Primary Causes of Chronic Kidney Disease
Diabetes and hypertension are the main causes of chronic kidney disease in all high-income and middle-income countries, and also in many low-income countries. 1
Major Causes of CKD
Diabetic Kidney Disease
- Accounts for 20-40% of all CKD cases 2
- Leading cause of end-stage renal disease (ESRD) in the United States 2
- Typically develops after 10 years in type 1 diabetes but may be present at diagnosis of type 2 diabetes 2
- Earliest manifestation is microalbuminuria with normal or elevated GFR 2
- Diabetic patients have approximately 50% higher risk of ESRD compared to non-diabetic patients with similar GFR 2
Hypertension
- Major cause of CKD alongside diabetes 1
- Contributes to progressive kidney damage through vascular injury
- Both a cause and complication of CKD 2
- Should be carefully controlled in all CKD patients 2
Glomerular Diseases
- Chronic glomerulonephritis is a significant cause, particularly in some Asian countries including China 2
- Accounts for more than 50% of CKD cases in China (along with diabetes) 2
Other Major Causes
- Vascular diseases - affecting kidney blood vessels 2
- Tubulointerstitial diseases - affecting tubules and surrounding structures 2
- Cystic kidney diseases - including polycystic kidney disease 2
- Genetic factors - hereditary kidney conditions 2
Diagnosis and Classification
CKD is defined as abnormalities in kidney structure or function present for >3 months with health implications 1. Diagnosis is based on:
- GFR <60 mL/min/1.73 m² persisting for >3 months
- Urine albumin-to-creatinine ratio (UACR) ≥30 mg/g creatinine
- Other evidence of kidney damage (imaging, biopsy)
CKD Staging
| Stage | GFR (mL/min/1.73m²) | Description |
|---|---|---|
| G1 | ≥90 | With evidence of kidney damage |
| G2 | 60-89 | With evidence of kidney damage |
| G3a | 45-59 | Moderate reduction in GFR |
| G3b | 30-44 | Moderate to severe reduction |
| G4 | 15-29 | Advanced CKD |
| G5 | <15 | Kidney Failure |
Risk Factors for CKD Development
- Diabetes - remains a consistent risk factor for CKD over time 3
- Hypertension - significant but improving risk factor 3
- Obesity - associated with increased risk 3
- High cholesterol - modifiable risk factor 3
- Smoking - consistent risk factor 3
- Advanced age (>60 years) 1
- Family history of kidney disease 1
- Racial/ethnic minority status in the US 1
- Acute kidney injury - can progress to CKD if not properly managed 1
- Nephrotoxic medications - NSAIDs, certain antibiotics, contrast agents 1
Clinical Implications
- Early detection is crucial as CKD increases risks of cardiovascular disease, progression to kidney failure, and mortality 1
- Patients with CKD are five to ten times more likely to die prematurely than to progress to end-stage kidney disease 4
- Cardiovascular disease is the major cause of morbidity and mortality in CKD 1
- Health-related quality of life decreases as GFR declines 4
- Complications begin to rise when GFR declines below 60 mL/min/1.73 m² 2
Management Considerations
- ACE inhibitors or ARBs are recommended for CKD patients with albuminuria, especially with diabetes 2
- Referral to a nephrologist is indicated when GFR falls below 30 mL/min/1.73m² 2, 1
- Preparation for kidney replacement therapy should begin during stage 4 2, 1
- Treatment should focus on slowing progression, managing risk factors, and treating comorbidities 1
Understanding the primary causes of CKD is essential for early detection, prevention, and management to improve outcomes and quality of life for affected patients.