Understanding Chronic Kidney Disease: Prevention and Treatment Options - Dr Kartikeya Kohli

The prevalence of Chronic Kidney Disease (CKD) in India has surged twofold in the past decade, with over 5 lakh individuals diagnosed with the condition. Unfortunately, only a fraction of these individuals are able to undergo a Kidney Transplant, highlighting the urgent need for preventive measures, early detection, and timely treatment of CKD.

Currently, 80% of Renal Replacement Therapy (RRT) is administered by the private healthcare sector. The crude and age-adjusted incidence rates of End-Stage Renal Disease (ESRD) are estimated at 151 and 232 per million populations, respectively, in India.

Despite these alarming figures, more than 90% of patients requiring RRT succumb within months of diagnosis due to the inability to afford treatment. Even among those who commence RRT, 60% discontinue treatment due to financial constraints. This underscores the critical need for enhanced access to affordable renal care and support services across the country.

What is Chronic Kidney disease?

Chronic Kidney Disease (CKD), also known as Chronic Renal Failure (CRF), is characterized by the gradual loss of kidney function. This condition arises when the kidneys sustain damage and become incapable of effectively filtering the body's metabolic wastes.

In the early stages of CKD, individuals may exhibit few or no signs and symptoms, making the disease difficult to detect until the kidneys are significantly impaired. As CKD progresses, levels of fluid, waste, and electrolytes can reach dangerously high levels, exerting profound effects on the body. If left untreated, CKD can advance rapidly and culminate in end-stage kidney failure, a potentially life-threatening condition that necessitates dialysis or a kidney transplant for survival.

Risks and Prevention

To prevent Chronic Kidney Disease (CKD) and mitigate its progression and associated complications, it is crucial to identify and address relevant risk factors. Individuals with diabetes and high blood pressure are at significantly higher risk of developing kidney problems, making effective management of these conditions paramount.

Blood sugar and blood pressure control are essential preventive measures, often achieved through medication. Some medications are specifically designed to reduce protein leakage in the urine (proteinuria), a major risk factor for CKD development and progression.

For individuals with diabetes, meticulous management of medications to control blood glucose levels is imperative, as elevated glucose levels can adversely affect kidney function. Similarly, hypertensive patients face added stress on the kidneys due to elevated blood pressure levels, compromising the organs' ability to effectively filter blood. Lifestyle modifications, including dietary changes and regular exercise, are recommended for these patients to optimize blood pressure control and overall kidney health.

Moreover, seeking regular medical consultation and adhering to prescribed medications are essential components of kidney disease prevention and management. By actively addressing risk factors and adopting a proactive approach to healthcare, individuals can significantly reduce their likelihood of developing CKD and mitigate its progression.

Managing Chronic Kidney Disease

The management of Chronic Kidney Disease (CKD) depends on the stage at which the patient seeks medical attention. Treatment aims to slow down disease progression and alleviate associated complications to prevent the onset of end-stage kidney failure. End-stage kidney failure occurs when the kidneys can no longer adequately clear waste and fluids from the body, necessitating renal replacement therapy such as dialysis or kidney transplant.

Dialysis is a common renal replacement therapy method, involving the artificial removal of waste and fluids from the blood when the kidneys are unable to perform this function. There are two main types of dialysis: hemodialysis, which utilizes a machine to filter excess fluids from the blood, and peritoneal dialysis, which involves filling the abdominal cavity with a dialysis solution to absorb excess fluid. The frequency of dialysis sessions varies depending on the patient's condition and medical advice, typically ranging from two to three times a week.

Kidney transplant is considered the optimal treatment modality for end-stage kidney failure. This surgical procedure involves the transplantation of a donor kidney into the recipient, sourced from either living or deceased donors. Lifelong medication is necessary to maintain the transplanted organ and prevent rejection by the recipient's body. Unlike dialysis, kidney transplant eliminates the need for ongoing dialysis sessions. Moreover, kidney transplant is associated with superior treatment outcomes and cost-effectiveness compared to dialysis.

Who is suitable to donate their kidneys?

Kidney transplants can be facilitated through living donations or cadaver donations, typically occurring upon brain death. Living donors must meet specific criteria to ensure the safety and viability of the donated kidney. These criteria include:

• They are not on more than one antihypertensive medication.
• There is no protein leak detected in their urine.
• No left ventricular hypertrophy is observed in an electrocardiogram (ECG).
• There is no evidence of retinopathy in the eye.

These criteria help ensure that the donor's kidney is healthy and suitable for transplantation, minimizing the risk of complications for both the donor and the recipient.