Kidney Diseases, CKD, Dialysis

Chronic kidney disease (CKD) is a permanent kidney damage that can develop over time, eventually leading to kidney failure. What are the symptoms of chronic kidney failure?

Unfortunately, kidney diseases often develop without any symptoms, or the symptoms present are so vague that they don't raise much concern – fatigue, reduced appetite, increased thirst. For this reason, prevention, regular check-ups, and a healthy lifestyle are very important.

In cases of end-stage kidney failure (defined as a reduction in kidney function to 15% or less), urine production will cease completely (or be significantly reduced), and waste products will not be removed from the body. These harmful waste products and excess water accumulate in the blood (uremia).

The following symptoms may occur:

• Swelling of the feet or hands (edema), skin color changes
• Shortness of breath - breathing problems
• Hypertension
• Extreme fatigue and exhaustion
• Nausea and loss of appetite
• Severe anemia
• Vomiting and nausea
• Localized and generalized itching
• Insomnia
• Increased urination, even during the night; only in the most severe stages of acute kidney failure can a decrease in urine output occur.

 In the case of complete loss of kidney function, their functioning must be replaced with renal replacement therapy. This is a specialized treatment – dialysis. The only alternative to dialysis is a transplant.

Untreated uremia has severe consequences for the health and life of the patient. It leads to seizures and coma, which in turn can be fatal.

Chronic kidney disease is on the rise worldwide: about 5-10% of adults suffer from various types of kidney diseases that can lead to kidney failure. 95% of patients are unaware they have it.
According to recent statistics, over 2,500,000 patients worldwide are undergoing dialysis due to chronic kidney failure.

There are many causes of kidney function impairment. Loss of kidney function can be the common consequence of a wide range of conditions that affect the kidneys directly (e.g., glomerulonephritis, polycystic kidneys, repeated kidney infections, etc.) or indirectly. The two most common indirect factors are diabetes and hypertension.

Diabetes

Diabetes can severely impair kidney health. Despite improvements in diabetes therapies today, diabetes can be a cause of kidney failure. If diabetes is not properly treated, blood sugar levels rise, damaging the blood vessels of the kidneys and making them less efficient.

High blood pressure/hypertension

It is the second most common cause of kidney failure. High blood pressure can damage filtration in the renal glomeruli, leading to severe kidney dysfunction. Remember, high blood pressure can also be a symptom of ongoing kidney disease.

Nephritis / glomerulonephritis

Another common cause is inflammation of the kidneys, most often of the glomeruli. This pathological process leads to a decrease in urine volume, infiltration of blood and proteins into the urine, and the development of peripheral edema localized to the eyelids, hands, and feet.

Kidney failure can also result from various conditions, such as those of genetic or autoimmune origin, see: KIDNEY DISEASES.

How to diagnose chronic kidney failure?

Only a few tests are essential: the urine test with proteinuria, azotemia, and creatinine levels help make an initial diagnosis. The doctor may deepen the evaluation with other tests (such as a complete blood count to check for anemia, blood glucose to check for insulin resistance, or electrolytes like sodium, potassium, calcium, and phosphorus to check for any imbalances).

It is crucial to consult a nephrologist who will investigate the cause of your disease with renal and bladder ultrasound and additional instrumental and biochemical tests, such as blood gas analysis to evaluate the status of metabolic acidosis, and who will monitor the disease progression over the years, prescribing appropriate preventive and corrective therapies.

Studies have shown that patients who are followed by a nephrologist from the early stages of chronic kidney disease do not reach or delay the need for dialysis, improving their quality of life and general conditions, thus extending life expectancy.

Can chronic kidney disease be prevented?

Chronic kidney failure cannot always be prevented; however, there are measures that can counteract its progression and slow down the disease's evolution. All these steps can help prevent kidney disease or stop it from progressing.

