Cases of chronic kidney disease (CKD) – the loss of kidney function over time – are unfortunately continuing to rise. The Centers for Disease Control and Prevention (CDC) estimates that 15% of U.S. adults — that’s over 37 million people – are affected. Worldwide, some 800 million people are estimated to have CKD. It is the ninth-leading cause of death.
The increasing prevalence of CKD, as well as the speed with which it can progress, can be attributed to the presence of, or an increase in, such chronic medical conditions as hypertension (high blood pressure), diabetes mellitus (deficiency or resistance to insulin) and/or obesity. There is also now more awareness about screening for CKD, which has resulted in more cases being detected.
Obviously this is a serious condition; just as unfortunate is the fact that it can be difficult to diagnose, especially in the early stages – and, as is the case with many diseases, early detection can be critical; it can lead to early intervention and delay in the progression of CKD.
Since a person in the early stages of CKD is typically asymptomatic, the condition is mainly diagnosed via a laboratory blood test. In the later stages of the disease, the laboratory test will show a decline in the kidney function and a person may start to complain of an array of symptoms – including, but limited to, generalized fatigue, loss of appetite, weight loss, nausea, vomiting, difficulty breathing, chest pain, itchiness, changes in urination, swelling in the legs, increased drowsiness, and/or confusion.
Other than a blood test, we may also examine a person’s urine for abnormalities such as blood, which may not be noticeable to the naked eye, or protein. We may also refer a person for a kidney ultrasound to evaluate the structure and size of the kidneys. At times, a person may require a kidney biopsy to help diagnose the kidney disease. With a kidney biopsy, parts of the kidney are examined under a microscope to look for the abnormality and/or damage.
Children can also develop CKD, but the cause is very different than with adults. For infants, children and adolescents, causes of chronic kidney disease may be related to congenital abnormalities (birth defects), hereditary conditions, urinary tract abnormalities, infections or glomerulonephritis (an inflammation of the kidney). Similar to adults, kidney disease in infants, children and adolescents may be detected with blood tests, a urine test, and/or a kidney ultrasound. A kidney biopsy may be necessary to help establish a diagnosis.
Some conditions to be aware of that may put a person at risk for kidney disease include hypertension and diabetes – the leading causes – as well as heart disease, obesity, advancing age, inherited kidney disorders, previous kidney damage, and/or a family history of kidney disease. If a person has some of these medical conditions, they may be at risk for developing CKD and should see a healthcare professional and possibly a nephrologist.
CKD is a process that is caused by an underlying disease or abnormality, so treating the underlying cause is key. Similar to other medical conditions, healthy lifestyle choices such as a balanced diet, regular exercise, avoidance of smoking, and maintaining a healthy weight can all help with managing CKD. Establishing regular care and follow-ups with a nephrologist is important to help with the management of the complications and symptoms of progressing CKD.
Unfortunately, there is no absolute cure for CKD and in most cases, reversing its progress isn’t possible. However, with the appropriate care, we can help delay its progression.
In conjunction with healthy lifestyle choices, prescription medications can help to treat the underlying causes of CKD, delay its progression, and manage the complications and symptoms. However, once the CKD has progressed to End Stage Renal Disease (ESRD), medications may do little to manage complications. At that point, a patient and their nephrologist should have conversations and make decisions made about initiating dialysis and/or kidney transplantation.
In 2019, as per the U.S. Renal Data System, approximately 560,000 people were on a version of dialysis in this country. Meanwhile, according to the United Network of Organ Sharing, while there were approximately 21,000 kidney transplantations performed in 2022 – but there are approximately 93,000 people on the waiting list for a kidney transplantation.
Although there is no cure, there is cause for hope. There are various studies being conducted on different aspects of kidney disease, including medications to delay its progression, other medications to treatment complications, and evolving ways to improve kidney transplantation.
A class of drugs called SGLT2 inhibitors, which are used to treat diabetes, have shown encouraging results in its ability to delay the progression of CKD in several recent studies. The American Diabetes Association now recognizes this class of medications as effective in treating type 2 diabetes in patients with CKD, cardiovascular disease, or heart failure. There are also other drugs used primarily to treat diabetes that may offer some renal protection for diabetic patients.
People who are concerned they may have kidney disease should consult with their healthcare professional and consider seeing a nephrologist to learn about their kidney disease and discuss what treatments can be right for them.
Dr. Renu D. Muttana is a board-certified nephrologist and internal medicine practitioner at White Plains Hospital Physician Associates and at Scarsdale Medical Group. For an appointment, call 914-235-8224.