Chronic Kidney Disease

Chronic kidney disease (CKD) is slow, progressive loss of kidney function. In India, diabetes and high BP cause most of it, and CKD of unknown cause (CKDu) is a serious issue in parts of Andhra Pradesh, Odisha, Chhattisgarh, and some agricultural regions. Because CKD is silent in early stages, routine screening is the single most useful step — and early treatment can slow or stop progression.

Who should be screened

• Everyone with diabetes or high blood pressure — annual urine ACR + serum creatinine.
• Age ≥ 60.
• Family history of kidney disease (polycystic kidney disease).
• Past AKI (including severe dengue, malaria, sepsis, snake-bite-related, heat-related).
• Repeated urinary stones or obstruction.
• Living in a CKDu-endemic district.
• Long-term use of painkillers / herbal products.

How it's staged

• Based on eGFR (mL/min/1.73m²):
• Stage 1 (≥ 90, with kidney damage), Stage 2 (60–89, with damage), Stage 3a (45–59), Stage 3b (30–44), Stage 4 (15–29), Stage 5 (< 15 — kidney failure).
• Urine albumin category (A1 normal, A2 moderate, A3 severe) independently predicts risk.

What slows progression

• Blood pressure control — target usually under 130/80; ACE inhibitor or ARB class are first-line and kidney-protective when protein is in the urine.
• Blood sugar control in diabetes.
• SGLT2 inhibitors — proven kidney and heart protection in CKD with or without diabetes.
• Stop smoking; moderate alcohol.
• Low-salt diet (< 5 g/day).
• Avoid nephrotoxic drugs — long-term NSAIDs, aminoglycoside antibiotics without need, and unregulated Ayurvedic/Unani products (several have caused rapidly progressive CKD).
• Treat other conditions — anaemia (iron, erythropoietin-stimulating agent class), bone–mineral disease, acidosis.
• Vaccinate — flu, pneumococcal, Hep B (before dialysis).

When renal replacement therapy comes in

• Stage 5 (eGFR < 15) usually needs dialysis or transplant.
• Plan ahead — AV fistula creation takes 6–12 weeks to mature, so it's done well before dialysis starts.
• Pre-emptive transplant (before starting dialysis) gives the best long-term outcome when a donor is available.

Practical India points

• Ayushman Bharat / PM-JAY and state schemes cover dialysis under the Pradhan Mantri National Dialysis Programme across public hospitals; transplant cost support is partly scheme-covered at empanelled centres.
• Tell every doctor about your kidney disease before any scan needing contrast, any painkiller, or any supplement.