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Understanding Chronic Kidney Disease

By Dr. Aniket Hase +2 more

Introduction

Our kidneys play a significant role in filtering waste and excess fluids from the body. But when their function is affected for a long period of time, it results in a condition known as Chronic Kidney Disease (CKD)1.  

CKD is found to affect about 13.4% of individuals across the world. What makes these statistics even more alarming is the fact that most of these people are unaware of this condition until later stages, with around 4-7 million people requiring kidney replacement therapy2. CKD is a silent killer, with no obvious symptoms until there is significant damage. This is the reason why awareness and early detection is crucial. If left unnoticed CKD can progress into kidney failure, heart disease or even death. 

What is Chronic Kidney Disease (CKD)?

CKD is a condition where the kidneys get damaged over time, leading to poor blood filtration. Due to kidney damage, there is an accumulation of toxic waste and extra fluids, which may result in high blood pressure, heart disease, stroke, and early death. People who have CKD or are at risk of developing it can work with their health care providers to take measures that help safeguard kidney health1

What Causes Chronic Kidney Disease?

CKD can develop in anyone regardless of age. It develops when an underlying illness or condition reduces kidney function, leading to progressive damage over months or years. 

Chronic kidney disease causes:

  • Major causes 
  • Diabetes (caused due to high blood sugar) 
  • High Blood Pressure 
  • Secondary causes 
  • Acute Kidney Disease (sudden but usually reversible decline in kidney function) 
  • Kidney stones with complications 
  • Autoimmune Disorders (body’s immune system attacks its own cells) 
  • Lupus (body’s immune system attacks its own tissues)  
  • Good pasture’s disease/ anti-glomerular basement membrane disease (body’s immune system makes antibodies that attack the kidneys) 
  • Glomerular disease 
  • Membranous nephropathy (protein loss due to immune attacks on glomerulus) 
  • Focal segmental glomerulosclerosis (scarring of glomerulus) 
  • IgA nephropathy (kidney inflammation due to IgA deposits) 
  • IgA vasculitis (blood vessel inflammation due to IgA deposits) 
  • Hepatorenal syndrome (kidney damage due to liver disease) 
  • Cardiorenal syndrome (kidney damage due to heart disease) 
  • Metabolic syndrome (a group of conditions like obesity, high blood pressure etc that increase the probability of kidney disease) 
  • Polycystic kidney disease (genetic disorder causing fluid-filled cysts to grow in the kidneys) 
  • Rare genetic conditions 
  • Alport syndrome (genetic disorder affecting the glomerulus) 
  • Uromodulin associated kidney disease (abnormal protein made in kidneys that stress and damage the kidney cells) 
  • Renal artery stenosis (narrowing of kidney blood supply) 
  • Severe obesity (excess weight straining the kidneys) 
  • Sickle cell disease (abnormal red blood cells)3 

What Are the Risk Factors?

Certain conditions increase your risk of getting CKD. These include:  

  • Old age1 
  • Misuse of painkillers1 
  • Smoking1
  • Being Black, Native American, or Asian American1 
  • Diabetes4 
  • High blood pressure4 
  • Heart (cardiovascular) disease4 
  • Obesity4
  • Family history of kidney disease4 
  • Acute Kidney Failure (if severe) 

Signs and Symptoms

Signs and symptoms appear gradually when kidney damage advances slowly. Declining kidney function may lead to fluid retention, accumulation of waste in the body, or disturbances in electrolyte balance5

  • Early-stage symptoms: The initial symptoms are very subtle and very similar to several other conditions. Possible early symptoms include: 
    • Reduced appetite 
    • Fatigue 
    • Headache  
    • Dry, itchy skin 
    • Nausea 
    • Weight loss 
  • Late-stage symptoms: As the kidney function gradually declines, further several symptoms appear such as: 
    • Trouble focusing, drowsiness, or confusion 
    • Easy bruising or bloody stool 
    • Shortness of breath 
    • Unusually dark/pale skin 
    • Bone pain 
    • Numb feeling in hands and feet 
    • Frequent hiccups 
    • Amenorrhea (absence of menstrual cycle) 
    • Difficulty sleeping 
    • Vomiting 
    • Sleep problems  
    • Swelling in the limbs 
    • Excessive thirst 
    • Odour in breath 

Diagnosis of Chronic Kidney Disease

Chronic kidney disease (CKD) happens when the kidneys are damaged and can’t clean the blood properly. 

