Chronic kidney disease

কিডনি দুটি শিমের মতো দেখতে অঙ্গ, আকারে প্রায় আপনার মুষ্টির সমান, পাঁজরের নিচে শরীরের দুই পাশে থাকে। এদের মূল কাজ হলো রক্ত থেকে বর্জ্য পদার্থ ছেঁকে বের করে মূত্র তৈরি করা। এর বাইরেও কিডনি আরও কিছু কাজ করে:

• রক্তচাপ স্বাভাবিক রাখতে সাহায্য করে
• শরীরের রাসায়নিক উপাদানগুলো সুষম রাখে, যার ফলে হৃদযন্ত্র ও পেশি ঠিকমতো কাজ করতে পারে
• vitamin D-র সক্রিয় রূপ তৈরি করে, যা হাড় মজবুত রাখার জন্য দরকার
• erythropoietin নামের একটি পদার্থ তৈরি করে, যা শরীরকে লাল রক্তকণিকা উৎপাদন করতে বলে

Chronic kidney disease মানে কিডনি দীর্ঘ সময় ধরে এই কাজগুলো করার ক্ষমতা আংশিকভাবে হারিয়ে ফেলেছে। বেশিরভাগ ক্ষেত্রে এটি হয় কারণ অন্য কোনো অসুস্থতা, বিশেষ করে ডায়াবেটিস বা উচ্চ রক্তচাপ, কিডনির ক্ষতি করেছে।

কারা বেশি আক্রান্ত হন?

CKD বেশ সাধারণ একটি সমস্যা, এবং বয়স বাড়ার সাথে সাথে এতে আক্রান্ত হওয়ার সম্ভাবনাও বাড়তে থাকে। 65 থেকে 74 বছর বয়সী প্রতি 5 জন পুরুষে 1 জন এবং প্রতি 4 জন নারীতে 1 জন কোনো না কোনো মাত্রার CKD-তে আক্রান্ত বলে ধারণা করা হয়।

South Asian বংশোদ্ভূত মানুষদের মধ্যে, অর্থাৎ Bangladesh, India, Sri Lanka ও Pakistan-এর পরিবার থেকে আসা মানুষদের মধ্যে CKD বেশি দেখা যায়। Black মানুষদের মধ্যেও সাধারণ জনগোষ্ঠীর তুলনায় এটি বেশি। South Asian মানুষদের মধ্যে ডায়াবেটিসের হার বেশি এবং African বা Caribbean বংশোদ্ভূত মানুষদের মধ্যে উচ্চ রক্তচাপের হার বেশি, এটি এর আংশিক কারণ।

Chronic kidney disease-এর কারণ

সাধারণত অন্য কোনো অসুস্থতা কিডনিতে অতিরিক্ত চাপ ফেলে বলেই কিডনির সমস্যা তৈরি হয়। উচ্চ রক্তচাপ (hypertension) ও ডায়াবেটিস এর সবচেয়ে সাধারণ কারণ।

উচ্চ রক্তচাপ

রক্তচাপ হলো প্রতিটি হৃদস্পন্দনে হৃদযন্ত্র ধমনিতে কতটা চাপ তৈরি করছে তার পরিমাপ। এই চাপ দীর্ঘদিন বেশি থাকলে শরীরের বিভিন্ন অঙ্গের ক্ষতি হয় এবং হৃদরোগ, স্ট্রোক ও কিডনির ক্ষতির ঝুঁকি বাড়ে।

প্রায় 90% ক্ষেত্রে উচ্চ রক্তচাপের সুনির্দিষ্ট কারণ জানা যায় না, তবে মনে করা হয় সাধারণ স্বাস্থ্য, খাদ্যাভ্যাস ও জীবনধারার সাথে এর সম্পর্ক আছে। পরিচিত ঝুঁকির কারণগুলো হলো:

• বয়স বৃদ্ধি (বয়স বাড়ার সাথে ঝুঁকি বাড়ে)
• পরিবারে উচ্চ রক্তচাপের ইতিহাস (এটি পরিবারে চলে আসতে পারে)
• African Caribbean বা South Asian বংশোদ্ভূত হওয়া
• অতিরিক্ত ওজন বা স্থূলতা
• পর্যাপ্ত ব্যায়াম না করা
• ধূমপান
• বেশি মদ্যপান
• বেশি লবণ খাওয়া
• বেশি চর্বিযুক্ত খাবার খাওয়া
• দীর্ঘস্থায়ী মানসিক চাপ

