Chronic kidney disease (CKD) is an important chronic non communicable disease epidemic that affects people all over the world, including India. It is a progressive loss of renal function over a period of months or years through five stages. Stage 5 CKD, also called end-stage renal disease (ESRD) is a severe illness and requires some form of renal replacement therapy (either dialysis or renal transplantation).
Burden of CKD:
Globally more than 500 million individuals or about 1 out of 10 adults in the general population have some form of chronic kidney disease. In US population approximately 11% have CKD and of them 0.2% have stage 5 CKD (NHANES).
More than 80% of ESRD patients in the developed world and only less than 10% of ESRD patients in the developing countries like India receive renal replacement therapy.
Individuals with early stages of CKD go undiagnosed, particularly in the developing world. The early detection of kidney impairment is essential and allows suitable treatment before kidney damage or deterioration manifests itself through other complications.
The most common causes of CKD are diabetes, hypertension and glomerulonephritis. In India as in the developed countries, diabetes and hypertension are responsible for 40% to 50% of all case of CKD.
Early detection of renal disease, determination of its underlying cause, treatment of correctible abnormalities, and retardation of progression to ESRF are the cornerstones of prevention of renal failure.
Detection of CKD:
Simple screening methods are available for allowing early detection of CKD, like urine albumin detection by dipstick method, serum creatinine and estimation of Glomerular Filtration Rate – GFR (Kidney Function estimation) by a simple formula.
Individuals at risk for developing CKD:
Screening must be high priority in subjects considered to be at high risk of kidney disease, namely advanced age, diabetes, hypertension, autoimmune diseases, obesity, chronic smokers and those with family history of diabetes, hypertension and chronic kidney diseases.
Patients with other kidney diseases like urinary tract infections, urinary stones and lower urinary tract obstruction should also be screened for chronic kidney disease.
Retarding progression of kidney disease to ESRD:
Key preventative measures for slowing progression of renal diseases
- Medications including ACEI or ARB group.
- Reduction of high blood pressure -the lower the blood pressure, the lower the GFR decline.
- Control of glucose and blood lipids to optimal levels.
- Smoking cessation.
- Increased physical activity.
- Control of body weight.
The evidence is clear, preventive nephrology is necessary to halt the epidemic of renal failure. There is an urgent need for a paradigm shift with detection and prevention of CKD back to the primary care physician. The time for action is now.
Dr. B. T. Anil Kumar
Consultant Nephrologist
BGS Global Hospitals
67, Uttarahalli Main Road
Bangalore – 560060
991695055
UM– USEKE.RW
