YOUR AMAZING KIDNEYS

The kidneys are complicated and amazing organs that do many essential tasks to keep us healthy.
The main job of your kidneys is to remove toxins and excess water from your blood. Kidneys
also help to control your blood pressure, to produce red blood cells and to keep your bones
healthy.
Each roughly the size of your fist, kidneys are located deep in the abdomen, beneath the rib cage.
Your kidneys control blood stream levels of many minerals and molecules including sodium and
potassium, and help to control blood acidity. Every day your kidneys carefully control the salt
and water in your body so that your blood pressure remains the same.

Did you know?

Your Kidneys:

Make urine

Remove wastes and extra fluid from your blood

Control your body's chemical balance

Help control your blood pressure

Help keep your bones healthy

Help you make red blood cells

CHRONIC KIDNEY DISEASE

What is Chronic Kidney Disease?
Chronic kidney disease (CKD) is a progressive loss in kidney function over a period of months
or years. Each of your kidneys has about a million tiny filters, called nephrons. If nephrons are
damaged, they stop working. For a while, healthy nephrons can take on the extra work. But if the
damage continues, more and more nephrons shut down. After a certain point, the nephrons that
are left cannot filter your blood well enough to keep you healthy.

When kidney function falls below a certain point, it is called kidney failure. Kidney failure
affects your whole body, and can make you feel very ill. Untreated kidney failure can be lifethreatening.

What you should not forget:

Early chronic kidney disease has no signs or symptoms.

Chronic kidney disease usually does not go away.

Kidney disease can be treated. The earlier you know you have it, the better your chances
of receiving effective treatment.

Blood and urine tests are used to check for kidney disease.

Kidney disease can progress to kidney failure.

Kidney Diseases are Common, Harmful and often Treatable

Common: Between 8 and 10% of the adult population have some form of kidney damage, and
every year millions die prematurely of complications related to Chronic Kidney Diseases (CKD).
Harmful:

The first consequence of undetected CKD is the risk of developing progressive loss of
kidney function that can lead to kidney failure (also called end-stage renal disease,
ESRD) which means regular dialysis treatment or a kidney transplant is needed to
survive.
The second consequence of CKD is that it increases the risk of premature death from
associated cardiovascular disease (i.e. heart attacks and strokes). Individuals who appear
to be healthy who are then found to have CKD have an increased risk of dying
prematurely from cardiovascular disease regardless of whether they ever develop kidney
failure.

Treatable: If CKD is detected early and managed appropriately, the deterioration in kidney
function can be slowed or even stopped, and the risk of associated cardiovascular complications
can be reduced.

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How is kidney function measured?

The main indicator of kidney function is your blood level of creatinine, a waste product of the
body produced by muscles and excreted by the kidneys. If kidney function is reduced, creatinine
accumulates in the blood leading to an elevated level when a blood test is checked.
Kidney function is best measured by an indicator called GFR (Glomerular Filtration Rate) which
measures the blood filtration rate by kidneys. This indicator allows doctors to determine if the
kidney function is normal, and if not, to what level the reduced kidney function has deteriorated.
In everyday practice, GFR can easily be estimated (eGFR), from measurement of the blood
creatinine level, and taking into account, age, ethnicity and gender.
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Stages of Chronic Kidney Disease (CKD)

Usually, kidney disease starts slowly and silently, and progresses over a number of years. Not
everyone progresses from Stage 1 to Stage 5. Stage 5 is also known as End-Stage Renal Disease
(ESRD).

GFR: Glomerular Filtration Rate

CGA: Cause, GFR and Albuminuria categories
Source: "KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of
Chronic Kidney Disease.
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Causes of CKD
High blood pressure (hypertension) and diabetes are the most common causes of kidney disease.
The high blood pressure causes just over a quarter of all cases of kidney failure. Diabetes has
been established as the cause of around one-third of all cases and is the commonest cause of
ESRD in most developed countries.

Other less common conditions include inflammation (glomerulonephritis) or infections

(pyelonephritis). Sometimes CKD is inherited (such as polycystic disease) or the result of
longstanding blockage to the urinary system (such as enlarged prostate or kidney stones).
Some drugs can cause CKD, especially some pain-killing drugs (analgesics) if taken over a long
time. Often doctors cannot determine what caused the problem.

