Chronic Kidney Disease: Causes, Symptoms, and Treatments

Chronic Kidney Disease (CKD) encompasses all conditions that result in reduced renal functions ranging from mild to severe chronic failure. CKD is a global problem, although most of those affected are unaware that they affected by the condition. Lack of knowledge is mainly due to the nature of the disease to progress slowly over the years; hence the term chronic and failure of the majority of the world population to undergo regular checkup. The reduced renal functions due to CKD cause fluid and waste build up in the body, which exposes the patient to other detrimental health conditions. The characteristic slow progression of CKD means few cases get detected in early stages, which could help in the treatment process since medication significantly slows the progression rate. Some cases, however, progress to kidney failure even with treatment, although not all cases lead to failure even without a diagnosis (Cobo et al., 2016). Patients with less progressed cases of CKD do not feel ill, and laboratory tests are the only sure way for diagnosis. Creatinine levels in blood and urine protein tests are preferred with medication and lifestyle changes proving almost efficient for slowing progression. This paper, therefore, explores the signs and symptoms of CKD, assess prevalence and surveillance processes before performing an epidemiological analysis. Attention is also accorded to existing screening tests and guidelines 

Background and Significance 

Chronic Kidney Disease (CKD) causes gradual loss of kidney function, leading to a build-up of electrolytes, fluids, and wastes in the body. Many of the symptoms do not reveal in the early stages of the disease, with most of them only becoming apparent when kidney functions become significantly impaired. Progression of kidney failure necessitates kidney transplant or dialysis for the patient to survive. CKD symptoms include fatigue and general body weakness, changes in urine amount, swollen feet, itchiness, loss of appetite, and chest pains. Patients may also experience muscle twitches, shortness of breath, sleep problems, and difficulty concentrating. Prevalence levels in the United States are 15%, with CKD occurring more in women (16%) than men (13%) (Centers for Disease Control, 2019). Interestingly, 16% of non-Hispanic blacks are affected by the condition as compared to 13% of Hispanic blacks. Prevalence levels tend to increase with age, with 7% in people aged between 18 and 44 years, 13 % in those between 44 and 65 years, and 38 percent in those above 65 years (CDC, 2019). Southern states have the highest prevalence of CKD except for Florida, which has a prevalence of about 12%. States in the Midwest and North East such as Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin, also showed high levels of prevalence at about 17% of the population (CDC, 2019). The 2019 statistics also show that states in the west have the lowest prevalence of about 10-11%. The high prevalence is attributable to the high occurrence of diabetes in the specified states, which is a risk factor for CKD. 

Comparison of the Percentage of CDK Prevalence by Age, Sex and Race Nationwide and in Florida 

Fig 1 

Surveillance and Reporting 

The CKD Surveillance Project was created to source and report aggregate data throughout the nation on the various age group. Several sources provide this kind of reported data, which include population survey data, public health records, screening activity, and cohort studies. Population-based survey provides useful data on health trends across the nation and are useful in CKD surveillance. The National Health and Nutrition Examination Survey (NHANES) conducted every two years involves laboratory tests, physical; examinations, and interviews to determine the cross-sectional health status of non-institutionalized US citizens (Myers et al.’, 2018). The acquired data is relevant in determining rates of major diseases as well as risk factors. Behavioral Risk Factor Surveillance System (BRFSS), on the other hand, assesses behavioral factors that lead to disease and death across the nations. Data from such population-based surveys cab be utilized in surveillance and reporting of CKD across all regions n the United States. 

Public health systems data such as the Center for Medicare and Medicaid Services, which serves both the elderly and the poor, is crucial in recording claims from both sections of the population. CMS captures data on all services provided in outpatient clinics, auspices, and nursing homes, among others. This kind of data from public health records thus becomes useful to the CKD Surveillance Project. The Indian Health Service (IHS) captures data about native and provide services to native Indians and Alaska natives. The data is thus crucial for tracking various diseases, which include CKD. Private providers ranging from insurance providers to laboratories are also an essential link in the surveillance and reporting process. Laboratories store data on test results, discharge records, and various research databases which helps to track disease incidence and progression. 