উচ্চ রক্তচাপ কিডনির ভেতরের ছোট ছোট রক্তনালিতে চাপ দিয়ে কিডনির ক্ষতি করে, ফলে ছাঁকার প্রক্রিয়া ঠিকমতো কাজ করতে পারে না।

ডায়াবেটিস

ডায়াবেটিস এমন একটি অবস্থা যেখানে শরীর হয় খুব কম বা একেবারেই insulin তৈরি করে না (type 1 diabetes), অথবা insulin ঠিকমতো ব্যবহার করতে পারে না (type 2 diabetes)। Insulin রক্তে গ্লুকোজের মাত্রা সুষম রাখে, খাওয়ার পর খুব বেশি বাড়তে বা খাবারের মাঝে খুব কমতে দেয় না।

ডায়াবেটিস নিয়ন্ত্রণে না থাকলে রক্তে গ্লুকোজ ধীরে ধীরে জমতে থাকে। এই অতিরিক্ত গ্লুকোজ কিডনির ভেতরের ছোট ছোট ছাঁকনি একককে ক্ষতিগ্রস্ত করে, ফলে কিডনি শরীর থেকে বর্জ্য ও তরল পরিষ্কার করতে পারে না।

ধারণা করা হয়, type 1 diabetes আক্রান্ত 20% থেকে 40% মানুষ 50 বছর বয়সের আগেই কিডনির সমস্যায় পড়বেন, এবং type 2 diabetes আক্রান্ত প্রায় 30% মানুষের মধ্যেও কিডনি ক্ষতির লক্ষণ দেখা যায়।

ডায়াবেটিস-সংক্রান্ত কিডনি রোগের প্রথম লক্ষণ সাধারণত হলো প্রস্রাবে সামান্য পরিমাণ প্রোটিন আসা। এ কারণেই ডাক্তাররা ডায়াবেটিস আক্রান্ত প্রত্যেকের জন্য প্রতি বছর প্রস্রাব পরীক্ষার পরামর্শ দেন, যাতে কিডনির কোনো সমস্যা যত তাড়াতাড়ি সম্ভব ধরা পড়ে। নিয়মিত বার্ষিক কিডনি পরীক্ষা গুরুত্বপূর্ণ, কারণ কিডনির সমস্যা আগেভাগে ধরা পড়লে চোখের সমস্যা ও যৌন অক্ষমতার মতো সংশ্লিষ্ট জটিলতার ঝুঁকিতে থাকা মানুষদেরও চিহ্নিত করা যায়।

অন্যান্য কারণ

CKD আরও কিছু কম সাধারণ কারণেও হতে পারে:

• glomerulonephritis (কিডনির ভেতরে প্রদাহ)
• pyelonephritis (কিডনির সংক্রমণ)
• polycystic kidney disease (একটি বংশগত রোগ যেখানে ধীরে ধীরে সিস্টের স্তূপ জমে দুটি কিডনিই বড় হয়ে যায়)
• জন্মের আগে গর্ভে কিডনির অস্বাভাবিক বিকাশ
• systemic lupus erythematosus (এমন একটি অবস্থা যেখানে রোগ প্রতিরোধ ব্যবস্থা কিডনিকে ভুলবশত বাইরের টিস্যু মনে করে আক্রমণ করে)
• দীর্ঘমেয়াদে নিয়মিত কিছু ওষুধ সেবন, যেমন lithium এবং non steroidal anti inflammatory drugs (NSAIDs), যার মধ্যে aspirin ও ibuprofen আছে
• মূত্রনালিতে বাধা, যেমন কিডনিতে পাথর বা প্রস্টেটের সমস্যা থেকে

Diagnosing chronic kidney disease

Chronic kidney disease is most frequently diagnosed through blood and urine tests.

If you’re at a high risk of developing CKD, you may be screened annually. Screening may be recommended if you have:

• high blood pressure (hypertension)
• diabetes
• a family history of CKD

Read more about diagnosing chronic kidney disease

Diagnosis of chronic kidney disease

Chronic kidney disease (CKD) is most frequently diagnosed through blood and urine tests.

