Chronic Kidney Disease or CKD is a silent and insidious disease affecting an astounding 700 million people worldwide. In the United States alone, there exist over 30 million cases of Chronic Kidney Disease. On average, one in three adults is at risk of developing the condition, a concerning matter for public health. To make matters even more complex, over 90% of the affected individuals do not notice their symptoms until the disease approaches its final stages.
Common symptoms like kidney disease itching, weight loss, and hair loss caused by kidney disease, followed by tests and treatment.
What Is Chronic Kidney Disease?
Chronic Kidney Disease is a result of prolonged destruction of the kidneys. The condition develops due to slow, progressive damage to the nephron, the small filtration unit in the kidney. A single kidney can contain up to a million nephrons, the most fundamental units of blood filtration. Chronic Kidney Disease causes irreparable damage to these tiny blood filters, hampering kidney function.
Your kidneys perform a slew of essential bodily functions like:
- Filtration of blood and the removal of toxins, wastes, and excess fluids.
- Maintaining a steady level of essential electrolytes like sodium, potassium, chloride, calcium, and phosphate.
- Excretion of any ingested medicines or drugs.
- Regulation of the heart rate by secreting specific hormones.
- Promoting the production of new red blood cells in the bone marrow.
- Maintenance of the delicate acid-base balance in the body and regulating a steady ph.
- Regulation of body temperature.
Chronic Kidney Disease can impair the kidneys’ ability to carry out these functions effectively or even cause the kidneys to fail in end-stage kidney disease.
- Control your blood pressure.
- Meet your blood glucose goal if you have diabetes.
- Work with your health care team to monitor your kidney health.
- Take medicines as prescribed.
- Work with a dietitian to develop a meal plan.
- Make physical activity part of your routine.
- Aim for a healthy weight
- Get enough sleep.
- weight loss and poor appetite.
- swollen ankles, feet or hands – as a result of water retention (oedema)
- shortness of breath.
- tiredness.
- blood in your pee (urine)
- an increased need to pee – particularly at night.
- difficulty sleeping (insomnia)
- itchy skin.
The Causes of Chronic Kidney Disease
Chronic Kidney Disease is often a long-term complication of other serious conditions. Some conditions that can result in persistent damage to the kidneys are:
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Hypertension & Chronic Kidney Disease
In the tiny nephrons within the kidney, there exist minute blood vessels that ensure effective filtration of your blood to the last drop. In conditions like hypertension, elevated blood pressure damages these blood vessels. These damaged blood vessels are incapable of sustaining effective filtration. The condition causes a build-up of excess fluid and some minerals, which in turn raises the blood pressure further. This is a vicious cycle where hypertension and kidney damage facilitate the progression of one another.
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Diabetes & Chronic Kidney Disease
Both Type-1 and Type-2 Diabetes can result in Chronic Kidney Disease. One of the serious long-term complications of the disease is a condition called diabetic nephropathy. Diabetic nephropathy is a sign of persistent damage to the filtration units in your kidney by sugar. The elevated sugar levels in your blood can impair the process of blood filtration. Prolonged diabetic nephropathy can result in Chronic Kidney Disease, or in this case, diabetic kidney disease.
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Autoimmune Diseases
Diseases such as Lupus are caused by the body’s immune system attacking some of its cells and tissues. The condition usually affects blood vessels and tissue fibers under the skin; however, Lupus can affect any part of the body, including the kidneys. When Lupus affects the kidney tissue, doctors call it Lupus Nephritis. It causes a severe inflammation of the blood vessels and tubes in the nephrons, hampering the kidneys’ ability to function properly.
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Kidney Scarring
Kidney scarring is the hardening of the nephron. Referred to as glomerulosclerosis in medicine, the condition renders the nephron unable to function. Certain conditions cause large parts of the kidney’s nephrons to harden or “scar”, causing most of the kidney to fail.
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Genetics & Chronic Kidney Disease
If you’ve had questions like “Is kidney disease genetic?”, you’re not alone. Certain causes of kidney disease have important genetic and hereditary components. Conditions like polycystic kidney disease are caused by genetic mutations. The disease results in the aggressive growth of several cysts throughout both kidneys, reducing the amount of viable kidney tissue. This hampers kidney function and can have serious implications for normal subsistence. Autoimmune diseases like Lupus and Alport’s syndrome also have underlying genetic components, while causing damage to the kidneys.
