WHAT IS CHRONIC KIDNEY DISEASE (CKD)? Información en Español

General Information

Chronic kidney disease (CKD) develops and progresses without any outward symptoms. Left untreated, CKD permanently damages the kidneys and other vital organs. Kidneys lose their ability to filter waste in the body, absorb calcium, control blood pressure, and stimulate the production of red blood cells as CKD progresses. Kidney disease may eventually lead to kidney failure, at which point dialysis treatment or a kidney transplant is needed for survival. Other complications include heart and blood vessel disease, weak bones, malnutrition, nerve damage, and a general feeling of sickness. Discovering kidney disease in its early stages is the best way to prevent it from becoming life-threatening.

Statistics

26 million Americans - 1 in 8 adults - have CKD and another 26 million are at high risk.
Approximately 100,000 people die every year from kidney disease.
9,000 Virginians are currently on dialysis.
The number of kidney failure patients is expected to reach 600,000 by 2010.
The number of individuals diagnosed with CKD increases by 8% each year.
Diabetes is the leading cause of CKD, accounting for nearly 43% of the cases.
Of the 100,000 patients awaiting an organ transplant, 72% await a kidney transplant.
3 simple tests can detect CKD: blood pressure, urinalysis and serum creatinine.

Who's at Risk?

Kidney disease may strike any age group. The most likely candidates are:

People with diabetes, high blood pressure, and/or a family history of the disease.
People who are overweight and especially those who are grossly overweight.
Most minorities, due to a higher incidence of diabetes and/or high blood pressure. African-Americans are 4 times more likely to develop kidney disease and experience kidney failure. Hispanics, Pacific Islanders, and Native Americans are also at increased risk.
People who have a hereditary condition known as polycystic kidney disease (PKD). PKD can appear in childhood, though it typically affects young adults.

Warning Signs

Getting tested for CKD and detecting it in its early stages is the best way to prevent kidney failure. See your physician if you have any of the following warning signs:

Diabetes
High blood pressure
Pain in lower back
Protein and/or blood in urine
Painful or frequent urination, particularly at night
Puffiness around eyes, swelling of hands and feet

The Importance of GFR

GFR (Glomurelar Filtration Rate) is the most accurate measure of kidney function. It is calculated from the results of a blood test for creatinine. The normal GFR in adults is equal to or greater than 90 mL/min. Lower GFRs signify declining kidney function.

GFR can also determine the stage of kidney disease. The National Kidney Foundation of the Virginias suggests that your primary care physician consult a nephrologist if your kidney function drops below a GFR of 60 mL/min. Once GFR falls below 30 mL/min, the patient will need to consider a kidney transplant or dialysis treatment.

Stage	Significance	GFR (mL/min)
1	Normal kidney function (abnormalities indicate kidney disease)	> 90
2	Mild decline in kidney function	60-89
3	Moderate decline in kidney function	30-59
4	Severe decline in kidney function (consider dialysis or transplant)	15-29
5	End stage kidney failure (dialysis or transplant required)	< 15

Ask your doctor about having your GFR tested or participate in one of the our free kidney health screenings. Symptoms of kidney disease may not become apparent until its final stages. The earlier kidney disease is detected, the better the chance of slowing or stopping its progression.

Dialysis Treatment

In the event of kidney failure, dialysis serves as a substitute for lost kidney function. Dialysis removes waste and excess fluid from the blood, but at this point does not perfectly replicate kidney function. Dialysis patients consequently live with strict dietary constraints and can only drink 20-60 ounces of fluid per day. Treatment is time consuming and often physically exhausting, but is the only alternative to a kidney transplant.

There are two primary forms of dialysis treatment. Consult a nephrologist when choosing between them.

Hemodialysis

The majority of dialysis patients select Hemodialysis over Peritoneal Dialysis. Hemodialysis patients are, in most cases, scheduled to undergo three-hour treatment sessions at a dialysis center three days a week, though this time varies in relation to an individual's overall health. Patients in poor health can spend as long as five hours hooked up to a dialysis machine.

