Chronic Kidney Disease (CKD)
(Updated 16 April 2021)

What is chronic kidney disease (CKD)?

Chronic kidney disease (CKD) or chronic kidney failure is a long-term health condition where the kidneys are damaged and no longer functioning as they should. This refers to the ability of the kidneys to remove excess fluid and toxins from our body and to produce hormones that regulate our blood pressure and control the production of red blood cells in our body.

Chronic kidney disease is different from acute kidney injury or acute renal failure, where your kidney stops working suddenly due to causes such as:

– Traumatic injury with blood loss
Severe liver or heart failure
Autoimmune diseases (when your immune system attacks your body)
Sudden shock due to sepsis
Pregnancy complications such as eclampsia and preeclampsia
Enlarged prostate or kidney stones that blocks your urine flow
– Take certain drugs that damage the kidneys

Find out more about acute kidney injury here

When the kidney damage worsens, high levels of waste products are built up in our blood, causing health complications such as heart disease, weaker bones, anemia (when your body doesn’t produce enough red blood cells), breathlessness, muscle cramps, etc. 

These health problems usually happen gradually over a long period of time, so for most people, chronic kidney disease is usually discovered only at its late stages. However, regular health screening can help in early detection and treatment to keep chronic kidney disease from getting worse or leading to complete kidney failure. 

A kidney patient with end-stage kidney disease would require dialysis or a kidney transplant to stay alive. Dialysis helps in removing excess fluid, salt, and toxins from our body. It is usually done in a dialysis center, hospital or at home. 

This report presents the trends on incidence, prevalence and survival of Singapore residents with Chronic Kidney Disease (stage 5) and underwent dialysis or kidney transplant in 2009 to 2018.

Causes of chronic kidney disease

2 of the most common causes of chronic kidney failure are diabetes and high blood pressure. 

Diabetes happens when our blood sugar is too high, thus causing damage to the major organs in our body, such as our heart, blood vessels, and of course, our kidneys. 

High blood pressure (hypertension) occurs when the pressure of our blood against the walls of our blood vessels increases. When poorly controlled, this is when high blood pressure can lead to strokes, heart attacks, and chronic kidney disease. 

Other risk factors for chronic kidney failure include obesity, smoking, high cholesterol, and family history of kidney disease. 

Signs & symptoms of chronic kidney disease

Kidney disease symptoms usually show up only when it is at a serious stage. That is why it is crucial to be aware of conditions that may predispose you to kidney disease. The best way to know if you have kidney disease is to get blood tests for kidney function and urine tests. 

How Can You Identify Kidney Disease | Dr Francisco Salcido-Ochoa

The most common signs and symptoms of chronic kidney failure may include:

  • dark urine
  • blood in urine
  • protein in urine
  • decreased urine output
  • more frequent urination, especially at night
  • persistent itching
  • chest pain (fluid building up around the lining of the heart)
  • fatigue
  • loss of appetite
  • hypertension
  • decreased mental alertness
  • anemia
  • sleeplessness
  • muscle cramps
  • nausea
  • pain on the side or mid to lower back
  • shortness of breath (fluid building up in the lungs)
  • swelling of feet and ankles
  • high blood pressure (hypertension)

That being said, symptoms of chronic kidney disease are often non-specific (which means they can also be caused by other diseases). So regular health screening will help you detect kidney disease earlier to prevent progression of kidney disease to total kidney failure.

Diagnosing chronic kidney disease

People who are at greater risk kidney diseases or end-stage renal failure are those with:

  • Diabetes
  • Strokes
  • High blood pressure
  • Family history of kidney disease
  • Congestive or coronary heart disease
  • Prolonged use of non-prescription drugs

If you have these risk factors that puts you at higher risks of chronic kidney disease, be sure to have regular checkups and report any unusual symptoms to your doctor. Having these underlying diseases and health issues can slow down the progression of kidney damage.

Preliminary physical examination

Kidney failure may be causing fluids to fill up in your heart or/and lungs. Your doctor will usually examine these major organs by listening to them with a stethoscope to check your condition. 

Blood & urine tests

If your kidney specialist suspects that you might have chronic kidney disease, the next step is usually going for urine and blood tests before diagnostic or therapeutic decisions are made.

Urine tests are carried out to check for abnormalities in the protein level in your urine (a symptom that usually emerges before other symptoms of chronic kidney disease). Usually, protein is only present in trace amounts in your urine. Your urine sediment and cells will be examined in a laboratory. Having an elevated protein level in your urine may indicate kidney problems. 

Blood tests for kidney function measure the levels of electrolytes and waste (such as blood urea and creatinine which are excreted when our kidneys are working optimally) in our blood. 

Kidney imaging tests

Your nephrologist will usually also order for imaging tests such as a CT scan, MRI scan or ultrasound to check the structural details of your kidneys. 

Kidney biopsy

In the case where your renal specialist still needs confirmation on the cause of the symptoms you’re facing, you may need to go through a kidney biopsy (either open biopsy or needle biopsy). 