Screening

If you are in a high-risk group for developing CKD, it is important to be regularly screened for the condition. People who are not in a high-risk group are not normally screened for CKD.

Annual screening is recommended for the following groups:

• people with high blood pressure (hypertension)
• people with diabetes
• people with acute kidney injury caused by medications such as lithium or NSAIDs such as ibuprofen, kidney stones or an enlarged prostate
• people with cardiovascular disease (conditions that affect the heart, arteries and veins, such as coronary heart disease or heart failure)
• people with a family history of stage 5 CKD (see below for more information about staging) or an inherited kidney disease
• people with diseases that affect several parts of the body and may affect the kidneys, such as systemic lupus erythematosus
• people with blood in the urine (haematuria) or protein in the urine (proteinuria) where there is no known cause

Your GP can advise you about whether or not you should be screened for CKD.

Most often, the diagnosis of kidney disease is made because a routine blood or urine test indicates the kidneys may not be functioning normally. If this happens, the test is usually repeated to confirm the diagnosis.

Glomerular filtration rate (GFR)

An effective way of assessing how well your kidneys are working is to calculate your glomerular filtration rate (GFR). GFR is a measurement of how many millilitres (ml) of waste fluid your kidneys can filter from the blood in a minute (measured in ml/min). A healthy pair of kidneys should be able to filter more than 90ml/min.

It is difficult to measure the GFR directly, so it is estimated using a formula. The result is called the estimated GFR or eGFR. Calculating your eGFR involves taking a blood sample and measuring the levels of a waste product called creatinine and taking into account your age, gender and ethnic group. The result is similar to the percentage of normal kidney function. For example, an eGFR of 50ml/min equates to 50% kidney function.

The following tests are used to detect proteinuria (protein in the urine)

• urine tests – used to see whether there is blood or protein in your urine
• albumin and creatinine testing – this is another urine test which compares the amounts of albumin (a protein) and creatinine in your urine, and the ratio of the 2 (the albumin:creatinine ratio or ACR) can be used with eGFR to give doctors a more accurate idea of how the kidneys are functioning

Staging

A 6-stage system, based on eGFR levels, is used to describe the progression of CKD. The higher the stage, the more severe the CKD.

Stage 1 (sometimes called G1): the eGFR is normal (above 90 or more), but other testing shows evidence of kidney damage.

Stage 2 (G2): the eGFR has decreased slightly (60 to 89), but is still considered to be in the normal range for a young adult.

If you have stage 1 or 2 CKD, it is recommended you have annual eGFR tests so the progression of the condition can be carefully monitored.

Stage 3 is divided into 2: stage 3a (G3a) and 3b (G3b). In stage 3a, the eGFR has decreased mildly (45 to 59) and this is termed a mild to moderate decrease in kidney function and should be checked annually. In stage 3b (G3b) it has decreased moderately (30 to 44) and is termed a moderate to severe reduction in kidney function and should be checked every 6 months.

Stage 4 (G4): the eGFR has reduced severely (15 to 29). By this time, it is possible you will be experiencing symptoms of CKD. Further testing should be carried out every 6 months.

Stage 5 (G5): the kidneys have lost almost all of their function (an eGFR of below 15), which is known as established renal failure. Further testing should be carried out every 3 months.

However, over time, GFR can fluctuate, so one abnormal test result does not automatically mean you have CKD. A diagnosis of CKD is usually only confirmed if repeated eGFR tests show your eGFR is consistently lower than normal over 3 months.

Other tests

Other tests are also used to assess the levels of damage to your kidneys:

• kidney scans, such as an ultrasound scan, a magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan, are used to find out whether there are any unusual blockages in your urine flow – in cases of advanced kidney disease, the kidneys are shrunken and have an uneven shape
• kidney biopsy – a small sample of kidney tissue is taken so that the cells can be examined under a microscope for damage

Lifestyle changes

The following lifestyle changes are known to help reduce your blood pressure and help control CKD:

• stopping smoking
• eating a healthy, low-fat, balanced diet
• restricting your salt intake to less than 6g (0.2oz) a day
• not using over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, except when advised to by a medical professional
• moderating your alcohol intake so it is within recommended limits
• losing weight if you are overweight or obese
• doing regular exercise for at least 30 minutes a day, 5 times a week

Read more about preventing high blood pressure through lifestyle changes.

