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Chronic Kidney Disease

Dec
01

Chronic Kidney Disease

Chronic kidney disease (CKD) affects over 13% of the global population, and 15% of the population in the US. That’s more than 37 million people in the United States (1 in 7 people) and over 1 billion people worldwide that have CKD.Unfortunately, about 90% of these people don’t even know they have chronic kidney disease(1, 2).

What is chronic kidney disease?

Chronic Kidney Disease (CKD) is an irreversible, progressive disease of the kidneys which affects their ability to properly filter blood and produce certain hormones (3). This causes a dangerous build-up of waste products in the body. The most common causes of chronic kidney disease are diabetes and hypertension. Other factors that put people at risk for CKD are heart disease, genetics, and autoimmune diseases (3).

How is CKD diagnosed?

Most people don’t know they have chronic kidney disease until it’s very advanced. In the earlier stages of CKD, you are unlikely to experience any symptoms. The best way for you to find out if you have kidney disease is to have your medical provider run simple blood and urine tests. In general, your medical provider will likely evaluate your estimated glomerular filtration rate (eGFR), creatinine, and urine to assess and stage your CKD.

What are the different CKD stages?

CKD is broken up into stages and reflects the severity of the condition. The stages are largely determined by your glomerular filtration rate (GFR), a test that shows how well your kidneys filter your blood of toxins and other waste products. If you have recently been diagnosed with CKD but are unsure of what stage you are in, get in touch with your medical provider. The KDIGO 2012 Clinical Guidelines defines CKD as abnormalities of kidney structure or function, present for >3 months, with implications for health (4). See the table below to see common diagnostic criteria for each CKD stage based on eGFR ranges (4).

What are the different CKD stages?

Although there is no cure for CKD, there are very effective and life-saving treatments available to help preserve kidney function and prolong life. Your treatment is dependent on which stage you are in among other health factors and conditions.

Kidney Disease in Asians: How it affects you differently

While most ethnic-specific CKD research is focused on African Americans, the focus at Asian Kidney Nutrition is tailored to you as an individual from Asian descent. I take the time to comb through the most up-to-date research on CKD in Asians, so you don’t have to.
A study following 2,626 Caucasians and 818 Asians over eight years with similar eGFRs showed Asians having a higher incidence of End Stage Renal Disease (ESRD) (3). The researchers found that Asians progressed through the stages of CKD quicker than Caucasians; therefore, there were more new cases of Asians that ended up with ESRD.

Asians overall had a faster decline in GFR compared to the Caucasians group (Asians have a 52% faster decline, while South Asians have the fastest at more than 80%). This rapid decrease puts Asians at higher risk for reaching ESRD faster.

It’s important to consider that this particular study was done in British Columbia, where many follow a typical westernized diet low in fruits and vegetables, fiber, and very high in protein. These dietary factors increase the risk for other conditions such as diabetes and hypertension, both of which are risk factors for developing CKD (3). This research provides valuable information on how CKD affects Asian individuals differently, but cannot be used alone to claim that being of a certain Asian descent is a risk factor for CKD in itself.

Renal lab values in the Asian population were also found to be significantly worse compared to Caucasians with CKD. Asian groups tended to test more for the following (3):
• Anemia (low iron levels)
• Hyperphosphatemia (high phosphorus levels)
• Hypocalcemia (low calcium levels)
• Hypoalbuminemia (low albumin levels)
• Hyperparathyroidism (highparathyroid hormone levels)

Diets within different Asian cultures vary greatly and may influence the incidence of CKD in certain groups. However, more research is needed to determine the significance of the role of genetics and other cultural factors within the Asian population on developing CKD, worsening decline in eGFR, and lab values. Such genetic differences have recently been found in the African American population that helps explain their susceptibility to CKD (5).

What is a renal diet?

