Kidney Disease

Unobtrusive Chronic Kidney Disease (CKD)

Muhammad Usman Naeem
Muhammad Usman Naeem
February 15, 2025 7 Mins Read
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Unobtrusive Chronic Kidney Disease (CKD)

Muhammad Usman Naeem, Abdul Ghani MD

Unlike heart or brain disease chronic kidney disease (CKD) has no symptoms. There is no chest pain, no headache, or abdominal pain, and matter of fact, there were no effective treatments to prevent its progression. It has been a silent disease but very harmful. Many Patients with coronary artery bypass grafting (CABG), pacemakers, stents, or chemotherapy can still live a normal life but with dialysis, the quality of life decreases tremendously. The patient is hooked up to a dialysis machine every other day and the day they are off dialysis is when they are tired because of the hectic dialysis procedure and can’t do anything. There is more research being done on dialysis and kidney transplantation but not on CKD prevention. Patients typically do not notice any changes in urine volume, appearance, odor, or color. According to the CDC, 1 in every 7 American adults has CKD—an estimated 35.5 million Americans [1]. CKD is serious stuff not just because of dialysis or kidney transplantation but also because it makes diabetes (DM), and heart disease worse too. Let’s start by understanding what CKD is and how we can prevent it and at last how can we treat it.
What is CKD?
It is a disease of kidney filtration capacity. Patients with CKD lose their ability to filter blood effectively. There is no blockage or infection present. CKD in most cases is secondary to hypertension (HTN) or diabetes and often gets progressively worse. CKD is measured using a urine test called the urine albumin-creatinine ratio (UACR) and a blood test called the estimated glomerular filtration rate (eGFR). The UACR value needs to be less than 30 mg/g while the eGFR needs to be higher than 60 mL/min. When the kidney loses 7-8 percent of its filtration capacity, it requires dialysis or transplantation. This stage is referred to as end-stage renal disease (ESRD) [2].
Edema
Some patients with CKD also develop edema. When dealing with these patients it is also important to ensure the edema is not from the heart by performing a Brain Natriuretic Peptide (BNP) test. While BNP levels can be elevated due to CKD, a low BNP result helps rule out cardiac problems. If the BNP is high, further investigation of the heart is necessary. In most CKD patients, edema results in lower extremities due to gravity. It is very simple when the water and salt are retained it ends up in edema. Other parts of the body may also swell, too. For example, in pulmonary edema, the air spaces of the lungs accumulate with fluid, and gas exchange is disrupted resulting in heart failure sometimes. In most cases, edema is not a serious concern until it occurs in the lungs. It is more uncomfortable for the patient as it makes them immobile, and no one wants that. For instance, one of my patient had a bilateral edema, which made it hard for her to go to church or do her mundane activities. Treating edema includes a salt-restricted diet (DASH diet) and prescribing the patient a diuretic drug.
CKD diagnosis
Most patients with CKD are not aware of their disease. Renal insufficiency is still widely ignored around the world. According to a survey in Venezuela, out of 1,436 adults 6 individuals with persistently elevated creatinine levels, without apparent cause for acute renal failure. Only 1 of these 6 individuals was aware of having CKD [2]. As many as 9 in 10 adults in the US with CKD do not know they have it and about 1 in 3 adults with severe CKD are not aware of their disease [1].

CKD is usually detected in routine blood work or if the doctor detect hypertension or DM and perform additional metabolic panel testing. Make sure your doctor is performing a metabolic panel and a urine UACR test every 6 months to make sure your kidneys are fine.
Prevention of CKD
Kidneys can be ameliorated using lifestyle and diet modifications. CKD is 100% reversible or at least can be stopped from progression into dialysis or transplantation besides some very few cases.
  1. Cut down on meat: I have several non-diabetic and type 2 diabetes mellitus(T2D) patients who can’t take Jardiance or kerendia. However, cutting down on meat and processed food helped them reverse their CKD. On the other hand, I also have patients who are on Jardiance but their creatinine and UACR are still high due to not giving up on meat or high salt food. It is crucial to consider various factors when preventing or treating disease. In terms of CKD, patients must cut down on red meat.
  2. Consume low salt diet: Processed food contains hidden salt which is very dangerous for the progression of CKD. A high salt diet alters sodium balance, reducing kidney function and removing less water resulting in hypertension. This increases the risk of kidney disease. Make sure to read the labels of food before buying to make sure it is low in sodium, Canned food should be washed before consumption to remove excess salt. Processed food needs to be cut down completely.
  3. Replace bad fats with good fats to treat high cholesterol: High triglyceride levels and/or cholesterol can not only contribute to heart disease (with or without kidney disease) but also play an important part in the progression of CKD [3]. Cholesterol buildup in renal arteries reduces blood flow to kidneys impairing its ability to properly filter waste from the blood.
  4. Quit smoking: Smoking causes proteinuria (high UACR) in both diabetic and nondiabetic patients. Abnormal proteinuria is a precursor of renal failure. A study in Japan concluded that smoking leads to proteinuria in working middle-aged men. Patients who smoke often exhibit an elevated eGFR, however, those with low eGFR levels tend to show proteinuria more often [4]. These observations suggest that smoking may cause kidney damage. The best way to quit smoking is to quit smoking gradually, if you smoke 10 cigarettes a day, reduce to 9 for a few days, then to 8, and continue this until the goal is reached. This approach helps prevent withdrawal symptoms.
  5. Exercise more: Although exercising doesn’t directly prevent CKD, it does help with hypertension. Lowering blood pressure can reduce strain on the kidneys, as hypertension damages the renal vessels, leading to impaired filtration function and ultimately kidney damage [5].
  6. Own your health: Some patients lose their insurance and forget about their health like health is connected to insurance. This is a common observation at the clinic: when a patient loses their job (insurance), they disappear from the practice like the disease also disappeared. Own your health. Losing insurance can be challenging, but what’s even worse is losing track of your health altogether. Know your numbers, you can now get the basic metabolic tests at Quest without a prescription at a reasonable price. If your results come back abnormal and you do not have insurance, it is crucial to make arrangements to follow up with a doctor before the disease progresses.
Numbers patient should know:
  1. UACR values less than 30 mg/g.
  2. Creatinine level should be less than 1.3 mg/dL.
  3. eGFR value should be higher than 90, although this number depends on age and several other factors.
  4. Low-density lipoprotein (LDL) should be less than 100 mg/dL.
  5. High-density lipoprotein (HDL) should be higher than 50 mg/dL.
  6. Triglycerides should be less then 150mg/dL.
  7. Hemoglobin A1C (HbA1c) should be lower than 6.5%.
  8. Blood pressure (BP) should be within Systolic < 120 mmHg and Diastolic < 80 mmHg.
  9. Resting heart rate should be between 60-80 beats per minute.

