This document discusses chronic kidney disease (CKD). It defines CKD as a progressive loss of renal function over months or years that is identified by increased creatinine levels and protein or blood in the urine. The two main causes of CKD are diabetes and high blood pressure, which together account for two-thirds of cases. Symptoms of CKD may not appear until later stages and include fatigue, poor appetite, and swollen limbs. Anyone can develop CKD, but those with diabetes, high blood pressure, family history, older age, or certain ethnicities are at higher risk. CKD is diagnosed through tests of kidney function and imaging and staged based on glomerular filtration rate.

1. Assignment
On
Chronic Kidney Disease:
A non-communicable disease
Submitted By:
Gaulib Haidar
NSU ID: 1510898630
Department: BBA
Course: PBH
Section: 47
Submitted To:
Dr. Tanzila Rafique
BDS, FCPS, MPH
Department of Public Health
Submission date: 28-01-2015
North South University (NSU)
Bashundhara, Dhaka 1229
Bangladesh

2. What is non-communicable disease?
Any disease that is not caused by a pathogen and not transmitted from one person to another is
called a non-communicable disease. It might be transmitted from hereditary factors, improper diet,
smoking, or other factors.
In other words, A non-communicable disease,
or NCD, is a medical condition or disease that can be
defined as non-infectious and non-
transmissible among people. NCDs can refer to
chronic diseases which last for long periods of time
and progress slowly.
Sometimes, NCDs result in rapid deaths such as seen
in certain types of diseases such as autoimmune
diseases, heart diseases, stroke,
most cancers, asthma, diabetes, chronic kidney
disease, osteoporosis, Alzheimer's disease, cataracts,
and many more. While sometimes (incorrectly)
referred to as synonymous with "chronic diseases",
NCDs are distinguished only by their non-infectious
cause, not necessarily by their duration. Some
chronic diseases of long duration, such as HIV/AIDS,
are caused by transmittable infections. Chronic
diseases require chronic care management as do all
diseases that are slow to develop and of long
duration.
The World Health Organization (WHO) reports NCDs to be by far the leading cause of death in the
world, representing over 60% of all deaths. That is approximately 63% of total deaths
worldwide. Risk factors such as a person's background, lifestyle and environment are known to
increase the likelihood of certain NCDs. Every year, at least 5 million people die because of tobacco
use and about 2.8 million die from being overweight. High cholesterol accounts for roughly 2.6
million deaths and 7.5 million die because of high blood pressure.
Some key non-communicable diseases:
 Cancer
 Cardiovascular disease
 Diabetes
 Chronic kidney disease
However, in this assignment, we will discuss about chronic kidney disease or CKD.

3. What is chronic kidney disease?
Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss in renal
function over a period of months or years. The symptoms of worsening kidney function are not
specific, and might include feeling generally unwell and experiencing a reduced appetite. Often,
chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney
problems, such as those with high blood pressure or diabetes and those with a blood relative with
CKD. This disease may also be identified when it leads to one of its recognized complications, such
as cardiovascular disease, anemia, or pericarditis. It is differentiated from acute kidney disease in
that the reduction in kidney function must be present for over 3 months.
Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate
a lower glomerular filtration rate and as a result a decreased capability of the kidneys to excrete
waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is
discovered if urinalysis (testing of a urine sample) shows the kidney is allowing the loss
of protein or red blood cells into the urine. To fully investigate the underlying cause of kidney
damage, various forms of medical imaging, blood
tests, and often renal biopsy (removing a small
sample of kidney tissue) are employed to find out
if a reversible cause for the kidney malfunction is
present. Recent professional guidelines classify
the severity of CKD in five stages, with stage 1
being the mildest and usually causing few
symptoms and stage 5 being a severe illness with
poor life expectancy if untreated. Stage 5 CKD is
often called end stage renal disease, end stage
renal failure, or end-stage kidney disease, and is
synonymous with the now outdated terms chronic kidney failure or chronic renal failure.
No specific treatment is unequivocally shown to slow the worsening of CKD. If an underlying cause to
CKD, such as vasculitis, is found, it may be treated directly to slow the damage. In more advanced
stages, treatments may be required for anemia and bone disease. Severe CKD requires renal
replacement therapy, which may involve a form of dialysis, but ideally constitutes a kidney
transplant.