Diet and nutrition are crucial components of living with chronic kidney disease. Although CKD is an irreversible disease, it is still possible to delay disease progression to ESRD and dialysis through diet and other lifestyle factors. Studies have found that even patients with stage 3 CKD can slow their progression and improve survival with plant-based and DASH diet approaches (6). Research has also found that a lower protein diet is associated with slower disease progression (7). A renal diet, unlike others, has more generalized guidelines compared to those focused on other chronic conditions such as heart disease or diabetes. Two people in the same stage of CKD can still have very different dietary needs. It is important to stay up to date with your medical visits and be in communication with your doctor and renal dietitian so that they can ensure you are following an appropriate diet to manage your disease. When following a renal diet, it is important to get your labs done regularly as this determines your adjusted needs for: • Protein • Phosphorus • Calcium • Sodium • Potassium A renal diet can be overwhelming to learn about all at once. It can feel at times that suddenly everything is off the table and you have to read food labels you’ve never had to before. A renal dietitian can help you learn to navigate healthy foods for you and show how you can still incorporate your favorite foods into your diet. While this can certainly be helpful, not all renal dietitians are familiar with more traditional Asian foods and how those can fit in a renal diet. Healthy Mission Dietitian, Inc is your primary resource for learning all you need to know about CKD nutrition in Asian groups from Chinese, Filipino, Japanese, Vietnamese, Korean, and more. Share where you are from in the comments below! Don’t see your ethnicity listed? Let me know what I missed and what you are interested in learning more about CKD in Asians.

Sources

1. Centers for Disease Control and Prevention. (2021, March 4). Chronic kidney disease in the United States, 2021. Centers for Disease Control and Prevention. Retrieved November 29, 2021, from https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html.

2. Coresh, J. (2017). American Society of Nephrology. Retrieved November 30, 2021, from https://jasn.asnjournals.org/

3. Barbour, S. J., Er, L., Djurdjev, O., Karim, M., & Levin, A. (2010, April 5). Differences in progression of CKD and mortality amongst Caucasian, Oriental Asian and South Asian CKD patients. OUP Academic. Retrieved November 27, 2021, from https://academic.oup.com/ndt/article/25/11/3663/1899075?login=true

4. KDIGO 2017 Clinical Practice Guideline Update for the … (n.d.). Retrieved November 28, 2021, from https://kdigo.org/wp-content/uploads/2017/02/2017-KDIGO-CKD-MBD-GL-Update.pdf

5. Umeukeje, E. M., Young, B. A., Fullerton, S. M., Cavanaugh, K., Owens, D., Wilson, J. G., Burke, W., & Blacksher, E. (2019, April 1). You are just now telling us about this? African American perspectives of testing for genetic susceptibility to kidney disease. American Society of Nephrology. Retrieved November 27, 2021, from https://jasn.asnjournals.org/content/30/4/526?WT.MC_ID=TMD01&utm_campaign=J_Am_Soc_Nephrol_TrendMD_1&utm_medium=cpc&utm_source=TrendMD

6. Umeukeje, E. M., Young, B. A., Fullerton, S. M., Cavanaugh, K., Owens, D., Wilson, J. G., Burke, W., & Blacksher, E. (2019, April 1). You are just now telling us about this? African American perspectives of testing for genetic susceptibility to kidney disease. American Society of Nephrology. Retrieved November 27, 2021, from https://jasn.asnjournals.org/content/30/4/526?WT.MC_ID=TMD01&utm_campaign=J_Am_Soc_Nephrol_TrendMD_1&utm_medium=cpc&utm_source=TrendMD

7. Metzger M;Yuan WL;Haymann JP;Flamant M;Houillier P;Thervet E;Boffa JJ;Vrtovsnik F;Froissart M;Bankir L;Fouque D;Stengel B; (n.d.). Association of a low-protein diet with slower progression of CKD. Kidney international reports. Retrieved November 27, 2021, from https://pubmed.ncbi.nlm.nih.gov/29340320/

Source Links
1. https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html CDC info

2. https://jasn.asnjournals.org/content/jnephrol/28/4/1020.full.pdf?with-ds=yes facts

3. https://academic.oup.com/ndt/article/25/11/3663/1899075?login=true asian CKD study

4. https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf KDIGO guidelines
5. https://jasn.asnjournals.org/content/30/4/526?WT.MC_ID=TMD01&utm_campaign=J_Am_Soc_Nephrol_TrendMD_1&utm_medium=cpc&utm_source=TrendMD AA ckd genetic

6. https://cjasn.asnjournals.org/content/clinjasn/14/1/141.full.pdf plant based diet CKD

7. https://pubmed.ncbi.nlm.nih.gov/29340320/ low protein diet

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