 I'm Dr. Rashouk Bhatt. I'm a consultant nephrologist working at KMC Hospital-Lambedkar Circle for the past 16 years. I'm here today to talk about chronic kidney disease. This is an important disease affecting millions of people worldwide and is also an important health hazard in our country. The disease causes significant morbidity and mortality and also substantial financial burden to patient and his or her family. However, if this disease is detected early, it can be treated effectively and the treatment can be relatively inexpensive and the results are likely to be good. However, once the disease reaches an advanced stage, the treatment is very expensive and the results can be suboptimal. Now, chronic kidney disease or short forms CKD is a disease in which the kidney function deteriorates slowly over a period of months to years and it progresses through several stages. Usually we recognize five stages in the progression and the final stage is known as a stage of kidney failure at which the patient requires dialysis or kidney transplantation. There are numerous causes for chronic kidney disease but the two most important among them which constitute almost 50% of cases of chronic kidney disease are diabetes and high blood pressure. In addition to this, the other causes could be in the form of glomerulonephritis, hereditary kidney diseases, kidney stones or obstruction to the urine flow in the urinary tract, repeated infections of the kidney, the urinary tract could be some of the other causes. It would be appropriate if we call chronic kidney disease a silent killer. The reason is that it is very difficult to identify this problem in its early stages. You would be surprised to know that majority of the patients who have chronic kidney disease are totally asymptomatic in the early stages of the disease. Once the disease progresses and reaches the terminal stages, patient starts getting various symptoms in the form of nausea, vomiting, breathlessness, loss of appetite, itching, swelling all over the body, excessive tiredness etc. By this time patient usually has reached a terminal stage known as stage of kidney failure and there is hardly any reversal from this point onwards. So then how do we recognize chronic kidney disease early would be the question that you would ask since the patient is asymptomatic, how should we know it? So basically this is detected by a process known as screening. By screening I mean patients who are asymptomatic but who are at risk of chronic kidney disease get certain routine tests done irrespective of whether they have symptoms or they are asymptomatic. Now what are these tests? These tests are relatively inexpensive and simple. This includes a simple blood test whereby we measure the level of a substance called creatinine in the blood and based upon the estimation of the level of the creatinine we would be able to assess what is the level of kidney function of the patient. In addition we do a urine test to look for protein as well as blood in the urine and the presence of either of these would suggest that the patient is suffering from kidney damage. So the next question arises as to who has to be screened. Now if you are at risk for chronic kidney disease then you need to get screened whether you are symptomatic or not. So who are these patients at risk? Those who have diabetes, those who have high blood pressure, those who have a family history of kidney disease, those who are obese, those who smoke, those who have recurrent kidney stones or obstruction to the flow of urine, those who have repeated urinary tract infections are the ones who need to be screened. And these screening tests are inexpensive and if these tests are positive and you are diagnosed to have chronic kidney disease then further evaluation may have to be done to stage the disease, to find out the cause of the disease and look for any reversibility and also to look for complications of chronic kidney disease. So by this method if we identify patients early then the progression to kidney failure can be substantially retarded and in some instances halted and in some instances like in case of glomerulonephritis or obstruction to the flow of the urine if these are treated effectively restoration of kidney function is also possible in a number of cases. So how to go about treating chronic kidney disease once diagnosed? Now this what I am going to say is the most important pillar of treatment of chronic kidney disease that is control of blood pressure, control of blood pressure and control of blood pressure. Now any patient with chronic kidney disease he or she should have his or her blood pressure brought down to less than 130 by 80 and should be maintained at this level consistently throughout his or her life to be effective. Now the most important thing to note here is that unlike simple hypertension which affects majority of the people blood pressure in patients with chronic kidney disease is highly resistant. So it is unlikely to come under control with the use of only one drug. Patients usually require multiple medications to bring the blood pressure under control and many of them may require maximum doses of these medications to bring blood pressure under control and you can understand that the same drug may not work the same way in two different individuals. So there is no one size fits all theory here. So it has to be tailored depending upon the requirement of the individual patient and no doctor on a single visit can tell you that you require these many BP medications and this is the dosage that you need. Hence early on the number of visits that you may have to do to get your blood pressure under control may be frequent but once the blood pressure comes under control the frequency of visits can be reduced. However adherence to treatment throughout your lifetime is mandatory and blood pressure should be brought and kept below 130 by 80 consistently for you to achieve good results. Now among the blood pressure medications we most often use drugs belonging to a group called asinibiters or angiotensin receptor blockers. These drugs have got additional beneficial effect over and above the other routine antihypertensives in reducing proteinuria and also preventing progression of chronic kidney disease. So unless otherwise contraindicated one of your antihypertensive drugs should be either an asinibiter or an angiotensin receptor blocker. Now in addition to control of blood pressure in diabetics it has been found that a good control of blood sugars keeping the glycated hemoglobin to less than 7% has helped in preventing progression of the disease. In addition to this diet plays a very important role. Salt restriction, restriction of proteins in the diet especially from animal sources meat and poultry can help in retarding progression. Avoidance of smoking if you are a smoker helps in preventing progression. Similarly if you are overweight bringing down your weight to normal limits also helps in reducing the progression of kidney disease. In addition to all these patients who have diseases like glomerulonephritis may have to be treated with immunosuppressants and patients who have obstruction to the urinary tract may have to undergo surgical intervention to help to improve their kidney function. These are all about what you have to do but there are a list of don'ts also. One of the important things which CKD patients should know is the drugs that they need to avoid. It is very dangerous for a chronic kidney disease patients to self-medicate or to take over the counter medications. There are several medications which can cause sudden onset loss of kidney function in these patients which include painkiller medications belonging to the class called NSAIDs, some antibiotics, certain contrast agents which are given during procedures like CT Scran, angiogram etc which these patients will have to avoid. In addition the doses of several medications may have to be modified depending upon the level of kidney function. Herbal medications are also not safe. People often take herbal medications thinking that they are safe and they may help to improve their health but there are several reports of herbal medications associated with these properties and worsening of kidney function. Therefore my advice to you would be not to use herbal medications. Now all these treatment modalities which I have listed out would be effective if it is started early in the course of the disease and their effectiveness decreases as stage of the disease progresses. Once the patient reaches an advanced stage we would be grappling more with the complications of the kidney disease and treatment of them rather than preventing progressions. So we may have to manage anemia, we may have to manage mineral and bone disorders, fluid overload and so on. And once the patient reaches the stage of kidney failure then the only treatment options that are available are dialysis and kidney transplantation. So my message to you would be help us to help you to prevent kidney failure. If you are at risk please report early, get tested. If you have the disease start preventive measures early and adhere to them throughout your life and prevent kidney failure.