The rate of kidney failure is steadily climbing in Australia, with the number of cases rising by around six per cent each year.
The good news is - with the right medication and management plan, the progression of Chronic Kidney Disease (CKD) can be slowed significantly
Alarmingly, one-third of Australians are at risk of kidney disease. More worrying is that many people are unaware of these risks. Up to 2 million Australians could have some form of kidney disease and not know it.
Our KEY kidney health messages focus on the importance of maintaining a balanced lifestyle and having a regular kidney and urinary health check, particularly for the 1 in 3 Australians who are ‘at increased risk’ of kidney disease.
You CAN lower your risk of CKD and other chronic diseases!
Early intervention can reduce CKD progression and cardiovascular risk by 50% and improves quality of life.
MeasureUp and CKD There is significant evidence that being overweight or obese, not getting enough physical activity, smoking, harmful alcohol consumption and unhealthy eating - are major risk factors for many chronic diseases. It is never too late to make positive changes - eating well and keeping active can improve long term health.
Kidney Health Australia in partnership with the Australian Better Health Initiative, encourage all Australians to MeasureUp - but particularly people with kidney disease. Find tips on how to achieve better health at our webpages - MeasureUp with Exercise * MeasureUp with health eating * MeasureUp and wellness.
The role of our kidneys is often underrated when we think about our health. Although only small organs, the kidneys are responsible for removing waste and fluid from the body, helping to control blood pressure, assisting with the production of red blood cells, and helping to keep our bones strong.
You can lose up to 90 per cent of kidney function without realising it, by which time it is almost impossible to prevent further serious problems
Be kind to your kidneys - take positive measures to avoid this diagnosis
There are a number of ways you can reduce your risk of kidney disease:
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Be aware of your family medical history - if close blood family relatives have had kidney disease or other chronic diseases, you may be 'at risk' too? Ask what their health problems were and be aware of the risk.
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If you are at increased risk' of developing kidney disease ask your doctor for an annual kidney health check
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Be a non-smoker - smokers are three times more likely to have reduced kidney function, not to mention four to five times greater risk of heart attack and stroke
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Make physical activity a regular habit - 30 minutes of regular moderate-intensity physical activity
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Maintain a positive 'stay well' attitude, do things that help you to relax and reduce stress
How is kidney function measured?
Blood and urine tests can determine how well or poorly your kidneys are functioning. A blood test can reveal, among other things, how much of the waste product creatinine there is in your blood.
Creatinine is a waste product generated from muscle energy metabolism, and it is usually removed in urine. If your kidney function is reduced, creatinine is not filtered out of your body as it should be but remains in the blood. Consequently, this increases the levels of creatinine in your blood. So the concentration of creatinine in the blood depends on how much creatinine is removed, but also on your muscle mass, the amount of protein you eat and your age (creatinine levels increase with age). The normal levels for blood or serum creatinine is less than 120μmol/L for males and 90μmol/L for females.
Your eGFR is usually recorded in millilitres per minute per 1.73m2 (a mathematical adjustment for normal body surface area). In practice, eGFR is roughly the same as the percentage of your normal kidney function (e.g., an eGFR of 60 mL/min/1.73m2 means that you have approximately 60% of normal kidney function).
Cystatin C is another substance that can be found in your blood and is not affected by your muscle mass. Its concentration in the blood is another way to measure your kidney function. The test for Cystatin C is still being introduced to laboratories in Australia. This test may have a role in measuring kidney function in the early stages of kidney disease but is unlikely to replace creatinine as the main measure of kidney function.
Urea is formed as a breakdown product of protein metabolism. The amount of urea in your blood reflects the build-up of waste products. The amount of urea also gives an indication of the correlation between your protein intake and protein breakdown, but urea levels in Filtration ability 100% Time the blood can also rise or fall for many reasons other than chronic kidney disease.
Creatinin clearance is a special urine test which requires you to collect all your urine over a 24-hour period which gives an indication of your kidneys’ filtration ability.
Your test results - what do they mean?
Below are simple brief explanations of what the different analyses are for, and what the different results mean.
Your doctor may order only some of these tests, especially in the early stages of chronic kidney disease.
Tests for Anaemia
- Haemoglobin, Hb (“blood count”) - is a protein found in red blood cells; it carries oxygen to all the body’s cells
from the lungs.
- Transferrin saturation (TSAT) – Indicates the proportion of the iron-transporting protein transferrin,
which binds iron.
- Ferritin – An iron-binding protein which is used as an
indicator of the amount of iron in the body.
Tests for minerals in the body
- Potassium – An important substance needed by all body cells. Excess or deficient potassium levels can cause an irregular heartbeat.
- Sodium – A substance which together with chloride makes up common salt. High levels of sodium may
indicate dehydration, but sodium concentration is a poor indicator of the body’s total sodium content.
- Creatinine – A muscle waste product. Levels rise in chronic kidney disease and it is routinely screened to
assess kidney function.
- eGFR - By combining the result of your blood creatinine level with your age and gender, your kidney function
is measured using a special formula to provide an ‘estimated glomerular filtration rate’ or eGFR.
- Urea – A waste and breakdown product of protein in the body and food. Levels increase in chronic kidney
disease, but they decrease with lower protein intake.
Tests and analyses
Regular testing
- Albumin – An important protein in the blood. One of its functions is to keep the fluid in its place in the blood
circulation.
- Calcium – Is needed for healthy bones and teeth. Most of the cells in the body need calcium to work properly.