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Inflammatory Diseases
Inflammatory kidney diseases like glomerulonephritis and interstitial nephritis can cause Chronic Kidney Disease. While the former is due to the inflammation of the tiny filtration units called nephrons, the latter is characterized by the inflammation of the tiny tubes within the kidney. A variety of factors like severe allergies, toxins, chronic drug abuse, infections, heavy metal poisoning, and autoimmune diseases can result in inflammatory diseases of the kidney, and consequently- Chronic Kidney Disease.
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Obstruction of Urinary Tract
Prolonged blockage of the urinary tract or tubes can result in damage to the kidney tissue. If you have had prolonged issues with kidney stones or an enlarged prostate, the chances of developing CKD rise. Conditions like cancers of the kidneys can also cause Chronic Kidney Disease due to their obstructive nature.
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Stress & Kidney Disease
Several studies have shown that stress can be an indirect promoter of Chronic Kidney Disease. Prolonged stress levels can cause bodily inflammation, raise blood pressure and elevate blood sugar levels which can be quite damaging to your kidneys. If you’ve ever wondered if stress can stress cause kidney stones, you just might be correct. Stress can also result in dehydration, an important factor of rising kidney stone prevalence in several individuals. Obstructive kidney diseases like kidney stones increase your probability of developing Chronic Kidney Disease.
The risk of contracting CKD is elevated in the elderly, and in addition to these causes of the disease, risk factors like smoking, obesity, elevated cholesterol, and liver cirrhosis can also result in a higher chance of CKD.
Symptoms of Chronic Kidney Disease
There are a variety of symptoms that indicate Chronic Kidney Disease. However, many of these symptoms can seem harmless and benign in the initial stages, causing many people to ignore them. A major cause for concern among people suffering from Chronic Kidney Disease is the number of people realizing they have CKD when it’s already too late. Here are some common symptoms of CKD to help you in being vigilant –
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Kidney Disease & Itching
Kidney disease itching or kidney itching as it is referred to colloquially is an important symptom of advanced CKD. The build-up of toxins, excess fluid, wastes, and excess electrolytes could be a potential cause for the itching. Itches are frequent and are accompanied by a persistent desire to scratch. Frequent bouts of itches can be aggravated by allergies, irritants, uncomfortable clothing, and pollution.
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Swelling of The Face, Eyelids, and Legs
A puffy face and eyelids can be some important factors to indicate CKD. Swollen legs are also an important symptom of CKD. Damaged kidneys fail to remove excess fluid from the body, causing the fluid to build up in convenient regions. The fluid moves to the legs due to gravity and is easily spotted in the face and eyes due to the thin skin present there.
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Frequent Fatigue & Chronic Exhaustion
Several CKD sufferers initially come in with a complaint of tiredness and fatigue. Most people suffering from CKD are also anemic. This is because a healthy kidney produces an important hormone called erythropoietin. The hormone stimulates the bone marrow to produce new red blood cells. In unhealthy or failing kidneys, like in CKD, the kidneys either produce too little erythropoietin or produce some of it infrequently, resulting in a lack of new red blood cells. Fewer red blood cells cause less oxygen to reach your body at a given time.
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Kidney Disease & Weight Loss
The build-up of toxins and wastes can cause symptoms like an upset stomach or persistent nausea. These symptoms adversely affect your appetite. A lot of CKD patients also complain of a metallic taste in their mouth, another cause for loss of appetite. This indirectly causes weight loss in patients suffering from CKD.
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Kidney Disease & Hair Loss
Hair is made of protein and an adequate intake of good dietary protein is essential for healthy hair. In patients with Chronic Kidney Disease, a reduced appetite, the build-up of toxins, mineral & vitamin deficiencies can result in thinning, brittle and falling hair. Hair loss is also an important symptom of severe CKD.
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Brittle Nails & Ashen Skin
Like hair, the skin and nails require adequate nutrition to remain healthy as well. Yellow, brittle and pitted nails, alongside a pale, ashen discoloration of your skin can be important indicators of CKD.
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Backache
Pain in the region of the kidneys can be an important indicator of obstructive kidney disease. A lot of patients complain of kidney pain in the morning, this is due to the build-up of urine overnight and the inability of the tubes to pump the urine into the bladder. It’s important to inform your healthcare provider in case you notice the symptom as it could indicate diseases like kidney stones, polycystic kidney, or CKD.