Common medications that can lead to the progression of CKD

Talk to your doctor if you are taking one of these drugs:

  1. Metformin.
  2. High dose of Aspirin.
  3. Nonsteroidal anti-inflammatory drugs (NSAIDs).
  4. Methotrexate.
  5. Midodrine.
  6. Aminoglycosides.
  7. Amphotericin B
Treatment Options
  1. Jardiance for T2D patients with CKD: Previously, kidney doctors had limited options for managing CKD and often felt helpless, waiting for the disease to reach end-stage before starting dialysis. Jardiance has been a wonderful drug. Jardiance not only helps in preventing CKD by lowering blood pressure and blood glucose levels but it also protects the heart from a cardiac event [6]. By reducing the volume of fluids in the blood, it decreases the damage to the walls of blood vessels.
  2. Diuretics (water pills) for diabetic and non-diabetic patients: Diuretics remove excess salt and water through urine. This lowers blood pressure and treats fluid retention. Diuretics also help patients minimize signs of heart failure [7].
  3. Angiotensin-converting enzyme-inhibitors or angiotensin-receptor blockers (ACE/ARBs) for diabetic and non-diabetic patients: ACE or ARBs reduce proteinuria and most importantly lower blood pressure by decreasing the stress on the kidneys through their effect on the renin-angiotensin system, which helps to reduce intraglomerular pressure within the glomerulus (tiny filtering units in the kidneys) and relax blood vessels [8]. More importantly, ACE/ARBs protects the remaining healthy nephrons (functional unit of the kidney) in CKD by reducing the workload.

“Jardiance with ACE/ARBs, low meat, and exercise can slow the progression of CKD”

Citation list
  1. Centers for Disease Control and Prevention. (n.d.). Chronic kidney disease in the United States, 2023. Centers for Disease Control and Prevention. https://www.cdc.gov/kidney-disease/php/data-research/index.html
  2. Walser, M., Thorpe, B., & Brereton, N. H. (2004). Coping with kidney disease: A 12-step treatment program to help you avoid dialysis. John Wiley & Sons.
  3. Visconti, L., Benvenga, S., Lacquaniti, A., Cernaro, V., Bruzzese, A., Conti, G., Buemi, M., & Santoro, D. (2016). Lipid disorders in patients with renal failure: Role in cardiovascular events and progression of chronic kidney disease. Journal of Clinical &amp; Translational Endocrinology, 6, 8–14. https://doi.org/10.1016/j.jcte.2016.08.002
  4. Noborisaka, Y., Ishizaki, M., Nakata, M., Yamada, Y., Honda, R., Yokoyama, H., Miyao, M., & Tabata, M. (2011). Cigarette smoking, proteinuria, and renal function in middle-aged Japanese men from an occupational population. Environmental Health and Preventive Medicine, 17(2), 147–156. https://doi.org/10.1007/s12199-011-0234-x
  5. De Bhailis, Á. M., & Kalra, P. A. (2022). Hypertension and the kidneys. British Journal of Hospital Medicine, 83(5), 1–11. https://doi.org/10.12968/hmed.2021.0440
  6. Shafiq, A., Mahboob, E., Samad, M. A., Ur Rehman, M. H., & Tharwani, Z. H. (2022). The dual role of Empagliflozin: Cardio Renal protection in T2DM patients. Annals of Medicine &amp; Surgery, 81. https://doi.org/10.1016/j.amsu.2022.104555
  7. Magdy, J. S., McVeigh, J., & Indraratna, P. (2022). Diuretics in the management of chronic heart failure: When and how. Australian Prescriber, 45(6), 200–204. https://doi.org/10.18773/austprescr.2022.069
  8. Vivian, E., & Mannebach, C. (2013). Therapeutic approaches to slowing the progression of diabetic nephropathy – is less best? Drugs in Context, 1–12. https://doi.org/10.7573/dic.212249
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Muhammad Usman Naeem

Muhammad Usman Naeem is a pre-medical student with a Bachelor’s degree in Biomedical Sciences from the University of South Florida. His primary interests are in neuro-oncology and preventive medicine. Muhammad is actively researching the role of MR1 - Major Histocompatibility Complex Class I-related gene in cancer immunotherapy. Additionally, he has experience working with elderly patients, managing a range of chronic diseases including diabetes, hypertension, and cardiovascular disease.

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