• Chronic kidney disease

    Chronic kidney disease is the progressive decline in kidney function over a period of months or years. Also known as chronic renal disease, symptoms can be subtle and are identified by screening patients at higher risk for the disease. Failure of the kidneys to filter blood can result in the buildup of waste materials in the body and may potentially endanger individual health.


    Among the various causes of chronic kidney disease (CKD), diabetes is one of the most insidious. Diabetic nephropathy is one of the leading causes of kidney failure followed closely by high blood pressure. Other kidney conditions that may lead to kidney failure are inherited familial diseases (e.g., polycystic kidney disease and chronic glomerulonephritis) as well as a variety of other kidney conditions that impair kidney function. Research shows that more than 20 million people (age 20 or older) in the United States have CKD.


    There are various clinical classifications of chronic kidney disease from mild to end-stage. Symptoms of CKD may include high blood pressure, itchy skin, malaise, difficulty breathing, leg cramps and lower back pain. A person may live normally with only one kidney, and not experience any chronic kidney disease. For patients with mild-to-moderate kidney disease, a special diet and medication may be enough to halt the progression to end-stage renal failure (ESRD). The function of the kidneys is to remove waste and from the body in the form of urine. When waste products build up in the bloodstream, a negative health affect occurs that can impact the entire system in the human body. For ESRD patients, compromised cardiovascular function can emerge as a secondary health problem to their renal failure.

    Testing and diagnosis

    Urine and blood tests are performed to assess kidney function. In chronic kidney disease patients, levels of the following may be outside normal range and indicate renal insufficiency:

    • Creatinine
    • BUN (Blood Urea Nitrogen)
    • Protein
    • Albumin

    Other diagnostic examination tools include:

    • lab tests for anemia
    • kidney ultrasound
    • CT scan
    • Biopsy


    Diet and nutritional management

    A low protein, low salt and low-phosphorus diet is usually instituted in the treatment of CKD. For diabetics, adhering to additional dietary restrictions can be a challenge. Adherence to a special dietary regimen may prevent the progression of CKD to ESRD.

    Kidney failure and dialysis

    In ESRD patients, dialysis is often initiated when the kidneys are unable to function to remove waste from the blood. Dialysis is a mechanical intervention that cleans the blood. It usually involves a four-hour period (three-to-four days per week) of attachment to an IV in a clinic setting or at home (or being surgically fitted with a peritoneal catheter). For this reason, patients often view dialysis as disruptive to the normal activities of daily life. However, dialysis may be essential for patients who have progressed to ESRD. One health risk is infection via the IV or peritoneal catheter; another risk is electrolyte imbalance. Yet, many ESRD patients function quite well on dialysis and are able to maintain their quality of life.

    Kidney transplant

    If the kidneys fail, patients may be a candidate for a kidney transplant. A living related donor is the best option, due to the higher success rate in terms of long-term outcome and lessened need for anti-rejection drugs. Blood typing and tissue typing are performed on potential donors to ensure there is a “match” so that the recipient’s body will not immediately reject the new kidney as foreign matter.

    If a living related donor is not available, the second-best option is a living non-related donor. If no living donor is found, a cadaver transplant may be a viable option. These donors have usually died due to a traumatic brain injury but without damage to their heart or kidneys—and have previously expressed that they wanted to donate their organ(s) in case of their death.