Chronic Kidney Disease: Symptoms, Causes & Treatment

Chronic Kidney Disease (CKD) is a serious medical condition characterized by a gradual and progressive loss of kidney function over months or years. It is defined as an eGFR (estimated glomerular filtration rate) below 60 mL/min/1.73m² lasting more than 3 months, with or without visible kidney damage (such as albuminuria). The kidneys are responsible for filtering waste from the blood, regulating fluid and mineral balance, and producing hormones. When they fail these functions, toxins and waste accumulate in the body, causing serious health complications.

In Jordan and the Middle East, CKD is among the most prevalent health issues, affecting approximately 10–15% of the adult population, with rising rates due to high prevalence of diabetes and hypertension. The disease progresses through 5 stages based on eGFR: stages 1–2 (asymptomatic), stage 3 (mild to moderate), stage 4 (advanced), and stage 5 (end-stage renal disease requiring dialysis or transplant). Early detection and effective management can slow disease progression and significantly improve quality of life.

In early stages (1–2), patients may have no symptoms and CKD is discovered incidentally on blood or urine tests. As disease progresses (stages 3–4), symptoms appear gradually. In end-stage (5), severe symptoms may develop. Symptoms can differ by gender: women may experience worse fatigue during menstruation due to iron loss; men may have sexual dysfunction related to CKD.

• Fatigue and weakness because kidneys produce insufficient erythropoietin (hormone for red blood cell production).
• Shortness of breath or dyspnea, especially on exertion or when lying down.
• Swelling (edema) in face, feet, hands, and ankles due to fluid retention.
• Persistent nausea and vomiting, especially in early morning.
• Loss of appetite and decreased food intake.
• Severe itching and dry skin from waste accumulation.
• Bad breath or uremic breath due to toxic waste buildup in blood.
• Difficulty concentrating and memory problems (brain fog) from uremic toxins.
• Persistently elevated blood pressure despite medication.
• Insomnia and sleep disturbances.
• Back or flank pain (in cases of stones or obstruction).
• Changes in urination frequency (may decrease or increase depending on stage).

• Type 2 Diabetes: The leading cause of CKD globally, as elevated blood sugar damages small blood vessels in the kidneys.
• Hypertension (High Blood Pressure): Sustained elevated pressure damages and scars kidney vessels over time.
• Type 1 Diabetes: Can cause diabetic nephropathy in 20–30% of patients without good glycemic control.
• Immunological Kidney Diseases: Such as glomerulonephritis (primary or secondary to lupus, vasculitis, etc.).
• Inherited Kidney Disorders: Such as polycystic kidney disease (PKD), passed through families.
• Chronic Urinary Tract Obstruction: Recurrent kidney stones or prostatic hyperplasia can cause longstanding renal damage.
• Recurrent Kidney Infections: Pyelonephritis or chronic glomerulonephritis can lead to renal scarring.
• Nephrotoxic Medications: Chronic overuse of NSAIDs, certain antibiotics, or ACE inhibitors in susceptible patients.

• Diabetes: Strong family history or personal prediabetes significantly increases risk.
• Chronic Hypertension: Uncontrolled BP above 140/90 accelerates renal decline.
• Obesity: Excess weight increases glomerular pressure and systemic inflammation.
• Smoking: Reduces renal blood flow and increases glomerular pressure.
• Aging: People over 60 are at higher risk, especially with other comorbidities.
• Ethnicity and Family History: African and Asian descent populations have higher incidence rates.
• Cardiovascular Disease: Stroke and coronary disease are associated with CKD.
• Alcohol and Drug Use: Addiction increases inflammation and renal stress.
• Long-term Medications: ACE inhibitors, NSAIDs, and certain antibiotics in susceptible patients.
• Environmental Toxin Exposure: Heavy metals and pesticides may cause gradual nephrotoxicity.

Diagnosis of CKD is based on a combination of clinical examination and laboratory tests. Early detection is vital to slow disease progression. CKD is classified into stages based on eGFR and urine albumin-to-creatinine ratio (UACR).

• Serum Creatinine: Normal range 0.6–1.2 mg/dL. Elevated creatinine suggests reduced kidney function, but this marker alone is insufficient.
• Estimated Glomerular Filtration Rate (eGFR): Calculated from creatinine, age, sex, and ethnicity. Normal eGFR ≥90 mL/min/1.73m². eGFR 60–89 = Stage 2 (mild); 30–59 = Stage 3 (moderate); 15–29 = Stage 4 (advanced); <15 = Stage 5 (end-stage).
• Urine Albumin-to-Creatinine Ratio (UACR): Normal <30 mg/day. Presence of albumin indicates kidney damage even if eGFR is normal.
• Urinalysis: Detects protein, blood, and white blood cells in urine.
• Complete Blood Count (CBC): Detects anemia from inadequate erythropoietin production.
• Serum Phosphorus and Calcium: Kidneys regulate minerals; imbalance is common in CKD.
• Blood Pressure Monitoring: Regular measurement is essential as hypertension accelerates CKD progression.
• Renal Ultrasound: Assesses kidney size and detects stones, obstruction, or cysts.
• CT Scan: For suspected obstruction or tumors.
• Renal Biopsy: Rarely indicated when cause is unclear and significant proteinuria is present.

