Kidney health

Why is kidney health important?

The kidneys are a pair of organs located in the small of the back, one on either side of the spine. They are responsible for filtering and removing waste products from the body (as urine via the bladder), keeping bones healthy and looking after blood pressure. As we age we are at increasing risk of our kidneys working less well, but they may also work less well as a result of certain medical conditions such as diabetes or high blood pressure, or as a result of long term use of certain prescription medicines. It is not always possible to know what has caused a particular person’s kidneys to work less well.

Most people will not notice if their kidneys are working slightly less well than they used to because this does not usually cause symptoms or stop the kidneys from working. In most cases kidney performance is affected in a mild way but remains stable for many years, while for a small minority of people it worsens rapidly and will cause problems with their health. Many people in the UK have some degree of kidney impairment (i.e. their kidneys are working less well than they used to). Estimates range from 6.8 to 13% [NICE Feb 2014], meaning that between 7 and 13 adults out of every 100 will have some kidney impairment. For most of these people this will never cause serious problems. In a few people this mild kidney impairment can progress (worsen) so they need treatment for their kidneys. All kidney impairment, whether it be mild or severe, is nowadays referred to by doctors as ‘chronic kidney disease’.
The term ‘chronic kidney disease’ (often shortened to ‘CKD’) is problematic for several reasons. Many lay people interpret the term ‘chronic’ to mean severe, although in medical language it means that the condition is a long term one rather than something that has a rapid onset and progression that may be quickly put right (known as an ‘acute’ condition). This misunderstanding can lead to unnecessary anxiety among patients who may think their kidney performance is worse than it is.
In addition, some professionals argue that impaired kidney performance is not a disease as such. Rather, it is an indicator that a person may be at increased risk of developing other health problems, in the same way that having a high cholesterol level is not in itself a disease, but it increases the risk of cardiovascular disease.
Research evidence shows that, as well as being at increased risk of cardiovascular disease, people with chronic kidney disease are also at increased risk of experiencing something known as acute kidney injury - often shortened to AKI. This is a major cause of avoidable harm and an often unrecognised but underlying cause of death in hospitals. Doctors knowing which of their patients are at risk of AKI, and being able to tell this to patients in advance, is important for prompt recognition and treatment.
The term ‘chronic kidney disease’ is used to cover all levels of kidney impairment, ranging from a tiny decline in kidney performance that causes no symptoms and may have no effect on someone’s long term health, to a life-threatening condition that requires regular dialysis or a kidney transplant and has a significant impact on daily life. chronic kidney disease is therefore divided into several stages based on the level of decline in performance. Stage 1 represents the smallest decline in function and stage 5 the worst. Symptoms don’t usually occur until the decline reaches stage 4; treatment with dialysis and/or a kidney transplant will be offered at stage 5.

Although scientific evidence shows that people with kidney impairment are at increased risk of many adverse outcomes, some doctors are reluctant to label people with early kidney impairment as having a disease. Here two experts speculate on some of the possible reasons for this reluctance.
Please read the next topic summary to learn how and why kidney function is monitored by doctors and what people can do to help look after their kidneys.
 

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