4. The Facts about Chronic Kidney Disease (CKD)
 26 million American adults have CKD and millions of others are at increased risk.
 Early detection can help prevent the progression of kidney disease to kidney failure.
 Heart disease is the major cause of death for all people with CKD.
 Glomerular filtration rate (GFR) is the best estimate of kidney function.
 Hypertension causes CKD and CKD causes hypertension.
 Persistent proteinuria (protein in the urine) means CKD is present.
 High risk groups include those with diabetes, hypertension and family history of kidney failure.
 African Americans, Hispanics, Pacific Islanders, American Indians and seniors are at increased risk.
 Two simple tests can detect CKD: blood pressure, urine albumin and serum creatinine.

5. What causes CKD?
The two main causes of chronic kidney disease are diabetes and high blood pressure, which are
responsible for up to two-thirds of the cases. Diabetes happens when your blood sugar is too high,
causing damage to many organs in your body, including the kidneys and heart, as well as blood
vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your
blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high
blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. Also,
chronic kidney disease can cause high blood pressure.
Other conditions that affect the kidneys are:
 Glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney's
filtering units. These disorders are the third most common type of kidney disease.
 Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys
and damage the surrounding tissue.
 Malformations that occur as a baby develops in its mother's womb. For example, a narrowing may
occur that prevents normal outflow of urine and causes urine to flow back up to the kidney. This
causes infections and may damage the kidneys.
 Lupus and other diseases that affect the body's immune system.
 Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.
 Repeated urinary infections.

6. What are the symptoms of CKD?
Most people may not have any severe symptoms until their kidney disease is advanced. However,
you may notice that you:
 feel more tired and have less energy
 have trouble concentrating
 have a poor appetite
 have trouble sleeping
 have muscle cramping at night
 have swollen feet and ankles
 have puffiness around your eyes,
especially in the morning
 have dry, itchy skin
 need to urinate more often, especially at night.

7. Who can get CKD?
Anyone can get chronic kidney disease at any age. However, some people are more likely than
others to develop kidney disease. You may have an increased risk for kidney disease if you:
 have diabetes
 have high blood pressure
 have a family history of kidney failure
 are older
 belong to a population group that has a high rate of diabetes or high blood pressure, such as African
Americans, Hispanic Americans, Asian, Pacific Islanders, and American Indians.

8. Diagnosis:
In many CKD patients, previous renal disease or other underlying diseases are already known. A
small number present with CKD of unknown cause. In these patients, a cause is occasionally
identified retrospectively.
It is important to differentiate CKD from acute
renal failure (ARF) because ARF can be reversible.
Abdominal ultrasound, in which the size of
the kidneys is measured, is commonly performed.
Kidneys with CKD are usually smaller (< 9 cm) than
normal kidneys, with notable exceptions such as
in diabetic nephropathy and polycystic kidney
disease. Another diagnostic clue that helps
differentiate CKD from ARF is a gradual rise in serum creatinine (over several months or years) as
opposed to a sudden increase in the serum creatinine (several days to weeks). If these levels are
unavailable (because the patient has been well and has had no blood tests), it is occasionally
necessary to treat a patient briefly as having ARF until the renal impairment has been established to
be irreversible.
Additional tests may include nuclear medicine MAG3 scan to confirm blood flows and establish the
differential function between the two kidneys. Dimercaptosuccinic acid (DMSA) scans are also used
in renal imaging; with both MAG3 and DMSA being used chelated with the radioactive
element technetium-99.
In chronic renal failure treated with standard dialysis, numerous uremic toxins accumulate. These
toxins show various cytotoxic activities in the
serum and have different molecular weights, and
some of them are bound to other proteins,
primarily to albumin. Such toxic protein-bound
substances are receiving the attention of
scientists who are interested in improving the
standard chronic dialysis procedures used today.

