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Chronic Kidney Disease

Five stages of Chronic Kidney Disease 



GFR Level
mL/ min

At increased risk

Risk factors for kidney disease (e.g., diabetes,
high blood pressure, family history, older age)

90 or more


Kidney damage with normal or higher GFR

90 or more


Kidney damage and mild decrease in GFR

60 to 89


Moderate decrease in GFR

30 to 59


Severe decrease in GFR

15 to 29


Kidney failure (dialysis or kidney transplant needed)

Less than 15

To prevent CKD progression

Early detection and treatment can often slow or stop CKD. How well your treatment can achieve this goal depends on:

Your stage of CKD when you start treatment.

The earlier you start, the better you are likely to do.

How carefully you follow your treatment plan.

 Learn all you can about CKD and its treatment, and make sure to follow all the steps of your treatment faithfully.

The cause of your kidney disease.

Some kidney diseases are more difficult to control..

Your checkup should include:


Urine test for protein (UKF Health Screening)


Blood pressure


Blood test for glucose


Blood test for creatinine

Kidney Failure

If kidney damage becomes too severe, one’s kidneys lose their ability to function normally, this is called End Stage Kidney (Renal) Disease, ESRD, or Kidney Failure.

Diabetes and high blood pressure are the two known leading causes of ESRD, accounting for more than 60 percent of new cases of dialysis patients in Malaysia. Kidney disease can also develop from infection, inflammation of blood vessels in the kidneys, kidney stones and cysts. Other possible causes include prolonged use of pain relievers and use of alcohol or other drugs (including prescription medications).

There are three types of Kidney Failure:

Acute Kidney Failure

This is the sudden loss of kidney functions over a few hours or days. It can be due to one of the various types of kidney diseases or may be due to infections or low blood pressure after an accident.

Loss of kidney functions in Acute Kidney Failure is usually temporary, but can be life threatening. In most cases, this type of kidney failure is reversible, but it occasionally may not respond to treatment and may progress to Chronic Kidney Failure or End Stage Kidney Failure.

Acute Kidney Failure is more common in men than in women. When Acute Kidney Failure occurs, investigations are undertaken to determine the cause. This may include a kidney biopsy.

Sometimes there are specific, treatable causes, but often it is simply a case of waiting patiently for the kidneys to heal themselves and recover their functions.

Many people with Acute Kidney Failure require dialysis, while they are waiting for their kidneys to recover. However sometimes Acute Kidney Failure can be managed conservatively, by simply watching the blood pressure and the blood chemistry and waiting for kidney functions to return.

Chronic Kidney Failure

When the loss of kidney functions is gradual and progressive, it is referred to as Chronic Kidney Failure. Eventually, the kidneys are unable to remove wastes or maintain the body’s salt and fluid balance, resulting in the need to receive dialysis treatment. The symptoms of this type of kidney failure may not be noticed immediately.

A build-up of creatinine (a waste product normally removed by the kidneys) in the blood will indicate kidney functions and the level of kidney impairment. The risk of Chronic Kidney Failure increases with age.

End Stage Kidney Failure

This phrase means that the kidneys have failed completely, and can no longer support life. Some people with End Stage Kidney Failure stop passing urine completely; others will still pass some weak, watery urine.

Signs & Symptoms of Kidney Disease

When kidney disease develops over a short period of time it’s called Acute Kidney Failure. This is usually caused by an acute 'insult' (damage) to the kidneys. Unlike Chronic Kidney Failure, this can usually be treated and cured. Acute kidney diseases often cause symptoms that are quite obvious, the most prominent being:
• blood in the urine
• swelling of the face, feet, ankles and legs
• new onset of high blood pressure
• shortness of breath

The above symptoms are more likely to occur in children because they are more likely to suffer acute kidney diseases. However, that does not mean adults are free of them, so if you note any combination of these symptoms, immediately seek medical attention.

Note that other diseases can also cause similar symptoms, but a simple urine test can indicate if they are due to kidney diseases. For instance, the urine test will indicate if albumin (protein) and blood are present in the urine, as they imply the presence of kidney diseases. A blood test can also show how well your kidneys are performing their main function of eliminating waste products.

In contrast, many chronic kidney diseases do not manifest clear warning signals in their early stages. There may be loss of appetite, mild swelling in the legs, and tiredness. It is not uncommon for these symptoms to be so mild or non-specific that they are ignored over long periods of time.

In fact, some people with chronic kidney disease do not have any symptoms in the initial stages. But as kidney function declines, symptoms may include:
• fatigue
• frequent headaches
• loss of appetite (anorexia)
• sleep problems (insomnia)
• itchy skin
• frequent urination or urinary retention
• nausea or vomiting
• swelling or numbness of the hands and feet
• darkening of the skin
• muscle cramps


Haemodialysis is a treatment for those patients whose kidneys cannot function any more. It is a way of cleansing the blood of toxins, extra salts and fluids through a dialysis machine called "artificial kidney". It helps maintain proper chemical balance such as potassium, sodium and chloride and keeps blood pressure under control.

During dialysis, two needles will be placed into the vascular access, one to remove the blood and the other to return cleansed blood to the body. You are connected (via tubing) to the dialysis machine through a vein in your arm, the blood is pumped from your body to a special filter called the dialyser, which is made of tiny capillaries.

Blood is continuously pumped through the dialyser, where waste products and excess water are removed. The blood becomes purified when the waste products diffuse from the blood across the membrane of these tiny capillaries. This purified blood is then returned to your body through larger tubes.

Haemodialysis is performed 3 times a week, with each session lasting about 3 to 5 hours, depending on the body size and medical condition. At the NKF, patients can choose Mondays, Wednesdays and Fridays or Tuesdays, Thursdays and Saturdays. They can also choose the morning, afternoon or evening session.