Medications

• ACE Inhibitors (ACEI): Such as lisinopril and enalapril. Reduce blood pressure and protect kidneys from further damage. First-line treatment in most CKD cases, especially with diabetes and hypertension.
• Angiotensin II Receptor Blockers (ARB): Such as losartan and valsartan. Work similarly to ACE inhibitors; used if patient cannot tolerate ACEI.
• SGLT2 Inhibitors: Such as empagliflozin and dapagliflozin. Modern agents that significantly improve renal outcomes, especially in diabetic CKD. Reduce proteinuria and lower BP.
• Phosphodiesterase-5 Inhibitors: Such as tadalafil (in research) for improving hemoglobin levels in uremic anemia.
• Iron Supplements: Oral or IV to treat anemia from insufficient erythropoietin production.
• Mineral-Regulating Agents: Calcium supplements, phosphate binders (such as sevelamer) to balance electrolytes.
• Additional Antihypertensive Agents: Beta-blockers (propranolol) and diuretics (furosemide) in advanced stages.
• Statins: Such as atorvastatin to reduce cholesterol and protect heart and kidneys.

Procedures and Interventions

• Hemodialysis (HD): Performed 3 times weekly for 4 hours. Used when eGFR <15. Blood is drawn from an arterial access in the arm, cleansed of waste, and returned. Available in most Jordanian hospitals.
• Peritoneal Dialysis (PD): Home-based treatment, 4–5 times daily. Dialysate solution is infused into the peritoneal cavity via catheter and drained after 4–6 hours. Better option for patients preferring flexibility and independence.
• Kidney Transplantation: Best treatment for end-stage renal disease. Kidney from living (family or altruistic) or deceased donor. Available in specialized centers in Jordan. Offers better quality of life but requires lifelong immunosuppression.
• Arteriovenous (AV) Fistula Creation: Minor surgical procedure for hemodialysis patients, connecting an artery to a vein in the arm to facilitate vascular access.

Lifestyle Changes

• Reduce Sodium (Salt): Keep intake <2.3 g daily. Excess salt raises BP and causes fluid retention. Avoid canned, processed, and fast foods.
• Blood Pressure Control: Target <130/80 mmHg. Requires medication adherence and regular monitoring.
• Diabetes Control: Maintain HbA1c <7% if diabetic to slow diabetic nephropathy.
• Reduce Protein Intake: 0.6–0.8 g/kg body weight daily in stages 4–5. Excess protein stresses kidneys. Consult renal dietitian.
• Limit Potassium: In stages 4–5. Excess potassium is cardiac risk. Avoid bananas, avocados, tomatoes, raisins, nuts.
• Limit Phosphate: In stages 4–5. Excess weakens bones. Avoid processed foods, full-fat dairy, nuts.
• Fluid Management: In stages 4–5, restrict fluids (including beverages) to control edema and BP.
• Regular Exercise: 150 minutes weekly of moderate activity (brisk walking). Improves cardiovascular health.
• Avoid Smoking and Alcohol: Smoking reduces renal blood flow; alcohol increases dehydration and inflammation.
• Maintain Healthy Weight: BMI 18.5–24.9. Obesity increases glomerular pressure.
• Regular Monitoring: Blood and urine tests every 3–6 months to track disease progression and treatment efficacy.

• Treatment-Resistant Hypertension: Blood pressure may remain uncontrolled despite multiple medications, increasing risk of stroke and MI.
• Cardiac Disease and Stroke: Damaged kidneys fail to regulate pressure and fluid, increasing cardiac load and thrombotic events.
• Anemia: Kidneys produce insufficient erythropoietin, causing severe fatigue and weakness.
• Mineral Bone Disorder (MBD): Kidneys fail to regulate calcium and phosphate, leading to osteoporosis and recurrent fractures.
• Hyperkalemia (High Potassium): Causes cardiac arrhythmias and potential cardiac arrest.
• Fluid Overload and Pulmonary Edema: Fluid accumulation in lungs causes severe dyspnea and life-threatening respiratory distress.
• Uremic Encephalopathy: Toxic waste accumulation in the brain causes poor concentration, memory loss, and confusion.
• End-Stage Renal Disease: May require lifelong dialysis or transplantation.

• Control Blood Pressure: Maintain BP <130/80 mmHg through medication, exercise, reduced salt, and limited alcohol.
• Manage Diabetes: If diabetic, maintain HbA1c <7%, monitor regularly, and take medications consistently.
• Avoid Overweight: Maintain healthy BMI 18.5–24.9 through balanced diet and regular exercise.
• Regular Physical Activity: 150 minutes weekly of moderate exercise improves cardiovascular and renal health.
• Reduce Dietary Salt: Keep intake <2.3 g daily to lower BP and protect kidneys.
• Avoid Overusing NSAIDs: Avoid OTC ibuprofen without medical need; use only when necessary and for short periods.
• Avoid Smoking and Alcohol: Smoking reduces renal blood flow; alcohol increases dehydration and inflammation.
• Regular Screening: Especially if diabetic or hypertensive. Check eGFR and urine albumin annually.
• Stay Adequately Hydrated: Drink sufficient water (without excess). Good hydration helps kidneys eliminate waste.
• Control Cholesterol: Through healthy diet and statins if needed to protect renal vasculature.