Nearly 80% of people with kidney disease die | The Silent Killer Understanding Kidney Disease and its Deadly Consequences

Chronic kidney disease (CKD) is a common and serious condition affecting millions of people worldwide. According to the World Health Organization (WHO), CKD is defined as the presence of kidney damage or decreased kidney function (GFR <60 mL/min/1.73m²) for three months or more, regardless of the underlying cause. The prevalence of CKD varies widely by country and age group, but it is estimated to affect around 10% of the global population.

One of the most concerning aspects of CKD is its high mortality rate. Studies show that nearly 80% of people with CKD die, with cardiovascular disease being the leading cause of death. In this article, we will explore the factors that contribute to this high mortality rate, as well as the steps that can be taken to improve outcomes for people with CKD.

Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of death in people with CKD, accounting for around 50% of all deaths. CVD refers to a group of conditions that affect the heart and blood vessels, including coronary artery disease, heart failure, and stroke. The risk of CVD is much higher in people with CKD than in the general population, even after adjusting for traditional risk factors such as hypertension, diabetes, and smoking.

There are several factors that contribute to the increased risk of CVD in CKD. One of the most important is the accumulation of uremic toxins, which are waste products that build up in the blood when the kidneys are not functioning properly. Uremic toxins can cause inflammation, oxidative stress, and endothelial dysfunction, all of which can lead to the development of atherosclerosis and other cardiovascular complications.

In addition to uremic toxins, other factors that increase the risk of CVD in CKD include anemia, hypertension, dyslipidemia, and mineral and bone disorders. Anemia, which is common in CKD due to decreased erythropoietin production, can lead to myocardial ischemia and heart failure. Hypertension, which is present in around 85% of people with CKD, can cause left ventricular hypertrophy and diastolic dysfunction. Dyslipidemia, which is characterized by elevated levels of LDL cholesterol and triglycerides, is a known risk factor for atherosclerosis. Mineral and bone disorders, which are common in advanced CKD, can lead to vascular calcification and arterial stiffness.

Infection

Infection is another important cause of mortality in people with CKD, accounting for around 25% of all deaths. People with CKD are at increased risk of infection due to several factors, including impaired immune function, frequent hospitalizations, and the use of immunosuppressive medications. In addition, certain infections, such as urinary tract infections and sepsis, are more common in people with CKD than in the general population.

Infection can have serious consequences in people with CKD, including sepsis, pneumonia, and cellulitis. These complications can be particularly severe in people on dialysis, who are at increased risk of infection due to the frequent insertion of catheters and other devices. In addition, infections can be more difficult to treat in people with CKD, as many antibiotics are cleared by the kidneys and may require dose adjustments or alternative medications.

Cancer

Cancer is another important cause of mortality in people with CKD, accounting for around 10% of all deaths. People with CKD are at increased risk of several types of cancer, including renal cell carcinoma, bladder cancer, and hematologic malignancies. The reasons for this increased risk are not fully understood, but may be related to factors such as chronic inflammation, oxidative stress, and immune

Dysfunction

In addition to an increased risk of cancer, people with CKD may also have poorer outcomes when they do develop cancer. For example, they may be less likely to receive recommended cancer treatments due to concerns about their kidney function. In addition, some cancer treatments can be nephrotoxic, meaning that they can cause kidney damage. This can be particularly concerning in people with CKD, who may already have impaired kidney function.

Other Causes of Mortality

In addition to CVD, infection, and cancer, there are several other factors that can contribute to mortality in people with CKD. These include:

• Malnutrition: Malnutrition is common in people with CKD, particularly those on dialysis. Malnutrition can lead to muscle wasting, weakness, and increased susceptibility to infections. In addition, it can contribute to the development of cardiovascular disease and other complications.
• Electrolyte Imbalances: People with CKD may experience electrolyte imbalances, which can have serious consequences. For example, hyperkalemia (high potassium levels) can cause arrhythmias and cardiac arrest, while hyponatremia (low sodium levels) can cause seizures and cerebral edema.
• Vascular Access Complications: People on dialysis require a vascular access, which can be associated with several complications, including infection, thrombosis, and bleeding. These complications can be life-threatening and may require hospitalization or surgical intervention.
• Medication Side Effects: People with CKD may be at increased risk of medication side effects due to altered drug metabolism and clearance. Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can cause kidney damage and should be avoided in people with CKD.

Improving Outcomes for People with CKD

Given the high mortality rate in people with CKD, it is clear that more needs to be done to improve outcomes for this population. Some of the key strategies for improving outcomes include:

• Early Detection and Treatment: Early detection and treatment of CKD can help to slow the progression of the disease and
• prevent complications. This includes regular monitoring of kidney function through blood and urine tests, and management of underlying conditions that can contribute to the development and progression of CKD, such as diabetes and hypertension.
• Lifestyle Modifications: Adopting a healthy lifestyle can also help to improve outcomes for people with CKD. This includes maintaining a healthy weight, following a balanced diet that is low in sodium, phosphorus, and protein, quitting smoking, and engaging in regular physical activity.
• Medication Management: Managing medications is important for people with CKD, as certain medications can be harmful to the kidneys. It is important for healthcare providers to regularly review and adjust medications to ensure they are safe and effective for individuals with CKD.
• Patient Education and Empowerment: Educating patients and empowering them to take an active role in their care can also improve outcomes. This includes educating patients about their condition, how to manage their symptoms, and the importance of adhering to treatment plans.
• Collaborative Care: Collaborative care, where healthcare providers work together to manage an individual's care, can also improve outcomes for people with CKD. This may include working with a nephrologist, primary care provider, and other specialists to manage medications, monitor kidney function, and address any complications or comorbidities.