Chronic Kidney Disease (CKD) Treatment

Chronic kidney disease (CKD) is a condition in which kidneys are damaged irreversibly. It is caused by my diseases or conditions namely:

1. Diabetes 2. High BP 3. Glomerulonephritis 4. OTC (over the counter) medications like Pain killers and some ayurvedic medications. 5. Kidney infections, Kidney tumours 6. Some genetic diseases

CKD is a long-term disease and usually progresses over time.

CKD most commonly does not have any symptoms until it is fairly advanced. It is diagnosed with blood tests like Renal function tests which include serum Creatinine, blood Urea and BUN, urine routine and microscopy

The level of kidney damage in CKD is classified into 5 stages of kidney damage, from very mild damage in Stage 1 to complete kidney failure in Stage 5. The staging is usually done taking in account Serum Creatinine, body Weight, age and race.

Patients with CKD can live normal, healthy lives by following lifestyle and diet changes; and taking appropriate medicines for their disease.

This disease is usually progressive. But with a proper medical care and regular medications along with an optimum diet as advised by your doctor the progress can be delayed reasonably to lead a normal and healthy life.

Acute kidney injury

It is condition in which the kidney is affected temporarily due to any transient or other chronic illness and it is usually REVERSIBLE after the primary cause of illness is treated or controlled.

It is in most instances treatable and some patients may require transient dialysis till the kidney functions improves with treatment. Many ICU and hospitalised patients may have acute kidney injury.

Hemodialysis

When a CKD patients kidney function drops to severely low levels along with significant increase in creatinine and other toxins like urea in blood, excess fluid accumulation in body and acid and potassium then his blood needs to be filtered to remove the excess toxins and fluid.

Similar process can be required in patients with AKI (acute kidney injury- a form of temporary kidney disease)

HEMODIALYSIS is a form of dialysis where blood is filtered by passing it through a machine and a filter called as a DIALYZER. Usually, patients require an AV fistula on their forearm for doing dialysis.

Haemodialysis also has few other variants like SLED and CRRT which are slow forms of dialysis and usually done in ICU patients who have very low BP.

Kidney Transplantation

Kidney or Renal transplant is carried out for patients with advanced kidney failure, i.e., when the kidney function is irreversibly reduced to below 15%.

Usually this is done when patient is started on dialysis, but rarely it is done even before starting dialysis when patient is expected to require dialysis in near future.

During a kidney transplant, a donor’s kidney is placed is placed into the body of a recipient. The damaged kidneys of the patient are usually kept except some special diseases.

Kidney transplants are usually performed with Blood group matched donors.

But with some special treatment protocols even non blood group matched (ABO incompatible) donors can donate their kidneys to a recipient.

Kidney transplant is broadly done under 2 categories

Live kidney transplant: the donor is alive and a near relative of the recipient.
Cadaveric/Deceased donor transplant: kidney or other organs are taken from a patient who is “Brain Dead” and has anyways a poor chance of survival without life support systems(ventilators).

Kidney Biopsy

A kidney biopsy or renal biopsy is a procedure where a small piece of the kidney is is obtained from a special needle and the piece is sent for special tests which give us an insight about the diagnosis of the kidney problem and the extent to which it is damaged.

A kidney biopsy is advised for one of the following indications:

To diagnose the cause of the kidney problem
To know whether the kidney disorder is acute or chronic and whether it is responsive to treatment and is reversible or not.
To know if the patient is responsive to treatment.
In some cases, repeat biopsy is required if the diseases “Flares up”.
In few transplant patients where there is kidney dysfunction.

Vascular access creation and planning

Vascular access if basically a medium through which dialysis is made possible. In dialysis blood is diverted from the vascular access and taken to the dialysis machine where it is cleared of the toxins and then again taken back to the patient. For dialysis to function adequately there should be a good flow rate of blood from the vascular access to the dialysis machine.

For achieving a good volume of blood reaching at the dialysis machine a vascular access is created in a CKD patient whom we anticipate that the patient will require dialysis in the near future.

Vascular access for dialysis is of two types:

Temporary – in the form of catheters (hollow tubes) in the neck or legs
Permanent – in the form of Arteria venous (AV) Fistula or AV Grafts

AV Fistula is the best type of vascular access in suitable patients.

Hypertension

High blood pressure, or hypertension, is the second leading cause of kidney failure worldwide and in India.

Most patients with high blood pressure do not have any symptoms.

Uncontrolled hypertension gradually affects and damages organs like the eyes, heart, brain and kidney. Uncontrolled hypertension can cause variety of diseases like ischemic heart disease (Heart attack), Stroke, Chronic kidney disease, Retinopathy (damage to the retina of eye and hence affects vision)

Hypertension can usually by controlled with the right medications and further damage to organs can be prevented by timely intervention.

Most common treatment involves quitting smoking and alcohol, regular exercise, healthy eating habits like low salt, low fat and low-calorie diet, avoid junk foods. After above interventions if BP is still high then patients require medications. Many patients if having a dangerously high BP are started directly on BP medications.

Peritoneal Dialysis

During peritoneal dialysis, a specialised fluid is passed through a tube called a catheter into the patient’s abdomen. The inner membrane of the abdomen called peritoneum functions like a filter and removes waste products from the blood. The fluid with the filtered waste products is drained a periodic interval out of the abdomen and is discarded and again new fresh fluid is passed into the abdomen. In this form of dialysis filtration of waste products happen continuously. This form of dialysis can be done at home or while travelling.

The procedure requires initially a tube(catheter) insertion in the abdomen and after few days this form of dialysis is started. It’s basically of 2 types:

CAPD – It’s done manually by the patient or the caregiver and involves usually 2-4 exchanges in 24 hours.
APD – It’s an Automated procedure done with help of a machine and several exchanges are done by the machine overnight. It does not require much assistance and usually done while going to bed.

Glomerulonephritis

IT is a group of disorders in which some Antibodies are developed which attack the kidney and damage it and cause the kidney function to worsen and also may attack other organs of the body. If untreated they usually are progressive and may lead to CKD.

They may present with

Protein in urine
Blood in urine (may be visible or may be found on urine routine testing)
Increased BP
Swelling legs
Increased creatinine