9. Stages of CKD:
All individuals with a glomerular filtration rate (GFR) <60 ml/min/1.73 m2
for 3 months are classified
as having chronic kidney disease, irrespective of the presence or absence of kidney damage. The
rationale for including these individuals is that reduction in kidney function to this level or lower
represents loss of half or more of the adult level of normal kidney function, which may be associated
with a number of complications.
All individuals with kidney damage are classified as having chronic kidney disease, irrespective of the
level of GFR. The rationale for including individuals with GFR > 60 mL/min/1.73 m2
is that GFR may
be sustained at normal or increased levels despite substantial kidney damage and that patients with
kidney damage are at increased risk of the two major outcomes of chronic kidney disease: loss of
kidney function and development of cardiovascular disease.
The loss of protein in the urine is regarded as an independent marker for worsening of renal function
and cardiovascular disease. Hence, British guidelines append the letter "P" to the stage of chronic
kidney disease if protein loss is significant.

10.  Stage 1:
Slightly diminished function; kidney damage with normal or relatively high GFR (≥90 ml/min/1.73
m2
): Kidney damage is defined as pathological abnormalities or markers of damage, including
abnormalities in blood or urine test or imaging studies.[1]
 Stage 2:
Mild reduction in GFR (60–89 ml/min/1.73 m2
) with kidney damage: Kidney damage is defined as
pathological abnormalities or markers of damage, including abnormalities in blood or urine test or
imaging studies.
 Stage 3:
Moderate
reduction in GFR
(30–59
ml/min/1.73
m2
):. British
guidelines
distinguish
between stage 3A
(GFR 45–59) and
stage 3B (GFR 30–
44) for purposes of
screening and
referral.
 Stage 4:
Severe reduction in
GFR (15–29
ml/min/1.73
m2
) Preparation for
renal replacement
therapy
 Stage 5:
Established kidney
failure (GFR <15 ml/min/1.73 m2
, permanent renal replacement therapy, or end-stage renal disease

11. What happens if my test results show I may have chronic
kidney disease?
Your doctor will want to pinpoint your diagnosis and check your kidney function to help plan your
treatment. The doctor may do the following:
 Calculate your Glomerular Filtration Rate (GFR), which is the best way to tell how much kidney
function you have. You do not need to have another test to know your GFR. Your doctor can
calculate it from your blood creatinine, your age, race, gender and other factors. Your GFR tells your
doctor your stage of kidney disease and helps the doctor plan your treatment.
 Perform an ultrasound or CT scan to get a picture of your kidneys and urinary tract. This tells your
doctor whether your kidneys are too large or too small, whether you have a problem like a kidney
stone or tumor and whether there are any problems in the structure of your kidneys and urinary
tract.
 Perform a kidney biopsy, which is done in some cases to check for a specific type of kidney disease,
see how much kidney damage has occurred and help plan treatment. To do a biopsy, the doctor
removes small pieces of kidney tissue and looks at them under a microscope.
Your doctor may also ask you to see a kidney specialist who will consult on your case and help
manage your care.
Treatments:
The presence of CKD confers a markedly increased risk of cardiovascular disease, and people with
CKD often have other risk factors for heart disease, such as high blood lipids. The most common
cause of death in people with CKD is cardiovascular disease rather than renal failure. Aggressive
treatment of hyperlipidemia is warranted.
Apart from controlling other risk factors, the goal of therapy is to
slow down or halt the progression of CKD to stage 5. Control
of blood pressure and treatment of the original disease,
whenever feasible, are the broad principles of management.
Generally, angiotensin converting enzyme inhibitors (ACEIs)
or angiotensin II receptor antagonists (ARBs) are used, as they
have been found to slow the progression of CKD. Although the
use of ACE inhibitors and ARBs represents the current standard
of care for people with CKD, people progressively lose kidney
function while on these medications, as seen in the IDNT and RENAL studies, which reported a
decrease over time in estimated GFR (an accurate measure of CKD progression, as detailed in the
K/DOQI guidelines) in people treated by these conventional methods.
Replacement of erythropoietin and calcitriol, two hormones processed by the kidney, is often
necessary in people with advanced disease. Guidelines recommend treatment with parenteral
iron prior to treatment with erythropoietin. A target hemoglobin level of 9–12 g/dl is recommended.

