Could you have Chronic Kidney Disease? 1 in 10 people do.

Most people have 2 kidneys which quietly go about the business of removing toxins from the blood, balancing the amount of salt and water in the body, and producing urine, 24 hours a day. When all is well we pay them little attention, but without their vital work we would not survive very long. This is why people whose kidneys no longer work must attend for hours of dialysis several times each week.

Chronic Kidney Disease or CKD is an increasingly recognised condition where the kidneys progressively reduce their capacity to function in the above way. It is a gradual process usually, and can be hidden for years, unnoticed. In the early stages the only way to detect the changing kidney function is with a blood test.
1 in 10 people in the general population have CKD. That is a huge number, making it one of the more common long-term health risks. However, many people are entirely unaware of the diagnosis as symptoms often do not develop until very late stage disease. It is sobering to consider that the number of cases has DOUBLED in the past 10 year mainly due to the aging population.

It might be helpful to consider some terms here. Chronic in medical terms means ‘long term’ or ‘ongoing’ disease and does not reveal anything about the severity of the problem. It is not uncommon to think of dialysis or kidney transplant when hearing the term kidney disease, but rest assured these are very rare outcomes. For most people CKD is something that is detected on routine testing and then monitored. Occasionally further testing, such as ultrasound of the kidneys may be needed, and your doctor will certainly encourage you to reduce any other risk factors you have. The choice of medication you can safely take is also restricted by this condition. Medication you can safely take is also restricted by this condition.
Of course, without testing it remains a hidden risk.

What causes CKD?
Sometimes the kidneys become impaired for no obvious reason. In such cases all treatment is aimed at reducing the work the kidneys do and reducing all related risk factors.Some causes however are preventable or at the very least can be identified early, and this gives us a chance to avoid complications and manage it as a priority:

• CHRONIC DISEASE. By far the most common causes are Hypertension (raised blood pressure) and Diabetes. This is one reason why doctors monitor the kidneys through blood and urine tests regularly in people with these conditions.
• MEDICATION. Long term use of some pain relievers or anti-inflammatory medications can also be a cause, and this is one area where our day to day behaviour may be a risk. Other medications implicated include ACE inhibitors, Lithium, Cyclosporin and Tacrolimus.
• OBSTRUCTION. Mechanical blockages in the outflow of urine, either by kidney stones or an enlarged prostate may cause CKD.
• INHERITED DISEASE. There are also some inherited conditions such as polycystic kidney disease, which may make CKD more likely.
• INFECTION. Infection of the kidney, known as pyelonephritis, and inflammatory conditions in general, are rarer causes.
• AGE. CKD is more common in the elderly as there tends to be a natural decline in function as we age.

Kidneys and the Heart - Perhaps surprisingly CKD is a risk factor for heart disease, in much the same way that smoking or high cholesterol are risk factors. There is a close link between High blood pressure and the functioning of the kidneys. People with CKD often have raised BP and raised BP can make kidney issues worse. But what does this mean for people who have the condition?

Managing CKD - For many people there is no need to start a new medicine. Treatment is initially guided by monitoring of the kidney function through blood tests and sometimes urine tests. Blood pressure has to be firmly controlled and this may involve medication, however lifestyle interventions are equally as important. Treatment of raised cholesterol and diabetes are also priorities.
If you are diagnosed with CKD, taking regular exercise, keeping your weight down and avoiding smoking are very helpful interventions. Alcohol and salt should also be kept to a minimum.

The take home message - As doctors we are increasingly aware of the need to test for this hidden problem and manage it as a priority in those affected. The simple messages are:

• CKD is on the rise.
• CKD is a risk factor for vascular disease.
• Many people with CKD are not diagnosed.

If you think you may be in a higher risk group such as those mentioned above, or if you have not had a blood test for some time, consider being screened for CKD much as you would for raised cholesterol or diabetes. The outcomes are excellent for those we are able to identify and treat.
I hope this is helpful.