Medications for high blood pressure

One of the main ways to reduce the progression of kidney damage is to manage high blood pressure. Good control of blood pressure is vital to protect the kidneys.

People with CKD should aim to get their blood pressure down to below 140/90mmHg but if you also have diabetes you should aim to get it down to below 130/80mmHg.

There are many types of blood pressure drugs. Medicines called angiotensin converting enzyme (ACE) inhibitors are used to control high blood pressure in people with CKD.

As well as reducing blood pressure around the body and reducing the strain on blood vessels, ACE inhibitors give additional protection to the kidney.

ACE inhibitors include:

• ramipril
• enalapril
• lisinopril
• perindopril

Side effects of ACE inhibitors include:

• a persistent, dry cough
• dizziness
• tiredness or weakness
• headaches

Most of these side effects should pass within a few days, although some people continue to have a dry cough.

If the side effects of ACE inhibitors are particularly troublesome, you can be given an alternative medication called an angiotensin-II receptor blocker (ARB). This group of medicines includes:

• candesartan
• eprosartan
• irbesartan
• azilsartan
• olmesartan
• temisartan
• valsartan
• losartan

The side effects of ARBs are uncommon, but can include dizziness.

Both ACE inhibitors and ARBs can cause a reduction in kidney function in some people and increased levels of potassium in the blood, so blood tests will need to be performed after you start treatment and whenever the dose changes. If you are on an ACE inhibitor or ARB and you develop a fever/infection or need medicines for other conditions, it’s important to ask your doctor if the ACE inhibitor or ARB needs to be temporarily stopped.

Medication to reduce cholesterol

Studies have shown that people with CKD have a higher risk of cardiovascular disease, including heart attacks and strokes. This is because some of the risk factors for CKD are the same as those for heart attacks and strokes, including high blood pressure and high levels of cholesterol in the blood (atherosclerosis).

Statins are a type of medication used to lower cholesterol levels. Cholesterol causes narrowing of the arteries that can lead to a blockage of the blood supply to the heart (causing a heart attack) or the brain (causing a stroke). Statins work by blocking the effects of an enzyme in your liver (called HMG-CoA reductase), which is used to make cholesterol.

Statins sometimes have mild side effects, including:

• constipation
• diarrhoea
• headaches
• abdominal pain

Occasionally, statins can cause muscle pain, weakness and tenderness. If you experience any of these symptoms, contact your GP. You may need to have a blood test or change your treatment.

If you have kidney disease, you may be asked to reduce your daily fluid and salt intake. You may develop a build-up of fluid as your kidneys will not be able to get rid of fluid as well as they did before.

If you are asked to reduce the amount of fluid you drink, you must also take into account fluid in foods, such as soup and yoghurt. Your GP or dietitian can advise you about this.

The excess fluid that occurs as a result of kidney disease often builds up in your ankles or around your lungs. You may also be given diuretics (water tablets), such as furosemide, which will help get rid of the excess fluid from your body.

If you do not have any fluid retention and you have not been told to reduce your fluid intake, there is no need to do so. In fact, it could be harmful in some circumstances.

Anaemia

Many people with stage three, four and five CKD develop anaemia. Anaemia is a condition in which you do not have enough red blood cells. Symptoms of anaemia include:

• tiredness
• lethargy
• shortness of breath (dyspnoea)
• palpitations (awareness of heartbeat)

Anaemia can occur because of many other conditions and your doctor will investigate to rule out other possible causes.

Most people with kidney disease will be given iron supplements because iron is needed for the production of red blood cells. To boost iron levels, iron may be given as tablets, such as daily ferrous sulphate tablets, or as occasional intravenous infusions.

If this is not enough to treat anaemia, you may be started on injections of erythropoietin, a hormone which helps your body produce more red blood cells. These injections are often administered into a vein (intravenously) or under the skin (subcutaneously). Examples of these injections include epoetin alfa, beta and zeta, darbepoetin and methoxy polyethylene glycol-epoetin beta.

Correction of phosphate balance

If you have stage 4 or 5 kidney disease, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it. Phosphate is a mineral that, with calcium, makes up most of your bones. Phosphate is obtained through diet, mainly dairy foods. The kidneys usually filter out excess phosphate. If phosphate levels rise too much, it can upset the normal calcium balance of the body. This can lead to thinning of the bones and furring of the arteries.

