Chronic Kidney Disease

CKD is classified by eGFR (estimated glomerular filtration rate) — how much blood your kidneys filter per minute. Stage 1: eGFR ≥90 (near-normal function, but kidney damage markers present). Stage 2: eGFR 60-89 (mild reduction). Stage 3a/3b: eGFR 30-59 (moderate reduction — most symptoms begin here). Stage 4: eGFR 15-29 (severe — preparation for kidney replacement therapy begins). Stage 5: eGFR under 15 (kidney failure — dialysis or transplant needed). Stages 1-3 are where treatment slows progression most effectively. Many Stage 1-2 patients stabilise for decades with good management.

Diet in CKD needs to balance several things at once. Protein restriction (0.6-0.8g/kg body weight) reduces waste the kidneys must filter — but this requires dietitian guidance to avoid malnutrition. Potassium restriction is needed in Stages 3-5 (limit banana, potato, tomato, orange, coconut water). Phosphorus restriction in later stages (limit dairy, nuts, whole grains, cola drinks). Low sodium to control blood pressure and fluid retention. Fluid restriction if you are making less urine. Indian diets can be adapted well — rice is lower in potassium than wheat, and many CKD-friendly South Indian dishes exist. A renal dietitian familiar with Indian cuisine is invaluable.

Dialysis is started when kidney function falls to Stage 5 (eGFR under 15) AND symptoms of uraemia appear — nausea, vomiting, difficulty breathing from fluid overload, confusion. Two main types: haemodialysis (HD) filters blood through a machine, typically 3 sessions per week of 3-4 hours each, done at a dialysis centre or home with training. Peritoneal dialysis (PD) uses the lining of the abdomen as a filter, done at home daily — better for those far from centres or who want more flexibility. Both have similar survival rates. Kidney transplant, when feasible, gives better quality of life than any dialysis.

Many Stage 4 patients never reach dialysis if progression is slowed aggressively. Key levers: keep blood pressure below 130/80 with ACE inhibitors or ARBs (which also protect the kidneys directly), control blood sugar tightly if diabetic, add SGLT2 inhibitors (empagliflozin, dapagliflozin) — trials show 30-40% reduction in CKD progression, avoid NSAIDs (ibuprofen, diclofenac) entirely — they are nephrotoxic, get nephrology review for all medications and supplements, treat anaemia and bone disease. Some patients remain in Stage 4 for 10+ years. Transplant evaluation should start at Stage 4 regardless, so you are prepared.

Yes — India performs thousands of kidney transplants each year, and outcomes at top centres are comparable to international standards. A donor can be a living related donor (spouse, parent, sibling, child) or a deceased donor from the government waiting list. Living donor transplants are far more common in India given the limited deceased-donor programme. The recipient needs lifelong immunosuppressive medication to prevent rejection — a daily medication routine that prevents the immune system from attacking the new kidney. With good care, transplanted kidneys function for 15-20 years or more. Pre-transplant evaluation, legal clearance (Transplantation of Human Organs Act), and a donor-recipient matching process all take time — starting early matters.