What is Chronic Kidney Disease? (CKD)

Chronic kidney disease (CKD) means that your kidneys are damaged in some way and have lost some of their functions such as: l Filtering your blood of waste products l Removing excess fluid l Controlling your blood pressure l Keeping your bones healthy l Preventing anaemia (low red cells in the blood) l Chronic means ongoing (persistent or long-term). It does not always mean severe as some people think. You can have a mild chronic disease. Many people have mild CKD l Renal means relating to the kidney l Many people have kidney problems What causes it? Kidney function may fall to low limits without noticeable symptoms. Once recognised, it is important for us to help you understand your figures, and identify factors in your life that may, if modified, be of help in addressing your problem. Three common causes in the UK, which probably account for about 3 in 4 cases of CKD in adults, are: l Diabetes. Kidney disease can be a common complication of diabetes l High blood pressure. Untreated or poorly treated high blood pressure is a very common cause of CKD. However, CKD can also cause high blood pressure, as the kidney works to keep the blood pressure stable. About nine out of ten people with CKD stages 3-5 have high blood pressure l Ageing kidneys. About half of people aged 75 or more have some degree of CKD. In most of these cases, the CKD does not progress beyond the moderate stage unless other problems of the kidney develop, such as diabetic kidney disease. Other less common conditions that can cause CKD include: l Diseases of the small filters in the kidney (glomeruli), this is called glomerulonephritis l Renal artery stenosis (narrowing of the blood vessels to the kidney) l Polycystic kidney disease; (cysts that develop on the kidneys) l Blockages to the flow of urine l Drug-induced and toxininduced kidney damage l Repeated kidney infections l This list is not complete and there are many other uncommon causes. l About 1 in 10 people have some degree of CKD. 1 2

How do we measure it? l A simple blood test can calculate the percentage kidney function l This test is called the estimated glomerular filtration rate (egfr) l A normal egfr is 90% or more l Sometimes your egfr can vary, it can go up and down l It can be affected by other factors such as infections, dehydration and medications l Your urine will also be checked for protein, blood and infection. Stages of Chronic Kidney Disease - 1 to 5 Chronic Kidney Disease is often referred to in stages from 1 to 5. The stage you are in will depend on the percentage of your kidney function Know your numbers! Ask your nurse or doctor when you next attend clinic. If you or your family have access to the internet you can apply for renal patient view, this will allow you to log on to your personal computer and see results from your hospital appointments with the renal team at Salford Royal. GFR Stage Description Plan 90% or over 60% to 89% 30% to 59% 15% to 29% Less than 15 1 2 3 4 5 This would be a normal level of function but would include people with protein in their urine Function is said to be reduced, but perhaps more protein loss in the urine At this level your kidneys are not working so well This shows more progressive deterioration in your kidney function Approaching the need to commence kidney replacement treatment as kidney function severely reduced Managed by your GP Managed by your GP More tests or appointments may be required with your specialist More frequent checks are needed. Consider discussion of treatment options if function deteriorates further Some patients may not want / be suitable for kidney replacement treatment. Treatment may be commenced where and if symptoms are occurring What are the symptoms of chronic kidney disease? l Sometimes patients do not have any symptoms or changes to how they feel l Symptoms tend to develop when CKD becomes severe (stage 4) or worse l The symptoms at first tend to be vague and nonspecific, such as feeling tired, having less energy than usual, and just not feeling well l With more severe CKD, symptoms that may develop include: n A poor appetite n Loss of concentration n Feeling tired n Weight loss n Dry, itchy skin n Muscle cramps n Fluid retention which causes swollen feet and ankles, shortness of breath n Puffiness around the eyes n A need to pass urine more often than usual n Being pale due to lack of red blood cells (anaemia) n Feeling sick n If the kidney function declines to stage 4 or 5 then various other problems may develop - for example, anaemia and an imbalance of calcium, phosphate, potassium and other chemicals in the bloodstream. These can cause various symptoms, such as tiredness due to anaemia, and bone thinning or fractures due to calcium and phosphate imbalance. 3 4

