Chronic Kidney Disease: Symptoms, Causes, Diet and Treatment

Your kidneys work quietly day and night, filtering waste and extra water from your blood. Chronic kidney disease (CKD) is a slow loss of that ability, and by some estimates more than one in ten adults in Pakistan has some degree of it. The trouble is that it causes almost no symptoms until most of the function is already gone. That is why knowing the causes and getting a simple test can protect you for life.

What is chronic kidney disease?

CKD means the kidneys have been damaged, or have reduced function, for three months or more. Doctors measure it with the eGFR (a calculation of how well your kidneys filter blood from a creatinine test) and with the amount of protein in the urine. There are five stages. Stages 1 and 2 are mild and usually silent, stage 3 is moderate, and stages 4 and 5 are advanced, with stage 5 (kidney failure) needing dialysis or a transplant.

What causes CKD?

• Diabetes, the commonest cause worldwide
• High blood pressure, which both causes and results from kidney damage
• Glomerulonephritis, an inflammation of the filtering units
• Repeated or untreated kidney stones, blocked urine flow and recurrent infections
• Long-term use of painkillers (NSAIDs), especially diclofenac and ibuprofen taken daily, and painkiller injections
• Herbal, “desi” or unregistered remedies of unknown content, some of which contain heavy metals or toxins
• Inherited conditions such as polycystic kidney disease, and an enlarged prostate that blocks urine
• Smoking, obesity and high uric acid, see gout and uric acid

Symptoms

Early CKD usually has no symptoms. As it advances, people may notice:

• Tiredness and weakness, and paleness from anaemia
• Swelling of the ankles, feet and around the eyes
• Foamy urine, or blood in the urine
• Passing urine more at night, or much less than usual
• Loss of appetite, nausea, a metallic taste and itching
• Muscle cramps, shortness of breath and trouble concentrating
• High blood pressure that is hard to control

Who should be tested?

Anyone with diabetes, high blood pressure, heart disease, a family history of kidney disease, or long-term painkiller use should be tested at least once a year. The tests are simple: a blood test for creatinine and eGFR, a urine test for protein (albumin), blood pressure measurement and, sometimes, a kidney ultrasound.

How CKD is treated

Treatment aims to slow the damage and treat complications. Kidney function lost cannot usually be regained, but progression can often be slowed to a crawl.

• Control blood pressure, usually aiming for below about 130/80, often with an ACE inhibitor such as ramipril or an ARB such as losartan, which also lowers protein leakage.
• Control blood sugar. Some diabetes medicines such as empagliflozin and dapagliflozin also protect the kidneys.
• Lower cholesterol with a statin.
• Treat anaemia with iron and, in advanced CKD, injections that stimulate red blood cells such as epoetin.
• Protect the bones with vitamin D forms such as alfacalcidol and phosphate binders like sevelamer or calcium acetate.
• Correct acidity with sodium bicarbonate, and relieve swelling with water tablets such as furosemide.
• Dialysis or a kidney transplant when the kidneys fail.

Eating with CKD

• Cut salt to reduce swelling and blood pressure. Avoid achaar, papad, chips and salty snacks.
• Do not eat excess protein or protein powders. A moderate amount is right, and your doctor or dietitian will advise the amount for your stage.
• In later stages you may need to limit potassium (bananas, oranges, potatoes, tomatoes, coconut water) and phosphorus (cola, processed foods), but only if your blood tests show it is needed.
• Avoid salt substitutes, because they contain potassium.
• Follow your doctor’s advice on how much fluid to drink. Early on, normal fluid intake is fine.

Protect your kidneys every day

• Avoid regular painkillers such as diclofenac and ibuprofen, and ask for paracetamol instead.
• Do not use herbal or unregistered products without your doctor’s approval.
• Tell every doctor and pharmacist that you have CKD, because many medicine doses need adjusting.
• If you are ill with vomiting or diarrhoea, ask your doctor whether to pause certain tablets for a day or two, such as ACE inhibitors, ARBs, water tablets, metformin and SGLT2 inhibitors.
• Do not smoke, stay active and keep a healthy weight.
• Have your hepatitis B vaccine, and see your doctor regularly.

When to see a doctor

• Swelling of the face or legs, or foamy or bloody urine
• Passing very little urine
• Persistent tiredness, nausea, itching or breathlessness
• Diabetes or high blood pressure, and no kidney test in the past year

Key takeaways

• CKD is usually silent, so a yearly creatinine and urine test matters if you have diabetes or high blood pressure.
• Controlling blood pressure and sugar is the best way to protect the kidneys.
• Avoid daily painkillers and unregistered herbal remedies.
• Tell every doctor you have CKD so doses can be adjusted.

Related medicines on Medimart

These medicines are commonly prescribed in kidney disease and its complications:

• Losartan: lowers blood pressure and protects the kidneys
• Ramipril: an ACE inhibitor for blood pressure and protein leakage
• Empagliflozin: a diabetes medicine with kidney benefits
• Furosemide: a water tablet to reduce swelling
• Sodium bicarbonate: used to correct acid build-up
• Sevelamer: a phosphate binder
• Iron sucrose: injectable iron for anaemia
• Alfacalcidol: an active form of vitamin D for bone health

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Browse kidney care medicines on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor. If you have diabetes or high blood pressure, please have your kidneys tested every year.