Furthermore, screening activity data provide through organizations such as NKF and others which engage in awareness campaigns keep screening and education records. NKF, for instance, engages in screening campaigns that eventually become essential in tracking the disease. The campaigns by other organizations targeting specific members of society, such as African Americans, also provide useful surveillance data. Cohort studies in various populations offer unique sets of data that are difficult to acquire from other sources. Due to the intensity of this study, specific renal function are measurable in participants with others making follow-ups after years. The data becomes useful in assessing progression patterns and for comparison with other sets of data acquired from different sources. The Chronic Kidney Disease Surveillance Project, which is responsible for handling the acquired data, then draws useful conclusions from these various sources. The information becomes essential in formulating strategies to control the disease or educate the public on healthier lifestyles. 

Epidemiological Analysis 

Chronic Kidney Disease (CKD) is a slowly progressing condition which moves from mild to moderate and severe stages. Progression measurement is, by the way, the kidney filters waste from the body such that the estimated glomerular filtration rate ranges from 90 or greater for efficiently functioning kidneys to less than 15 in end-stage renal disease (ESRD). Prevalence levels for early-stage EKD have remained stable for almost a decade at 14.8% of the population, translating to an estimated 30 million people (Saran et al., 20120). ESRD patients’ numbers peak to over half a million with about 500, 000 receiving dialysis treatment and the other 200,000 living with kidney transplants. New cases of ESRD are a worrying trend, with approximately 100,000 patients reaching the ESRD annually (Saran et al., 20120). 

In light of that, there are increased financial and social burdens to individuals and families. For instance, Medicare spending for CKD in 2015 totaled $100, 000 with a majority of the funds going to patients with ESRD. At an individual level, spending can amount to$22,000 for patients with kidney failure. In addition to the financial burden associated with CKD, patients also faced reduced quality of life and lack of productivity at the end stages of the condition. A lot of time spent at the hospital either doing dialysis, waiting for a transplant, or recovering takes a toll on both the patient and family members. 

Several risk factors exist that increase an individual’s chances of developing CKD. Type 2 diabetes is the leading cause of kidney diseases and is among the main causes of the condition. The association between high blood pressure and kidney disease is not well understood by physicians. However, damage to vessels and filters in the kidney is likely to interfere with the removal of waste. A family history of CKD means that related individuals with such history at a greater risk genetically. The high prevalence of CKD in people above the age of 65 is also an indicator of age being a risk factor. Renal function characteristically diminishes with age hence causing accumulation of wastes that might result in kidney disease. Notably, a healthy lifestyle can significantly reduce the chances of developing CKD. Determinants of health, which include lifestyle, nutrition, environment, and genetics, play a critical role in the development of the disease. As such, leading a healthy lifestyle through exercise and proper nutritional habits can in avoiding obesity hence reducing the risk of CKD. 

Screening and Guidelines 

Screening is key to the early detection and commencement of treatment for kidney disease. The most common screening test is the urine test for albumin, eGFR blood test, and Serum Cystatin C test. eGFR blood test measures the way kidneys filters waste from the body such that the estimated glomerular filtration rate ranges from 90 or higher for efficiently functioning kidneys to less than 15 in end-stage renal disease (ESRD). Creatinine occurs in the body due to the breakdown of muscles, hence the presence of creatinine in blood is an indicator that the kidney is not functioning well. Although an eGFR of 90 is not a cause for concern, it also indicates that kidneys are not operating at the optimum level either due to obesity or other lifestyle issues. Alternatively, albumin tests in urine are efficient in screening for kidney disease. Normal kidneys do not allow albumin to pass through and enter the urine. Hence, an albumin level of 30mg/g in urine is an indicator of kidney disease. The Cystatin C test measures the amount of the protein Cystanin C in blood. An increase of Cystsnin C from 0.5ml/dL to 1 ml/dL indicates the possibility of kidney disease. 

Notably, Cystatin C is the most reliable than the other test for CKD. Cystatin C is a protein produced by cells into the blood. The protein is transported into the kidney where it is filtered out to form a filtrate fluid where small amounts of the protein are reabsorbed but are broken down without entering the bloodstream. Reduced renal functions cause Cystanin Cto to accumulate in the blood. Hence, a slight increase in Cystanin C protein in blood indicates kidney disease, thus making the test the most sensitive. Research places the specificity of Cystanin C at 0.82 ml/dL for acute CKD (Faraji et al., 2017). The predictive value of Cystanin C of >1.025ml/dL indicates hospitalization within a year. The Cystatin C test id relatively cheap and effective, costing less than $20 in most facilities. 

