry and itchy skin, muscle cramps, fluid retention which causes swollen feet and ankles and being pale due to anaemia.
People tend to be told they have CKD when it is at stage 3. Stage 3 means moderate chronic kidney disease. Your doctor will need to see you regularly for monitoring, including blood and urine tests. You may need treatments to reduce your risk of progressing to more severe chronic kidney disease. You will probably also need other treatments to reduce your risk of any other problems, particularly cardiovascular diseases. However, if regular blood and urine tests show that your chronic kidney disease is progressing to stage 4 then you will usually need to be referred to a kidney specialist to consider further assessments and treatment.
A number of conditions can cause permanent damage to the kidneys and/or affect the function of the kidneys and lead to chronic kidney disease. Three common causes in the UK, which probably account for about three in four cases of chronic kidney disease in adults, are Diabetes. Untreated or poorly treated high blood pressure is a major cause of CKD. However, CKD can also cause high blood pressure, as the kidney has a role in blood pressure regulation. About nine out of ten people with CKD stages 3-5 have high blood pressure. There appears to be an age-related decline in kidney function. About half of people aged 75 or more have some degree of CKD. In most of these cases, the CKD does not progress beyond the moderate stage unless other problems of the kidney, such as diabetic kidney disease, develop. Certain medications, including non-steroidal anti-inflammatory drugs (if they are used long-term, especially at high doses).
Knowing you have CKD is better than not knowing as it can be monitored regularly and treated to control it and slow its progression. . Good control of blood pressure with specific medication will help slow progression and if you have diabetes, good control of is essential.
Dr Makis
Dr Makis offers medical advice via his monthly article in the Paphos Post newspaper. If you require personal medical advice, contact your own GP in the first instance. For further information about Veramedica Medical Center, please contact us.