12. Phosphate binders are also used to control the serum phosphate levels, which are usually elevated
in advanced chronic kidney disease. The normalization of hemoglobin has not been found to be of
any benefit. It is unclear if androgens help with anemia. Although the evidence for them is
limited, phosphodiesterase-5 inhibitors and zinc show potential for helping men with sexual
dysfunction.
At stage 5 CKD, renal replacement therapy is usually required, in the form of either dialysis or a
transplant.
Organizations:
In the USA, the National Kidney Foundation is a national organization representing patients and
professionals who treat kidney diseases. The American Kidney Fund is a national nonprofit
organization providing treatment-related financial assistance to one of every five dialysis patients
each year. The Renal Support Network is a nonprofit, patient-focused, patient-run organization that
provides nonmedical services to those affected by CKD. The American Association of Kidney
Patients is a nonprofit, patient-centric group focused on improving the health and well-being of CKD
and dialysis patients. The Renal Physicians Association is an association
representing nephrology professionals.
In the United Kingdom, the UK National Kidney Federation represents patients, and the Renal
Association represents renal physicians and works closely with the National Service Framework for
kidney disease.
Kidney Health Australia serves that country.
The International Society of Nephrology is an international
body representing specialists in kidney diseases.

13. CKD in Bangladesh:
The prevalence of Chronic Kidney Disease (CKD) is rapidly increasing worldwide. Population-based
studies on the prevalence of kidney damage are limited in developing countries. The present work
relates to a population-based screening study in a rural population.
The study was performed to investigate the prevalence of chronic kidney disease (CKD) in rural
residents and find out the association of the associated risk factors and variables.
This is a descriptive cross sectional study. The demographic variables included were age, sex, marital
status, religion, occupation, socioeconomic status, monthly income. The clinical variable was
hypertension. The risk factors under the study were Body Mass Index (BMI), smoking habit,
hypertension, and diabetes mellitus. Data pertaining to biochemical investigations were urine for
albumin, serum creatinine and random serum glucose. CKD suspected patients were subjected to
repeat serum creatinine and urinary albumin testing three months after the initial testing to confirm
diagnosis of true CKD.
1240 patients of which 650 were males and 590 females, aged between 18 and 65 years were
entered into this study. The result evidenced over-all CKD prevalence 19 % determined by Cockcroft-
Gault and 19.5 % MDRD equations. Stage 3 CKD was found to be predominant in both Cockcroft-
Gault (12.8%) and MDRD equations (13.2%). The risk factors were thought to be associated with CKD
which demonstrated association with hypertension (19.3%), diabetes (4.9%) and others (1.3%). A
total of 206(88%) patients determined by Cockcroft-Gault and 210 (89.4%) by MDRD equations were
diagnosed as having CKD in 2nd follow up visit (3 months after the 1st visit).
Conclusion:
It appears from this study that one out of three people in this population at risk remained undiag-
nosed as CKD and with poorly controlled CKD risk factors. This is a growing problem and a challenge
to this country. On priority basis CKD needs to be addressed through the development of
multidisciplinary health teams and establishment of improved communication between traditional
health care givers and nephrology services.

14. THE END