Things to take care...

Before and during dialysis, you need to clean the skin covering the access before inserting the needles to avoid infection. If you notice any signs of infection, inform the nurse immediately. Besides, you need to make sure that your blood is flowing and not clotting while on treatment, lightly touch the area to feel a pulse. It is important that the catheter be kept dry, even when you are taking a bath.

You also need to take care of your fistula or graft. You should not wear anything tight around the fistula/graft arm i.e. watches, bracelets, tight clothing, or carry heavy bags looped over the fistula/graft. Despite of checking that the fistula/graft is working by feeling for the buzzing sensation every morning and night, you should not allow non-dialysis staff to take blood or blood pressure on your fistula/graft arm. Observe for signs of infection, such as redness, oozing of blood or pus, swelling and heat, you need to contact the nurse immediately if there are any problems with your fistula/graft.

Peritoneal dialysis (PD)

Peritoneal dialysis (PD) is an alternative treatment to haemo-dialysis. A special sterile fluid is introduced into the abdomen through a permanent tube that is placed in the peritoneal cavity. The fluid circulates through abdomen to draw impurities from surrounding blood vessels in the peritoneum, and it is then drained from the body.

PD can be carried out at home, at work, or on trips, but requires careful supervision. PD gives patients more control. However, they need to work closely with the health care team including the nephrologist, dialysis nurse, dialysis technician, dietitian and social worker. The role of the PD patient and his/her family are very important. By learning more about the treatment, patients can work with the health care team to achieve the best possible results and lead an active life.

How does it work?

The walls of the abdominal cavity are lined with a membrane called the peritoneum, which allows waste products and extra fluid to pass from your blood into the dialysis solution. In PD, a soft tube called a catheter is used to fill the abdomen with a cleansing liquid called dialysis solution. The solution contains a type of sugar called dextrose that will pull waste and extra fluid into the abdominal cavity, will be exuded out of the body when the dialysis solution is drained. The used solution will be thrown away.

The process of draining and filling is called an exchange and takes about 30 to 40 minutes. The period when the dialysis solution is in the abdomen is called the dwell time. A typical schedule calls for four exchanges a day, each with a dwell time of 4 to 6 hours. Different types of PD have different schedules of daily exchanges.

Types of PD

There are two types of Peritoneal Dialysis: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD).

You do not need a machine for CAPD. You simply need gravity to fill and empty your abdomen. The doctor prescribes the number of exchanges a patient needs, typically three or four exchanges during the day and one evening exchange with a long overnight dwell time while one sleeps. As the word "ambulatory" suggests, you can walk around with the dialysis solution in your abdomen.

An alternative to CAPD is Automated Peritoneal Dialysis (APD) where a machine called a cycler changes the dialysate solution during the night, usually while patients are asleep. This means that patients have to be attached to the machine for 8-10 hours.

Why APD?

APD is suggested to offer a number of unproven psychosocial benefits over CAPD. It relates directly to fewer connections and allows patient to lead a normal lifestyle during the day, particularly for workers, school pupils and those taking care of the elderly or debilitated patients. Additional benefits include the absence of fluid during the day, which possibly reduces back pain and body image difficulties. Performing APD at night in the supine position also results in reduced intra-abdominal pressures as compared with the upright position in CAPD.

APD is designed to be simple and is often performed in the bedroom. The machines are user-friendly. Before going to sleep, the machine needs to be loaded with fluid. It will then perform a number of cycles throughout the night. The fluid is drained away into a large drainage bag for disposal. Often, the machine will provide a last fill of fluid, which stays inside the tummy until the following night when it is drained away.

Peritoneal dialysis units worldwide are increasingly adopting APD. It is estimated that one quarter of the world's peritoneal dialysis patients are now on APD. The use of cyclers in North America has increased from 10% in 1990 to 43% in 1997. 60% of patients treated with APD in North America also receive at least one exchange during the day. APD is more expensive than CAPD, but is usually cheaper than a transfer to in-centre Haemodialysis.


Organ donation is the removal of the organs or tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting them into other persons. People of all ages may be organ and tissue donors. Organ and tissue donation is the ultimate humanitarian act of charity.

The commonly transplanted organs are kidneys, heart, liver, lungs and pancreas (currently no pancreas transplant has been done in Malaysia) while the transplantable tissues are cornea (eyes), arteries or veins, intestines, tendons, ligaments ,bones, skin and heart valves.

There are two sources:

(a) Living Donors

For many years, most living donors were closely related to the potential recipient, e.g. brother, sister or parent. Such close relatives were likely to be a close tissue match to the recipient, resulting in excellent outcomes. With the advent of improved immunosuppressive medications (anti-rejection medications), it is now possible to achieve similar outcomes using living donors who are unrelated to the recipient, but only emotionally related such as spouses are sometimes found to have a compatible blood group and tissue match to the potential recipient.

(b) Cadaveric Donors

Organs from cadaveric donors are allocated to the best tissue matched patients on the transplant waiting list. Potential cadaveric donors with a history of cancer or transmissible viruses such as Hepatitis B, Hepatitis C and HIV are not considered for organ donation.

There are 2 sources of cadaveric donors:

- Heart-Beating Donors
These donors have suffered severe trauma to the brain. In order to be considered as organ donors, these patients must be ventilated in an intensive care unit and medically certified as 'brain stem" dead, meaning that all functions of the brain have ceased. In other words, life cannot be sustained. Heart beat and lung function are artificially maintained by a respirator. A very small proportion of all deaths in hospitals occur under these conditions. Heart, kidney and liver transplants are only possible from heart-beating donors.

- Non Heart-Beating Donors
Only tissues such as cornea (eye), skin and heart valves can be procured after cardiac death.