Chronic Kidney Disease, often abbreviated as CKD, is a condition characterised by a gradual loss of kidney function over time.
The kidneys, a pair of bean-shaped organs below the ribcage, are essential in filtering waste and excess fluids from the blood. When CKD progresses, it can lead to kidney failure. When that happens, it necessitates dialysis or a kidney transplant. For this article, we consulted with Dato’ Dr. Ong Yoke Meng. Dato’ Dr Ong is a nephrologist & physician at Island Hospital, Penang. He retired from the Ministry of Health (MOH) in 2022, where he served as the Head of Nephrology Services and the Head of the Department of Medicine at Penang Hospital.
What Exactly is CKD?
Tiny units called nephrons sit at the core of the kidneys and act as filters. When damaged, they can’t filter blood anymore. Over time, the damage can accumulate, leading to chronic kidney disease.
The Five Stages of CKD
CKD is classified into five stages, with stage 1 being the mildest and stage 5 (or end-stage renal disease, ESRD) being the most severe:
- Stage 1: Kidney damage with normal or elevated filtration.
- Stage 2: Mildly reduced kidney filtration.
- Stage 3: Moderately reduced kidney filtration.
- Stage 4: Severely reduced kidney filtration.
- Stage 5: Kidney failure or ESRD.
Common Causes of CKD
- Diabetes: High blood sugar levels can damage the nephrons over time.
- High Blood Pressure: Like diabetes, elevated blood pressure over extended periods can cause harm to the nephrons.
- Other Causes: Glomerulonephritis, polycystic kidney disease, prolonged urinary tract issues, and inherited conditions can also lead to CKD.
Spotting the Symptoms
In the early stages, CKD often goes unnoticed as symptoms may not manifest. However, as kidney function deteriorates, one might experience:
- Fatigue and weakness
- Swollen ankles, feet or hands
- Shortness of breath
- Blood in urine
- Frequent urination during the night
Dr Ong warned that “CKD can be symptomatic or in many cases do not have symptoms. Symptoms can include swelling around the eyes or feet or, more generalised, urinary symptoms like increased frothiness of urine (usually a sign of excessive protein in the urine), blood in the urine, reduced or changes in urination.”
He added, “Symptoms of kidney failure tend to occur late and are often non-specific, e.g. lethargy, reduced appetite, nausea, vomiting, breathlessness, pallor, darkening of the skin etc. Similar to blood pressure and diabetes, CKD is often a silent disease, and you may not know that you have kidney disease unless you check your urine and blood.”
Early diagnosis can help manage the disease better. Doctors typically use:
- Blood tests: To measure the Glomerular Filtration Rate (GFR), indicating how well the kidneys filter blood.
- Urine tests: To check for protein or blood, which can signify kidney damage.
- Imaging tests: Like ultrasounds, to visualise the kidneys.
- Biopsy: A small sample of the kidney may be extracted to determine the cause or extent of the damage.
Treatment and Management
Early diagnosis and treatment can slow the progression of CKD. As explained by Dr Ong, general supportive measures comprise treatment to, firstly, slow the progression of the kidney disease and, secondly, treatment of complications of kidney disease.
As a final resort, Dr Ong stated that “Dialysis is only required when the kidney function has deteriorated to about 7% function. However, preparation for dialysis has to begin much earlier and not wait until the patient has symptoms of kidney failure. The function of dialysis is to replace the kidneys by removing toxins and excess fluid from the body but does not help the kidneys per se. If patients are otherwise fit, kidney transplant is better than dialysis, but kidneys are not widely available.”
Prevention: Your Best Line of Defence
Dr Ong recommends early prevention. He stated, “Prevention of kidney disease starts from identifying those who are more prone to kidney disease, e.g. diabetes, high blood pressure, kidney stones, other medical diseases which can affect the kidneys, the elderly, and those frequently taking painkillers. 50-60% of kidney failure in Malaysia is due to diabetes.”
He added that “Diabetes and high blood pressure need to be well controlled,, and patients need to see their doctors regularly. Patients should avoid taking painkillers as much as possible, especially those who have been known to have CKD and also the elderly. Some traditional medicines and herbs contain substances that can cause kidney problems. In warm weather, drinking more water will prevent dehydration and is important to prevent the recurrence of stones. However, drinking excessive amounts of water can be harmful.”
Chronic Kidney Disease remains a pressing public health concern with far-reaching implications. Awareness, early diagnosis, and appropriate medical interventions are crucial to manage and mitigate its impacts. We need to stay informed and maintain a kidney-friendly lifestyle. By doing so, we can reduce the risks associated with CKD.