You may be asked to limit the amount of phosphate in your diet. Foods high in phosphate include red meat, dairy produce, eggs and fish. Your GP or dietitian should be able to advise you about how much phosphate you can eat. However, there is no advantage in reducing your intake of these foods unless you have a raised phosphate level. Always ask a healthcare professional before changing your diet.

If reducing the amount of phosphate in your diet does not lower your phosphate level enough, you may be given medicines called phosphate binders. These medicines bind to the phosphate in the food inside your stomach and stop it from being absorbed into your body.

To work properly, phosphate binders must be taken just before meals. The most commonly used phosphate binder is calcium carbonate, but there are also alternatives that may be more suitable for you.

The side effects of phosphate binders are uncommon but include:

• nausea
• stomach ache
• constipation
• diarrhoea
• flatulence (wind)
• skin rash
• itchy skin

Vitamin D supplements

People with kidney disease can have low levels of vitamin D, necessary for healthy bones. This is because the kidneys need to activate the vitamin D from food and the sun before it can be used by the body.

Treating chronic kidney disease

There is no cure for chronic kidney disease, although treatment can slow or halt the progression of the disease and can prevent other serious conditions developing.

People with CKD are known to have an increased risk of a heart attack because of changes that occur to the circulation.

In a minority of people, CKD may cause kidney failure, also known as established renal failure (ERF) or end-stage kidney disease. In this situation, the usual functions of the kidney stop working.

To survive, people with ERF may need to have artificial kidney treatment, called dialysis, or a kidney transplant.

Read more about treating chronic kidney disease

Living kidney donation

A kidney transplant from a living donor can be planned to avoid or reduce the time someone is on dialysis. This can offer a better long term outcome for the person receiving the organ.

There are 2 types of living kidney donation:

• directed donation – a person can donate a kidney to someone they know, like a family member or a friend
• altruistic kidney donation – a person can donate a kidney anonymously to someone they do not know

Further information about living donation.

Treatment for kidney failure – transplant or dialysis

Many people with kidney failure can continue with treatment using medicines and will have good-functioning kidneys for the rest of their lives.

In a few people, kidney disease will progress to the stage where the kidneys stop working and it becomes life threatening. This is called kidney failure or established renal failure (ERF).

This rarely happens suddenly, and there will be time to plan the next stage of your condition. The decision whether to have dialysis, a kidney transplant or supportive treatment should be discussed with your healthcare team.

Read more about dialysis and kidney transplants.

Supportive treatment

If you decide not to have dialysis or a transplant for kidney failure, or they are not suitable for you, you will be offered supportive treatment.

This is also called palliative care.

The aim is to treat and control the symptoms of kidney failure without using dialysis or transplantation. Supportive treatment includes medical, psychological and practical care for both the person with kidney failure and their family, including discussion about how you feel and planning for the end of life.

Many people choose supportive treatment because they:

• are unlikely to benefit or have quality of life with treatment
• do not want to go through the inconvenience of treatment with dialysis
• are advised against dialysis because they have other serious illnesses that will shorten their life, and the negative aspects of treatment outweigh any likely benefits
• have been on dialysis but have decided to stop this treatment
• are being treated with dialysis, but have another serious physical illness, especially severe heart disease or stroke, that will shorten their life

If you choose to have supportive treatment, your kidney unit will still look after you.

Doctors and nurses will make sure you receive:

• medicines to protect your remaining kidney function for as long as possible
• medicines to treat other symptoms of kidney failure, such as feeling out of breath, anaemia, loss of appetite or itchy skin
• help to plan your home and money affairs
• bereavement support for your family after your death

Read more information on bereavement support from CRUSE.

Managing your condition

If you have a chronic (long-term) condition, such as diabetes, that could potentially cause chronic kidney disease, it is important it is carefully managed.

Follow the advice of your GP and keep all appointments relating to your condition. People with diabetes are advised to have their kidney function tested every year.

Read more about Type 1 diabetes and Type 2 diabetes

Smoking

Smoking increases your risk of cardiovascular disease, including heart attacks or strokes, and it can increase the likelihood that any existing kidney problems will get worse.

