Early Detection and Management of CKD

What Is CKD?

Chronic kidney disease is a long-term and progressive medical condition that negatively affects the kidneys.

The kidneys’ primary function is to filter waste products and excess fluid from the blood, which are then voided during urination. In CKD, the kidneys slowly lose their ability to function correctly. At first, kidney disease is silent and symptomless, making early detection difficult without regular screening and testing. Unfortunately, many people don’t experience any symptoms until their kidney disease is advanced.

For these reasons, scheduling and attending regular preventative health screenings with your primary care doctor is imperative.

Blood and urine tests are the only way to detect and confirm CKD diagnoses.

What Are the Causes of CKD?

The two most common causes of CKD are diabetes and high blood pressure (hypertension). However, it often results from a combination of health factors, including:

• Glomerulonephritis (chronic kidney inflammation)
• Polycystic kidney disease (PKD)
• Chronic or recurrent kidney infections
• Obstructive kidney disease
• Long-term use of certain antibiotics and nonsteroidal anti-inflammatories (NSAIDs)
• Lupus and other autoimmune diseases
• Recurrent kidney stones
• Genetic predisposition
• Nephrotoxic Agents (e.g., dyes) (x-ray contrast media)
• Environmental agents – pesticides and fungicides
• Heavy metals – lead and arsenic

What Are the Risk Factors for CKD?

Common risk factors that increase a person’s likelihood of developing CKD include:

• Being older (age 60+)
• Being African American, Native American, or Hispanic
• Having cardiovascular disease or heart-related conditions
• Smoking
• Being overweight or obese
• Having high cholesterol
• Having prolonged exposure to certain drugs, toxins, or environmental pollutants
• Having a low birth weight

If you or a loved one has one or more risk factors, regular check-ups and health screenings are crucial for early detection of CKD and disease management.

What Are the Five Stages of CKD?

CKD is divided into five stages based on the Glomerular Filtration Rate (eGFR). eGFR is a measure of how well your kidneys are functioning. It is an estimated number based on a person’s blood test, age, sex, and body type. It is considered a reliable test to determine kidney function.

Let’s explore the five stages of CKD.

1. Stage 1
   Kidney damage is present, but the eGFR is normal or slightly reduced. Individuals in this stage may not have noticeable symptoms.
2. Stage 2
   There is a mild reduction in kidney function, and symptoms may be apparent. However, for some individuals, they may still not experience noticeable symptoms. Complications, such as blood in the urine, kidney stones, or cysts, begin to arise in this stage.
3. Stage 3
   A moderate reduction in kidney function and symptoms like fatigue, swelling, and changes in urine output are becoming more serious. Blood and urine tests may show elevated levels of waste products.
4. Stage 4
   There is a severe reduction in kidney function, symptoms are pronounced, and complications are becoming more serious. During this stage, your doctor may begin preparing you for therapies like hemodialysis, which includes discussions with a nephrologist about potential treatment options and lifestyle modifications. Transplantation may also be considered.
5. Stage 5
   This stage is known as end-stage renal disease (ESRD) and is the most advanced stage of CKD. Kidney function is very low, symptoms are severe, and there is a high risk of complications that negatively impact other organ systems, like cardiovascular issues and bone health problems. Individuals in this stage often require hemodialysis or a kidney transplant for survival.

The Importance of Early Detection and Intervention

CKD is often called a “silent” disease because noticeable symptoms may not appear until the disease has progressed, making regular check-ups, preventive screening, early detection, and intervention critical for slowing its progression and improving health outcomes.

Regular monitoring through blood and urine tests is essential for individuals at risk or already diagnosed with early-stage CKD. Identifying and implementing treatment strategies during CKD early detection allows healthcare providers to manage risk factors, reduce the risk of severe complications, and potentially halt or delay further disease progression and kidney damage.

Taking a proactive approach to kidney health is the best way to improve long-term health outcomes and enhance an individual’s quality of life.

If you are concerned about your risk for CKD, talk to your healthcare provider. They can recommend the best tests and monitoring based on your overall health.

Diagnostic Tools and Tests

Here are four ways to detect CKD early.

