CHRONIC KIDNEY DISEASE

It’s estimated that over 2.5 million Australians have some evidence of kidney disease.

Fortunately, very few people with chronic kidney disease will progress to end-stage renal failure. However, there are a number of factors that can influence outcome. Some of these are specific to your kidney disease, and some of these apply to all forms of chronic kidney disease. As well as treatments to preserve kidney function and avoid the need for dialysis, other aspects of health are equally important, as kidney impairment has an impact on blood pressure, bone health, energy, and can cause anaemia, all of which may need attention and specific therapy.

What is Chronic Kidney Disease (CKD)?
CKD is defined as evidence of kidney disease and/or impaired kidney function, which has been present for more than three months.  It is graded in five stages.  The mildest is Stage 1 CKD  This includes individuals with normal kidney function but evidence of kidney disease.  Examples of this can include mild non damaging forms of kidney inflammation with microscopic amounts of blood in the urine.  Stage 5 CKD includes people whose kidneys will soon fail, or have already failed and are on dialysis or have received a kidney transplant.

How common is CKD?
A population study of over 11,000 Australian adults (AUSDIAB) suggests that approximately 11% of adults have Stage 3 CKD.  At the other end of the spectrum, approximately 25,000 Australians, or 1:1000, are on dialysis or have a kidney transplant.

What are the causes of CKD?
The commonest causes of advanced CKD are diabetes, blood vessel damage from hypertension, and glomerulonephritis.  These are strongly influenced by obesity and smoking.

Symptoms and signs of CKD
Many patients with CKD have no symptoms, and are commonly diagnosed by detection of renal impairment on routine blood tests, or detection of urine abnormalities on routine urine dipstick testing.  This why a health check by your GP or other doctors will often include a blood and urine test.  Common features of CKD include symptoms or signs of the cause of CKD, such as poorly controlled blood pressure, high blood sugar, blood or protein in the urine, or the presence of ankle swelling.  Advanced CKD patients often become anaemic (low red blood cell count) and will feel lethargic and may report feeling short of breath with exercise.

Treatment of CKD
The management of CKD has a number of components.  These include trying to establish the cause of CKD, its severity, and trying to determine if it will remain stable, or if it is likely to get worse.  In terms of treatment, the most important step is treatment of the underlying cause of CKD.   In addition, there are factors which may aggravate CKD, and these include hypertension, poorly controlled diabetes, obesity, and smoking.  Diet is important in some people, and may include restrictions of protein, sodium, potassium, or phosphate.  The need for diet restriction varies significantly from person to person.  Patients with Stage 4 and 5 CKD can develop anaemia and renal bone disease.  These are monitored, and treated when they arise.

Does having CKD mean I will end up on dialysis or need a kidney transplant?
For the overwhelming majority of people the answer is no!  Most people having mild CKD, and with treatments and other interventions that slow down decline, most patients with CKD can be prevented from needing dialysis or a kidney transplant.  However, there are some less common causes of CKD where dialysis or transplant are more commonly needed, and some people who have more severe patterns of kidney disease .