What Is Chronic Kidney Disease?

The kidney is a part of the renal system that plays an important role in filtering and regulating the amount of water and electrolytes in the blood, regulating blood pressure, stimulating red blood cell production, and maintaining acid-base balance.¹ Chronic kidney disease (CKD) is defined as abnormalities of the kidney structure or function that have persisted for more than 3 months.² The disease is characterized by elevated albuminuria (albumin, or protein, found in urine) and worsened kidney function (measured by estimated glomerular filtration rate, or eGFR).³ 

Who Should Be Screened for Chronic Kidney Disease?  

There are several risk factors for CKD that should prompt screening: >60 years of age, hypertension (ie, high blood pressure), or diabetes.² People with other clinical risk factors should also be considered for screening: obesity, recurring urinary tract infections, prior acute kidney injury, kidney stones, and exposure to medications such as non-steroidal anti-inflammatory drugs (NSAIDs).

How Is Chronic Kidney Disease Diagnosed?

CKD is diagnosed if one or more of the following indicators of kidney abnormality is found:²

1. Glomerular filtration rate (GFR) <60 mL/min/1.73m²
2. Albuminuria (urine albumin-to-creatinine ratio >30 mg/g or urine albumin >30 mg/24 hours)
3. Abnormalities in urine sediment, histology, or imaging that suggest kidney damage
4. Renal tubular disorders
5. Prior kidney transplantation

How Is Chronic Kidney Disease Managed?

Manage Your Heart Disease Risk – Cardiovascular diseases (CVD; ie, diseases of the heart and blood vessels) are much more common in individuals with CKD.² In addition, CKD is associated with worse cardiovascular outcomes. Statin therapy is recommended for people >50 years old with CKD. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines also suggest controlling blood pressure to <140 mm Hg/90 mm Hg, with studies showing that intensive blood pressure control was associated with significantly lower risk of CVD and risk of all-cause mortality.⁴ Smoking cessation is recommended in all patients.

Manage Your Diabetes – CKD increases the risk of various comorbidities in diabetes such as atherosclerotic cardiovascular disease, heart failure, cardiovascular death, and all-cause deaths.^5,6 It is approximated that over 25% of people with diabetes have CKD and that 30-40% of people with diabetes will develop CKD (known as diabetic kidney disease when CKD is caused by diabetes) during their lifetime. However, it is estimated that only 9 of 10 people with CKD are aware of their disease. 

In patients with CKD and diabetes, a hemoglobin A1c target of 7.0% is recommended, as proper glycemic control can delay worsening of CKD. Furthermore, various studies have shown that intensive glucose control can lower the risk of kidney impairment.^7,8 Medications such as oral hypoglycemic agents should be carefully picked, avoiding the ones that are cleared by the kidney (eg, glyburide) and reducing the dosage of medications partially excreted by the kidney (eg, metformin, some sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase 4).² Specific medication classes (eg, SGLT-2 inhibitors) are recommended in people with severely increased albuminuria and diabetes, with studies showing better renal and cardiovascular outcomes.

Avoid Certain Medications – Routine administration of NSAIDs should be avoided in people with CKD.² Additionally, phosphate-based bowel preparations and proton pump inhibitors should be used with caution as they may cause acute kidney injuries.

Eat a Healthy Diet With Low Protein – As the kidney must work harder to filter and remove protein wastes, eating a balanced healthy diet with limited protein can help delay the progression of CKD.² The KDIGO guidelines recommended <0.8 g/kg per day of protein intake while eating a balanced diet if feasible.⁴

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