Chronic Kidney Disease (CKD)

This educational piece is written by Dr. Sze Xun Quan, Consultant Nephrologist, to help you better understand your kidney health.

Our kidneys are vital organs where they help in few things:

• Remove nitrogen waste (toxin)
• Regulate the water we took (passing out through urine)
• Regulate our electrolytes (Sodium, Potassium)
• Regulate our body acid-base balance
• Regulate our hemoglobin level by producing erythropoietin hormone

However, kidney diseases are common and represent a complication of chronic illness (Diabetes Mellitus, Hypertension). Chronic Kidney Disease (CKD) is common which involve 10-15% of population globally.

                                                                                 Normal                                                 CKD

What is chronic kidney disease (CKD)?

Answer: CKD is defined as abnormal creatinine levels and/or persistent albumin or blood in the urine for more than 3 months.

How many stages of CKD are there?

Answer: 5 stages

• Stage 1: GFR > 90
• Stage 2: GFR 60–89
• Stage 3: GFR 30–59
• Stage 4: GFR 15–29
• Stage 5: GFR < 15

What causes CKD?

Answer:

• Diabetes
• Hypertension
• Glomerular diseases
• Polycystic kidney disease
• Medications (especially frequent use of NSAIDs)
• Kidney stones causing urinary tract obstruction or infection

Is there a cure?

Answer:
Currently, there is no medication that can cure CKD. Treatment aims to slow down the progression of kidney damage.

What is the treatment process like?

1. Detailed patient history, including current medications, to identify any possible cause affecting kidney function (and to rule out acute kidney injury).
2. Ultrasound of the kidneys, to rule out congenital issues or obstruction from kidney stones.

Non-pharmacological treatment options:

1. Weight reduction
Being overweight (BMI > 25) is increasingly common. In Malaysia, 54.4% had BMI>25, and 21.8% are obese (BMI > 30). Obesity not only worsens CKD but also leads to other illnesses.

2. Regular exercise
Engage in moderate physical activity (5 times a week, 30 minutes each session). Physical activity can be categorized into sedentary, light, moderate, and vigorous.

3. Quit smoking
Cigarettes contain many harmful chemicals. Nicotine and cadmium, in particular, can damage the kidneys.

4. Dietary recommendations:

• Reduce salt (sodium) intake. (This includes not only table salt but also soy gsauce, canned foods, etc.) Excess sodium can cause high blood pressure and cardiovascular disease.
  For CKD patients, salt intake should be <5g/day.
• Eat more fruits and vegetables.
• Reduce high-protein foods (to discussed with your doctor, as too little protein can lead to malnutrition).

5. Avoid unnecessary medications or supplements

Medication-Based Management

As mentioned earlier, up to now, there is no medication that can cure chronic kidney disease (CKD). What we can do is only slow down the progression of kidney function deterioration.

1. Control Blood Sugar (For Diabetic Patients)
Target HbA1c: between 6.5–8.0.
If the patient is younger or has no diabetic complications yet, blood sugar control tends to be more stringent.

2. Target systolic blood pressure (SBP): below 120 mmHg,
but this depends on the individual case. For example, in elderly patients who may experience symptoms of low blood pressure or have unstable walking and a higher risk of falling, the target should not be set too low.

3. The 4 Pillars of Diabetic Kidney Disease Treatment

• ACE-Inhibitors / ARBs
  These are types of blood pressure medications.
  Besides effectively controlling blood pressure, they also help slow down the progression of CKD and reduce the loss of protein (albumin) in urine.
  ACE inhibitors usually end in “-pril”, and ARBs usually end in “-sartan”.
• SGLT2-Inhibitors
  These are anti-diabetic medications, primarily used to reduce urinary albumin loss.
  They also have mild effects in lowering blood pressure and reducing body weight.
  These drugs usually end in “-gliflozin”.
• Non-Steroidal MRA Blockers
  These medications not only help reduce urinary albumin loss,but also have effects in reducing kidney inflammation and sclerosis (scarring).
  These drugs usually end in “-renone”.
• GLP-1 Agonists
  These are also anti-diabetic medications, which are effective in reducing body weight and slowing kidney disease progression.
  These drugs usually end in “-glutide”.

All of the above four medications not only help reduce urinary albumin loss and slow the progression of CKD, but also offer cardiovascular protection.
However, each medication has its own side effects, so you must discuss them with your doctor.

This educational piece is written by Dr. Sze Xun Quan, Consultant Nephrologist, to help you better understand your kidney health. Book your appointment now at Pantai Hospital Batu Pahat. You can also schedule an appointment through our website or by downloading the My Health 360 app from the Google Play Store or Apple App Store.