Chronic kidney disease (CKD), also called chronic kidney failure, is a long-term condition where the function of your kidneys gradually declines. There are many possible causes of impaired kidney function. But it is worth noting that kidney function can decline (to a degree) not just with normal ageing. Chronic Kidney Disease is not uncommon - it is estimated that around 7.2 million people in the UK have Chronic Kidney Disease but the majority of people with the condition will be entirely unaware.

Your kidneys play an important role in filtering waste and excess fluids from your blood.

CKD can get worse over time and, while it’s uncommon if CKD progresses to an advanced stage, dangerous levels of fluid, electrolytes and waste will build up in your body and you need to consider dialysis or a kidney transplant.

Because many causes of chronic kidney disease have no symptoms it is often only usually detected by the results of blood or urine tests.

With the correct treatment and management, many people with CKD can have the progression of their disease slowed or halted.

Stages of kidney failure

There are 5 “stages” of chronic kidney disease–from stage 1, which is very mild, to stage 5, which is kidney failure. Please note that the term stage is used to define the severity of CKD is stages but this is not a cancer related disorder

The stages are based on how well your kidneys can filter out waste from your blood. This is determined with a blood test that measures your global kidney function or the estimated glomerular filtration rate (eGFR).

As CKD progresses through each stage, symptoms worsen. The main symptoms of each stage of CKD are as follows:

Early-stage CKD (stages 1 and 2)

Stage 1 CKD means you have a normal eGFR of 90 or greater. Your kidneys may not be showing symptoms outwardly however, even with a normal eGFR you may be leaking protein into your urine of have structurally abnormal kidneys eg multiple cysts or some internal scarring.

Stage 2 CKD means your eGFR is between 60 and 89. This indicates mild damage to your kidneys. Again, you are unlikely to have any symptoms but you may have features associated with mild kidney damage.

Features of stage 1 and 2 CKD can include:

• High blood pressure

• Swelling in your hands or feet

• Protein in your urine (proteinuria), which can be detected by a urine test

• Blood in your urine (hematuria)

Moderate CKD (stages 3 and 4)

Stage 3 CKD means you have an eGFR between 30 and 59. This is mild to moderate damage to your kidneys which may begin to cause symptoms. With the right treatment and some healthy lifestyle changes, many people with stage 3 CKD do not progress to stage 4 of 5.

CKD stage 3 is often not associated with symptoms and is most usually detected by blood tests but occasionally certain symptoms can occur on top of the previously listed symptoms which may include:

• Feeling weak and tired

• Swelling in your hands or feet

• Dry or itchy skin

• Muscle cramps

• Trouble sleeping 

• Restless leg syndrome

• Urinating more often than normal

• Dark or foamy urine

Stage 4 CKD means you have an eGFR between 15 and 29 and the damage to your kidneys is moderate to severe. Your kidneys no longer work as well as they should, so you’re likely to notice symptoms.

Symptoms of stage 4 CKD may include:

• Feeling weak and tired

• Swelling in your arms or legs

• Urinating more often than normal

• Muscle cramps

• Feeling sick or vomiting

• A reduced appetite

• Poor concentration

• Itchy skin

Perhaps one of the most important consequences of CKD is that it is associated with a higher risk of other problems, most particularly high blood pressure, bone disease and heart disease.

End-stage kidney disease (stage 5)

Stage 5 CKD means you have an eGFR of less than 15 and your kidneys are severely damaged and you are close to kidney failure.

When your kidneys have stopped working, waste products are no longer filtered out of your body so start to build, which can make you sick.

Symptoms of stage 5 CKD include:

• Feeling weak and tired

• Swelling in your arms, hands, legs or feet

• Headaches

• Lower back pain

• Muscle cramps

• Feeling sick or vomiting

• Reduced appetite

• Trouble breathing or shortness of breath

• Changes in your skin colour

• Poor concentration

• Itchy skin

What causes chronic kidney disease?

Causes of chronic kidney disease

Chronic kidney disease is caused by kidney damage that usually happens over the course of several years. However, on occasions chronic kidney disease can be acute.

Common health conditions that damage the kidneys and lead to the development of chronic kidney disease include:

• Diabetes – Diabetes is the leading cause of CKD. This is due to prolonged high blood sugar levels damaging kidney blood vessels

• High blood pressure (hypertension) – Hypertension may strain on kidney function over time and is the second most common cause of CKD but is generally more prevalent in the US as biopsies are usually less frequent

• Glomerulonephritis – This is an inflammatory type of kidney disease where damage occurs to the kidney’s filtering units (the glomeruli)

• Autoimmune diseases – Conditions such as Lupus Nephritis cause the body to attack kidney tissues these can also cause glomerulonephritis

• Polycystic kidney disease (PKD) – This is a genetic disorder that leads to fluid-filled cysts in the kidneys that reduce function

Who is at risk of CKD?