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Bone Pain & Weak Bones
The kidneys are important regulators of blood calcium levels. Impaired kidney function can result in lower blood calcium. This causes the bones to release calcium into the blood to enable muscle functioning. A persistent release of calcium from the bones reduces bone density and can result in weak bones.
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Frequent Urination & Discolored Urine
Patients with CKD often complain of frequent, pale urine. Urine can also be foamy due to the presence of protein in the urine or be discolored due to blood in the urine.
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Bad Breath
The poor excretion of ammonia in urine can cause symptoms like bad breath. CKD can result in your breath smelling like urine due to failing kidneys.
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Impaired Focus & Concentration
A lack of oxygen due to anemia can hamper the ability of the brain to function. This causes difficulty in thinking coherently and results in confusion.
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Chest Pain & Shortness of Breath
A build-up of excess fluid in the wall of the heart or the lungs can cause shortness of breath and chest pain. This is a serious symptom of CKD and you should consider visiting your healthcare provider at the earliest in case you’re facing either of these symptoms.
It is important not to ignore any of the symptoms you might encounter. With CKD, most patients get diagnosed only when it’s too late. Be sure to visit your doctor if you notice any symptoms and are in doubt.
What are Kidney Diagnostic Tests?
A variety of tests exist to diagnose CKD, and if you’re wondering how to check kidney function at home, test packages like this one help you check your kidney function at the comfort of your house. Some common kidney function tests are:
- Blood Tests: Tests like blood urea nitrogen test, serum creatinine, a 24-hour glomerular filtration rate test, complete blood count, and basic metabolic panel help your doctor tell if your kidneys are functioning normally.
- Urine Tests: Tests like albumin to creatinine ratio, urine albumin, and urine glucose tests can help your doctor tell if anything is amiss with your kidney function by examining urine.
- Imaging Tests: Ultrasound of the kidneys, abdominal CT scans, and MRIs can be ordered by your physician in case they suspect any obstructions or growths in your kidney.
- Biopsies: In case your kidney has growths or cysts that have been detected on the imaging tests, your doctor might recommend a biopsy. The procedure involves removing a part of the growth to be examined in a laboratory.
Though Chronic Kidney Disease is irreversible, it is manageable through a nutritious diet, managing the causative disease, necessary lifestyle changes, and abiding by the doctor’s advice on time. Be sure to visit your healthcare provider regularly in case you have concerns regarding your health.
Malnutrition in Chronic Kidney Disease
- Removal of excess fluid from the body
- Removal of waste products from blood
- Maintains electrolyte and acid base balance
- Maintains blood pressure
- Promotes bone health
- Produces glucose
- Reabsorbs amino acids filtered from the blood
- Produces hormone called erythropoietin to maintain hemoglobin levels
Chronic kidney disease or CKD is a condition in which there is a defect in the function or structure or both of kidneys lasting for more than 3 months. Chronic kidney disease is generally a permanent damage which is irreversible and may progress to further worsening of kidney function. There are 5 stages in chronic kidney disease from stage 1 to stage 5 based on the glomerular filtration rate (GFR). Higher stage is suggestive of more severe damage to the kidneys.
Metabolic changes in Chronic Kidney Disease
Kidneys help in keeping the bone health. This they do by keeping calcium, phosphorus, vitamin D and parathyroid hormone levels in normal range. Chronic kidney disease can lead to high phosphorus and parathyroid hormone levels, low calcium and vitamin D levels. These changes can lead to weakening of bones with more risk of fractures. The changes in calcium and phosphorus can lead to their deposition in blood vessels supplying the heart, causing heart attacks and heart failure. Failure of kidneys can lead to low hemoglobin. High potassium levels in blood and acid accumulation also occur, as they cannot be excreted properly in urine. Malnutrition with muscle wasting (protein energy wasting) can develop in patients with kidney failure.
Protein energy wasting (PEW) is common in patients with chronic kidney disease. It is characterized by simultaneous loss of body protein and energy stores. It can be seen even in patients with lower stages of CKD like stage 3. As the severity of kidney disease increases, malnutrition also increases. Studies done in India have shown that up to more than 90% of patients on dialysis have malnutrition in lower income group. More than 60% of middle-income group patients on dialysis have malnutrition.
Why is identifying protein energy wasting (PEW) important?
Protein energy wasting leads to-
- Poor quality of life
- Infections
- Heart disease
- Lesser life expectancy compared to those without malnutrition
What causes protein energy wasting in CKD patients?
