What is Chronic Kidney Disease (CKD)? Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm
Introduction This leaflet gives background information about chronic kidney disease (CKD). It is aimed at improving knowledge and understanding about CKD so informed choices about lifestyle and treatment can be made. Before reading this, you may wish to read the leaflet that explains how the kidneys work and why they are important to our health. What is CKD and why is it important? You have CKD when you have abnormalities of either blood tests or urine tests that are used to measure your kidney function. Some people without abnormalities of their blood tests or urine tests are also said to have CKD if they have an abnormality of the anatomy of the kidneys, examples of this include a small or absent kidney on one side, kidney stones and kidney cysts. In the large majority of people with CKD the kidneys are working well enough to keep you healthy in both the short and long-term, but you may require increased monitoring of your kidney function and enhanced care from your general practice. There are two main reasons why CKD is important: 1. It can put you at higher risk of developing problems that involve the heart and blood vessels (cardiovascular diseases), such as heart attacks and strokes. This does not mean that you are going to develop these problems, but knowing that you have CKD does allow your doctor to work with you to make sure that you have the right treatment to keep your risk of developing these problems as low as possible. 2. A small number of people with CKD develop failure of the kidneys. This means kidney function is sufficiently poor that they are at risk of requiring treatment for complete kidney failure with dialysis or transplantation. If you are at risk of this happening you will be referred to a hospital kidney specialist 2
(often called a nephrologist). Around 1 in 40 people with CKD need to be seen by kidney specialists. How common is CKD? Around 1 in 7 adults have CKD. However in the large majority of people the CKD is mild. Around 1 in 15 adults have CKD that requires regular monitoring. Whilst doctors are agreed on how we can measure for CKD, there is controversy about the true significance of CKD for many people who are classified as having CKD. What causes CKD? CKD develops over a long period of time and is usually caused by general wear and tear on the kidneys that occur with some very common medical problems. It may not always be possible to find out the cause, however the most common are: Diabetes Furred-up blood vessels (vascular disease, usually in people who have had heart attacks or strokes) which lead to decreased blood supply to the kidneys High blood pressure (hypertension) How is CKD diagnosed? As explained in all about my kidneys, blood and urine tests are used to find out if the kidneys are working properly. From the blood test an estimate can be made about how well the kidneys are working. This estimate is called an egfr. The urine test gives additional information by assessing if the kidneys are leaking protein into the urine. The amount of protein, if present, provides additional information that allows your doctor to better assess and to explain to you the overall risk to you of CKD. 3
The stages of CKD CKD is divided into 5 stages. The stages are based on the level of kidney function as measured by egfr and whether or not there are any other problems you have and are shown in the table below. Stages 1 & 2 Stage 3 Stage 4 Stage 5 Mild CKD egfr is normal (60 ml/ min or more) Mild-moderate CKD Advanced CKD Established severe CKD Overall kidney function is in the normal range egfr is 30-59 ml/min egfr is 15-29 ml/min Remaining kidney function is below 15% At all levels of kidney function, regular exercise of 30 minutes a day and a healthy diet can protect both your general health and kidney function. Most people with CKD require treatment of high blood pressure. People are classified as having CKD based on having protein in the urine or abnormal structured kidneys You may need treatment for anaemia and fluid retention Around 50% of people with this level of kidney function will require dialysis treatment or transplantation within 2 years 4
What are the symptoms of CKD? In the early stages of CKD (stages 1-3) people usually have no symptoms. Many people only develop symptoms when they have very advanced kidney disease. The main symptom for most people with kidney disease is mild fatigue. Some people get fluid retention that can cause ankle swelling and breathlessness. People with very advanced kidney disease may get symptoms of: poor appetite itching breathlessness leg cramps poor sleep patterns People with these symptoms will be under review by hospital based kidney specialists, and in many cases, will be planning to start dialysis. 5
How is my CKD monitored and how do you keep me safe? In many people kidney function will stay very steady over time. In some people there will be a slow decline in kidney function. Most people will have occasional blood tests that will be arranged by your GP. GPs and hospital kidney teams work closely together. Therefore, if at any time it is felt that you need to be reviewed by the hospital team, this will be arranged. The main risks of having CKD then become an increased risk of heart attacks and strokes. Management should therefore be: occasional monitoring with blood and urine tests good control of blood pressure lowering of high cholesterol if it is felt appropriate by your doctor not smoking keeping as fit as possible following a healthy diet keeping good blood sugar control if diabetic taking all medication as prescribed avoiding medications that can cause damage to your kidneys; you should always mention you have kidney disease when being prescribed any medication or buying any from the pharmacists. Anti-inflammatory tablets for arthritis are a particular problem Some people have kidney disease that is getting worse at such a rate that they may develop stage 5 CKD and kidney failure. Decisions will then need to be made as to how this is treated. This can include dialysis and transplantation if that is what the patient would like. Patients who are likely to end up with CKD 5 will need to be seen by a kidney specialist to make sure that they are prepared 6
to make decisions about the type of care they would like. Your GP will monitor the level of your kidney function and if they have concerns that you are at risk from CKD they will discuss with a hospital consultant. Other advice If you become unwell with another illness, particularly bad diarrhoea and vomiting or a severe infection you may find that your kidney function gets worse. At this time you should: Stop your ACE inhibitor (eg ramipril, lisinopril, other blood pressure tablets ending in pril ) or Angiotension2 blocker (losartan, irbesartan, other blood pressure tablets ending in sartan ) for a few days until you are better If you do not feel better after a few days, ask your GP to check your kidney blood test You should also consider stopping these tablets if you are about to have an operation. You may want to discuss this with your GP 7
Where can I find further web based sources of information? The National Kidney Federation: www.kidney.org.uk NHS Kidney Care: www.kidneycare.nhs.uk Kidney Research UK: www.kidneyresearchuk.org Kidney Alliance: www.kidneyalliance.org Transplant Support Network: www.transplantsupportnetwork.org.uk Expert Patient Programme: www.expertpatients.nhs.uk West Midlands Renal Network website: www.wmrn.co.uk NHS Choices: www.nhs.uk Other sources of information There are a wide range of local information leaflets that give further information. The following leaflets provide more in-depth information: A wide range of patient information leaflets and fact sheets are available through the University Hospitals Birmingham NHS Foundation Trust website: www.uhb.nhs.uk/patient-information-leaflets.htm The National Kidney Federation: www.kidney.org.uk West Midlands Renal Network website: www.wmrn.co.uk Go online and view NHS Choices website for more information about a wide range of health topics at www.nhs.uk Renal Unit Queen Elizabeth Hospital Birmingham Mindelsohn Way, Edgbaston, Birmingham, B15 2WB Telephone: 0121 627 2000 PI11_1170_01 UHB/PI/1170 (Edition 1) Author: Paul Cockwell, Clara Day Date: June 2012 Review Date: June 2014