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Treating CKD
There is no cure for chronic kidney disease, although treatment can slow or halt the progression
of the disease and can prevent other serious conditions developing.
The main treatments are a proper diet and medications, and for those who reach ESRD, long
term dialysis treatment or kidney transplantation. In the early stages of kidney disease, a proper
diet and medications may help to maintain the critical balances in the body that your kidneys
would normally control. However, when you have kidney failure, wastes and fluids accumulate
in your body and you need dialysis treatments to remove these wastes and excess fluid from your
blood, dialysis can be done either by machine (hemodialysis) or by using fluid in your abdomen
(peritoneal dialysis). In suitable patients a kidney transplant combined with medications and a
healthy diet can restore normal kidney function. Dialysis and kidney transplantation are known
as renal replacement therapies (RRT) because they attempt to replace the normal functioning
of the kidneys and are discussed in more detail below.

Kidney Transplantation
A kidney transplant is an operation to place a healthy (donor) kidney in your body to perform the
functions your own diseased kidneys can no longer perform.
Kidney transplantation is considered the best treatment for many people with severe CKD
because quality of life and survival are often better than in people who use dialysis. However,
there is a shortage of organs available for donation. Many people who are candidates for kidney
transplantation are put on a transplant waiting list and require dialysis until an organ is available.
A kidney can come from a living relative, a living unrelated person, or from a person who has
died (deceased or cadaver donor); only one kidney is required to survive. In general, organs from
living donors function better and for longer periods of time than those from donors who are
deceased.
Overall, transplant success rates are very good. Transplants from deceased donors have an 85 to
90% success rate for the first year. That means that after one year, 85 to 90 out of every 100

transplanted kidneys are still functioning. Live donor transplants have a 90 to 95% success rate.
Long-term success is good for people of all ages.
WKD 2012 was devoted to spreading the message about the importance of organ donation and
kidney transplantation for people with ESRD.

Dialysis
Healthy kidneys clean blood and remove extra fluid in the form of urine. They also make
substances that keep our body healthy. Dialysis replaces the blood cleaning functions when
kidneys no longer work.
There are two types of dialysis: hemodialysis and peritoneal dialysis.
In hemodialysis, your blood is pumped through a dialysis machine to remove waste products
and excess fluids. You are connected to the dialysis machine through a needle in a vein that is
surgically enlarged (vascular access) or through a temporary plastic catheter placed in a vein.
This allows blood to be removed from the body, circulate through the dialysis machine for
cleansing, and then return to the body. Hemodialysis can be done at a dialysis center or at home.
When done in a center, it is generally done three times a week and takes between three and five
hours per session. Home dialysis is generally done three to seven times per week and takes
between three and ten hours per session (often while sleeping).
Peritoneal dialysis is another form of dialysis used to remove waste products and excess water.
It works on the same principle as hemodialysis, but your blood is cleaned while still inside your
body rather than in a machine by adding clean fluid to your abdomen, letting it accumulate waste
products from the blood and then draining it out. It is typically done at home. Some patients can
perform peritoneal dialysis continuously while going about normal daily activities (continuous
ambulatory peritoneal dialysis, CAPD)
To find out more about these possible treatments and how they work, visit
http://www.uptodate.com/contents/dialysis-or-kidney-transplantation-which-is-right-for-mebeyond-the-basics

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Prevalence of CKD
About 1 in 10 people have some degree of CKD. It can develop at any age and various
conditions can lead to CKD.

Kidney disease can affect people of all ages and races. African Americans, Hispanics, American
Indians and people of South Asian origin (those from India, Bangladesh, Sri Lanka or Pakistan)
have a higher risk of CKD. This risk is due in part to high rates of diabetes and high blood
pressure in these communities.
CKD can occur at any age, but r becomes more common with increasing age and is more
common in women. Although about half of people aged 75 or more have some degree of CKD,
many of these people do not actually have diseases of their kidneys; they have normal ageing of
their kidneys. Simple blood and urine tests can detect CKD and simple, low cost treatments can
slow the progression of the disease, reduce the risk of associated heart attacks and strokes and
improve quality of life.
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Cost of CKD
The prevalence of kidney disease is increasing dramatically and the cost of treating this growing
epidemic represents an enormous burden on healthcare systems worldwide. Even in high income
countries, the very high cost of long term dialysis for increasing numbers of people is a problem.
In low and middle income countries long term dialysis is unaffordable. The best hope for
reducing the human and economic costs of chronic kidney disease and end-stage renal disease
therefore lies in prevention, for the following reasons:

Chronic kidney diseases are not curable and can cause people to need care for the rest
of their lives.
If CKD is not detected early enough, the patient may progress to kidney failure which
requires Renal Replacement Therapy (dialysis or transplantation) that is extremely costly
and weighs heavily on healthcare budgets.
Chronic Kidney Diseases trigger other healthcare issues like cardiovascular diseases
(heart attack and stroke), which will lead to premature death or disability and multiply the
amount of amount of money needed for the healthcare of a patient.