A graft is installed in the patient's arm to provide an access point for the machine's tubes. Blood travels from here to the machine by way of a tube and needle, where it is cleaned and then returned to the body through a second tube and needle. Researchers are exploring whether shorter and more frequent sessions are more effective than longer sessions performed overnight while the patient sleeps. While in-home hemodialysis treatment is possible with a portable machine, the patient must receive extensive training by nurses and social workers. Monthly check-ups with a nephrologist are still necessary to track blood counts and evaluate results of the treatment.

Peritoneal Dialysis

A catheter is surgically installed into a the patient's lower abdomen to draw waste from the blood through an osmosis effect. When the abdominal cavity is filled with a solution called dialysate, the stomach's natural lining and the dialysate together cause waste and excess fluid to flow through the peritoneal membrane of the abdominal cavity into the dialysate. The dialysate is then drained out of the stomach into an empty bag. The catheter cavity is also highly prone to infection, making a sterile living environment a must.

A machine called a cycler makes it possible for the peritoneal dialysis exchanges to be done overnight. No trips need to be made to a dialysis center, but a nephrologist needs to evaluate the treatment on a monthly basis.

Organ Transplantation

Donors

More than 1,500 Virginians are on the transplant list waiting for a kidney, but just 300 of these individuals will receive a transplant this year. Only one kidney is needed for the body to function normally, and while kidneys are the most commonly donated organ, they also remain extremely short in supply. The application process to make it onto the transplant list is very rigorous as a result, and many kidney failure patients in need of a transplant are denied eligibility due to separate health factors.

More living donors would give thousands suffering from kidney failure the opportunity to live normal lives again. Becoming an organ donor is as easy as registering with the state donor registry, designating the decision on your driver’s license, and signing a donor card. Living kidney donors may be family members, spouses, friends, colleagues, or even complete strangers (known as “Good Samaritan” donors).

Living donation has plenty of advantages:

Living donor transplants done between family members have lesser risk of rejection because of better genetic match.
Potential donors can be tested ahead of time to determine their compatibility with the recipient.
Surgery is planned and scheduled for an optimal time.
A kidney from a living donor usually functions immediately, whereas patients who receive kidneys from non-living donors may need to continue dialysis until the kidney starts to function.
If the living donor is not compatible with the recipient by blood type or crossmatch, the Living/Deceased Donor Exchange Program allows the incompatible living donor to donate a kidney to a compatible recipient on the deceased donor transplant waiting list. In exchange for this donation, the incompatible recipient is moved to the top of his or her blood group on the deceased waiting list and remains there until a crossmatch compatible organ becomes available. The usual waiting time for the recipient, in this case, would be less than six months.


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To view statistics related to living donation, click here to visit United Network for Organ Sharing (UNOS) website. Thanks to new medicines, improved surgical techniques, and skilled health professionals, survival rates after transplantation continue to improve.

Recipients

A successful kidney transplant eliminates a patient's need for dialysis and lifts a number of fluid and dietary restrictions. Kidney transplants often lead to a better quality of life for recipients. Furthermore, a transplant can be less costly than dialysis in the long run. Transplantation is unquestionably an option worth exploring for end renal failure patients.

Before saying yes to a kidney transplant, consider the following:

Risks and benefits of a transplant
Medications and their side effects
Financial coverage
Your ability to continue follow-up care as well as follow instructions from your physician

If you have questions or concerns about these subjects, be sure to ask during your health evaluation. All kidney transplant applicants must undergo an evaluation with a transplant team. The team consists of a surgeon, transplant coordinator, social worker, and others depending on your own circumstances. Evaluations are designed to determine who is a good candidate for transplantation and decrease post-transplant complications. Prior to going on the transplant waiting list, medical history is reviewed and tests such as chest x-rays, electrocardiograms (EKGs), and blood tests for infection are conducted.

Keep the name and contact information of the transplant center handy. Let the transplant center know of your whereabouts and phone numbers, and keep the center informed of any major changes in your health status, including your weight. Planning ahead for a kidney transplant usually results in much better health after surgery.