If you stop smoking, you will improve your general health and reduce your risk of developing other serious conditions, such as lung cancer and heart disease.

The NHS smoking helpline can offer you advice and encouragement to help you quit smoking. Phone Quit Your Way Scotland on 0800 84 84 84.

Read more about stopping smoking

Diet

A healthy diet is important for preventing chronic kidney disease. It will lower the amount of cholesterol in your blood and keep your blood pressure at a healthy level. Eat a balanced diet that includes plenty of fresh fruit and vegetables (5 a day) and whole grains.

Limit the amount of salt in your diet to no more than 6g (0.2oz) a day. Too much salt will increase your blood pressure. One teaspoonful of salt is equal to about 6g.

Avoid eating foods high in saturated fat because this will increase your cholesterol level.

Foods high in saturated fat include:

• meat pies
• sausages and fatty cuts of meat
• butter
• ghee (a type of butter often used in Indian cooking)
• lard
• cream
• hard cheese
• cakes and biscuits
• foods that contain coconut oil or palm oil

Eating some foods that are high in unsaturated fat can help decrease your cholesterol level. Foods high in unsaturated fat include:

• oily fish
• avocados
• nuts and seeds
• sunflower oil
• rapeseed oil
• olive oil

Read more about healthy food and diet

Alcohol

Drinking excessive amounts of alcohol will cause your blood pressure to rise, as well as raising cholesterol levels in your blood. Therefore, sticking to the recommended alcohol consumption limits is the best way to reduce your risk of developing high blood pressure (hypertension) and CKD.

Exercise

Regular exercise should help lower your blood pressure and reduce your risk of developing CKD.

At least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (such as cycling or fast walking) every week, is recommended.

Read more about health and fitness

Painkillers

Kidney disease can be caused by the improper use (such as taking too many) of non-steroidal anti-inflammatories (NSAIDs), such as aspirin and ibuprofen.

If you need to take painkillers, make sure you follow the instructions. This can help to avoid kidney damage.

Relationships and support

Coming to terms with a condition such as kidney disease can put a strain on you, your family and your friends. It can be difficult to talk to people about your condition, even if they are close to you.

Learning about kidney disease often helps because you and your family will understand more about what to expect and feel more in control of the illness, instead of feeling that your lives are now dominated by kidney disease and its treatment.

Be open about how you feel, and let your family and friends know what they can do to help. However, do not feel shy about telling them that you need some time to yourself, if that is what you need.

Get support

Your GP or nurse can reassure you if you have questions about your kidney disease, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP practice will have information on these.

Some people find it helpful to talk to other people with kidney disease at a local support group or online.

Money and finances

If you have to stop work or work part time because of your kidney disease, you may find it hard to cope financially. You may be entitled to one or more of the following types of financial support:

• if you have a job but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer
• if you do not have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance
• if you are aged 64 or under and need help with personal care or have walking difficulties, you may be eligible for Disability Living Allowance
• if you are aged 65 or over, you may be able to get Attendance Allowance
• if you are caring for someone with kidney disease, you may be entitled to Carer’s Allowance
• you may be eligible for other benefits if you have children living at home or if you have a low household income

Sex and pregnancy

The symptoms of kidney disease and the stress it causes in your life can affect your sexual relationships.

Some couples become closer after a diagnosis of kidney disease, while others find that their loved ones are affected by worries about how they will cope with the effects of the illness. Both men and women may experience issues about body image and self-esteem, and this can affect the relationship.

Try to share your feelings with your partner. If you have problems with sex that do not get better with time, speak to a counsellor or sex therapist.

People on dialysis often experience specific sexual difficulties. Loss of sex drive in both men and women and impotence in men are commonly reported problems.

Treatment is available, but it may take some time and requires commitment from both partners. The first step is to discuss it with your healthcare team.

Pregnancy

Both men and women with early stage kidney disease will find their fertility is unaffected. This means it is important to use contraception unless you want to have a baby.

Later stage kidney disease may affect women’s periods, which can make pregnancy more difficult. For men, later stage kidney disease can cause a reduction in sperm count. However, having kidney disease does not mean you will not get pregnant or be able to father a child, so both men and women need to use an effective method of contraception unless they want to have a baby.