What is the treatment for chronic kidney disease? The aims of treatment are: Medication l To keep you as healthy and active as possible l Try to slow down any worsening of your kidneys l Plan for any future treatments you may need. The treatment will include: l Keeping your blood pressure within a safe target (130/80) l Preventing your kidneys from leaking protein (proteinuria) l Preventing you from becoming anaemic (reduced red blood cells) l Keeping your bones healthy l Keeping your heart healthy (preventing heart disease) l Keeping any other health problems under control, such as diabetes l Keeping your blood levels within safe limits, such as potassium, phosphate and calcium. l You may need to have a variety of medications as part of your treatment. These are often essential to care for your kidney disease l There are often lots of different medications that can be confusing or difficult to take l Make sure you ask what your medication is for and tell us if you are having any side effects or difficulties l Remember there are many other choices of medication if one particular doesn t suit you - tell us l Always bring a list of your current tablets to your clinic appointment. What can you do to keep well? l Talk to your kidney team and keep them well informed: They won t know unless you tell them: n How you are, n How you feel, n Any changes, n Any questions n Any concerns you have l Get regular health checks such as dental and routine screening l Attend your appointments l Try to reduce salt in your diet, salt is often highest in processed foods, so try to eat fresh food as much as possible. Reduce intake of fatty foods, high sugar foods l Take medication as prescribed and tell someone if you having problems with any medication l Try to be as active as you can dependant on your mobility, for some people this means going to the gym, running, cycling, swimming. For others it means walking, shopping, dancing or just being more active around the house l Try to stop smoking and limit your alcohol intake l If you have other concerns or important issues, you can share them with your team so they can provide you with support l Bring an up to date list of your medication to each hospital appointment. 5 6

Where can I get more information? l From your kidney care team l Other information leaflets - see your kidney care team l Patient education afternoons - see your kidney care team l RenalPatientView is a website for kidney patients l Internet sites: Kidneypatientguide.org National Kidney Federation (NFK) www.kidney.org.uk Patient.co.uk NHS choices Renal Association NICE Edren (Edinburgh renal unit website) British Kidney Patients Association (BKPA) www.britishkidney.pa.co.uk 0142 054 1424 PKD Foundation www.pkd.org.uk l Hope Kidney Patients Association - see your kidney care team info.hopekpa@gmail.com l National Kidney Federation (NKF) via website 0845 601 0209 l Contact your nursing team: 0161 206 1882 l Email your nursing team on: RenalCKD@srft.nhs.uk l Diabetes UK www.diabetes.org.uk l Patient Advice & Liaison Service (PALS) l GMKIN - Greater Manchester Kidney Information Network info@gmkin.org 07724776848 Facebook : GM Kidney Information Network Twitter @GMKINet Notes 7 8

G17051601W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2017 This document MUST NOT be photocopied Information Leaflet Control Policy: Unique Identifier: CS 29 (17) Review Date: May 2019 University Teaching Trust For further information on this leaflet, it s references and sources used, please contact 0161 206 1882. Copies of this information are available in other languages and formats upon request. If you need this interpreting please telephone In accordance with the Equality Act we will make reasonable adjustments to enable individuals with disabilities, to access this treatment / service. Email: InterpretationandTrans@srft.nhs.uk Under the Human Tissue Act 2004, consent will not be required from living patients from whom tissue has been taken for diagnosis or testing to use any left over tissue for the following purposes: clinical audit, education or training relating to human health, performance assessment, public health monitoring and quality assurance. If you object to your tissue being used for any of the above purposes, please inform a member of staff immediately. Salford Royal operates a smoke-free policy. For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service on 0161 206 1779 Salford Royal NHS Foundation Trust Stott Lane, Salford, Manchester, M6 8HD Telephone 0161 789 7373 www.srft.nhs.uk If you would like to become a Foundation Trust Member please visit: www.srft.nhs.uk/ for-members If you have any suggestions as to how this document could be improved in the future then please visit: http://www.srft.nhs.uk/ for-patients