Most Common Causes of Chronic Kidney Disease (CKD)
The most common causes of Chronic Kidney Disease (CKD) are diabetes, hypertension, age over 60 with genetic factors, and decreased renal perfusion.
Primary Causes of CKD
Diabetes: Diabetes is one of the leading causes of CKD worldwide and is the primary cause of end-stage kidney disease (ESKD) in the United States. Diabetic kidney disease typically develops after a duration of 10 years in type 1 diabetes but may be present at diagnosis of type 2 diabetes 1. Diabetic nephropathy accounts for more than 30-40% of cases in many countries 1.
Hypertension (HTN): Along with diabetes, hypertension is one of the most frequent causes of CKD in developed countries 1. Hypertension can both cause kidney damage and result from kidney disease, creating a dangerous cycle that accelerates kidney function decline 1.
Age over 60 and genetic factors: Advanced age is a significant non-modifiable risk factor for CKD, with kidney function naturally declining with age. Genetic predisposition plays an important role in CKD development, particularly in certain kidney diseases 2. The combination of aging and genetic factors substantially increases CKD risk 1.
Decreased renal perfusion: Reduced blood flow to the kidneys can lead to kidney damage and CKD. This can occur due to cardiovascular disease, heart failure, severe dehydration, or other conditions that compromise renal blood flow 3.
Other Contributing Factors
Glomerulonephritis is another significant cause of CKD, particularly in certain regions. In China, for example, chronic glomerulonephritis and diabetes together account for more than 50% of CKD cases 1.
Autosomal dominant tubulointerstitial kidney diseases, while less common, can lead to progressive tubulointerstitial fibrosis and progression to end-stage renal disease 1.
Clinical Implications
Early identification of these risk factors is crucial for timely intervention. Patients with diabetes and hypertension should be regularly screened for CKD using urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) 1.
The presence of CKD markedly increases cardiovascular risk and healthcare costs in patients with both type 1 and type 2 diabetes 1.
Patients with multiple risk factors (such as both diabetes and hypertension) have a significantly higher risk of CKD progression 4.
Diagnostic Considerations
CKD is diagnosed by the persistent elevation of urinary albumin excretion (albuminuria), low eGFR, or other manifestations of kidney damage for at least 3 months 1.
Screening for albuminuria can be most easily performed by urine albumin-to-creatinine ratio (UACR) in a random spot urine collection 1.
In patients with diabetes, the typical presentation of CKD includes long-standing duration of diabetes, retinopathy, albuminuria without gross hematuria, and gradually progressive loss of eGFR 1.
Prevention and Management
Optimal management of diabetes and hypertension is essential for preventing CKD development and progression 5.
For people with diabetes and CKD, use of a sodium-glucose cotransporter 2 (SGLT2) inhibitor is recommended to reduce CKD progression and cardiovascular events 1.
Individuals should be referred for evaluation by a nephrologist if they have continuously increasing urinary albumin levels, continuously decreasing eGFR, or if the eGFR is <30 mL/min/1.73 m² 1.