Women who want to have a baby should talk to their renal specialist or an obstetrician with an interest in kidney disease. Depending on the stage of kidney disease, there can be risks to both the mother and the baby. It is important to minimise any risk with a planned pregnancy. Your healthcare team can advise you about this.

Holidays and insurance

If you have mild kidney disease or you’ve had a transplant, going on holiday shouldn’t pose additional health problems, whether you’re staying in the UK or going abroad.

If you’re on dialysis, you can still enjoy holidays provided you book your treatment before you go away.

If you’re on dialysis and want to travel, discuss your plans with your renal unit as early as you can. It can sometimes be more difficult to arrange dialysis in the UK than it is abroad.

The NHS will look after you if you get ill while on holiday in the UK. If you’re in Europe, the European Health Insurance Card (EHIC) entitles you to free or reduced-cost hospital treatment.

It’s a good idea to take out holiday health insurance in addition to carrying the EHIC. Anyone with kidney disease should declare it as a pre-existing medical condition on standard insurance application forms. It may exclude you from some policies.

Using over-the-counter medicines

Some remedies are potentially harmful for people with kidney disease. Make sure you check with your doctor before taking a new over the counter medicine.

You’re at higher risk of being harmed by certain over the counter remedies if:

• you have advanced kidney disease (stage 4 or 5, or a kidney function below 30% of normal)
• you have mild-to-moderate kidney disease (stage 3 with a kidney function between 30 and 60% of normal) and are elderly with another serious illness, such as coronary heart disease

What’s safe and what’s not

Summarised below is a list of which over the counter remedies are safe for people with kidney disease to use and which should be avoided. This is just a guide. For more detailed information, consult your pharmacist, renal specialist or GP.

Headaches

Paracetamol is safe and the best choice of painkiller to treat a headache, but avoid soluble products as they are high in sodium. If your kidney function is less than about 50%, avoid painkillers containing aspirin, ibuprofen or similar drugs such as diclofenac. These products can deteriorate the function of damaged kidneys. Low-dose aspirin of 75mg to 150mg a day can be used if it’s prescribed for the prevention of vascular disease. You should also avoid ibuprofen if you’re taking anti-rejection treatment following a kidney transplant.

Coughs and colds

Many of the products available for coughs and colds contain a mixture of ingredients, so check the packaging carefully. Some products contain paracetamol, which is safe, but others contain high doses of aspirin, which it’s best to avoid.

Many cold remedies also contain decongestants, which you should avoid if you have high blood pressure. The best way to clear congestion is by steam inhalation with menthol or eucalyptus. For coughs, try a simple linctus or glycerine honey and lemon to soothe your throat.

Muscle and joint pains

If you have muscle or joint pain, it’s ideal to use topical preparations (applied to the skin), which are rubbed on to the painful area. Avoid tablets containing ibuprofen or similar drugs such as diclofenac if your kidney function is below 50%. Ibuprofen gel or spray is safer than ibuprofen tablets, but it isn’t completely risk-free as a small amount of the drug penetrates the skin into the bloodstream.

Kidney failure

About 1% of people with stage three CKD develop kidney failure, also called established renal failure (ERF). Kidney failure has a major impact on your life and the lives of those close to you. People diagnosed with kidney failure usually go through shock, grief and denial before they accept their condition.

Choices if you have established renal failure

If you have established renal failure (ERF), you will need to decide whether to have treatment with dialysis or a kidney transplant. You may decide to have neither treatment and to have supportive care. These choices should be made with your healthcare team.

For people who want active treatment for their ERF, a transplant would be the best option. However, a transplant is only suitable for about half of all people with ERF. This is because they may have had recent cancer or are not physically fit.

Many people who have slowly progressive kidney failure and other serious health problems, and who are usually older, may choose to avoid dialysis. Supportive care can still allow you to live for some time with a good quality of life.

Transplant

A kidney transplant, when suitable, is the best treatment for ERF. The transplanted kidney can be obtained from a deceased or living donor and survival rates are now extremely good. About 90% of transplants still function after five years and many transplants work usefully after 20 years. The main reason people have to wait for a transplant is the shortage of available donors.

Over a third of kidney transplants are now from live donors. A live donor kidney can be transplanted before the need for dialysis, rather than after a period of time on dialysis.

