Chronic Kidney Disease: Progression, Management & Outcomes

Chronic kidney disease (CKD) is progressive loss of kidney function over months to years, reducing the kidneys' ability to filter waste and excess water from the blood. The kidneys normally remove metabolic wastes and regulate fluid, electrolyte, and blood pressure balance. As kidney function declines, waste accumulates (uremia), affecting multiple body systems. CKD is staged by estimated glomerular filtration rate (eGFR), with stage 5 being end-stage renal disease (ESRD) requiring dialysis or transplantation.

Common causes:

• Diabetes (most common, ~30-40%)
• Hypertension (25-30%)
• Glomerulonephritis
• Polycystic kidney disease
• Recurrent urinary tract infections
• Chronic obstructions
• Chronic use of nephrotoxic medications

Risk factors include:

• Age over 60
• Family history of kidney disease
• Obesity
• Smoking
• Systemic diseases (lupus, vasculitis)

Early stages often asymptomatic. Progressive symptoms include:

• Fatigue
• Weakness
• Shortness of breath
• Ankle swelling
• Loss of appetite
• Nausea and vomiting
• Itching
• Reduced urine output

Advanced stages: uremia symptoms including altered mental status, pericarditis.

CKD staging uses:

• Creatinine and estimated glomerular filtration rate (eGFR)
• Urinalysis (proteinuria, hematuria)
• Kidney ultrasound or biopsy
• Electrolyte panel
• Hemoglobin and bone markers

General management:

• Control blood pressure (ACE inhibitors/ARBs)
• Diabetes control
• Smoking cessation
• Weight management
• Dietary sodium restriction
• Protein intake modification
• Lipid management
• Anemia management
• Bone-mineral metabolism management

Specific interventions based on stage and underlying cause.

Prevention of CKD onset:

• Diabetes and hypertension control
• Reducing nephrotoxic medication use
• Maintaining healthy weight
• Regular physical activity
• Adequate hydration
• Smoking cessation

Prevention of progression:

• Early ACE inhibitor/ARB use
• Tight blood pressure control
• Glycemic control in diabetes

Any elevated creatinine or reduced eGFR warrants specialist evaluation. Regular nephrology follow-up helps manage progression. Those approaching ESRD need advance planning for renal replacement therapy.