Overview#
Chronic Kidney Disease (CKD) is the progressive and irreversible loss of kidney function over months or years. The kidneys gradually lose their ability to filter waste, regulate fluid balance, and maintain electrolyte homeostasis. India has an estimated 17 % prevalence of CKD, with diabetes and hypertension being the two leading causes. CKD is often called a "silent epidemic" because most patients are asymptomatic until late stages (Stage 4-5), when dialysis or transplant may be needed.
Causes & Risk Factors#
- Diabetes mellitus – the single largest cause of CKD in India, responsible for 30-40 % of cases (diabetic nephropathy).
- Hypertension – uncontrolled high BP damages glomerular capillaries over time.
- Chronic glomerulonephritis – a common cause in younger Indian patients.
- Obstructive uropathy – kidney stones, enlarged prostate, or congenital anomalies.
- Overuse of NSAIDs and nephrotoxic drugs – self-medication with painkillers (ibuprofen, diclofenac) is a significant issue in India.
Signs & Symptoms#
- Often asymptomatic in early stages (Stage 1-3)
- Fatigue, weakness, and reduced stamina
- Swelling of feet, ankles, and face (oedema)
- Foamy or bubbly urine (indicating proteinuria)
- Decreased urine output or nocturia (increased urination at night)
- Loss of appetite, nausea, and metallic taste
- Itching (pruritus) – due to toxin build-up
- Shortness of breath – from fluid overload or anemia
Diagnosis#
Early detection through simple tests can slow progression:
- Serum Creatinine and eGFR – eGFR < 60 mL/min/1.73m² for 3 months confirms CKD. Book Kidney Function Test
- Urine Albumin-to-Creatinine Ratio (UACR) – detects early kidney damage before creatinine rises.
- Blood Urea Nitrogen (BUN) – elevated in kidney dysfunction.
- Electrolytes – potassium, sodium, calcium, phosphorus for monitoring.
- Renal ultrasound – to assess kidney size and structure; small kidneys suggest chronic disease.
- HbA1c and BP monitoring – to manage underlying causes. Book HbA1c
CKD Stages: Stage 1 (eGFR > 90, kidney damage present) → Stage 5 (eGFR < 15, kidney failure requiring dialysis or transplant).
Treatment Options#
Slowing progression:
- Strict BP control (target < 130/80 mmHg) with ACE inhibitors or ARBs – these specifically protect the kidneys.
- Tight diabetes control (HbA1c < 7 %).
- SGLT2 inhibitors (dapagliflozin, empagliflozin) – now recommended for CKD patients even without diabetes; shown to slow progression by 30-40 %.
Dietary management:
- Low-salt diet (< 5 g/day) to control BP and fluid retention.
- Protein restriction (0.6-0.8 g/kg/day) in Stage 3-5 to reduce kidney workload.
- Limit potassium-rich foods (bananas, coconut water, oranges, potatoes) in advanced CKD.
- Adequate hydration – 1.5-2 L/day unless fluid-restricted.
Advanced CKD (Stage 5):
- Haemodialysis or peritoneal dialysis.
- Kidney transplantation – the best long-term option for eligible patients.
Prevention#
- Control diabetes and hypertension – these two conditions cause 60-70 % of CKD cases.
- Avoid unnecessary NSAID use – do not self-medicate with painkillers regularly.
- Stay hydrated, especially in hot Indian climates.
- Get an annual kidney function test if you have diabetes, hypertension, or a family history of kidney disease.
- Treat urinary tract infections promptly and manage kidney stones to prevent obstructive damage.
When to See a Doctor#
See a nephrologist if you have persistent swelling, foamy urine, reduced urine output, or if your creatinine is elevated. Patients with diabetes or hypertension should have kidney function tested annually. Seek urgent care for severe shortness of breath with swelling (fluid overload), very high potassium (cardiac risk), or inability to urinate.