29/07/2023
What is Kidney Disease?
Chronic kidney disease (CKD) means your kidneys are damaged and losing their ability to keep you healthy by filtering your blood. In the early stages of the disease, most people do not have symptoms. But as kidney disease gets worse, wastes can build up in your blood and make you feel sick. You may develop other problems, like high blood pressure, anemia, weak bones, poor nutritional health, and nerve damage. Because kidneys are vital to so many of the body's functions, kidney disease also increases your risk of having heart and blood vessel disease. While these problems may happen slowly and without symptoms, they can lead to kidney failure, which can appear without warning. Once kidneys fail, dialysis or a kidney transplant is needed to stay alive. Kidney failure is also called kidney failure with replacement therapy (KFRT).
What Causes Kidney Disease?
The two main causes of kidney disease are diabetes and high blood pressure.
These two conditions were the primary diagnosis in 76% of kidney failure cases between 2015-2017: 47% of new KFRT patients had a primary diagnosis of diabetes, the leading cause of KFRT, while 29% of new KFRT patients had a primary diagnosis of hypertension, the second leading cause of KFRT.
Other conditions that can lead to KFRT are: glomerulonephritis (diseases that damage the kidney's filtering units), which are the third most common type of kidney disease; inherited diseases, such as polycystic kidney disease; malformations at birth that occur as a fetus develops; lupus and other immune diseases; obstructions such as kidney stones or an enlarged prostate; and repeated urinary tract infections, which can also lead to kidney infections and can cause long-term damage to the kidneys.
People with kidney disease are at greater risk for cardiovascular disease and death at all stages of kidney disease. Kidney disease and heart disease are linked and have common risk factors, such as diabetes and hypertension. Each condition can lead to or worsen the other.
How is Kidney Disease Treated?
The best treatment of kidney disease is facilitated by early detection, when the disease can be slowed or stopped. Early treatment includes diet, exercise, medications, lifestyle changes, and treating risk factors like diabetes and hypertension. However, once kidneys fail, treatment with dialysis or a kidney transplant is needed.
Dialysis comes in two forms: hemodialysis (HD) or peritoneal dialysis (PD). Both forms remove wastes and extra fluid from your blood. Patients receive hemodialysis usually 3–4 times a week, either at home or at a dialysis center. During hemodialysis, your blood is pumped through a dialysis machine, where it is cleaned and returned to your body. With peritoneal dialysis, your blood is cleaned inside your body every day through the lining of your abdomen using a special fluid that is periodically changed. Peritoneal dialysis can be done at home, at work, at school, or even during travel. Home dialysis is an increasingly popular mode of treatment, and is associated with better outcomes.
A kidney transplant places a healthy kidney into your body from a deceased donor or from a living donor, such as a close relative, spouse, friend, or generous stranger. A kidney transplant, however, is a treatment, not a cure. Antirejection and other medications are needed to maintain the transplant. Per the United States Renal Data System (USRDS), more than 22,000 (22,393) kidney transplants were performed in the United States in 2018. The active waiting list remains substantially larger than the supply of donor kidneys, which presents a continuing challenge.
Although it is very important for patients who are nearing the need for dialysis or kidney transplantation to be cared for by a nephrologist, in 2018, 38.8% of incident (newly occurring) KFRT patients (18–44 years) had received little or no pre-KFRT nephrology care.
How Many People Require Dialysis or Transplant?
In 2018, 785,883 Americans had kidney failure, and needed dialysis or a kidney transplant to survive (2 in every 1,000 people). 554,038 of these patients received dialysis to replace kidney function and 229,887 lived with a kidney transplant.
About 130,000 people started KFRT treatment in 2018, of which approximately 128,000 started dialysis as the initial mode of therapy.
In 2018, 22,393 people received a kidney transplant. By the end of 2018, a total of 229,887 Americans were living with a kidney transplant.
While about 100,000 Americans are waiting for a kidney transplant, only 22,817 Americans received one in 2020. About one-third of these transplants came from living donors.
Living and deceased kidney donors are crucial: 12 people die every day while waiting for a kidney transplant.
In 2016, more than 3,600 kidneys from deceased donors were surgically discarded; NKF is making efforts to utilize more of these kidneys for transplantation.
People with kidney disease are five to ten times more likely to die prematurely than they are to progress to KFRT. More than 100,000 people with KFRT died in 2018.
Without increased investment in prevention, the total number of patients with kidney failure will likely exceed 1 million by 2030.
Who is at Risk for Kidney Disease?
1 in 3 adults in the U.S. is at risk for kidney disease. Some demographic groups are at higher risk. (See "What's Behind Racial Disparities in Kidney Disease?" section.)
Risk factors for kidney disease include: diabetes; high blood pressure; family history of kidney failure; age 60 or older; obesity; heart disease; past damage to kidneys; and being in minority populations that have high rates of diabetes or high blood pressure, such as Black/African Americans, Hispanics or Latinos, Asian Americans or Pacific Islanders, and American Indians or Alaska Natives (Note: current CDC/ NHANES demographic terminology.).