Doctors usually use two main tests to check kidney health: 

To confirm CKD, these tests are repeated to show that kidney damage is long-term, lasting at least three months. 

Stages of Chronic Kidney Disease

CKD is classified into five stages based on estimated glomerular filtration rate (eGFR) by CKD EPI formula, and into three stages based on the level of albuminuria7. Table 1 explains the stages of CKD based on eGFR and table 2 explains the stages of CKD based on albuminuria levels. 

Stage of CKD eGFR result Interpretation 
Stage 1 90 or higher Mild kidney damage; kidneys function normally 
Stage 2 60-89 Mild damage; kidneys still function normally. 
Stage 3a 45-59 Mild to moderate damage; kidney function is reduced. 
Stage 3b 30-44 Moderate to severe damage; the kidneys function below normal. 
Stage 4 15-29 Severe damage; kidneys are nearly nonfunctional. 
Stage 5 Less than 15 Most severe damage; the kidneys are very close to failing or have stopped functioning. 

Table 1:  Chronic Kidney Disease stages based on eGFR value6 

Category Albuminuria level Interpretation 
A1 <30 mg/g or <3 mg/mmol Kidneys are functioning well or only slightly affected. 
A2 30–300 mg/g or 3–30 mg/mmol Indicates kidney damage; requires closer monitoring and management. 
A3 >300 mg/g or >30 mg/mmol Significant kidney damage; high risk of kidney failure and heart disease. 

Table 2: Chronic Kidney Disease stages based on Albuminuria6 

Knowing the CKD stage helps to: 

  • Estimate how quickly the disease might progress 
  • Understand the risk of complications, such as heart disease 
  • Plan the most suitable treatment options 

Complications

When kidneys fail to function correctly, they cause problems throughout the body, including8

  • Hypertension: Usually poorly maintained. Speeds up the CKD progression 
  • Salt and fluid imbalance: very common in stages 3 to 5. Causes oedema, hypertension, and thickening of heart valves. 
  • Hyperkalaemia (excess potassium in blood) 
  • Metabolic acidosis: acid buildup as a result of reduced excretion. 
  • Hyperphosphatemia (excess phosphorus in blood) 
  • Anaemia: Due to low erythropoietin/ iron 
  • Cardiovascular disease: can lead to thickened heart muscles, valve problems, and calcium deposit in blood vessels.  
  • Uremic symptoms: loss of appetite, fatigue, muscle degradation, itching, nausea, restlessness (in legs), poor sleep and sexual problems. 

Chronic Kidney Disease Treatment

Although CKD has no cure, the symptoms can be managed through treatments and slow the progression. The approach depends on the disease stage.  

1. Lifestyle changes

  • Quit smoking8 
  • Eat a balanced, low salt diet8 
  • Exercise regularly8
  • Limit alcohol8
  • Maintain a healthy weight8
  • Avoid NSAIDS unless prescribed8

2. Medications to manage

  • Blood pressure: Drugs like ACE inhibitors, ARBs (angiotensin receptor blockers), Beta-blockers, Calcium channel blockers are used to keep blood pressure under control1,8
  • Diabetes: Oral antidiabetic drugs (like biguanides or sulfonylureas) and insulin help lower blood sugar levels1,8 
  • Cholesterol: Statins is the most common type of medication used to lower cholesterol1,8 
  • Hyperkalaemia: Calcium salts, Potassium binders, and Diuretics are used to control/ lower high potassium levels1,8
  • Swelling: Diuretics such as thiazides are used to remove extra fluid from body1,8
  • Anaemia: Iron supplements, and Erythropoiesis-stimulating agents (trigger red blood cell production) like ferrous sulphate or shots1,8 
  • Weak bones: Calcium supplements and vitamin D analogues and Phosphate binders to strengthen bones1,8  
  • Inflammation: NSAIDs (pain relievers) like ibuprofen reduce swelling in heart lining/lungs (must be used responsibly, only with a prescription. As NSAIDs are often avoided in CKD1,8.) 

3. Advanced treatments

  • Dialysis: Filters blood artificially (haemodialysis or peritoneal dialysis)1
  • Kidney transplant: Best long-term option but requires lifelong immunosuppressants1
  • Supportive (palliative) care: For those who choose not to pursue dialysis/transplant, focusing on symptom relief and quality of life1.  
  • Vaccinations: When diagnosed with CKD the patient must be up-to-date on the following vaccinations8

Early management through lifestyle changes and medications can delay CKD progression, while dialysis or transplant becomes vital in the later stages. Regular monitoring and doctor consultations are crucial for more efficient treatment. 

