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  • Writer's pictureAlan Frischer, MD, MPH

Chronic Kidney Disease

There have been advances in treatment for chronic kidney disease (CKD). We have, as you likely are aware, two kidneys, which are fist-sized bean-shaped organs located toward our back, on either side of our spine, and just underneath our rib cage. Their main job is to clean the blood - getting rid of toxins, waste and excess water through the urine. Our kidneys also balance electrolytes (including salt and potassium) and minerals, produce hormones that control blood pressure, make red blood cells, and keep our bones strong.


There are five stages of chronic kidney disease, with stage 1 (mild) through 5 (kidney failure) based on how well the kidneys filter out waste from the blood. The diagnosis is made through blood and urine tests.


Loss of kidney function can occur in a matter of days, or over years. As we grow older, there is some gradual decline of kidney function, but this loss accelerates when other factors are present. These include type 1 or type 2 diabetes, high blood pressure, heart disease, smoking, obesity, glomerulonephritis, interstitial nephritis, polycystic kidney disease, prolonged obstruction of the urinary tract (from an enlarged prostate, kidney stones, or some cancers), recurrent kidney infections, severe dehydration, lupus, multiple myeloma, and some medications.


In the early stages, chronic kidney disease typically shows no symptoms. Over time, as kidney damage progresses, the loss of kidney function can cause a buildup of fluid or body waste, or problems with electrolytes. Depending on how severe it is, symptoms can include nausea, vomiting, bubbly urine, itchy skin, loss of appetite, fatigue and weakness, sleep problems, urinating more or urinating less, decreased mental sharpness, muscle cramps, swelling of feet and ankles, dry skin, hypertension, shortness of breath, and chest pain. Because these complaints are seen in a number of conditions, a diagnosis may very well not be made until after irreversible damage has occurred.


What can be done to reduce your risk of CKD? Avoid excessive use of over-the-counter (OTC) medication that can affect the kidneys, like NSAIDs (aspirin, ibuprofen, naproxen, etc.). Maintain a healthy weight and be physically active. Stay well hydrated. Avoid smoking cigarettes. Keep any medical conditions, such as hypertension and diabetes, well managed.


We do have medications that can slow the progression of kidney disease. Both angiotensin converting enzyme (ACE) and angiotensin receptor blockers (ARB) have long been available. Recently, important new classes of medications have been approved to slow CKD, including SGLT-2 medications and aldosterone receptor antagonists.


There is no cure for CKD, but steps can be taken. Treatment and significant lifestyle changes are lifelong. I urge you to seek support from loved ones and from your community, as well as from online and in-person support groups. You and your doctor will want to monitor your condition carefully, and have regular conversations about the best ways to manage chronic kidney disease. 

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