Chronic kidney disease (CKD) is a prevalent yet too-often undetected condition affecting tens of millions of Americans. Its silent progression renders many unaware until irreversible damage has occurred, necessitating intensive interventions like dialysis or kidney transplants. Here, Dr. Randy Luciano, a nephrologist at Yale Medicine, shares insights on CKD’s nuances and effective management.*

The nature of CKD

CKD is defined by a gradual decline in kidney function over a minimum of three months, though it’s frequently not detected for several years, even decades. This decline leads to the accumulation of toxins and fluids in the body. Diabetes and high blood pressure are the two primary culprits, and if left unmanaged they will continue exacerbating the kidney damage. 

Other contributors include obesity and genetic predisposition. Polycystic kidney disease is one form of CKD that a person is born with, for which there is currently no cure. Understanding CKD’s multifaceted origins is pivotal in its early detection and treatment.

Identifying risk factors for CKD

Certain demographics face heightened susceptibility to CKD, such as:

• Older adults, 
• Individuals with diabetes or hypertension, and 
• Those with familial predispositions, including first-degree relatives (parent, sibling) who have CKD. 

Racial and socioeconomic disparities underscore the complex interplay of:

• Genetics, 
• Access to healthcare, and 
• Lifestyle factors. 

Genetic testing offers a proactive approach for high-risk populations, enabling tailored interventions to mitigate CKD progression.

Diagnosis and stages of CKD

Early diagnosis hinges on routine blood and urine tests, gauging kidney function and detecting proteinuria (excessive protein levels in your urine). Determining your stage of CKD involves assessing glomerular filtration rates (GFR)–the percentage of your remaining kidney function–and identifying associated symptoms. The progressive nature of CKD underscores the importance of timely interventions, as treatment efficacy varies across stages.

In general, the stages of CKD by estimate GFR (eGFR) are:

Stage 1: eGFR is equal to or greater than 90 but less than 100

Stage 2: eGFR is 60 to 89

Stage 3a: eGFR is 45 to 59

Stage 3b: eGFR is 30 to 44

Stage 4: eGFR is 15 to 29

Stage 5: eGFR is less than 15

Treatment strategies

Tailored treatment usually involves dietary and other lifestyle adjustments, such as quitting smoking and getting sufficient sleep, alongside pharmacological interventions to address underlying causes like diabetes and hypertension. 

Emerging medications like SGLT-2 inhibitors and GLP-1 receptor agonists offer promising avenues for slowing CKD progression. 

While not all CKD cases culminate in end-stage kidney disease (ESKD), dialysis and transplantation are vital treatment models for those affected. Depending on your individual situation, various dialysis options provide flexibility and convenience, enhancing and prolonging patients’ quality of life. Kidney transplantation remains the gold standard, offering improved outcomes and reducing reliance on dialysis.

Many of the lifestyle habits used to prevent CKD progression can also be used to help prevent it from starting in the first place. An effective, holistic approach to kidney health encompasses:

• Regular screenings, 
• Balanced, kidney-friendly nutrition, 
• Physical activity, 
• Adequate sleep, and 
• Avoiding tobacco and excessive alcohol consumption. 

By fostering kidney awareness and proactive management, you can mitigate the impact of CKD and optimize your long-term health.

*Katella, K. (2024, April 24). Why Is Chronic Kidney Disease on the Rise? 6 Things to Know. Yale Medicine.

https://www.yalemedicine.org/news/why-is-chronic-kidney-disease-on-the-rise 

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