Question 1

What is chronic kidney disease?

Accepted Answer

CKD is persistent damage to the kidneys — defined as abnormal kidney function (eGFR below 60 mL/min/1.73m2) or kidney structure (urine albumin above 30 mg/g creatinine) lasting more than 3 months. The kidneys' primary functions are filtering waste from blood, regulating fluid balance, blood pressure and electrolytes, and producing hormones (EPO, renin, active vitamin D). When they fail, waste accumulates and all these functions are impaired.

Question 2

How many people have CKD?

Accepted Answer

An estimated 850 million people globally have CKD — more than diabetes and cancer combined. CKD causes approximately 2.4 million deaths per year and is one of the fastest-growing causes of death globally. 90% of people with CKD are unaware — because early stages are asymptomatic. In LMICs, CKD mortality is 10 times higher than in high-income countries, reflecting poor access to detection and treatment.

Question 3

What causes CKD?

Accepted Answer

The two most common causes globally are diabetes (diabetic nephropathy — responsible for approximately 40% of CKD in high-income countries) and hypertension (hypertensive nephrosclerosis). Other causes: glomerulonephritis; polycystic kidney disease (genetic); recurrent urinary tract infections; NSAIDs and other nephrotoxic drugs; and CKD of unknown cause (CKDu) in agricultural workers. Early, effective control of diabetes and hypertension prevents or substantially slows CKD progression.

Question 4

What is CKDu?

Accepted Answer

CKD of unknown (or uncertain) cause is a distinct, rapidly growing epidemic — primarily affecting young male agricultural workers in Central America (Costa Rica, El Salvador, Nicaragua — the "Mesoamerican nephropathy" belt) and parts of South Asia (Sri Lanka, India). Unlike typical CKD, it is NOT explained by diabetes or hypertension. Leading hypotheses include chronic dehydration and heat stress, agrochemical exposure, NSAIDs and low-grade infections. CKDu has devastated communities, with workers dying in their 30s and 40s.

Question 5

How is CKD diagnosed?

Accepted Answer

CKD is diagnosed by two simple, cheap tests: eGFR (from a blood creatinine measurement — assessing kidney filtration rate) and urine albumin-to-creatinine ratio (UACR — detecting kidney damage from protein leakage). Both tests should be performed at least annually in all people with diabetes, hypertension, cardiovascular disease, obesity or a family history of kidney disease. CKD is confirmed if abnormalities persist for more than 3 months.

Question 6

Can CKD progression be slowed?

Accepted Answer

Yes — several proven interventions slow CKD progression: controlling blood pressure to below 130/80 mmHg (ACE inhibitors or ARBs are preferred, especially in proteinuric CKD); controlling blood sugar in diabetes (SGLT-2 inhibitors reduce CKD progression by 30-40%); reducing dietary sodium and protein; avoiding nephrotoxic drugs (NSAIDs, iodine contrast, aminoglycosides); and stopping smoking. SGLT-2 inhibitors (dapagliflozin, empagliflozin) have transformed CKD management.

Question 7

What is the dialysis access crisis?

Accepted Answer

End-stage kidney disease (ESKD) requires dialysis or kidney transplantation to survive. More than 2 million people receive renal replacement therapy (RRT) globally, but 2-7 million more who need it cannot access it — primarily in LMICs. Annual haemodialysis costs $15,000-80,000; peritoneal dialysis is more affordable. Many countries have no publicly funded dialysis programme. The dialysis access gap is one of the starkest healthcare equity failures globally.

Question 8

What is acute kidney injury?

Accepted Answer

Acute kidney injury (AKI) is a sudden (within 7 days) deterioration in kidney function — common in hospitalised patients, sepsis, dehydration, heart failure, post-surgery and from nephrotoxic drugs. AKI is associated with high mortality (especially in ICU) and, if severe, can lead to permanent CKD. In LMICs, obstetric AKI (from haemorrhage, sepsis, pre-eclampsia) and tropical disease-related AKI (malaria, leptospirosis, snakebite) are important causes.

Question 9

Who is at highest risk of CKD?

Accepted Answer

High-risk groups: people with diabetes (40% of CKD in HICs); hypertension; cardiovascular disease; obesity; family history of kidney disease; age over 60; history of AKI; those taking chronic NSAIDs or analgesics; and — specifically — agricultural workers in tropical climates (CKDu risk). Annual screening of all high-risk groups with eGFR and UACR is the most cost-effective detection strategy.

Question 10

What are the signs of kidney failure?

Accepted Answer

Early CKD is asymptomatic. Advanced CKD symptoms include: fatigue and weakness (from anaemia); fluid retention (ankle swelling); shortness of breath; decreased urine output; nausea and poor appetite; confusion and difficulty concentrating; persistent itching; and muscle cramps. These symptoms typically appear only when kidney function is below 20-25% of normal — emphasising the importance of screening high-risk groups before symptoms appear.

Question 11

What is the ISN and what is it doing?

Accepted Answer

The International Society of Nephrology (ISN) coordinates global kidney health advocacy — including the World Kidney Day campaign (second Thursday of March), the ISN Global Kidney Health Atlas tracking global CKD burden and access to care, and the Global Kidney Health 2040 initiative. ISN advocates for screening of high-risk groups, affordable dialysis in LMICs and SGLT-2 inhibitor access globally.

Question 12

How does GMJ News cover kidney disease?

Accepted Answer

GMJ News tracks ISN Global Kidney Health Atlas data, SGLT-2 inhibitor trial results, CKDu research, World Kidney Day and dialysis access equity. Kidney disease burden in Georgia — including in the context of high rates of diabetes and hypertension — is a direct public health concern for PHIG and the Georgian Medical Journal.

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