Chronic kidney disease in the community

Chronic kidney disease is becoming more prevalent in the UK due to increased testing, with potentially millions of people seriously affected. Respected consultant nephrologist Dr Andrew Palmer provides a detailed insight into its characteristics and symptoms, treatment options and how the wider community can be made aware of this condition. 

What is chronic kidney disease?

Chronic kidney disease (CKD) is defined as the persistent loss of renal function for more than three months and usually is a long-term condition with structural and functional abnormalities in the kidney. This can be due to primary kidney diseases or secondary medical conditions such as diabetes, hypertension or obstruction. 

It is usually diagnosed by blood tests, namely serum creatinine and eGFR readings, and patients can be classified into categories (CKD 1 to 5) according to the severity. Patients with CKD 1 to 2 have relatively mild disease whilst CKD 3 to 5 have more advanced loss of renal function. In the case of CKD 4 to 5, this category frequently leads to dialysis as a result of end-stage kidney failure. It is not necessarily the case that patients with chronic kidney disease will have continued loss of renal function but it will occur in a significant proportion, although it is often slow and over many years. 

Does chronic kidney disease always show symptoms?

One of the characteristics of chronic kidney disease is that patients frequently do not have any symptoms and it is diagnosed incidentally, either because they are having blood tests for another medical reason, as part of an insurance medical or routine health check-up. 

It also means that patients often attend an appointment later than desired because of the lack of symptoms. Any symptoms that do occur are often only with more advanced kidney disease (CKD 4 to 5) and are non-specific such as tiredness, loss of appetite or nausea. These obviously can occur for many other reasons. 

Some patients may be easier to diagnose because of side effects of losing kidney function, such as fluid retention or poor blood pressure control, or because of another illness where the kidney disease is secondary. Kidney disease also may be detected by urine testing for blood and protein which is usually a part of any insurance medical.

How much of the UK population has kidney disease?

We now know that kidney disease is much more common than previously thought. This is because of increased blood tests being done and the classification of CKD 1 to 5 being implemented. The latter is because serum creatinine levels may be normal with early loss of kidney function and the use of eGFR readings based on the creatinine and patient age and sex are a more sensitive marker. The incidence of chronic kidney disease stages 3 to 5 in the UK will be approximately 3.2 million in 2021 and is comparable to chest and cardiac disease.

Do some communities/groups have a higher risk of chronic kidney disease?

We know that chronic kidney disease is much more common with declining age. We also know it is more common in certain ethnic groups, and particularly Afro-Caribbean and Indo-Asian populations, where the risk in patients over 60 years is five to tenfold. We also know that chronic kidney disease is more common in lower socio-economic groups. This difference is due to multiple causes including the higher incidence of hypertension and diabetes.

What treatment is available for chronic kidney disease?

The treatment options for chronic kidney disease are primarily limited to diagnosing and treating the cause. Once a patient has reached a certain level of kidney function [eGFR] it is not likely to be reversible but there is still a lot to be achieved by diagnosing the cause and halting further loss of function.

Fortunately, because people have considerable reserves of renal function this will prevent most patients requiring dialysis. There are a number of specific measures that can be taken to prevent progression. The most important is blood pressure control and the specific use of drugs called Angiotensin Converting Enzyme (ACE) inhibitors, which have been shown to help prevent progressive loss of kidney function. There are also a new group of diabetic drugs called SGLT2 inhibitors that may become increasingly used shortly. 

It is important to avoid drugs that further damage kidneys such as non-steroidal inti-inflammatory drugs (ibuprofen, naproxen, diclofenac, etcetera). It is also important to treat any underlying cause such as primary forms of kidney disease and other secondary causes such as diabetes and relieving obstruction of the kidneys. Finally, one of the most serious complications of kidney disease is cardiac disease and treatment of blood pressure, obesity and cholesterol are extremely important.

How could communities improve care for chronic kidney disease?

It is important to diagnose kidney disease early to prevent further loss of function and therefore increasing awareness for groups at risk, such as certain ethnic populations, is essential.

This includes encouraging patients to attend their GP practice, compliance with appointments and getting the appropriate referral as needed. It is also important that conditions that cause kidney disease are managed in the best way possible. Ways to manage include:

• Better diabetic control
• Addressing obesity 
• Diet in the wider community
• Reducing risk factors for coronary disease such as smoking

If you´d like to find out more about chronic kidney disease and how it affects you or your family, Dr Andrew Palmer can provide his expert assistance. You can visit his Top Doctors profile here.