Today, one in seven Australians show at least one indicator of kidney damage. There are often no warning signs for kidney disease - you can lose up to 90% of kidney function before experiencing any symptoms or feeling sick – by then it’s too late.
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 that with the right medicaiton and management plan, the progression of Chronic Kidney Disease 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.
What do the stages of CKD mean?
Early stages - small amount of kidney damage, although GFR may be normal
- Often there are no symptoms in the early stages of kidney disease, blood tests can be normal.
- There may be scarring and blockages that change blood flow to parts of the kidney so they don't work as well as they should.
- There is an increased risk of heart disease. You doctor can help you reduce your risk of heart disease.
Middle stages - sometimes discovered because the level of waste product in the blood rises
- Some people begin to feel unwell and notice an increase in urine frequency.
- Blood pressure can rise as the kidneys slow down. High blood pressure further increases the risk of heart disease, heart attack and stroke.
- Early signs of bone disease may be present.
- Anaemia may appear, caused when there are not enough red blood cells in the blood to carry oxygen around the body. Symptoms include weakness, fatigue and a shortness of breath.
Later stages - high blood pressure almost always occurs
- High blood pressure almost always occurs.
- You may start to notice changes in the amount of urine you pass.
- Lack of energy, increased tiredness and reduced appetite are common symptoms.
- You may need to make dietary changes, including limiting the use of salt or reducing the amount of potassium or phosphorus in your diet.
End-stage kidney disease
- The kidneys are only functioning at 10-15 per cent of their capacity and are unable to properly filter waste products, remove extra water from the body and help maintain the blood's chemical balance.
- This is the time to consider commencing dialysis or having a kidney transplant.
Kidney failure brings with it many changes. Adjusting to kidney failure is more difficult for some people than others, even with time to prepare for it. When there is no time to prepare, the sudden impact makes dealing with kidney failure much harder.
If recently diagnosed, we highly recommend our booklet Living with Kidney Failure and you may like to read Yesterday, Today and Tomorrow - Patient stories.
For all health professionals
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.
Quick Links for Health Professionals
- CKD Management in General Practice Booklet
- MDRD eGFR Calculator
- Proteinuria
- Summary Card for CKD Management in General Practice
- Type 2 Diabetes from a GPs perspective booklet
Clinical tips to help identify, manage and refer CKD in your practice
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 a free booklet by phoning 08 8334 7555 or email health@kidney.org.au
Indications for referral to a nephrologist
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 Chronic Kidney Disease, 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).
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