Following standard health recommendations is particularly important for people diagnosed with any form of kidney dysfunction. Even healthy individuals who want to avoid kidney damage should follow these guidelines:

• Regular check-ups: Simple blood tests (complete blood count and blood glucose) and urine tests help monitor your kidney health and prevent kidney diseases. Regular kidney check-ups are mandatory if you have diabetes or high blood pressure.
• Monitor your blood pressure: Measure it regularly and always follow your doctor’s instructions and therapy.
• Exercise regularly and maintain an optimal body weight: A high body mass index (BMI) is also a risk factor. If you lead a sedentary lifestyle, it's time to change! Remember – you don’t need to do extreme sports for a significant change; regular walks are enough.
• Watch your diet: Avoid salty foods and preservatives, and follow a balanced diet. Do not consume stimulants like alcohol and cigarettes. Limit coffee intake as well. Fast food, ready-made meals, and sugary drinks damage your kidney health! For this reason, try to follow a balanced diet, avoid excess calories, and steer clear of miracle diets. Always consult a specialist. Are you diabetic? Keep an eye on your blood glucose levels! Remember, diabetes is the main cause of kidney disease! Avoid blood sugar spikes and follow your doctor’s instructions.
• Be mindful of medications, painkillers, and supplements you take: Never take medications against your doctor’s recommendations, avoid overuse, and steer clear of nephrotoxic drugs.
• Get rid of bad habits: Do you smoke? Do you neglect infections? Do you delay going to the bathroom? If you answered YES to these questions, rest assured that you are neglecting your kidney health.

When Should Dialysis Begin?
If kidney disease progresses to the point where the kidneys are no longer able to perform their functions, leading to the accumulation of toxins and water in the body and endangering the health and life of the patient, dialysis treatment becomes necessary. Dialysis allows you to:

• Remove toxic substances and excess fluids, preventing their buildup in the body.
• Maintain the balance of certain substances in the blood (potassium and bicarbonate).

In Chronic Kidney Disease, the kidneys do not heal, but chronic kidney failure is treatable.
There are three fundamental types of treatments available, depending on the patient's physical constitution and existing medical conditions:

• Peritoneal dialysis
• Hemodialysis
• Kidney transplant

A patient with chronic kidney failure will need dialysis for life. The only alternative to dialysis treatment is a kidney transplant. Dialysis is a treatment that needs to be repeated regularly, typically 2-3 times a week.

How Does Hemodialysis Work?
In hemodialysis, an artificial kidney is used – a modern machine that, instead of a healthy kidney, filters the blood to remove toxic substances and excess fluids. To pass blood through the artificial kidney, a vascular access is required, which can be either an arteriovenous fistula or a central venous catheter.

Is Dialysis Painful?
Dialysis is a painless therapy that allows you to read a book, watch TV, talk, or eat. There may be slight discomfort when inserting the needles if an AV fistula is used, but generally, there are no other issues.
Dialysis typically makes you feel better, as it resolves and corrects many issues associated with kidney failure. Some patients are additionally prescribed intradialytic therapy or therapy to continue at home, for example, to treat anemia, which is often related to chronic kidney failure. You and your family will need some time to adjust to the rhythms of dialysis.

How Does the Patient’s Life Change? For Example, How Does Diet Change?
This is variable, as it depends on the individual patient's condition, but generally, you can eat freely as long as you avoid excessive intake of fluids and foods containing potassium (potatoes, fruits, vegetables) and phosphorus. Your doctor will provide specific recommendations regarding this.
If you want to travel or go on vacation, you can always do so, as dialysis treatment is standardized, but you need to plan sessions in advance and take some precautions for travel.
It’s also advisable to take walks and avoid a sedentary lifestyle.

In addition to diabetic nephropathy or hypertensive nephropathy, various other conditions can also lead to kidney failure, such as genetic or autoimmune diseases, including:

• Polycystic kidney disease - a hereditary disease that causes cysts to form in the kidneys, reducing their filtration capacity and obstructing the flow of urine. There is no cure, but treatments can slow the clinical progression of the condition.
• Lupus nephritis - an autoimmune disease (a condition that causes the body’s immune system to attack its own tissues). It causes damage throughout the body, including the kidneys. The exact cause of lupus nephritis is still unknown and cannot be cured, but specific treatments can help reduce symptoms.
• Unknown causes - about 20% of people on dialysis cannot determine the cause of kidney failure. Additionally, it is not uncommon for treatment to begin when the disease is already at an advanced stage, making it even more difficult to identify the cause of kidney damage.