In developed countries, ESRD is a major cost driver for patients, their families and the taxpayer.
Patients with ESRD require dialysis or kidney transplantation, which are highly costly and
consume a sizeable portion of the health budget.
For instance:

According to a recent report published by NHS Kidney Care, in England Kidney Disease
costs more than breast, lung, colon and skin cancer combined.

In Australia, the cost of treating all current and new cases of ESKD to 2020 is estimated
at $12 billion. The annual cost of dialysis per patient per year varies between 50,000 and
80,000 AUD depending on the type of treatment.

In the US, treatment of CKD () is likely to exceed $48 billion per year, and the ESRD
program consumes 6.7% of the total Medicare budget to care for less than 1% of the
covered population.

In China, the economy will lose US$558 billion over the next decade due to effects on
death and disability attributable to chronic cardiovascular and renal disease.

In Uruguay, the annual cost of dialysis is close to $ US 23 million, representing 30% of

the budget of the National Resources Fund for specialized therapies.

In middle-income countries, access to life-saving therapies has progressively increased over the
same period yet renal replacement therapy remains unaffordable for the majority of patients.
Developing countries, with a combined population of over 600 million people, cannot afford
renal replacement at allresulting in the death of over 1 million people annually from untreated
kidney failure. Indeed, more than 80% of individuals receiving renal replacement therapy (RRT)
live in the developed world because in developing countries it is largely unaffordable. In
countries such as India and Pakistan, less than 10% of all patients who need it receive any kind
of renal replacement therapy. In many African countries there is little or no access to RRT,
meaning many people simply die. RRT is also used to treat acute kidney injuries where recovery
of kidney function usually occurs if the patient can be kept alive by dialysis until that happens.
The lack of available RRT results in the preventable deaths of many thousands of children with
diarrheal diseases and women with complications of pregnancy in the developing world every
year (see below). WKD 2013 was dedicated to spreading the message of the importance of acute
kidney injury (AKI).
Examples of costs from other regions of the world:
http://www.academia.edu/3633811/Chronic_kidney_disease_global_dimension_and_perspective
s
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CKD in elderly people

About 1 in 10 people have some degree of CKD. It can develop at any age and various
conditions can lead to CKD. It however becomes more common with increasing age. After the
age of 40, kidney filtration begins to fall by approximately 1% per year. On top of the natural
aging of the kidneys, many conditions which damage the kidneys are more common in older
people including diabetes, high blood pressure and heart disease.
It is estimated that about one in five men and one in four women between the ages of 65 and 74,
and half of people aged 75 or more have CKD. In short, the older you get the more likely you are
to have some degree of kidney disease. This is important because CKD increases the risk of heart

attack and stroke, and in some cases can progress to kidney failure requiring dialysis or
transplantation. Regardless of your age, simple treatments can slow the progression of kidney
disease, prevent complications and improve quality of life.
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Sources

WebMD - CKD Topic Overview :http://www.webmd.com/a-to-z-guides/chronic-kidneydisease-topic-overview

National Kidney Disease Education
Program - http://nkdep.nih.gov/learn.shtml#sthash.tl0ROPJ8.dpuf

Kidney Research UK - http://www.kidneyresearchuk.org/home.php

The Kidney Foundation of Canada - What is Kidney Disease? http://www.kidney.ca/

Kidney Health Australia - Fast Facts on CKD in Australia

http://www.kidney.org.au/KidneyDisease/FastFactsonCKD/tabid/589/Default.aspx

NHS - Kidney Disease, chronic Causes : http://www.nhs.uk/Conditions/Kidneydisease-chronic/Pages/Causes.aspx

The renal Association: http://www.renal.org/home.aspx

Patient.co.uk - CKD - http://www.patient.co.uk/health/chronic-kidney-disease-leaflet

National Kidney and Urologic Disease Information Clearinghouse (NKUDIC) Kidney Disease Statistics for the US
- http://kidney.niddk.nih.gov/kudiseases/pubs/kustats/

Cass A et al. The Economic Impact of End-Stage Kidney Disease in Australia:

Projections to 2020. 2010. Kidney Health Australia

- See more at: http://www.worldkidneyday.org/faqs/about-kidneys-and-kidney-disease/kidneysand-chronic-kidney-disease/#sthash.Jpl3ccky.dpuf

HOW TO TAKE CARE OF YOUR

KIDNEYS

Are you at risk?

