About Chronic Kidney Diseases

CKD is present if renal function or protein excretion have been impaired for more than three months and are affecting general health. The kidneys then filter less harmful substances, produce less hormones and do not control blood pressure appropriately. Consequences may be high blood pressure, anaemia, and derangements in bone metabolism. In case of complete kidney failure, blood pressure derailment and massive fluid build-up in tissues are impeding dangers that may necessitate dialysis treatment or kidney transplantation. Unfortunately, CKD is often only diagnosed at a late stage when therapies can only alleviate the symptoms.

The main risk factors for developing kidney failure are not rooted in the kidneys themselves, but in diseases like diabetes and high blood pressure. Nowadays, heart and kidney impairment are considered as strongly intertwined, as approximately every second patient with heart failure also suffers from chronic kidney disease and many CKD patients have cardiovascular disease. However, there are also many other potential causes of kidney failure such as inflammatory processes in the kidneys themselves, auto immune diseases and congenital diseases.

The noticeable symptoms of CKD are not always distinct and often only occur at a late stage. Oedema, foamy or discoloured urine or headaches with increased blood pressure may be perceptible earlier, but often happen without being paid attention. Many of the more severe symptoms only occur at stage 4 or even 5. They may include:

• Abnormally increased amount of urine

• Strongly decreased amount of urine

• Swelling (oedema), e.g. in the legs or in the face

• Dry, itchy skin

• Shortness of breath

• Tiredness, lethargy, weakness

• Loss of appetite, nausea, vomiting

• Lack of concentration, confusion

• Disturbed consciousness up to unconsciousness

While full recovery is usually not possible, especially in the more advanced stages, slowing down disease progression is a valid option. Close contact with the specialist and adherence to the therapy are very important.

The only therapeutic options for the last stage of CKD are dialysis and kidney transplantation. There are two kinds of dialysis available for kidney replacement which both cleanse the blood: Haemodialysis, the most frequently used procedure, and peritoneal dialysis. For haemodialysis, the patient’s blood passes through blood tubes outside the body, from a vascular access on the forearm to a dialysis machine. In the machine, it passes a membrane that filters waste substances from the blood. The filtered blood flows back to the body. Haemodialysis is performed at a dialysis center or at home for several hours thrice weekly. Peritoneal dialysis uses the peritoneum as the dialysis membrane. Since it takes longer to filter the blood in this way, peritoneal dialysis is performed daily, but this can be done by the patients themselves at home.

Kidney replacement therapy comes at a high societal cost. The share of global healthcare costs spent on dialysis and transplantation is proportionally 10-20 times higher than the number of patients treated. For example in Europe, yearly reimbursement per country reaches up to €80 000/patient. Costs will rise further due to the projected growth in patient numbers.

The ABCDE profile can reveal the risk not only for kidney diseases, but also for cardiovascular diseases and should be part of every routine check-up for every person beyond 50 years old.

A for albuminuria

B for blood pressure

C for cholesterol

D for diabetes

E for eGFR status