2. Chronic kidney disease (CKD)
• Chronic kidney disease (CKD) is a long term condition caused by damage to
both kidneys. There is no single cause and the damage is usually irreversible
and can lead to ill health.
• In some cases dialysis or transplantation may become necessary.
• Diabetes mellitus is one cause of CKD.
• Chronic kidney disease is seen more frequently in older people and therefore
is likely to increase in the population as a whole.
• People with CKD are at higher risk of cardiovascular disease and they
should be identified early so that appropriate preventative measures can be
taken.
2
3. In the early stages of CKD people may be unaware that they have any illness and a
blood or urine test may be the only way it is discovered. Establishing which
conditions predispose to CKD identifies those who should have the necessary blood
or urine tests.
Early detection of CKD can establish if kidney disease is likely to be progressive
allowing appropriate treatment to slow progression. Previous renal clinical
guidelines have focused on patients with end-stage renal disease (ESRD). End-stage
renal disease, also called established renal failure, is chronic kidney disease which
has progressed so far that the patient’s kidneys no longer function sufficiently
and dialysis or transplantation become necessary to maintain life.
3
4. Causes of kidney disease:
The two most common causes of kidney disease are:
•Diabetes: This causes damage to many organs and muscles in
the body, including the kidneys, heart and blood vessels, nerves,
and eyes.
•High blood pressure: happens when the pressure of the blood
against the walls of blood vessels is too high. If high blood
pressure is not controlled, it can cause chronic kidney disease,
heart attacks, and strokes.
4
5. Many other conditions can harm the kidneys. These include:
Glomerulonephritis: a group of diseases that hurt the kidneys' filtering units.
Inherited diseases: like polycystic kidney disease, which causes cysts to form
in the kidneys.
Lupus and other diseases: that affect the body’s immune system.
Obstructions: caused by problems like abnormally shaped ureters, kidney
stones, tumours, or an enlarged prostate gland in men.
Repeated urinary tract infections.
Some pain relieving drugs: can harm the kidneys if they are used for a long
time. They are called NSAIDs (nonsteroidal anti-inflammatory drugs).
They include aspirin, ibuprofen, and naproxen.
5
7. Symptoms: Most people with early kidney disease do not have symptoms.
That’s why it’s important to be tested.
In the later stages of kidney disease, may have:
Feel tired or short of breath
Have trouble thinking clearly
Not feel like eating
Have trouble sleeping
Have dry, itchy skin
Have muscle cramping at night
Need to go to the bathroom more often, especially at night
Have swollen feet and ankles
Have puffiness around eyes, especially in the morning
7
10. Prevention of kidney disease, even if at higher risk:
Not everyone who is at risk will get kidney disease. But should also:
1. Have regular checkups by healthcare provider
2. Control blood sugar if have diabetes
3. Control blood pressure if have high blood pressure
4. Make healthy food choices
5. Exercise regularly
6. Lose weight
7. Stop smoking
8. Stop alcohol intake
9. Use only the medicines, vitamins and supplements that the healthcare provider
recommends. Some can harm the kidneys.
10.Avoid herbal supplements and those used for body building
10
11. What happens if kidney disease gets worse?
•If kidney disease gets worse, it can lead to kidney failure.
•Kidney failure means kidneys no longer work well enough
to keep the person alive.
•There is no cure for kidney failure. But there are
treatments to replace the work of failed kidneys.
11
12. How is kidney failure treated?
There are 2 treatments for kidney failure: dialysis and kidney
transplantation.
1 -Dialysis: is a treatment that removes wastes & extra water from the blood.
Two types of dialysis are available: hemodialysis or peritoneal dialysis.
2 -A kidney transplant: is an operation that places a new kidney inside the
body. The new kidney will take over the work of failed kidneys. The new kidney
may come from a living donor (usually a relative or friend) or someone who died
and wanted to be an organ donor.
12
13. 13
Hemodialysis uses a machine and a filter to remove waste products and water from the blood.
Peritoneal dialysis uses a fluid (dialysate) that is placed into the patient's abdominal cavity to
remove waste products and fluid from the body
14. Role of physiotherapy and Benefits of exercise in CKD:
CKD is associated with malnutrition, secondary sarcopenia, osteoporosis,
mobility limitations, and elevated fall risk. Thus, screening for low muscle
mass, low bone mass is needed with attention to rapid progression occur
with dialysis.
Renal rehabilitation program should be inclusive to a warm-up and cool
down, a strengthening component, a cardiovascular component and
flexibility section. The therapist also needs to monitor progression and
educate patients in monitoring their progress.
Dietitian consultation is needed.
Hand squeezing exercises for end-stage renal disease patients with newly
placed arteriovenous fistulae (AVF) to increase the rate of fistula
maturation.
14
17. Precautions:
Patients with CKD are mostly hypertensive. So, Blood pressure
monitoring pre session and during is needed.
Similarly, CKD patients are usually diabetic with same
precautions of DM.
CKD patients fatigue easily with multiple rest break needed.
17
