We asked Ms Nicola Thomas, kidney nurse specialist and senior lecturer at City University London, what she would want to know about CKD.
What is CKD?
CKD is the name used to describe any permanent loss of kidney function.
Does kidney function decline naturally with age?
Yes, it does. For every year over the age of 40, you lose 1% of your kidney function and by the age of 80, you only have 60% kidney function. However, this doesn’t mean that you'll necessarily suffer from health problems. Many people are able to live healthy lives even when their kidney function is reduced to as low as 30%.
I have CKD. How do I know how serious it is?
To find out how well the kidneys are functioning and the stage of your CKD, the estimated glomerular filtration rate (or eGFR) is measured. The eGFR test estimates the volume of blood filtered by your kidney at a given period of time. This blood test shows how effectively the kidneys are cleaning the blood. Anyone with an eGFR of 90% or more has perfectly normal kidney function.
- Stage one and stage two CKD: These stages indicate there's some slight sign of kidney damage but that the eGFR is normal or only slightly reduced.
- Stage three CKD: The eGFR is 30-59% This indicates a moderate reduction in kidney function but not to a level that is worrying or life-threatening. The aim of treatment and lifestyle changes is to keep people within stage three CKD and stop them from progressing to stage four.
- Stage four CKD: This indicates an eGFR of 15-29% and a more severe reduction in kidney function. People with stage four CKD are more likely to see a specialist for treatment.
- Stage five CKD: An eGFR of 15% or less. This shows established kidney failure. Dialysis or a kidney transplant may be needed in the future.
What’s the next step after diagnosis?
You should continue going for regular blood tests. These will be organised by your GP.
- If you know that you have high blood pressure, it's very important that you keep on top of your medication because high blood pressure is a key factor in the progression of CKD.
- Do not smoke.
- If you have diabetes, make sure you control your blood sugar level.
- If you're buying tablets over-the-counter (particularly anti-inflammatory drugs), you should tell the pharmacist that you have chronic kidney disease.
- You should talk to your GP before using certain complementary therapies, such as Chinese medicines.
Will I need a special diet?
With CKD stage three, you should make sure that you have a healthy diet that's low in salt, fat and sugar. Eating plenty of fresh fruit and vegetables and a good balance of nutrients is advisable. If your kidney disease progresses, you may be referred to a dietitian.
Will I need dialysis with stage three CKD?
Most people with stage three kidney damage have stable kidney function which, with recommended lifestyle changes, is unlikely to get worse. However, a minority of people with chronic kidney disease will see a slow deterioration in function and there's a chance they'll need dialysis in the future. However, this is by no means definite, and there are lots of self-help measures that can prevent it.
Does kidney disease make me more at risk of other health conditions?
Yes, it does. You're at a greater risk of heart attack and stroke, which is why both a healthy diet and plenty of exercise are important to keep it under control.
Will I have to see a kidney specialist?
If you have stage three CKD with no other kidney problems, it’s likely you will remain under the care of your GP. If you have stage four CKD and are found to have protein in the urine, or if your kidney function is dropping quickly, you'll probably have shared care between your GP and a kidney specialist.
For people with stage five CKD, hospital-based care under a multi-disciplinary team will be advised.
I’ve been referred to a kidney specialist. Does this mean I will soon need dialysis?
Don’t panic. It doesn’t necessarily mean that dialysis is on the horizon. It may be that a combination of high blood pressure and chronic kidney disease needs specialist care. Remember that each case of chronic kidney disease is unique to each patient. The specialist’s aim is to slow down kidney damage and, if need be, plan for some people to have further treatment, such as dialysis or a kidney transplant.
