Chronic Kidney Disease
Gradual loss of kidney function over months to years.
Overview
CKD is staged by eGFR and albuminuria. Most patients never reach dialysis but cardiovascular risk is substantially elevated.
Symptoms
- • Often silent until advanced
- • Fatigue
- • Swelling
- • Foamy urine
- • Itching, poor appetite (late)
Risk factors
- • Diabetes
- • Hypertension
- • Family history
- • Recurrent kidney infections
- • Long-term NSAID use
Causes
- • Diabetic and hypertensive kidney disease (most common)
- • Glomerular disease
- • Polycystic kidney disease
🚨 Red flags — seek urgent care
- • Reduced urine output
- • Severe swelling
- • Breathlessness
- • Confusion
When to seek care
- • Rising creatinine
- • New proteinuria
- • Uncontrolled BP
Diagnosis
- • eGFR <60 mL/min/1.73m² and/or urine ACR ≥3 mg/mmol persisting >3 months
- • Stage by eGFR (G1–G5) and albuminuria (A1–A3)
- • Identify cause: diabetes, hypertension, glomerular, polycystic, obstructive
- • Renal ultrasound; immunology if intrinsic renal disease suspected
Treatment
- • Tight BP control (<130/80 if albuminuria) with ACE inhibitor or ARB
- • SGLT2 inhibitor (dapagliflozin, empagliflozin) reduces progression in CKD with or without diabetes
- • Optimise diabetes (HbA1c individualised), lipids (statin) and cardiovascular risk
- • Treat anaemia (iron, ESAs), bone-mineral disease, acidosis as eGFR falls
- • Avoid nephrotoxins: NSAIDs, contrast where avoidable, dose-adjust drugs
- • Plan renal replacement therapy (dialysis or transplantation) at advanced stages
Prevention
- • Tight control of BP and glucose in at-risk groups
- • Avoid prolonged NSAID use
- • Hydration, healthy weight, no smoking
- • Annual screening with eGFR and ACR in high-risk groups (diabetes, hypertension, CVD)
Complications
- • Cardiovascular disease (leading cause of death)
- • Anaemia
- • CKD–mineral and bone disorder
- • Metabolic acidosis, hyperkalaemia
- • Progression to end-stage renal disease requiring dialysis or transplant
Prognosis
Most CKD does not progress to dialysis. Cardiovascular risk dominates outcomes. SGLT2 inhibitors and renin-angiotensin blockade substantially slow progression.
Education & self-care
Avoid nephrotoxins (NSAIDs, contrast without hydration), control BP and glucose tightly, and review medications regularly.
Frequently asked questions
Will I need dialysis?
Most patients with CKD never progress to dialysis when BP, glucose and proteinuria are well controlled.
Will I need dialysis?
Most people with mild-to-moderate CKD never reach dialysis. Good blood pressure and glucose control plus ACE inhibitors or ARBs and SGLT2 inhibitors can slow progression substantially.
Are over-the-counter painkillers safe?
Paracetamol is generally safe. NSAIDs (ibuprofen, naproxen, diclofenac) can worsen kidney function and should be avoided or used sparingly under medical advice.
Why do I need annual urine albumin tests?
Albuminuria predicts both kidney decline and cardiovascular events independently of eGFR. Treating it with ACE inhibitors, ARBs or SGLT2 inhibitors significantly improves outcomes.