One major risk after transplantation is rejection, where the immune system attacks the donated kidney because it mistakes it for a foreign object. This is prevented with the use of strong drugs to suppress the immune system. These drugs need to be taken meticulously. They are usually well tolerated but may have side effects, including an increased susceptibility to infections and some forms of cancer. For this reason, transplant patients are given regular reviews in a specialist transplant clinic.

Dialysis

Dialysis can take place at home or in hospital. It involves filtering the blood of waste products and excess water. It is not as efficient as a human kidney, so people with kidney failure usually need to restrict their intake of fluid and certain foods. They also require additional medicines such as iron supplements, phosphate binders and antihypertensive medicine (to reduce blood pressure). There are 2 types of dialysis: peritoneal dialysis and haemodialysis.

Peritoneal dialysis

The abdomen (tummy) has a lining called the peritoneal membrane, which can be used as a filter to remove excess waste and water. If you have opted for peritoneal dialysis, a tube (catheter) will be inserted into your abdomen during an operation. This will allow you to drain dialysis fluid in and out of your tummy yourself. You will not need to go into hospital to be treated, but you will have to spend an hour or two each day draining the fluid. The treatment involves either four exchanges spaced out during the day, each taking half an hour, or attaching yourself to a machine overnight that pumps the fluid in and out for you.

Haemodialysis

Haemodialysis removes waste products and excess fluid that build up in the body when the kidneys stop working. Blood is taken from the body to be cleaned in a filter known as a dialyser. It is effectively an artificial kidney. The whole process takes about four hours and usually has to be repeated three times a week. Most people go into hospital to have haemodialysis. However, some people choose to have the treatment in their own home.

Home haemodialysis will give you more flexibility, but comes with greater responsibility. You’ll need to have the space in your home for a dedicated machine and, in most cases, a lot of support from a close family member or friend. Some people choose to have their dialysis at night while they are asleep. Most people who choose home haemodialysis have it every day, so their fluid intake is not as restricted.

Quality vascular access

During haemodialysis, it is important that large volumes of blood are passed through the machine. This requires special measures to get into large enough blood vessels. For this reason, haemodialysis patients need a minor operation to join one of the deep arteries to a superficial vein (called a fistula). This is carried out in day surgery and should be done at least 6 weeks before dialysis is required because it needs time to mature before it can be used.

Occasionally, there will be insufficient time for a fistula to be created before dialysis is required. In this case, a temporary solution is found, usually involving the use of an indwelling plastic dialysis catheter. A catheter is a surgical tube inserted into the body to allow for the transfer of fluid.

All the issues will be discussed in detail with you by the dialysis team before any decisions are made.

Don’t include personal information e.g. name, location or any personal health conditions.

CKD প্রতিরোধ করার বিষয়টি মূলত ডায়াবেটিস এবং উচ্চ রক্তচাপের মতো বিদ্যমান রোগগুলোকে ভালোভাবে নিয়ন্ত্রণে রাখার ওপর নির্ভর করে।

কিছু জীবনযাত্রার অভ্যাসও আপনার ঝুঁকি কমাতে সাহায্য করতে পারে:

• পুষ্টিকর খাবার খাওয়া
• নিরাপদ সীমার মধ্যে অ্যালকোহল সেবন সীমিত রাখা
• শারীরিকভাবে সক্রিয় থাকা
• কিডনির ক্ষতি করতে পারে এমন ওষুধ এড়িয়ে চলা

ক্রনিক কিডনি ডিজিজ প্রতিরোধ সম্পর্কে আরও পড়ুন।

বেশিরভাগ ক্ষেত্রে CKD পুরোপুরি প্রতিরোধ করা সম্ভব না হলেও, এই পদক্ষেপগুলো গ্রহণ করলে আপনার এটি হওয়ার সম্ভাবনা কমে যেতে পারে।

ক্রনিক কিডনি ডিজিজ বা দীর্ঘমেয়াদি কিডনি রোগ ধরা পড়ার বিষয়টি আপনার মনে উদ্বেগের সৃষ্টি করতে পারে, তবে আপনার জন্য সাহায্য ও দিকনির্দেশনা রয়েছে।

দীর্ঘমেয়াদি কিডনি রোগ নিয়ে বেঁচে থাকা সম্পর্কে আরও পড়ুন