Definition

Chronic kidney disease (CKD) is a long-term condition characterized by decreased kidney function. This condition is commonly found in older individuals. Currently, the global prevalence of CKD is estimated to be 843.6 million cases. According to the Riskesdas data from 2018, in Indonesia alone, an estimated 713,000 individuals are affected by CKD.

CKD is classified into five stages, with the fifth stage being the most severe, known as kidney failure or end-stage renal disease. Patients in the fifth stage require dialysis to filter blood and remove waste products, as the kidneys can no longer perform this function.

Causes

Chronic kidney disease (CKD) often arises as a complication of other health conditions that impair kidney function. Commonly, CKD results from a combination of several factors, including:

• High blood pressure: Persistent high blood pressure can strain the small blood vessels in the kidneys, impairing their function over time.
• Diabetes: Elevated blood glucose levels can damage the small filters in the kidneys, leading to CKD.
• High cholesterol: Excessive cholesterol levels can cause the buildup of fatty deposits in the blood vessels supplying the kidneys, hindering proper kidney function.
• Kidney infections and inflammation (glomerulonephritis): Infections and inflammation can damage kidney tissues and impair their function.
• Polycystic kidney disease: An inherited condition characterized by the development of cysts in the kidneys, which can interfere with their function.
• Blockage of urine flow: Conditions such as recurrent kidney stones or an enlarged prostate can obstruct urine flow, leading to kidney damage.
• Long-term use of certain medications: Some medications, like lithium and non-steroidal anti-inflammatory drugs (NSAIDs), when used over an extended period, can contribute to kidney damage.

Risk factor

Although chronic kidney disease (CKD) can affect anyone, it is more prevalent in individuals with dark skin or of South Asian ethnicity. Additionally, a family history of CKD or inherited kidney disease increases the risk of developing CKD.

Symptoms

Chronic kidney disease (CKD) can range from mild symptoms or no symptoms at all to severe kidney failure. Typically, CKD is detected during routine blood or urine examinations conducted for other purposes, revealing abnormalities in kidney function.

Kidney disease often goes unnoticed in the early stages as the body can compensate for the significant reduction in kidney function. However, in advanced stages, symptoms may include:

• Fatigue
• Swelling in the ankles, feet, or hands due to fluid retention
• Shortness of breath
• Nausea
• Decreased appetite
• Weight loss
• Blood in the urine
• Increased frequency of urination, especially at night
• Difficulty sleeping (insomnia)
• Itchy skin
• Headaches
• Erectile dysfunction in men

Diagnosis

Chronic kidney disease (CKD) can be diagnosed using several diagnostic tests, including:

• Blood tests: Doctors analyze creatinine levels, a waste substance, and use this data, along with other factors such as age, gender, and ethnicity, to calculate the estimated glomerular filtration rate (eGFR), which indicates how well the kidneys filter blood. A normal eGFR should be above 90 ml/min. If it's lower, CKD may be present.
• Urine tests: These are conducted to check levels of albumin and creatinine and detect blood and protein. Results, combined with eGFR, provide a comprehensive picture of kidney function.
• Imaging tests: Ultrasonography, MRI, and CT scans visualize the kidneys' structure and detect any obstructions.
• Kidney biopsy: Tissue samples are examined under a microscope to identify damage or disease.

Blood and urine test results can determine the stage of kidney disease, indicating the severity of kidney damage. Higher numbers suggest more serious CKD.

Individuals at high risk of developing CKD, such as those with risk factors like high blood pressure or diabetes, may be advised to undergo regular health checks to screen for CKD, enabling early detection and intervention.

Management

There is no known cure for CKD, so treatment focuses on managing symptoms and halting disease progression. The choice of therapy depends on the severity of the condition and may include:

• Lifestyle changes to maintain overall health, such as quitting smoking, adopting a healthy diet, limiting salt intake, engaging in regular exercise, maintaining an ideal weight, limiting alcohol consumption, and avoiding NSAID medications unless recommended by a doctor.
• Medications are prescribed to control underlying conditions that can cause CKD and manage its complications. This may include drugs to control high blood pressure, high cholesterol, fluid buildup, anemia, bone issues, and kidney inflammation.
• Dialysis (hemodialysis) is necessary when the kidneys fail to function adequately. This treatment removes waste products and excess fluid from the blood.
• Kidney transplantation offers an alternative to dialysis and is often the most effective treatment for advanced kidney disease. However, it requires major surgery and lifelong use of immunosuppressive drugs to prevent organ rejection

In addition to these therapies, regular check-ups are essential to monitor the progression of CKD. With proper management, most CKD patients can effectively control their condition and maintain a good quality of life.

Complications

CKD can lead to complications affecting nearly every part of the body, including:

• Fluid retention, which can lead to swelling in the arms, legs, lungs (pulmonary edema), as well as high blood pressure
• Sudden increase in blood potassium levels, which can disrupt heart function and be life-threatening
• Anemia (low red blood cell count)
• Heart disease
• Weak bones and increased risk of fractures
• Decreased libido, erectile dysfunction, and decreased fertility
• Damage to the central nervous system, which can cause difficulty concentrating, personality changes, or seizures
• Decreased immune response, making one more vulnerable to infections
• Inflammation of the heart membrane (pericarditis)
• Pregnancy complications that pose risks to both the mother and fetus
• Irreversible kidney damage (end-stage renal disease) that eventually requires dialysis or kidney transplantation to sustain life

Prevention

CKD prevention involves adopting a healthy lifestyle and effectively managing other existing health conditions.

When to see a doctor?

If you experience symptoms or suspect kidney disease, it's essential to consult a doctor. Kidney disease symptoms can also be caused by other milder conditions, so obtaining an accurate diagnosis is crucial.

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