Overview

Chronic kidney disease (CKD) is a condition in which there is long-term decreased function in the kidneys. This is a progressive disease, and the kidney function will likely continue to decline as time passes. This is often due to inadequately controlled high blood pressure/or diabetes.

As the kidneys are responsible for regulating fluid and filtering blood to remove toxins, CKD can lead to a build up of excess fluid and waste in the blood. Long-term, this can lead to complications such as anemia, bone disease, metabolic acidosis, and heart disease.

This also has impacts on any medication(s) you may be taking. Many medications leave your body as a waste in your urine, so if your kidneys have declined function the medications may build up in your blood. It is essential to monitor kidney

Diagnosis

If you have high blood pressure, diabetes, and/or any kidney damaging conditions, your healthcare provider will likely regularly screen your kidney function.

A kidney function test will likely include blood and urine tests, as well well as possible imaging. Blood tests will look for the level of a waste product, creatinine, in your blood. Excess creatinine can be due to a decreased function of kidneys in filtering and excreting this waste. They also may test for albumin, a protein, that should not be found in urine and therefore could indicate kidney disease.

Using these values, your healthcare provider will calculate your GFR (glomerular filtration rate) and using this, your stage of kidney disease, from 1-5.

A GFR greater than 90 indicates proper kidney function (stage 1), while a kidney function lower than 15 is complete kidney failure (stage 5).

Based on your specific level of kidney function, your healthcare provider will initiate treatment in order to prevent disease progression. They may also alter dosages of some of your medications that use the kidneys, in order to prevent any unsafe drug toxicities.

Treatment

Depending on your stage of CKD and health outside of your kidney function, there are a number of possible treatments your healthcare provider may suggest.

With less risk for disease progression, your healthcare provider will likely suggest lifestyle modification and management of your current diseases, in particular regard to keeping blood pressure and blood sugar within normal limits.

As the disease progresses your lifestyle management may become more intense, especially in regard to your diet. This may include lowering your intake of sodium, potassium, and protein. If not managed enough with lifestyle modification, there are medications that your healthcare provider may prescribe to attempt to protect your kidneys, prevent progression of CKD, and reduce your experience of any adverse effects.

Treatment for chronic kidney disease also includes treatment for CKD-associated complications, such as anemia and bone disease, both of which would require individualized treatments.

In the most severe stage 5 of CKD, your kidneys will no longer function enough, and you will likely require dialysis. Dialysis is essentially an external kidney that will filter your blood for you while your own kidneys cannot. In some situations, you may also be eligible for a kidney transplant.

Medications

There are 5 main medication types used to treat chronic kidney disease.

Angiotensin-converting enzyme (ACE) inhibitors

Angiotensin (an-gee-oh-ten-sin)-converting enzyme is part of the renin-angiotensin-aldosterone system (RAAS): a hormone system that controls blood pressure. ACE converts angiotensin I to angiotensin II, which causes blood vessels to constrict therefore increasing blood pressure. ACE inhibitors blocks angiotensin I from producing angiotensin II, resulting in vasodilation (widening of your blood vessels).

Angiotensin Receptor Blockers (ARBs)

Angiotensin receptor blockers reduce your blood pressure by preventing the action of angiotensin II. Angiotensin II is a hormone that make your blood vessels narrow/constrict. High blood pressure and inadequate blood flow to your kidney may result from this constriction. Angiotensin II can also cause salt and water retention in your body, which further increases your blood pressure. Blocking this, therefore allows for a decrease in blood pressure.

Calcium channel blockers (CCBs)

Calcium channel blockers decrease the amount of calcium that enter the heart and blood vessel walls. This relaxes the blood vessels and makes it easier for the heart to pump, resulting in decreased blood pressure.

Diuretics

Diuretics (water pills) help the kidney to excrete more sodium and water into urine, decreasing the sodium and water in your blood and therefore decreasing your blood pressure. They are used to treat high blood pressure, heart failure, edema, liver failure, kidney disorders and glaucoma.

Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors

SGLT2 inhibitors work in the kidneys by increasing the amount of glucose you lose in your urine. This helps to lower your blood glucose as well as lower your risk of developing cardiovascular disease, heart failure, and kidney dysfunction.