Why Is My Kidney Function Declining

Chronic Kidney Disease & Covid

Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia , weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

Predictors Of Kidney Function Decline

Age, sex and race were the primary predictors in this analysis. Additional predictors of kidney decline were used for adjustment in multivariate analysis. These included prevalent cardiovascular disease coronary heart disease , stroke and transient ischemic attack], hypertension, diabetes mellitus , body mass index, smoking history , and fasting levels of low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Models were similar when systolic or diastolic blood pressure measurements were used.

We compared the characteristics of participants with and without at least 2 measurements of kidney function. Among participants with multiple measurements, characteristics of white women, black women, white men and black men were compared by ANOVA and a Ï2 test as appropriate.

We compared the annual rates of kidney function decline across age categories and among the 4 sex/race categories. We created linear regression models that modeled the annual rate of change in eGFRcrea or eGFRcys as the dependant variable in separate models adjusted for the covariates listed above. Sidak-adjusted tests for significance were used to evaluate differences in mean levels among sex and race groups . Multivariate logistic regression was used to evaluate age, sex and race as independent predictors of the dichotomized outcome: rapid kidney function decline.

S-Plus and SPSS statistical software were used for the analyses. p < 0.05 was considered statistically significant.

Stage 5gfr Of 15 Ml/min Or Less

Patients at Stage 5 have chronic CKD. They have a GFR of 15 mL/min or less and have End Stage Renal Disease .The kidneys have lost almost all ability to function effectively at this stage. They will need dialysis or a kidney transplant to live.

Our kidney specialists can work with you to provide individualized evaluation and treatment, taking into consideration your GFR and other factors. To learn more or schedule an appointment at one of our clinics call 412-802-3043 or toll free 1-800-533-UPMC .

You should discuss this result with your kidney specialist.

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Is There A Diet For Chronic Kidney Disease

Chronic kidney disease is a disease that must be managed in close consultation with a doctor. Self-treatment is not appropriate.

• There are, however, several important dietary rules one can follow to help slow the progression of kidney disease and decrease the likelihood of complications.
• This is a complex process and must be individualized, generally with the help of a health care practitioner and a registered dietitian.

The following are general dietary guidelines:

• Protein restriction: Decreasing protein intake may slow the progression of chronic kidney disease. A dietitian can help one determine the appropriate amount of protein.
• Salt restriction: Limit to 2 to 4grams a day to avoid fluid retention and help control high blood pressure.
• Fluid intake: Excessive water intake does not help prevent kidney disease. In fact, the doctor may recommend restriction of water intake.
• Potassium restriction: This is necessary in advanced kidney disease because the kidneys are unable to remove potassium. High levels of potassium can cause abnormal heart rhythms. Examples of foods high in potassium include bananas, oranges, nuts, avocados, and potatoes.
• Phosphorus restriction: Decreasing phosphorus intake is recommended to protect bones. Eggs, beans, cola drinks, and dairy products are examples of foods high in phosphorus.

Other important measures that a patient can take include:

Medication To Protect Your Kidneys

• ACE inhibitors and ARBs. If you have high levels of protein in your urine then you may be advised to take medication even if your blood pressure is normal. Two related types of medication have been shown to be beneficial for many people with CKD. This is because they can prevent further worsening of the function of your kidneys. These medicines are called:
• Angiotensin-converting enzyme inhibitors and
• Angiotensin receptor blockers , such as losartan, valsartan, candesartan, telmisartan).
• SGLT2 inhibitors. A group of medicines called the SGLT2 inhibitors were originally used to keep blood sugar under control in type 2 diabetes. However, more recent studies show that some of them can significantly reduce decline in kidney function. These may be recommended whether you have type 2 diabetes or not. The National Institute for Health and Care Excellence has issued new guidance recommending that they should be offered to, or considered for, most people with type 2 diabetes and CKD.

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Dialysis For Kidney Failure

Dialysis artificially removes waste from your blood. There are two forms of dialysis haemodialysis and peritoneal dialysis. Peritoneal dialysis is further broken down into two main types, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis .The choice of dialysis method depends of factors such as your age, health and lifestyle. Over 2,000 Australian adults start renal replacement therapy each year.

Diabetes And Kidney Failure

Without management, high blood sugar can damage your kidneys. The damage can worsen over time.

Diabetic nephropathy, or kidney damage caused by type 1 or type 2 diabetes, cant be reversed. Managing your blood sugar and blood pressure may help prevent or limit kidney damage. Taking medications as prescribed by your doctor is important, too.

If you have diabetes, your doctor will likely perform regular screenings to monitor for kidney failure.

Your risk for diabetic nephropathy increases the longer you live with diabetes.

Diabetes is the most common cause of kidney failure. About one-third of adults with diabetes have kidney disease, according to the

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How Can I Prevent Acute Kidney Failure

Preventing and treating illnesses that can lead to acute kidney failure is the best method for avoiding the disease. According to the Mayo Clinic, having a healthy lifestyle that includes regular physical activity and a sensible diet can help to prevent kidney failure. Work with your doctor to manage existing medical conditions that could lead to acute kidney failure.

