Understanding Chronic Kidney Disease
Chronic Kidney Disease (CKD) is a progressive condition where the kidneys gradually lose their ability to filter waste and excess fluids from the blood. This leads to the accumulation of harmful substances in the body, which can cause various health issues. CKD is a global health concern, affecting millions of people and leading to significant morbidity and mortality.
"Chronic kidney disease is a progressive condition that affects >10% of the general population worldwide, amounting to >800 million individuals. Chronic kidney disease is more prevalent in older individuals, women, racial minorities, and in people experiencing diabetes mellitus and hypertension. Chronic kidney disease represents an especially large burden in low- and middle-income countries, which are least equipped to deal with its consequences. Chronic kidney disease has emerged as one of the leading causes of mortality worldwide, and it is one of a small number of non-communicable diseases that have shown an increase in associated deaths over the past 2 decades. The high number of affected individuals and the significant adverse impact of chronic kidney disease should prompt enhanced efforts for better prevention and treatment."
Glomerular Filtration Rate (GFR) is a key indicator of kidney function, reflecting how well the kidneys are filtering blood.
It measures the rate at which the kidneys filter waste products, excess fluids, and other solutes from the blood, typically expressed in milliliters per minute (mL/min).
The 5 Stages of CKD
Stage 1
Kidney damage with normal or increased GFR (≥90 mL/min/1.73 m²). Often asymptomatic.
Stage 2
Mild reduction in GFR (60-89 mL/min/1.73 m²). Some signs of kidney damage may be present.
Stage 3
Moderate reduction in GFR (30-59 mL/min/1.73 m²). Symptoms such as fatigue, swelling, and changes in urination patterns may begin to appear.
Stage 4
Severe reduction in GFR (15-29 mL/min/1.73 m²). Symptoms become more pronounced, and preparations for dialysis or transplantation may be necessary.
Stage 5
Kidney failure (GFR <15 mL/min/1.73 m²). Dialysis or kidney transplantation is required to sustain life.
CKD is estimated to affect about 10% of the global population. It is a leading cause of death worldwide, with millions of deaths each year attributable to CKD and its complications.
Challenges in Current CKD Treatment
Overview of Existing Treatments
Medications
- Used to manage symptoms, control blood pressure, and reduce proteinuria. Common medications include ACE inhibitors, ARBs, diuretics, and erythropoiesis-stimulating agents.
Lifestyle Modifications
- Dietary changes, exercise, and smoking cessation are recommended to slow disease progression and improve overall health.
Dialysis
- A life-sustaining treatment for advanced CKD, where a machine filters waste products and excess fluids from the blood.
Kidney Transplantation
- The preferred treatment for end-stage CKD, offering the best long-term outcomes. However, it is limited by the availability of donor organs and the need for lifelong immunosuppressive therapy.
Limitations and Side Effects
Medications
- Can have significant side effects, such as hyperkalemia, hypotension, and gastrointestinal issues. Long-term use of some medications may also cause additional kidney damage.
Dialysis
- While life-saving, dialysis is invasive, time-consuming, and can significantly impact quality of life. It is associated with complications such as infections, cardiovascular problems, and muscle wasting.
Transplantation
- Despite being the best option for many, transplantation involves risks such as organ rejection, infections, and the long-term side effects of immunosuppressive drugs.
Unmet Needs
Early Detection and Intervention
- There is a need for better methods to detect CKD early and intervene before significant damage occurs.
Non-Invasive Treatments
- Developing treatments that are less invasive and have fewer side effects is crucial to improving patient outcomes and quality of life.
Improved Management of Complications
- Better strategies are needed to manage the numerous complications associated with CKD, such as cardiovascular disease, anemia, and bone disorders.