World Kidney Day 2024: All you need to know about chronic kidney disease

World Kidney Day is being observed on March 14 this year. The global health awareness campaign aims to raise awareness about the importance of our kidneys and the vital role they play in maintaining our overall health and well-being. It also seeks to educate people about kidney diseases, their risk factors, and how to prevent them.

Chronic kidney disease (CKD), a term used to describe irreversible damage to the kidneys that is usually progressive, is becoming more prevalent across the globe. As per research, estimates suggest that by 2040, CKD will be the fifth most common cause of years lost from life. The financial cost of CKD is high and frequently leads to substantial, ongoing medical expenses.

"Kidney disease often develops silently. Many patients are unaware of their kidney disease until it reaches an advanced stage. By the time signs and symptoms such as high blood pressure or leg swelling occur, the disease may have progressed considerably. The goal of treatment when CKD is diagnosed at an earlier stage is to preserve and maintain remaining kidney health thereby, slowing the progression to end-stage kidney disease - the stage when kidney replacement therapies are required to sustain life. Therefore, screening and preventative care play vital roles in nephrology," shares Dr. Pallavi Patri, consultant, and chief of nephrology at Manipal Hospital, Sarjapur. On World Kidney Day, Patri sheds light on different aspects of chronic kidney disease, from treatment options to lifestyle factors, to help us further our understanding.

Who is at risk
Many medical conditions may lead to or are associated with underlying kidney disease. Patients who have diabetes, high blood pressure, heart disease, certain auto-immune diseases or a family history of kidney disease should have their kidney health screened regularly. Frequent upper urinary tract infections, kidney stones and urinary obstruction from an enlarged prostate in an older male patient are all conditions that may be associated with the development of CKD.

Kidney disease does not exclusively affect the elderly. Many kidney ailments affect children and young adults leading to CKD and even End Stage Kidney Disease. It is not always possible to predict the development of CKD in young patients, especially since CKD may be silent in early stages and since this demographic rarely undergoes general health screening. Though certain kidney conditions are not preventable, early detection of high blood pressure or abnormalities in blood or urine tests should prompt immediate follow-up, as ignoring these signs can lead to significant kidney problems later on. Early detection increases the likelihood of slowing the progression, emphasising the critical role of timely medical attention in preserving kidney health.

How to screen and diagnose
Screening for kidney disease involves basic blood tests including electrolyte levels, urea and creatinine levels and urine tests such as a urine routine and quantification of urine protein losses. Simple physical exam findings such as high blood pressure, and swelling around the eyes and legs may be indicative of a kidney problem. An ultrasound of the abdomen and pelvis may reveal structural causes of kidney disease and chronic changes in the kidneys. Occasionally, the Nephrologist may have to perform a kidney biopsy to ascertain the cause, stage and prognosis of the kidney condition.
The role played by lifestyle factors, and their impact on kidney health

Prevention relies on regular screening but also the maintenance of a healthy lifestyle. A healthy diet and regular exercise can reduce the risk of developing obesity, diabetes, hypertension and heart disease - conditions which may lead to kidney disease. Lifestyle choices continue to impact the progression of kidney disease even when these comorbidities have already been diagnosed.

High ongoing salt intake can make high blood pressure difficult to control and a diet heavy on simple carbohydrates can make blood sugar difficult to manage in a diabetic patient. Poor blood pressure control and poor sugar control accelerate the progression of CKD. Obesity and smoking, independent of any other medical condition can also negatively impact kidney health. High salt intake and dehydration are linked to the formation of kidney stones. Patients who have had multiple kidney stone episodes should undergo an evaluation with a nephrologist to understand what kind of stones they are forming. This information helps guide dietary changes and medication implementation to reduce the risk of more stone formation. A proactive approach helps in reducing the severe pain and potential damage to the kidneys from an obstructed stone as well as the expense associated with stone removal procedures.

Simple over-the-counter medications that seem benign to use regularly can be toxic to the kidneys - for example, a group of medications referred to as the non-steroid anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, diclofenac amongst others even in small quantities can cause substantial irreversible kidney damage. Medications for gastritis such as pantoprazole or omeprazole when used chronically can also lead to CKD. Awareness about the risks of these commonly used drugs and the use of kidney-safe substitutes can help prevent kidney disease.

Treatment options
Chronic kidney disease by definition is irreversible damage to the kidneys. And as discussed earlier, it is often progressive. The goal of early detection and referral to a nephrologist is focused on slowing this progression to delay or even prevent end stage kidney disease. This late stage of kidney disease necessitates the initiation of kidney replacement therapies such as dialysis and kidney transplantation as life-sustaining measures.

The tools used in slowing progression of CKD include management of comorbidities (such as diabetes, high blood pressure and heart disease), appropriate diet and exercise and initiation of certain kidney-supportive medications. As CKD progresses, several other medical conditions arise such as anemia (low blood count), bone disease, and electrolyte disturbances. Therefore, CKD patients will need to follow up with their nephrologist regularly to ensure these conditions are appropriately managed.

Once CKD has advanced to later stages, follow-up will include preparation of the patient for the best possible kidney replacement therapy they are eligible for. In the vast majority of cases, this means kidney transplantation. Age-appropriate medically fit patients live longer and healthier lives following a kidney transplant than if they are left on maintenance dialysis.

Kidney care tips for everyone
Embracing a lifestyle that incorporates regular exercise and a healthy diet are basic tips to reduce the risk of developing a multitude of medical conditions including kidney disease.

Minimising the use of potentially harmful commonly used medications such as certain painkillers and gastritis medications is important in maintaining kidney health.

Understanding your family history and your specific risk for the development of CKD will help your doctor tailor kidney screening and preventative measures for you.

If you have been found to have high blood pressure or any abnormalities on your blood, urine or imaging tests, follow up with your doctor to understand what these findings mean and what steps should be taken next.