There are many reasons for Protein energy wasting (PEW) as explained below:
- Anorexia: increase in levels of hormones which suppress appetite in seen in CKD patients. This leads to decreased calorie intake and malnutrition.
- Acidosis: Acid accumulation because of the inability of the kidneys to excrete in urine leads to protein breakdown in the muscles. This lead STO lean muscle mass
- Increased energy expenditure: CKD patients have increased resting energy expenditure due to various reasons which leads to more energy consumption
- Increased inflammation: there is increased inflammation in the body of these patients which leads to protein breakdown and reduced protein synthesis in the liver (e.g., albumin)
How to identify protein energy wasting (PEW)?
There are specific scales like Subjective Global Assessment (SGA) and Malnutrition Inflammation Score (MIS) which are used in clinics by nephrologists and dieticians.
PEW is to be suspected if any or all of the following are present:
- More than 5% weight loss over 3 months or 10% over 6 months
- Decreased BMI
- Reduced albumin levels in blood
- Unintentional less intake of calories and protein for at least 2 months
- Muscle wasting (e.g., reduced arm circumference)
- Loss of strength / stamina
Importance of nutritional management in chronic kidney disease patients
Nutritional therapy is important in patients with kidney disease because it helps in a variety of ways as follows:
- Nutritional therapy prevents the occurrence of protein energy wasting, and it helps in treatment of protein energy wasting if it has already occurred
- It helps in managing symptoms of kidney failure due to accumulation of waste products
- It helps in correcting electrolyte levels
- It helps in correcting acid base balance
- It promotes bone health
- It prevents the accumulation of salt and water in the body
- It helps in delaying the progression of kidney disease
General guidelines for nutrition therapy
1. Protein in the diet
In patients with reduced kidney function, a smaller number of nephrons (functional units of kidney) are working compared to a kidney with normal function. Higher protein intake and more of animal protein intake (e.g., meat) will lead to more pressure in the remaining glomeruli. Higher pressure occurs in these glomeruli because excess protein in the diet will cause more blood supply, and it leads to damage to these remaining glomeruli and further worsening of kidney disease
In patients of CKD who are not dialysis dependent, it is advised to take less protein in the diet of 0.6-0.8gm/kg/day. Less protein intake leads to less acid generation, decreased pressure in glomeruli, less production of waste products in the body and decreased protein loss in urine. Animal proteins are digested in the intestines by bacteria and leads to toxin productions which can do harm to the body. Preferring plant-based protein prevents this, and plant protein compared to animal protein is less acid producing and is less in sodium content. In patients who are on dialysis it is advised to take proteins up to 1 -1.2gm/kg/day as these patients have increased protein breakdown and protein loss during dialysis procedure.
2. Energy requirement
Patients with CKD should take at least 30-35Kcal/kg body weight / day, with 50 to 60% calories from carbohydrates. Fats should be restricted to less than 30% of calories and fats should contain less of saturated fat. Saturated fats should be less than 10% of total fat intake. Avoid foods with high fructose content like fruit juices with added sugars, soft drinks etc., High fructose content foods can cause insulin resistance, increased uric acid levels and heart disease.
3. Sodium
Sodium restriction in patients with CKD helps in lowering blood pressure, slowing the progression of kidney disease and improves the cardiovascular outcome of the patient. Excess sodium intake in patients on dialysis leads to excess weight gain, as sodium retains water in the body. Removal of this excess water during dialysis can lead to complications like drop in blood pressure and weakness. Recommended amount of salt to be taken per day in less than 5.5 grams (less than 2300 mg of sodium). Each gram of salt contains around 400 mg of sodium.
4. Dietary fiber
Constipation is common in patients with CKD because of the toxins which get accumulated in the body and altered bacterial composition in the gut. Fiber in the diet is broken down by good bacteria in the gut to produce products which strengthen the gut wall. In CKD patients’ good bacteria are decreased and bad bacteria are increased in the gut which breakdown protein in the diet to toxins which are absorbed and gut wall is damaged. It is advised to take at least 25grams of fiber in the diet to prevent constipation and maintain healthy gut flora.
Overall nutrition is very important in patients with chronic kidney disease. Low protein diet and plant-based diet will help in slowing the kidney disease progression. Avoiding constipation and restricting sodium will help in preventing complications related to CKD.