1. Blood pressure
   Regular blood pressure monitoring to watch for signs of hypertension (high blood pressure), a leading cause of CKD. We recommend individuals with an elevated risk of CKD get their blood pressure checked at least annually.
2. Blood test
   A blood test measures the level of serum creatinine in your blood. Healthy kidneys filter out creatinine, so elevated levels in your blood could indicate a kidney problem.
3. Urine test
   An Albumin-to-Creatinine Ratio (ACR) urine test measures the albumin level in your urine. Healthy kidneys should allow little to no protein into the urine, so low levels in your urine could indicate a kidney disorder.
4. Regular health check-ups
   Annual check-ups and regular testing are critical for early detection of CKD and intervention therapies, especially for individuals with a family history of chronic kidney disease or other risk factors. It’s also important to seek immediate medical care if you notice early symptoms of CKD like fatigue, swelling, or decreased urine output.

What Are the Consequences of Untreated CKD?

If left untreated, chronic kidney disease can progress to kidney failure and early cardiovascular disease.

The first noticeable symptoms may include swelling in the hands and feet, followed by overwhelming fatigue and weakness. This happens because your body needs clean blood to function properly and maintain your overall health and wellness.

Without it, you will notice a sharp decline in your overall health as your kidney disease quickly progresses to end-stage renal disease (ESRD) and kidney failure.

To slow the progression of CKD, see your healthcare provider.

What Is the Connection Between CKD and Heart Health?

When an individual has chronic kidney disease, their kidneys aren’t functioning properly. This stresses a person’s heart as CKD requires it to pump harder and more often to get blood to the kidneys.

This can lead to heart damage and disease, the leading cause of death in the United States.

The relationship between CKD and heart health involves several key factors, making early detection of CKD and heart problems crucial.

• Hypertension

Uncontrolled high blood pressure is a common cause and consequence of CKD. It damages small blood vessels in the kidneys, accelerating the progression of CKD. However, CKD can also worsen hypertension, creating an unhealthy and potentially harmful cycle.

• Cardiovascular disease (CVD)
  Those with CKD have a higher risk of experiencing heart-related issues (e.g., heart attack, heart failure, and stroke). The reason for this is increased inflammation, oxidative stress (due to low antioxidant levels), and changes in blood vessel structure.
• Fluid and electrolyte imbalance
  CKD can lead to excess fluid buildup in the blood, which puts extra strain on the heart and contributes to cardiovascular complications.
• Anemia

CKD can lead to decreased red blood cell production, resulting in anemia. Anemia reduces the body’s capacity to carry oxygenated blood to various organs, including the kidneys, which can increase CKD complications and lead to heart-related issues.

CKD Treatment Options

Treatment options for CKD largely depend on the specific stage of the disease and its underlying causes. Talk to your doctor to determine which treatment options are right for you and your unique medical needs.

Here is a general guideline of treatment options by stage.

Stages 1 and 2

• Monitor and control blood pressure
• Monitor and control blood sugar
• Eat a healthy, well-balanced diet (e.g., whole grains, lean meats, leafy green vegetables)
• Do aerobic exercises for 30 minutes on most days of the week (e.g., walking, swimming, cycling, etc.)
• Get regular follow-ups and monitoring of kidney function

Stage 3

• Monitor and control blood pressure
• Monitor and control blood sugar
• Take prescription medication to manage anemia or bone and mineral disorders
• Modify diet to control protein, phosphorus, and potassium intake

Stage 4

• Monitor and control blood pressure
• Monitor and control blood sugar
• Take prescription medication to manage anemia or bone and mineral disorders
• Modify diet further to tighten control on protein, phosphorus, and potassium intake
• Learn about renal replacement therapies and have vascular access placed if hemodialysis is selected.

Stage 5

• Continue all treatments and modifications from stage four
• Initiate dialysis treatments
• Consider kidney transplant or palliative care (for those unable or unwilling to undergo further treatments)

Early detection of CKD is crucial because of its silent and often asymptomatic progression.

Regular health screenings are critical to preventive care and help detect, diagnose, and treat the disease before symptoms become apparent.

Through personalized treatments, lifestyle adjustments, and timely interventions, individuals can proactively manage CKD, ensuring longer, healthier lives.