Anyone can get chronic kidney disease, but certain factors can increase your risk. These include:

• Ageing – Kidney function naturally declines with age

• Ethnicity – There is a higher prevalence of CKD in Black, South Asian and Hispanic populations

• A family history of kidney disease

• Certain health conditions, including those listed above

• Having abnormal kidney structure or size

• Lifestyle factors – Smoking, obesity, poor diet and excessive alcohol consumption

• A long history of NSAID (nonsteroidal anti-inflammatory drugs) use

How is chronic kidney disease diagnosed?

At OneWelbeck, our specialists use diagnostic techniques to accurately diagnose chronic kidney disease and identify the stage of the condition to provide you with the most appropriate management plan.

Diagnostic tests

• Blood tests can be used to check how well your kidneys are removing a waste products and measure your estimated glomerular filtration rate (eGFR), which determines the stage of kidney disease. Specific blood tests can also be used to help diagnose the underlying cause of your kidney dysfunction, including looking for markers of autoimmunity, blood problems and viral infections

• Urine tests can be used to detect blood/ and or protein called (particulaly albumin) in your urine, both of which indicate ongoing damage to your kidneys

• Imaging scans such as ultrasound, MRI scans and CT scans can be used to look for structural abnormalities in the kidneys

• A kidney biopsy may be performed to determine the underlying cause and amount of kidney damage

The Kidney Health Check

When assessing kidney health the key parameters we look for are the blood test for GFR, urine abnormalities and particularly the presence of albuminuria in and how well your blood pressure is controlled.These three elements together comprise the basic kidney health check.

How chronic kidney disease is treated at OneWelbeck

Over the last 10 years there have been extraordinary advances in the management of CKD with the introduction of new drugs that effectively and safely slow down deterioration of kidney function in people who have CKD. The kidney team at OneWelbeck are committed to ensuring that all people with kidney disease have the underlying cause specifically treated and are optimised on the best management that will preserve their kidney function for their natural life.

Lifestyle and medication management for CKD

Lifestyle changes and medications can help slow down progression. Treatment options and lifestyle advice can include:

• Dietary changes – Reducing your salt and protein intake

• Blood pressure control – Medications like ACE inhibitors (drugs with names ending in pril) and ARBs (drugs with names ending in sartan) may be prescribed to lower blood pressure and help protect your kidney function

• SGLT2 inhibitors or “Flozins” - are drugs that help slow down the progression of CKD

• Other treatments  -  a number of other drugs including Nonsteroidal mineralocorticoid receptor antagonists (nMRA) may be prescribed to  help prevent further kidney damage

• Diabetes management – Better glucose control can help to slow down diabetes-related damage

• Staying active – Regular exercise can help you shift any excess weight, which is a risk factor for CKD

• Diuretic medications - Medicines that help your kidneys to get rid of salt and water and make you urinate more can help relieve swelling

• Iron supplements – To help treat anaemia if your condition has caused there to be a low level of red blood cells in your body

• Stopping certain medications – No longer taking medicines like non-steroidal anti-inflammatories (such as nurofen and voltarol) and some arthritis medicines that can worsen kidney damage. This will be need to be discussed in further detail with your doctors to ensure that a holistic view of your overall health is taken.

• Treating the underlying cause -  Starting new medications such as immune suppression for autoimmune disorders of the kidney or anti-viral agents if associated with infections such as Hepatitis C or HIV can slow down progression

Treatment for kidney failure (Stage 5)

If you have stage 5 CKD, your kidneys are very close to failure or have failed. This is also known as end-stage kidney disease (ESKD). The treatment options for stage 5 CKD are dialysis, kidney transplant or maximal supportive therapy.

Dialysis

Dialysis is a treatment that uses machines to remove waste products from your body when your kidneys can’t. There are two major types of dialysis: haemodialysis and peritoneal dialysis.

Hemodialysis circulates your blood through a machine that removes waste products and excess water and salt before returning it to your body. Each haemodialysis treatment takes approximately 4 hours and is generally done 3 times a week.

In peritoneal dialysis, a dialysis solution is inserted directly into your abdomen through a catheter to absorb waste before being removed via the same catheter. This can be repeated 4 times a day, or a machine can be used overnight to automatically fill, remove and refill the fluid.

Kidney transplant

Unlike other types of organ donation, a donor kidney can come from two sources: living donors and deceased donors.

If you’re put on a transplant list to receive a kidney from a deceased donor, it may take a few years for a suitable match to be found. Getting a kidney from a living donor tends to be quicker as the donation usually comes from a family member, partner or friend who is a match and willing to donate. This

Maximal Supportive Therapy

With proper discussion and explanation some people choose not to have dialysis or transplant and receive symptomatic treatment only. This

Why choose OneWelbeck for CKD treatment?

At OneWelbeck, our kidney consultants are leaders in their field and are experienced in providing specialist care and treatment to patients with CKD.

With access to advanced diagnostic technology, our kidney consultants can detect CKD in its earliest stages and provide the necessary treatments to slow the progression of the condition.

Taking a multidisciplinary team approach, our kidney consultants work alongside dietitians, cardiologists and urologists to provide holistic world-class care.

Get in touch today to make an appointment with one of our leading kidney consultants