Chronic kidney disease

Chronic kidney disease — silent until advanced

Chronic kidney disease (CKD) is abnormal kidney structure or function lasting over 3 months — measured by eGFR and urine albumin.

~3 million UK adults — mostly stages 1–3 — primary care management

Causes

Cause	Mechanism
Diabetes	Glomerular hyperfiltration → sclerosis
Hypertension	Nephrosclerosis
Glomerulonephritis	Immune kidney inflammation
Polycystic kidney disease	Genetic cysts
Reflux nephropathy	Childhood UTIs
NSAIDs	Chronic interstitial damage

Two-thirds from diabetes + hypertension — preventable progression

Diagnosis

Two readings needed:

• eGFR from creatinine — race-free equations now standard
• Urine ACR — albumin leak

CKD confirmed if:

• eGFR <60 for ≥3 months, OR
• eGFR ≥60 + ACR ≥3 mg/mmol or other damage markers

Ultrasound — structural assessment — size, obstruction, polycystic

Staging and monitoring

Stage 3+ — more frequent bloods

Bone-mineral disease — vitamin D, phosphate, PTH

Anaemia — erythropoietin deficiency — treat if symptomatic

Cardiovascular risk — CKD is heart disease equivalent

Treatment pillars

Blood pressure:

• ACEi/ARB first line if ACR elevated
• Monitor creatinine rise <30% acceptable

Diabetes:

• SGLT2 inhibitors — kidney protection proven
• GLP-1 agonists — additional benefit

Lifestyle:

• Salt restriction
• Protein moderation if advanced
• Smoking cessation

Avoid:

• Regular ibuprofen/naproxen
• Contrast dye without precaution if eGFR low
• Phosphate additives in processed food if hyperphosphataemia

Kidney failure (stage 5)

Pre-dialysis education — modality choice

Transplant — best quality of life — living or deceased donor

Conservative care — valid choice — symptom-focused — some prefer no dialysis

Acute on chronic

Infection, dehydration, NSAIDs, ACEi during acute illness — sick day rules — pause ACEi/ARB/diuretics/SGLT2i if vomiting unwell — local policy

If you have diabetes or hypertension — annual eGFR + ACR — 15-minute test prevents dialysis decades later.

Common questions

What are the symptoms of chronic kidney disease?

Early CKD — usually no symptoms. Advanced CKD — fatigue, ankle swelling, foamy urine (protein), nausea, poor appetite, itching, muscle cramps, concentration problems, shortness of breath from fluid overload. Symptoms often appear only when kidneys significantly damaged — reason for screening high-risk groups.

What are the stages of CKD?

Stage 1 — eGFR 90+ with kidney damage markers. Stage 2 — eGFR 60–89. Stage 3 — eGFR 30–59 (split 3a and 3b). Stage 4 — eGFR 15–29. Stage 5 — eGFR under 15 or on dialysis — kidney failure. Higher stage number means lower function.

How can I slow kidney disease progression?

Control blood pressure — target often under 130/80 with proteinuria. Optimise diabetes — HbA1c individualised. ACE inhibitor or ARB if albumin in urine. Avoid nephrotoxic drugs — regular NSAIDs, some antibiotics. Stop smoking. Maintain healthy weight. SGLT2 inhibitors (dapagliflozin) now recommended in CKD with albuminuria even without diabetes.

When do you need dialysis?

When eGFR falls below 10–15 and symptoms of uraemia appear — nausea, confusion, fluid overload not controlled by diuretics, high potassium. Planned start better than emergency — attend low-clearance clinic beforehand. Haemodialysis (usually 3 times weekly hospital) or peritoneal dialysis (home) — discuss preferences early.

Can you live a normal life with one kidney?

Yes — living kidney donors and people born with one kidney often have normal lifespan if remaining kidney healthy. After donation, annual blood pressure and kidney function checks recommended. Contact sports caution — protect solitary kidney.

Sources

• NHS — Chronic kidney disease
• NICE — Chronic kidney disease
• Kidney Care UK