What is Chronic Kidney Disease?
Your kidneys filter 200 liters of blood every day — removing waste, regulating blood pressure, balancing electrolytes, and producing hormones that control red blood cell production and bone health. CKD means this filtering capacity is gradually, and sometimes silently, declining.
CKD is defined as kidney damage or reduced kidney function lasting three months or more. It is diagnosed through blood tests, urine tests, and imaging — not just how you feel. Many people with early CKD feel completely normal.
The key measure is your eGFR (estimated Glomerular Filtration Rate) — think of it as a percentage of your kidney's filtering capacity. A healthy eGFR is above 90. CKD progresses through 5 stages based on this number.
Why "chronic"?
Unlike acute kidney injury — which can recover — CKD represents structural changes to the kidney that are largely irreversible. The goal is to slow progression, not reverse it.
How common is it?
Approximately 1 in 10 Filipinos has CKD. Most cases are driven by diabetes and hypertension — both of which damage the delicate filtering units (glomeruli) over time.
The kidney-heart connection
Kidney disease and heart disease are deeply linked. Damaged kidneys raise blood pressure, worsen anemia, and promote inflammation — all of which strain the heart. This is why your nephrologist pays close attention to your blood pressure, cholesterol, and heart health simultaneously.
The 5 Stages of CKD
CKD is classified by eGFR (mL/min/1.73m²) and albuminuria (protein in urine). Knowing your stage helps guide how often you need labs, what treatments apply, and when referral to a specialist is needed.
Proteinuria matters independently of eGFR
The amount of protein in your urine (albuminuria) is a powerful predictor of kidney decline — separate from your eGFR. Even with a normal eGFR, significant proteinuria requires treatment. Your doctor uses both together to guide your care plan.
What Causes CKD?
In the Philippines, the overwhelming majority of CKD cases stem from two preventable, treatable conditions. Understanding the cause of your CKD is essential — because different causes require different treatments.
Diabetic kidney disease
Chronically elevated blood sugar damages the glomerular filtration membrane. High glucose causes thickening of basement membranes and eventually scarring (diabetic nephropathy). It is the #1 cause of kidney failure in the Philippines.
Hypertensive nephrosclerosis
Uncontrolled high blood pressure damages kidney arterioles — the tiny vessels that feed each glomerulus. Over years, this causes ischemic scarring and progressive loss of nephrons (the filtering units).
Other causes include:
Signs and Symptoms
CKD is famously "silent" in early stages. Symptoms typically emerge only when eGFR falls below 30 — which is why routine laboratory screening is so important, especially if you have diabetes or hypertension.
Uremia — the end-stage warning sign
Uremia refers to the toxic accumulation of waste products when kidneys can no longer excrete them. It causes a syndrome of nausea, confusion, pericarditis (heart sac inflammation), and bleeding. This is a medical emergency requiring immediate evaluation for dialysis initiation.
Key Laboratory Targets
These are the evidence-based targets your nephrologist aims for at each follow-up visit. Keeping these numbers within range significantly slows CKD progression and reduces complications.
| Parameter | What it measures | Target (KDIGO 2024) |
|---|---|---|
| eGFR | Kidney filtering capacity | Track trend over time |
| Urine albumin-creatinine ratio (UACR) | Protein leak; damage marker | < 30 mg/g (aim to reduce) |
| Hemoglobin | Anemia of CKD | 100–115 g/L |
| Ferritin / TSAT | Iron stores for erythropoiesis | Ferritin >200 / TSAT >30% |
| Parathyroid hormone (iPTH) | Bone-mineral metabolism | 130–600 pg/mL (dialysis) |
| Phosphorus | Mineral balance; vessel calcification risk | 3.5–5.5 mg/dL |
| Calcium | Bone health and cardiac function | 8.4–10.2 mg/dL |
| Potassium | Heart rhythm safety | 3.5–5.5 mEq/L |
| Bicarbonate | Acid-base balance (metabolic acidosis) | 22–26 mEq/L |
| Blood pressure | Hypertension control | < 140/90 mmHg |
| LDL cholesterol | Cardiovascular risk (CKD = very high risk) | < 55 mg/dL (ACC/AHA 2026) |
| HbA1c (if diabetic) | Long-term blood sugar control | 7–8% (individualized) |
How CKD is Managed
CKD management is multifaceted — targeting the underlying cause, protecting residual kidney function, and preventing cardiovascular complications simultaneously. There is no single pill; it is a lifestyle and medication partnership.