The Purpose of a Kidney Biopsy | Dr Francisco Salcido-Ochoa

 

For open biopsy, your renal specialist will perform an incision (surgical cut) with general anaesthesia to collect a sample of your kidney tissue.

Whereas for the less invasive needle biopsy, your kidney doctor will only need to insert a special needle into your kidney to collect your kidney tissue.

Your kidney tissue will then be sent to a lab for microscopic examination.

But it is important to note that kidney biopsy is not suitable for certain people, such as those who are taking blood thinners like aspirin, and when the kidneys are too small.

What happens if my test results show I may have chronic kidney disease?

The results of your blood and urine tests, imaging tests, and kidney biopsy will help your doctor make a diagnosis and determine the real cause of your kidney damage.

If you have chronic kidney disease, on top of regular blood tests and kidney function tests (to check urea and creatinine levels), you need to adopt a healthier lifestyle and a holistic renal diet

Stages of chronic kidney disease 

Stages of Chronic Kidney Disease | Dr Francisco Salcido-Ochoa

Early stages of CKD

Chronic kidney disease usually does not show obvious signs and symptoms during the early stage because our body can normally cope with the reduction in our kidney function. That is why we can donate one kidney to someone and still live a normal life as our remaining kidney works harder to compensate for the absent partner.

However, regular health screening with blood and urine tests can help discover potential kidney problems earlier before other chronic renal disease symptoms appear. This way, more regular tests can be conducted to monitor the patient’s condition, and renal diet or medicine can be prescribed to prevent the kidney problems from deteriorating.

Late stages of CKD

If not discovered early, people with kidney disease may experience undesirable symptoms such as blood and/or protein in the urine, increased frequency or urination, muscle cramps, poor appetite, etc. 

Changes in the GFR (Glomerular Filtration Rate) can be used to assess how advanced the kidney disease is (though the Glomerular Filtration Rate measurement alone is not sufficient to identify stage 1 and stage 2). The stages of chronic kidney disease (CKD) are classified as follows:

Stage 1: Kidney damage with normal or increased GFR (>90 mL/min/1.73 m2)

Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m2)

Stage 3a: Moderate reduction in GFR (45-59 mL/min/1.73 m2)

Stage 3b: Moderate reduction in GFR (30-44 mL/min/1.73 m2)

Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m2)

Stage 5: Total renal failure, or end-stage kidney disease (GFR < 15 mL/min/1.73 m2 or dialysis)

It is crucial for kidney disease to be diagnosed and treated as early as possible to avoid irreversible damage, especially those with diabetes. Diabetes patients should go for microalbuminuria test at least once a year to detect diabetic nephropathy early. Diabetic nephropathy is the chronic loss of kidney function occurring in those with diabetes mellitus.

Treatment for chronic kidney disease

There is no actual cure for chronic kidney disease. Upon total renal failure, the only true solution is a successful kidney transplant. The purpose of chronic kidney disease treatments are to ease the harmful symptoms, reduce further complications and slow down the deterioration of the kidney disease. 

Once the kidneys are no longer able to remove excess fluid and toxins from the body properly, kidney patients will have to first go for dialysis treatment to slow down the progression of kidney disease, such as haemodialysis and peritoneal dialysis

For haemodialysis, a kidney machine removes the extra fluids and waste products from your blood, while peritoneal dialysis uses the abdomen lining (the peritoneum) for the blood filtering process.

If you are suitable for a kidney transplant, and there is a suitable donor, you can receive a healthy kidney from the (living or deceased) donor. In most cases, the damaged kidney is usually left in place and the transplanted kidney is placed in the lower belly on the front side of the body. 

In some rare cases, your diseased kidney may need to be removed.

After the kidney transplant procedure, you need to take immunosuppressants, or anti-rejection medicines (which will weaken your immune system) to ensure that your body does not reject your new kidney.

How can I prevent chronic kidney disease?

If you have diabetes or high blood pressure (which are the most common causes of chronic kidney disease), the first step is to work with your doctor to keep your blood sugar and blood pressure under control.

Even if you seem healthy now, living a healthy lifestyle and adopting a healthy diet can help you prevent chronic kidney disease, such as exercising regularly, adopting a low fat and low salt diet, avoid foods with high levels of phosphorus, sodium, and potassium, not smoking or drinking excessive alcohol, and going for regular health screening.

Battling the chronic kidney disease (CKD) can be a daunting and exhausting journey. And the treatment for kidney diseases varies for everyone based on their medical history, current medical conditions, lifestyle and diet. That is why a personalised approach is crucial. If you need any advice on chronic kidney disease (CKD), feel free to reach out to Dr Francisco at Francisco Kidney & Medical Centre.

What is chronic kidney disease (CKD)?
Signs and symptoms of chronic kidney disease
Stages of chronic kidney disease
Diagnosing chronic kidney disease
Treatments for chronic kidney disease
How can I prevent chronic kidney disease?
Renal diet for chronic kidney disease patients
Kidney dialysis for chronic kidney disease patients