Symptom Management and Prevention Strategies

Some steps can protect the kidneys from further damage when diagnosed with CKD. The earlier the detection, the better the outcome. Protecting the kidneys can also prevent heart disease and improve overall health9.  

  • Control Blood Pressure: High blood pressure accelerates kidney damage by straining blood vessels. Maintaining blood pressure below 140/90 mmHg (or as a doctor advises) is crucial. This can be achieved through a low-sodium diet, regular exercise, stress management, and medications like ACE inhibitors or ARBs, which also protect kidney function. 
  • Manage Blood Sugar (If diabetic): Uncontrolled diabetes harms the kidneys by damaging their filtering system. Consistently checking blood glucose levels and maintaining an A1C below 7% helps prevent further kidney decline. Adjusting diet, staying physically fit, and taking diabetes medications as prescribed are essential to keep blood sugar in check. 
  • Monitor Kidney Function with Regular Tests: Tracking eGFR (kidney filtration rate) and urine albumin helps assess kidney function over time. Declining GFR or rising albumin levels signal worsening disease. Discussing test results with a doctor ensures timely treatment adjustments to slow kidney damage. 
  • Prepare for Doctor Visits Effectively: Writing down questions about test results, medications, diet, and symptoms before appointments ensure no concerns are missed. Bringing a family member or friend helps remember advice and provides support. Keeping a health journal can also help track progress. 
  • Work Closely with Your Healthcare Team: A nephrologist (kidney specialist), dietitian, pharmacist, and primary care doctor all play roles in managing kidney disease. Dietitians create kidney-friendly meal plans, pharmacists check for safe medications, and social workers assist with treatment logistics like dialysis planning. 
  • Take Medications Safely: Some drugs, like ACE inhibitors and ARBs, protect the kidneys, while others (e.g., NSAIDs like ibuprofen) can cause harm. Always consult a doctor before taking new medications. Keeping an updated medicine list helps avoid dangerous interactions. 
  • Follow a Kidney-Friendly Diet: A diet low in sodium, processed foods, and excess protein reduces kidney strain. A dietician can tailor meal plans to individual needs, balancing nutrition while managing blood pressure, diabetes, and waste buildup in the blood. 
  • Adopt a Healthy Lifestyle: Regular exercise, avoiding smoking, getting enough sleep, and maintaining a healthy weight all support kidney health. Managing stress with relaxation techniques or counselling also helps, since ongoing stress raises blood pressure and harms overall well-being. 

Living with CKD

Chronic kidney disease (CKD) requires careful management, but not everyone with the condition progresses toward kidney failure. With the right strategies in place, further harm to the kidneys can be prevented. 

Many people with CKD can maintain a good quality of life through self-management. Critical components of self-care are the following10

  • Fostering social connections 
  • Sustaining an active lifestyle 
  • Following prescribed medications 
  • Consuming appropriate kidney dietary meals 
  • Quit smoking 
  • Limit alcohol consumption 
  • Keep blood pressure below 140/90 mm Hg 
  • Monitor and manage blood sugar range 
  • Get annual flu shot 

Patients play a central role in achieving good health outcomes through self-management. At each process step, health care providers are available to support and guide the patient. 

When to See a Doctor?

Knowing the risk factors and paying attention to the warning signs of kidney problems is very important. Things like swelling in legs or face, fatigue, changes in urination without any definitive reason shouldn’t be ignored. People with risk factors (diabetes, high blood pressure or family history of CKD) also need to be extra careful. Spotting these signs early and getting a consultation will help catch problems in early stages, slows down kidney damage and prevents complications5. The patient must be referred to a nephrologist under the following circumstances7

  • GFR < 60mL/min/1.73 m² 
  • GFR drops ≥ 25% or > 5 mL/min per year 
  • Significant albuminuria (protein in urine) 
  • Persistent unexplained blood in urine 
  • Secondary hyperparathyroidism, metabolic acidosis, or anaemia from low EPO 
  • High BP not controlled with 4+ drugs 
  • Ongoing potassium imbalance 
  • Recurrent/severe kidney stones 
  • Hereditary or unknown cause of CKD 

Conclusion

CKD is when the kidneys are damaged and fail to filter blood effectively. CKD leads to a gradual decline in kidney function, causing kidney failure. Conditions like diabetes and high blood pressure can lead to CKD. Even though there is no cure, several steps can be taken to prevent this condition. In individuals with CKD, working in collaboration with the healthcare provider for proper treatment and adapting to a healthier lifestyle can help preserve kidney function and lead a normal life.  

