Chronic Kidney Disease: How to Fight This Silent Threat

 This article presents the most important information that patients with Chronic Kidney Disease (CKD) need to know, summarized in five key questions and answers. It is entirely based on the monograph Chronic Kidney Disease and Renal Transplantation (2012), published by INTECH Open Access Publisher. The volume was edited by Professor Manisha Sahay, a nephrology specialist at Osmania General Hospital & Osmania Medical College, Hyderabad, India.

The book brings together the expertise of leading researchers and clinicians from Australia, the United Kingdom, the United States, and other countries, including Dr. Ross Francis and Dr. David Johnson (Princess Alexandra Hospital, Australia). It covers early diagnosis, modern treatment approaches, and the social impact of the disease. The information provided below aims to help patients and their families better understand CKD and learn how to ask the right questions when speaking with healthcare professionals.

“In 90% of cases, chronic kidney disease remains symptomless until it’s too late. Early diagnosis is the key to preserving kidney function and maintaining quality of life.”

Expert Insights 

Chronic kidney disease and kidney transplantation are highly significant health topics affecting millions of people worldwide. The condition often progresses silently, but early diagnosis and timely treatment can significantly reduce the risk of serious complications, including cardiovascular disease and the need for dialysis or transplantation. The expert opinions and quotes below provide key insights to help patients and their loved ones understand current knowledge and approaches to this serious medical condition.

1. Who is most at risk, and how should CKD screening be conducted?

“Many patients with CKD follow a predictable clinical course of progressive kidney dysfunction that ultimately leads to end-stage renal disease. Critically, CKD is clinically silent in up to 90% of patients until it reaches an advanced stage... Therefore, there is an opportunity to detect patients with asymptomatic CKD through screening and to apply therapies that can slow disease progression.”

Comment: Patients with diabetes, high blood pressure, a family history of kidney disease, individuals over 55, and those with other cardiovascular risk factors should be prioritized for screening. This includes testing estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (uACR), and monitoring blood pressure.

2. What is the connection between CKD and cardiovascular disease?

“In addition to the risk of progression to end-stage renal disease, CKD itself is a powerful risk factor for cardiovascular disease... People with early-stage CKD are up to 20 times more likely to die (mostly from cardiovascular causes) than to progress to dialysis or transplant.”

Comment: This underscores the need for rigorous monitoring and prevention of cardiovascular complications in people with CKD.

3. What are the most effective medications for slowing CKD progression?

“There is strong and consistent evidence that antihypertensive medications—especially those that inhibit the action of angiotensin II (ACE inhibitors and angiotensin receptor blockers)—reduce proteinuria and the rate of CKD progression.”

Comment: ACE inhibitors and ARBs (angiotensin receptor blockers) are strongly recommended, particularly in patients with diabetic or non-diabetic nephropathy and proteinuria. These should be a cornerstone of therapy for blood pressure control and kidney protection.

4. Do lipid-lowering drugs (statins) help in CKD?

“Data from the SHARP trial show that CKD patients treated with simvastatin plus ezetimibe experienced significantly fewer major atherosclerotic events... This suggests that CKD patients are likely to benefit from statin therapy.”

Comment: Patients with CKD should discuss the risks and benefits of statin therapy with their healthcare provider, especially if they have other cardiovascular risk factors.

5. Who should be screened, and when is screening most effective?

“Screening people with hypertension, diabetes, or age over 55 is the most effective strategy for detecting CKD, allowing for identification of over 93% of cases... Risk stratification and targeted screening in these groups is more cost-effective and avoids unnecessary testing in low-risk individuals.”

Comment: This approach is endorsed by international guidelines, which recommend annual screening of high-risk groups using simple and accessible tests.

Questions and Answers

1. Can I know I have chronic kidney disease before symptoms appear? How?

Answer: In most cases, CKD develops "silently" with no noticeable symptoms until it has progressed significantly. The authors emphasize that up to 90% of patients are unaware they have a problem until the disease is in its later stages. That makes early screening crucial—blood tests (serum creatinine to calculate eGFR), urine protein tests, and blood pressure monitoring can detect the disease months or even years before symptoms like fatigue, swelling, or changes in urination appear.

2. What can cause false-positive results in urine protein tests?

Answer: Urine protein testing (for proteinuria) is a key tool for detecting CKD, but several factors can cause temporary protein elevations unrelated to kidney disease. These include urinary tract infections, high-protein diets, heart failure, fever, intense physical activity within the past 24 hours, menstruation or vaginal discharge, and certain medications (e.g., NSAIDs, ACE inhibitors, ARBs, calcineurin inhibitors). That’s why results should be confirmed through repeat testing and discussed with a healthcare provider.

3. How is my kidney function measured, and what are the stages of CKD?

Answer: Kidney function is assessed using the “estimated glomerular filtration rate” (eGFR), calculated from a blood sample. Several formulas (e.g., MDRD, CKD-EPI) take into account creatinine levels, age, gender, and race. According to international classification, CKD is divided into five stages:

• Stage 1: Normal or elevated eGFR (≥90) with other signs of kidney damage

• Stage 2: Mildly decreased eGFR (60–89)

• Stage 3: Moderately decreased eGFR (30–59)

• Stage 4: Severely decreased eGFR (15–29)

• Stage 5: Kidney failure (<15) or need for dialysis

As the stages progress, the risk of complications increases.

4. What lifestyle changes are recommended if I have CKD?

Answer: The article highlights that controlling blood pressure, regularly monitoring kidney function, quitting smoking, maintaining a healthy weight, and managing blood sugar in diabetes are key to slowing disease progression. It also recommends limiting salt intake and avoiding non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, which can further damage the kidneys. Protein intake may need to be slightly reduced in advanced disease stages—this should be discussed with a doctor or dietitian.

5. If my kidneys are working less efficiently, does that mean I’ll definitely need dialysis or a transplant?

Answer: Not necessarily. The publication emphasizes that CKD progression varies widely—some patients maintain stable kidney function for years, especially with early detection and proper treatment, while others may see faster decline. Many older adults live for years with reduced kidney function without ever requiring dialysis. For them, the main concern is cardiovascular disease. The primary goal of early diagnosis and treatment is to slow disease progression and reduce complications—not to assume dialysis is inevitable.

Conclusion 

Understanding chronic kidney disease and modern approaches to its diagnosis and treatment is the first step toward better health and quality of life. As emphasized in the book Chronic Kidney Disease and Renal Transplantation (Ed. Prof. Manisha Sahay, INTECH Open Access Publisher, 2012), early detection, monitoring key health markers, adopting healthy lifestyle changes, and actively participating in one’s own care are essential for slowing disease progression and reducing the risk of complications.

With accurate, science-based information, patients can make more confident decisions and work more effectively with their healthcare team.

Source: Sahay, Manisha (Ed.). (2012). Chronic Kidney Disease and Renal Transplantation. INTECH Open Access Publisher. https://www.intechopen.com/books/3373