Acute kidney failure can be a life-threatening illness. Chronic renal failure or end-stage renal disease can develop. Theres a greater risk of death if kidney failure is caused by severe infection, trauma, or surgery.

The following can also increase the risk of death:

Preventing Or Slowing Down The Progression Of Chronic Kidney Disease

There are ways to stop chronic kidney disease becoming any worse or to slow down any progression. You should have checks every now and then by your GP or practice nurse to monitor your kidney function – the eGFR test. They will also give you treatment and advice on how to prevent or slow down the progression of CKD. This usually includes:

• Blood pressure control. The most important treatment to prevent or delay the progression of chronic kidney disease, whatever the underlying cause, is to keep your blood pressure well controlled. Most people with CKD will require medication to control their blood pressure. Depending on the amount of albumin in your urine, your doctor may recommend a target blood pressure level to aim for of below 140/90 mm Hg or 130/80 mm Hg, and even lower in some circumstances. For children and young people with CKD and high levels of albumin in the urine, blood pressure should be kept less than average for their height.
• Review of your medication. Certain medicines can affect the kidneys as a side-effect which can make CKD worse. For example, if you have CKD you should not take anti-inflammatory medicines unless advised to by a doctor. You may also need to adjust the dose of certain medicines that you may take if your CKD gets worse.
• Diet. if you have more advanced CKD then you will need to follow a special diet. See the separate leaflet called Diet in Chronic Kidney Disease.

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Is High Protein Bad For Kidneys

Some high–protein diets include foods such as red meat and full-fat dairy products, which may increase your risk of heart disease. A high–protein diet may worsen kidney function in people with kidney disease because your body may have trouble eliminating all the waste products of protein metabolism.

What Are The Normal Ranges Of Gfr

The classification of GFR is as follows:

• Normal range: 100-140 ml/min
• Mild kidney function GFR< 90 ml/min
• Moderate damage to the kidneys GFR< 60 ml/min
• Severe stage of kidney damage GFR< 30 ml/min
• End stage renal disease: GFR< 15 ml/min

Also, learn that GFR naturally decreases as you age by 0.5-1ml/min and this is normal. For instance, a healthy person at the age of 60 or 70 will have GFR count in the range of 60-70 ml/min, half of their young adult normal.

The reasons why your GFR decreases

If you have decreased GFR, the doctor may do some clinical examination to know the underlying cause of the abnormal result.

Following can be the reason why your GFR may reduce:

• You have been taking any new medication such as anti-inflammatory, diuretics, antibiotics, or fluid tablets from a long time that too without the prescription from your consultant.
• Dehydration is another factor that may cause GFR to decrease, at least temporarily. This is because our kidneys need water in order to clean the blood for waste and in the absence of water, they may not work largely.
• If you have been taking any procedures that include administering contrast and dyes such as angiograms or CT scan.

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The doctor may also choose to carry out further tests to determine the cause of damage to the kidneys.

If there are any abnormalities in your blood test or physical test then you may be referred to a nephrologist.

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What Is Kidney Disease

Having kidney disease means that there is damage to your kidneys and they arent working as well as they should. Kidney disease is called chronic because kidney function slowly gets worse over time. Kidney disease leads to kidney failure, which is also called end-stage kidney disease. At this point, youll need dialysis or a kidney transplant.

Are There Stages Of Chronic Kidney Disease

Yes, there are five stages of kidney disease. The stages are based on how well your kidneys are able to do their job to filter out waste and extra fluid from your blood. The stages range from very mild to kidney failure . Healthcare providers determine the stage of your kidney function according to the glomerular filtration rate . Your GFR is a number based on the amount of creatinine, a waste product, found in your blood, along with other factors including your age, race and gender.

Stages of Chronic Kidney Disease
Stage

• Are African-American, Hispanic, Native American or Asian.
• Are over 60 years of age.
• Have a long history of taking painkillers, including over-the-counter products such as aspirin and ibuprofen.

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How Low Is Low

A healthy kidney filters wastes from the blood at a rate of 90 milliliters per minute or more. This is known as the glomerular filtration rate, or GFR. With time, many men’s kidneys start to slip, but function must decline quite a lot before you start to really feel the impact. You feel fine up to the point that kidney function is almost gone, which means you can lead a normal life with reduced kidney function.

On the other hand, lack of early warning from symptoms can deny you the chance to slow the slide. Most people don’t start feeling really ill until kidney function is under 10%.

Lifestyle And Health Behaviors

Smoking is an established factor for increased risk of development and rapid progression of diabetic kidney disease. Also, some studies suggest an association between diet and renal function decline in diabetics, for example in those with high alcohol consumption or a high-protein diet. It has been demonstrated that a high dietary acid load is associated with rapid progression of diabetic nephropathy to ESRD in Westernized South Asian people. Lack of physical activity is also considered to be a risk factor in diabetic nephropathy, with a previous study reporting that high physical activity in women was associated with an improvement in eGFR.