Frequently Asked Questions (FAQs)

What are other conditions that mimic chronic kidney disease but are reversible if treated early? 

-Acute kidney injury 
-Renal artery stenosis (narrowing of kidney blood supply) or thrombosis (blood clots in kidney vessels) 
-Multiple myeloma (cancer of the plasma cells) 
-Obstruction to kidney tract by kidney stones or other causes.  
-Rapidly progressive Glomerulonephritis (rapid decline in kidney function) 
-Severe hypertension1

How is my diabetes related to my kidney function? 

Elevated blood sugar levels tent to damage blood vessels in the kidneys and nephrons (filtration units of the kidneys). This results in the decline of kidney function. Therefore, regularly checking blood glucose levels and adjusting your lifestyle based on the results can help your kidney’s function and may prevent CKD8.  Earliest manifestation is leakage of protein albumin in urine. 

Are there medications I should avoid with CKD? 

Painkillers like ibuprofen, diclofenac, aceclofenac and indomethacin can lead to kidney damage. Taking more than the advised amount of medication can be harmful. It is essential to follow the prescribed dose carefully. Since the kidneys are responsible for filtering medicines, using them correctly helps avoid extra stress on these organs. If pain relief is needed often, doctors can suggest safer options11

Can I prevent kidney disease and how? 

Yes, CKD can be prevented. All patients with risk factors like diabetes, hypertension, obesity, recurrent Urine infections, kidney stones should be tested to detect early kidney damage by urine albumin creatinine ratio and serum creatinine test. Good control of diabetes, hypertension, control of weight can help prevent kidney damage and CKD12.  

References

  1. Vaidya, S.R. (2024) Chronic kidney disease, StatPearls [Internet]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK535404/  (Accessed: 18 August 2025).  
  2. Lv JC, Zhang LX. Prevalence and Disease Burden of Chronic Kidney Disease. Adv Exp Med Biol. 2019;1165:3-15. Available at: https://pubmed.ncbi.nlm.nih.gov/31399958/  
  3. Causes of chronic kidney disease in adults – niddk (2025) National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/causes (Accessed: 18 August 2025).  
  4. Center for Disease Control (2024, May 15). Risk Factors for Chronic Kidney Disease. Retrieved August 22, 2025, from https://www.cdc.gov/kidney-disease/risk-factors/index.html 
  5. National Library of Medicine (2023, August 28). Chronic Kidney Disease. Medlineplus. Retrieved August 22, 2025, from https://medlineplus.gov/ency/article/000471.htm 
  6. Testing for chronic kidney disease (2024) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/kidney-disease/testing/index.html  (Accessed: 18 August 2025).  
  7. Ammirati AL. Chronic Kidney Disease. Rev Assoc Med Bras (1992). 2020;66Suppl 1(Suppl 1):s03-s09. Published 2020 Jan 13. doi:10.1590/1806-9282.66.S1.3. Available at: https://pubmed.ncbi.nlm.nih.gov/31939529/  
  8. Bello AK, Alrukhaimi M, Ashuntantang GE, et al. Complications of chronic kidney disease: current state, knowledge gaps, and strategy for action. Kidney Int Suppl (2011). 2017;7(2):122-129. doi:10.1016/j.kisu.2017.07.007. Available at: https://pubmed.ncbi.nlm.nih.gov/30675426/  
  9. Managing chronic kidney disease – NIDDK (2016) National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/managing  (Accessed: 15 August 2025).  
  10. Living with Chronic Kidney Disease. (2024, May 15). Chronic Kidney Disease. https://www.cdc.gov/kidney-disease/living-with/index.html  
  11. Baker M, Perazella MA. NSAIDs in CKD: Are They Safe?. Am J Kidney Dis. 2020;76(4):546-557. doi:10.1053/j.ajkd.2020.03.023. Available at: https://pubmed.ncbi.nlm.nih.gov/32479922/  
  12. Hemodialysis – NIDDK. (2025, August 11). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis#working-hd 

Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.

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