Control the primary driver
If the cause is diabetes, tight glucose control (HbA1c 7–8%) is essential. If it's hypertension, blood pressure must reach <140/90 mmHg. ACE inhibitors or ARBs are first-line in both — they reduce intra-glomerular pressure and cut proteinuria directly.
SGLT2 inhibitors — a kidney-protective revolution
Medications like dapagliflozin (Catania/Rhea) now have strong evidence for slowing CKD progression regardless of diabetes status. They reduce intra-glomerular hypertension, decrease proteinuria, and provide cardiovascular protection simultaneously.
Manage CKD complications
Anemia (erythropoiesis-stimulating agents + iron), bone-mineral disorder (active vitamin D, phosphate binders), metabolic acidosis (sodium bicarbonate), and hyperkalemia all require active, targeted treatment as kidney function declines.
Aggressive cardiovascular protection
CKD patients are at very high cardiovascular risk. Statin therapy targeting LDL <55 mg/dL, aspirin where indicated, and smoking cessation are non-negotiable. Your heart and kidneys must be protected together.
Prepare for renal replacement therapy (Stage 4–5)
Planning for dialysis or kidney transplant should begin at Stage 4. This includes AV fistula creation (for hemodialysis), vaccination completion (Hepatitis B double-dose, pneumococcal, flu), and transplant workup if appropriate.
Nutrition for Kidney Health
Diet in CKD is highly individualized. What you should or should not eat depends on your stage, your lab values, and whether you are on dialysis. The following are general principles — always confirm specifics with your nephrologist or renal dietitian.
Safe foods for most CKD patients
- White rice, bread, pasta (low potassium/phosphorus)
- Egg whites (high-quality protein, low phosphorus)
- Cabbage, cauliflower, green beans, cucumber (low potassium after leaching)
- Apples, grapes, cranberries, pineapple
- Unsalted crackers, corn, rice cakes
- Poaching or boiling vegetables (reduces potassium by ~50%)
Warning Signs — Do Not Wait
⚠ Go to the Emergency Room or call your doctor immediately if you experience:
Frequently Asked Questions
Will my kidneys get better?
CKD is not curable, but it is manageable. With good control of blood pressure, blood sugar, and proteinuria, many patients remain stable for years or even decades. Progression is not inevitable — it depends heavily on how well the risk factors are managed.
Should I avoid contrast dye or NSAIDs?
Yes. Nonsteroidal anti-inflammatory drugs (ibuprofen, mefenamic acid, naproxen) reduce blood flow to the kidneys and can precipitate acute injury — avoid them unless directed otherwise. Iodinated contrast for CT scans also carries risk; always inform your doctor and radiologist of your CKD diagnosis before any imaging study.
Can I take herbal supplements or alternative medicines?
Many herbal preparations (including common "kidney cleanse" supplements) contain aristolochic acid, heavy metals, or oxalates that are directly nephrotoxic. Please always disclose any supplement, herbal, or traditional medicine you are taking. Some may interfere with medications or worsen kidney function.
How often do I need to see my nephrologist?
Frequency depends on your stage and stability. Stage 1–2: every 6–12 months. Stage 3: every 3–6 months. Stage 4–5: every 1–3 months. Your doctor will set the appropriate interval based on your individual trends.
W. G. M. Rivero, MD, FPCP, DPSN
Specialist in Internal Medicine, Nephrology, and Clinical Nutrition. Practicing integrative and evidence-based nephrology across Quezon City, Pampanga, and Bulacan.
PRC 0105184 · seriousmd.com/doc/williamrivero · williamrivero@gmail.com