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Incident Ckd By Creatinine And Cystatin C

Among participants without CKD at the initial visit, we compared the proportion who developed incident CKD at the final kidney function measurement . Using eGFRcrea, 10% had developed CKD at the year 7 measurement of kidney function. The proportion with new CKD was nearly 2-fold when measured by cystatin C, making up 19% of the participants . Similarly, the proportion that reached eGFR < 45 was twice as high when kidney function was measured by cystatin C making up 2% of the participants by eGFRcrea versus 4% by eGFRcys . We also compared eGFRcrea and eGFRcys with the combined endpoint of âdeath or CKDâ. Each 5 ml/min/1.73 m2 lower eGFRcys had significantly higher adjusted odds of the combined outcome. The association per 5 ml/min/1.73 m2 lower eGFRcrea was significant, but weaker .

Become Your Own Expert

Many kidney patients choose to take an active role in their care and treatment. You can too by logging on to the PatientView website, where you may be able to keep track of all your medications, test results, scans and medical letters. You may also be able to see your medical history and get information about a wide range of tests .

You need to be referred to Patient View by your kidney unit so make sure you ask them to do this.

• For more ways to take control of your kidney disease visit our How can I help myself? section.

And for further information about kidney tests visit:

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Can Kidney Disease Be Prevented

Seeing your healthcare provider on a regular basis throughout your life is a good start for preventing kidney disease. About one in every three people in the United States is at risk for kidney disease. Identify and manage any risk factors for developing kidney disease.

• Control your high blood pressure. Normal blood pressure is 120/80.
• Control your blood sugar if you have diabetes.
• Eat a healthy diet. Follow a low-fat, low-salt diet.
• Dont smoke.
• Be active for 30 minutes at least five days a week.
• Maintain a healthy weight.
• Take nonprescription pain relievers only as directed. Taking more than directed can damage your kidneys.

Diagnosis Of Kidney Failure

A number of tests can be used to measure kidney function. If CKD is found, tests may be used to determine:

• the cause of the kidney damage
• the amount of kidney damage
• treatment options.

• blood tests to establish the estimated glomerular filtration rate , which measures how well the kidneys filter wastes from the blood
• urine tests for albumin, blood, glucose and red or white blood cells
• a blood pressure check
• ultrasound, computed tomography , x-ray and other imaging techniques to take pictures of your kidneys
• a kidney biopsy, where a needle is used to remove a small piece of kidney tissue for examination under a microscope.

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What Causes Gfr To Decrease

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Kidney disease has been affecting people worldwide and the condition remains undetected and untreated for long years. An acute or chronic kidney problem is normally detected with routine urine or blood tests. If any further you need to detect any abnormality, then it is important to go for further investigation of the underlying causes. Once you know what caused you reduced kidney function, you can initiate management and the treatment for kidney deterioration.

The glomerular filtration rate is extremely helpful to measure the level of kidney function. It is a measure of how much damage has been made to the kidneys and determines which stage of kidney disease you are in. The earlier the detection, the better are the chances of slowing down the progression of kidney disease into a chronic problem.

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The blood creatinine level is another measure of kidney function. This chemical waste is produced after muscle metabolism and stays in your blood only. By the way, your kidneys are bound to eliminate an excess of creatinine from the blood, but if they start to compromise with their working, the creatinine level in the blood rises. Besides, creatinine is affected by various factors such as age, gender, and the type of physical activity you do. Hence, compared to blood creatinine levels, the GFR provides a much accurate measure of kidney function.

Abnormalities In Cardiovascular Function

CKD shares many risk factors with cardiovascular disease, and dysfunction in one system can often lead to dysfunction in the other. In patients with concomitant hypertension and type 2 diabetes, the risk of progression to ESRD is 7 fold that for age-matched control subjects. Hypertension is a significant risk factor for insufficient renal function, cardiovascular events, and death in patients both with and without type 2 diabetes. Previous studies show that systolic blood pressure and pulse pressure are stronger predictors than diastolic blood pressure of renal outcomes, and are independent risk factors in the rapid decline of eGFR in type 2 diabetics, while another study suggests that both SBP and variability in SBP are risk factors in the development and progression of diabetic nephropathy.

In addition to blood pressure, peripheral arterial functional markers are also associated with renal function in type 2 diabetics. A low ankle-brachial index was found to be significantly associated with a low eGFR. Also, arterial stiffness is associated with incident albuminuria and decreased eGFR, and brachial-ankle pulse-wave velocity values are independently associated with rapid renal function decline in type 2 diabetics without symptomatic cardiovascular disease. One study reports that impaired left ventricular systolic function and increased ba-PWV are independently associated with a rapid decline in renal function.

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