Definition

Chronic Kidney Disease (CKD) is a long-term condition where the kidneys gradually lose their ability to filter waste products and excess fluids from the blood effectively. According to medical guidelines, CKD is characterized by an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m² or the presence of kidney damage (e.g., albuminuria or abnormalities in imaging or biopsy) persisting for three months or more, regardless of the underlying cause. Early detection is crucial as it allows for interventions to slow progression and manage complications, which can include cardiovascular disease, bone disorders, and anemia.

Causes

CKD can result from various factors, often involving a combination of genetic, environmental, and lifestyle elements. In India, the most common causes include:

• Diabetes: Accounts for approximately 45% of incident kidney failure cases, as high blood sugar damages kidney filters over time.
• Hypertension: Contributes to about 20% of cases, straining kidney blood vessels.
• Glomerulonephritis: Inflammation of the kidney’s filtering units, seen in a significant portion of cases.
• Congenital Anomalies: In about 73% of end-stage kidney disease (ESKD) patients, structural kidney issues from birth are a factor.
• Other Factors: Chronic infections, drug toxicity, and obstructions (e.g., kidney stones) also play roles, alongside lifestyle factors like poor diet and lack of physical activity.

The rising prevalence in India is linked to increasing rates of diabetes and hypertension, exacerbated by limited healthcare access and awareness.

Stages

CKD is classified into five stages based on eGFR levels, which reflect kidney function, and albuminuria levels, which indicate protein leakage into urine. The stages are:

• Stage 1: eGFR ≥ 90 mL/min/1.73 m² with evidence of kidney damage (e.g., albuminuria). Kidneys are still functioning well, often asymptomatic.
• Stage 2: eGFR 60–89 mL/min/1.73 m² with mild damage. Symptoms are rare, but monitoring is essential.
• Stage 3: eGFR 30–59 mL/min/1.73 m², indicating moderate damage. Fatigue or swelling may begin.
• Stage 4: eGFR 15–29 mL/min/1.73 m², severe damage. Symptoms like nausea or itching may appear.
• Stage 5: eGFR < 15 mL/min/1.73 m² or on dialysis, known as kidney failure or ESKD. Requires renal replacement therapy (e.g., dialysis or transplant).

Albuminuria is categorized as A1 (300 mg/g), helping assess progression risk.

Management

Management of CKD focuses on slowing progression, managing complications, and improving quality of life. Strategies include:

• Lifestyle Modifications:
  • Adopt a low-sodium diet (
  • Reduce protein intake to 0.8 g/kg/day in advanced stages (Stages 4–5) to ease kidney workload, balanced against malnutrition risks.
  • Increase fruit and vegetable intake to lower dietary acid load.
  • Engage in regular physical activity to control blood pressure and blood sugar.
• Medication Adjustments:
  • Use ACE inhibitors or ARBs to control blood pressure and reduce albuminuria.
  • Consider SGLT2 inhibitors (e.g., canagliflozin) to slow progression, especially in diabetic patients.
  • Adjust doses of drugs cleared by kidneys (e.g., metformin) as eGFR declines.
• Monitoring:
  • Regular eGFR and albuminuria tests (annually for early stages, more frequent in advanced stages).
  • Screen for complications like anemia (hemoglobin
• Renal Replacement Therapy:
  • Hemodialysis: Preferred with AV fistula access, especially in Stage 5.
  • Peritoneal Dialysis: An option for home management.
  • Kidney Transplant: Ideal for ESKD, offering better long-term outcomes, with eligibility considered when eGFR falls below 20 mL/min/1.73 m².
  • Conservative Care: For those declining therapy, focusing on symptom management and palliative care.
• Interprofessional Care: Involve nephrologists, dietitians, nurses, and pharmacists for comprehensive support.

India-Specific Data

India faces a significant CKD burden due to its large population (over 1.4 billion) and healthcare challenges:

• Prevalence: Studies like the SEEK-India project report a 17.2% prevalence, with about 6% in Stage 3 or worse. Regional hotspots include Andhra Pradesh, Goa, and Odisha.
• ESKD Incidence: The age-adjusted incidence rate is 229 per million population, with over 100,000 new patients entering renal replacement programs annually. However, only about 10% receive such therapy due to resource constraints.
• Awareness: Many patients are diagnosed late, often with eGFR
• Risk Factors: Diabetes and hypertension dominate, with socioeconomic disparities and limited access to care worsening outcomes, particularly among disadvantaged groups.

Keywords

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