Interventions 

Despite screening and education efforts, over half of CKD patients in the United States progress to ESRD stage (Hardy et al., 2018). This revelation points to the need for better intervention techniques not only at the primary level but also at the secondary and tertiary levels. Primary interventions must focus on the risk factors for CKD. These include high blood pressure and type 2 diabetes. Interventions will consist of education programs that encourage physical exercise and a healthy diet, not just for people with diabetes but for the whole population. Maintaining body fitness thus prevents obesity and high blood pressure, which lad to CKD. 

Secondary intervention techniques focus on those at the most considerable risk of developing CKD. Prevalence level is highest for people above the age of 65 years, followed by adults between 44 and 65 years, implying that these are the people at greatest risk. Screening campaigns targeting these individuals are essential to early diagnosis and commencement of management regimes. The campaigns, however, need to be more aggressive with proper education on the need for screening. Targeting diabetic individuals who already have acute CKD will also improve management techniques reducing the chances of progression to ESRD. Tertiary intervention includes a longterm delay of progression to ESRD, which results in less desirable outcomes (Pecoraro, 2015). Maintenance of a healthy diet means that the kidneys can function less strenuously. Strict adherence to medication requirements while also engaging in exercise can delay the period of progression. 

Conclusion 

Prevalence levels of CKD underline the need for concerted efforts by all stakeholders to reduce the development and progression of the disease. Often lack of knowledge about CKD hinders the effort to seek screening, which will result in early diagnosis and better management. Surveillance efforts by the CKD Surveillance Project will likely increase understanding about the disease and improve strategies of treating and managing. The epidemiological progression of CKD, however, points to weaknesses in identifying risk factors and educating the population on ways preventing disease development and progression. Emphasis on screening using the recommended guidelines such as the Cystatin C test can help inform caregivers on the best intervention depending on the stage of disease progression. 

References 

Centers for Disease Control (CDC). (2019). Chronic kidney disease in the United States, 2019 . cdc.gov. https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html 

Cobo, G., Hecking, M., Port, F. K., Exner, I., Lindholm, B., Stenvinkel, P., & Carrero, J. J. (2016). Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis.  Clinical science ,  130 (14), 1147-1163. https://doi.org/10.1042/CS20160047 

Faraji, M. A. H., Anwar, M. R., Debnath, D. K., Alam, M. B., Morshed, S. M., & Hasan, K. M. (2017). Serum Cystatin C as an Endogenous Marker of Renal Function in Patients with Chronic Kidney Disease (CKD).  Journal of Current and Advance Medical Research ,  4 (1), 3-12. https://doi.org/10.3329/jcamr.v4i1.36168 

Hardy, S. T., Zeng, D., Kshirsagar, A. V., Viera, A. J., Avery, C. L., & Heiss, G. (2018). Primary prevention of chronic kidney disease through population‐based strategies for blood pressure control: The ARIC study.  The Journal of Clinical Hypertension ,  20 (6), 1018-1026. 10.1111/jch.13311 

Myers, O. B., Pankratz, V. S., Norris, K. C., Vassalotti, J. A., Unruh, M. L., & Argyropoulos, C. (2018). Surveillance of CKD epidemiology in the US–a joint analysis of NHANES and KEEP.  Scientific reports ,  8 (1), 1-9. 10.1038/s41598-018-34233-w 

Pecoraro, C. (2015). Prevention of Chronic kidney disease (CKD) in children. In  Italian journal of pediatrics  (Vol. 41, No. 2, p. A56). BioMed Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707590/ 

Saran, R., Robinson, B., Abbott, K. C., Bragg-Gresham, J., Chen, X., Gipson, D. ... & Kapke, A. (2020). US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States.  American journal of kidney diseases: the official journal of the National Kidney Foundation ,  75 (1S1), A6. https://doi.org/10.1053/j.ajkd.2019.09.003