Do you have high blood pressure?

Do you suffer from diabetes?

Do you have a family history of kidney disease?

Are you overweight?

Do you smoke?

Are you over 50 years?

Are you of African, Hispanic, Aboriginal or Asian origin?

If you have answered yes to one or more of these questions, you should discuss with your doctor,
you may need testing for kidney disease! Early chronic kidney disease has no sign or symptoms.
You can help delay or prevent kidney failure by treating kidney disease early.
Did you know?
A person can lose up to 90% of their kidney function before experiencing any symptoms.

Symptoms
Most people have no symptoms until CKD is advanced. Signs of advancing CKD include
swollen ankles, fatigue, difficulty concentrating, decreased appetite, blood in the urine and
foamy urine.

Detection of Kidney Diease

The majority of individuals with early stages of CKD go undiagnosed. On WKD we are calling
on everyone to check if they are at risk for kidney disease and encouraging people with any risk
factors to take a simple kidney function test.
Kidney disease usually progresses silently, often destroying most of the kidney function before
causing any symptoms. The early detection of failing kidney function is crucial because it allows

suitable treatment before kidney damage or deterioration manifests itself through other
complications.
Simple laboratory tests are done on small samples of blood (to measure creatinine content and
estimate GFR) and on urine (to measure creatinine and albumin excretion).
Your doctor uses the results of your Serum Creatinine measured in the blood to estimate your
overall kidney function, or Glomerular Filtration Rate (GFR) and your blood sugar to be sure
you do not have diabetes. A simple dipstick test may be used to detect excess protein in the
urine.

Serum Creatinine: Creatinine is a waste product in your blood that comes from muscle
activity. It is normally removed from your blood by your kidneys, but when kidney
function slows down, the creatinine level rises. Your doctor can use the results of your
serum creatinine test to calculate your kidney function, or GFR.

Glomerular Filtration Rate (GFR): Your GFR tells how much total kidney function
you have. It may be estimated from your blood level of creatinine. Normal is about 100
ml/min, so lower values indicate the percentage of normal kidney function which you
have. If your GFR falls below 60 ml/min you will usually need to see a kidney disease
specialist (called a nephrologist), If the treatment you receive from the nephrologist does
not prevent a further reduction in GFR, your nephrologist will speak to you about
treatments for kidney failure like dialysis or kidney transplant. A GFR below 15 indicates
that you may need to start one of these treatments soon.

Urine albumin. The presence of excess protein in the urine is also a marker of CKD and
is a better indicator of the risk for progression and for premature heart attacks and strokes
than GFR alone. Excess protein in the urine can be screened for by placing a small plastic
strip embedded with chemicals that change color when protein is present (urine dipstick)
into a fresh urine specimen or can be measured more accurately with a laboratory test on
the urine.

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8 GOLDEN RULES FOR PREVENTION

Kidney diseases are silent killers, which will largely affect your quality of life. There are
however several easy ways to reduce the risk of developing kidney disease. Check out the 8
golden rules!

Secondary Prevention - slowing disease progression disease:

Key preventative measures have been defined and proven successful in those with early stages
of CKD as secondary prevention measures, which help slow disease progression and protect
against both kidney and cardiovascular disease, such as:

Reduction of high blood pressure -the lower the blood pressure (within the normal
range) , the slower the GFR decline
Specific medications to reduce proteinuria as well as lower blood pressure angiotensin
converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs)

Reduce salt intake to lower blood pressure

Control of glucose, blood lipids and anemia

Smoking cessation

Increase of physical activity

Control of body weight

Treatment: Clinical research over the last two decades has shown the potential benefit of
blockade of the renin-angiotensin system by medicines known as ACE inhibitors and ARBs. This
can significantly delay the progression of CKD, especially in people with diabetes and
hypertension at relatively low cost.
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What you should ask your doctor?

Here are some key questions that you can ask your doctor:

What is my GFR?

What is my urine albumin result?

What is my blood pressure?

What is my blood glucose (for people with diabetes)?

Other important questions:

What happens if I have kidney disease?

What should I do to keep my kidneys healthy?

Do I need to be taking different medicines?

Should I be more physically active?

What kind of physical activity can I do?

What can I eat?

Do I need to talk with a dietitian to get help with meal planning?

Should I be taking ACE inhibitors or ARBs for my kidneys?

How often should I get my kidneys checked?

- See more at: http://www.worldkidneyday.org/faqs/take-care-yourkidneys/#sthash.LYUC8Ldy.dpuf