- Phosphate – In conjunction with calcium, phosphate is instrumental in skeletal formation and also helps to
regulate the acid-base balance in the body. In chronic kidney disease phosphate levels increase.
Tests for proteins:
- Albumin – An important protein in the blood. One of its functions is to keep the fluid in its place in the blood
circulation.
Tests for hormones
- Parathyroid hormone, PTH – Regulates the calcium balance in the body. If the PTH level is too high, calcium is
released from the skeleton, causing serious bone disease and the calcium level in the blood increases.
Tests for cholesterol
- Cholesterol – Blood lipids. The overall cholesterol level is often normal or low in advanced chronic kidney diseasE and is not directly related to the risk of heart disease the
way it is in people with healthy kidneys.
- LDL-cholesterol – This is the “bad” cholesterol. Levels do not necessarily increase in chronic kidney disease.
- HDL-cholesterol – The “good” cholesterol. In chronic kidney disease the HDL level is often low.
- Triglycerides – the most common type of fat stored in your body. Usually only a small amount is found in your
blood. Triglycerides may not cause fatty deposits in your arteries but are often linked to low HDL.
Tests for Diabetes
- Glucose – Blood glucose monitoring is a measurement of glucose (sugar) in the blood. Values can vary depending on physical activity, meals and insulin administration.The glucose level is raised in diabetes.
- Glycosylated haemoglobin (HbA1c) – A test that measures the amount of glycosylated haemoglobin in the blood.Glycosylated haemoglobin is a molecule in red
blood cells that attaches to glucose (blood sugar).There is higher levels of glycosylated haemoglobin if you have more glucose in your blood.
Urine tests
- Urine dipstick – Leukocytes, white blood cells, in the urine which may be elevated in urinary tract infections.
- Erythrocytes – The presence of red blood cells in the urine can be a common occurrence in kidney diseases but it is abnormal if found in healthy people.
- Albumin/protein – Protein excretion in the urine – the lower the better.
The role of Health Professionals in diagnosis
Primary health care providers; the GP and other health professionals play a pivotal role in the early detection and management of kidney disease.
Identifying people ‘at risk’
- have diabetes
- have high blood pressure
- smoke
- are over 50 years
- are obese
- or are of Aboriginal or Torres Strait Islander descent
A kidney health check includes a:
- blood pressure test
- blood test for creatinine (eGFR) click here for eGFR Clincial Tools
- urine test for protein
Chronic Kidney Disease (CKD)
- Is a silent condition, but can be readily detected with tests for proteinuria, haematuria and eGFR
- Is increasingly common due to our ageing population and a rising incidence of Type 2 diabetes
- Is a potent independent risk factor for cardiovascular disease
- Optimal management of the risk factors for cardiovascular disease also slows progression of CKD
Most common reasons people start dialysis or have a kidney transplant in Australia:
While the causes of end stage kidney disease are well known, the causes of CKD are not established.
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Increasing amounts of protein in the urine correlate directly with an increased rate of progression into end-stage kidney disease
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The amount of proteinuria/albuminuria in the urine can be reduced significantly by the use of an ACE inhibitor or ARB agent singly or in combination
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Reduction in the amount of proteinuria is associated with improved outcomes
Early intervention can reduce CKD progression and cardiovascular risk by 50%, and improves quality of life
The CKD Management in General Practice Booklet (and supporting Reference list ) endorsed by the RACGP and ANZSN, was published by Kidney Health Australia to provide a comprehensive summary of current guidelines and recommendations on the management of Chronic Kidney Disease in general practice. It is accompanied by a Summary Card for CKD Management in General Practice which highlights key points for easy access. We hope general practitioners and practice staff will consult these guidelines in order to ensure a high standard of care for their patients.
Health Professionals may order this free booklet by phoning 1800 4 KIDNEY (1800 4 543 639) or by email health@kidney.org.au
Who may be considered for referral to a nephrologist?
Anyone with:
eGFR <30 mL/min/1.73m2
- Unexplained decline in kidney function (>15% in eGFR over 3 months)
- Proteinuria >1g/24 hrs
- Glomerular haematuria (particularly if proteinuria present)
- CKD and hypertension that is hard to get to target
- Diabetes with eGFR <60 mL/min/1.73m2
- Unexplained anaemia (Hb < 100 g/L) with eGFR < 60mL/min/1.73m2
Anyone with an acute presentation and signs of acute nephritis should be regarded as a medical emergency and referred without delay.
CKD Stage 2 and 3
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Stable eGFR 30 - 89 mL/min/1.73m2
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Minor proteinuria (<0.5 g/24hrs with no haematuria)
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Controlled blood pressure
The decision to refer or not must always be individualised, and particularly in younger patients the indications for referral may be less stringent (e.g. minor proteinuria).
In CKD Stages 2 and 3
Don't refer to nephrologist if targets of therapy are achieved
- Pay attention to CVD risk reduction
- Use ACE inhibitors/ARBs
- Monitor three to six monthly
Clinical tip: When referring to a nephrologist, ensure patient has had a recent kidney ultrasound, current blood chemistry, and quantification of proteinuria.
Patients do not normally present with symptoms of CKD, so annual checking of those at risk is essential. People with CKD may not notice any symptoms until they reach end stage kidney disease requiring dialysis or transplant (eGFR < 15 mL/min/1.73m2).
Quick Links for Health Professionals
- CKD Management in General Practice Booklet
- MDRD eGFR Calculator
- Proteinuria - How to treat
- Summary Card for CKD Management in General Practice
- Type 2 Diabetes from a GPs perspective booklet
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