high blood pressure kidneys

Chronic Kidney Disease

What is Chronic Kidney Disease?

Chronic kidney disease (CKD) is a long-term condition in Singapore that develops over time due to declining kidney function. Our kidneys are a vital organ that plays an important role in filtering waste and excess fluids from the blood, regulating blood pressure, and maintaining the balance of electrolytes and other essential substances in the body. When CKD occurs, the kidneys’ ability to perform these functions becomes impaired.

There are five stages of chronic kidney disease based on the level of kidney function. The stage of kidney disease is determined using the glomerular filtration rate (GFR), a formula that considers a person’s age, gender, and serum creatinine level. Creatinine is a waste product from the muscles that indicates kidney function. When kidneys work normally, they can effectively remove creatinine from the blood. However, as kidney function slows down when the organ is not working correctly, creatine levels in the blood rise. This can be identified through a blood test. 

CKD stages
The five stages of chronic kidney disease are identified based on a person's age, gender, and serum creatinine level.

The five stages of chronic kidney disease, as measured by the glomerular filtration rate (GFR), are:  

  • Stage 1: kidney damage with normal or high GFR (GFR > 90 mL/min)
  • Stage 2: mild reduction in GFR (GFR 60-89 mL/min)
  • Stage 3: moderate decrease in GFR (GFR 30-59 mL/min)
  • Stage 4: severe decrease in GFR (GFR 15-29 mL/min)
  • Stage 5: kidney failure (GFR < 15 mL/min), also known as end-stage renal disease (ESRD)

What are the common causes of Chronic Kidney Disease in Singapore?

There are several causes and factors that lead to the development of CKD. In general, these are the common causes: 

  • Diabetes: one of the most common causes of CKD, especially if left unmanaged. This is because, over time, high blood sugar levels damage the small blood vessels in the kidneys, reducing their ability to function correctly.
  • Hypertension: uncontrolled hypertension/high blood pressure can also damage the blood vessels in the kidneys and lead to CKD. Additionally, CKD can make hypertension worse.
  • Ageing: as we age, the risk of developing CKD increases, as kidney function naturally deteriorates.
  • Glomerulonephritis: a group of diseases that cause inflammation in the glomeruli, which are the small filters in the kidneys. Chronic or recurrent inflammation can eventually lead to chronic kidney disease. 
  • Polycystic kidney disease (PKD): PKD is a genetic disorder where cysts filled with fluid form in the kidneys. Over time, if left untreated, these cysts can grow and impact kidney function, eventually leading to chronic kidney disease.
  • Kidney infections: repeated or severe kidney infections can cause scarring and damage to the kidney tissue, which may lead to chronic kidney disease for some people. 
  • Obstructive nephropathy: when the urinary tract gets blocked due to enlarged prostate or kidney stones, it may cause damage to the kidney over time and develop into CKD. 
  • Autoimmune diseases: conditions like lupus and other autoimmune diseases cause kidney inflammation. Over time, it may lead to chronic kidney disease. 
  • Medications: when used over a long period, certain medications can be toxic to the kidneys and contribute to CKD. Examples include nonsteroidal anti-inflammatory drugs (NSAIDs) and some antibiotics.
polycystic kidney disease
Polycystic kidney disease can lead to chronic kidney disease.

What are the symptoms of Chronic Kidney Disease?

Chronic kidney disease may not cause many symptoms in the early stages as it is slow-progressing. However, as CKD progresses and reaches the advanced stages, the following symptoms may be more noticeable:

  • Fatigue: persistent tiredness and a significant drop in energy levels are common symptoms of CKD in the early stages.
  • Swelling (Oedema): fluid retention that leads to swelling in the legs, ankles, feet, or face.
  • Urination issues: CKD can affect urination habits such as increased urination (especially at night, known as nocturia) or decreased urination. Urine may also appear foamy, dark in colour, or contain blood. 
  • Weight loss: unexplained and sudden weight loss may occur when a person has CKD due to metabolic changes and reduced appetite. 
  • Nausea and vomiting: feeling nauseous and vomiting is often a symptom of advanced stages of CKD due to the accumulation of waste products in the bloodstream.
  • Itchy skin: accumulation of waste products in the blood that the kidneys have not adequately filtered due to CKD can cause itching and dry skin.
  • Muscle cramps and weakness: electrolyte imbalances due to CKD can lead to muscle cramps and weakness.
  • Difficulty concentrating: cognitive issues, trouble concentrating, and memory problems also commonly occur in advanced stages of CKD.
  • Sleep issues: sleep disturbances, such as difficulty falling or staying asleep, are common for CKD patients. 
  • Bone and joint issues: CKD affects bone health and may lead to osteoporosis and bone pain.
  • Shortness of breath: fluid retention and anaemia, common complications of chronic kidney disease, can lead to shortness of breath and tiredness.
  • Bruising and bleeding: CKD affects blood clotting, leading to easy bruising and bleeding.

Not everyone with CKD will experience all of these symptoms, and the severity of symptoms varies among individuals. Some symptoms, like fatigue and changes in urination, may also be caused by other conditions, so they are not specific to CKD. 

If you are experiencing these symptoms but are unsure if you have CKD, make an appointment with Aare Urocare today. Helmed by a female urologist, the urology specialist clinic in Singapore can address your kidney issues.

Is Chronic Kidney Disease painful?

Chronic kidney disease may not cause significant or noticeable pain in the early stages. However, as CKD progresses and complications develop, some individuals may experience discomfort or pain related to specific issues. These include kidney pain, muscle cramps, and bone and joint pain.

feet water retention
Oedema or swelling in the feet is characteristic of chronic kidney disease.

Who is at risk of Chronic Kidney Disease in Singapore?

In Singapore, as in many other countries, certain factors may increase your risk of developing chronic kidney disease (CKD). While CKD can affect people from all walks of life, those with the following conditions and factors may have a higher risk in Singapore:

  • Diabetes: those with diabetes are at a significantly higher risk of developing CKD. Diabetes is one of the leading causes of CKD worldwide, and Singapore has a relatively high prevalence of diabetes.
  • Hypertension: hypertension or high blood pressure is another major cause of CKD. Those with uncontrolled or poorly managed hypertension in Singapore are at an increased risk of developing kidney disease. 
  • Ageing: as the risk of CKD generally increases with age, older adults are more susceptible to kidney function decline in Singapore.
  • Family history: genetic factors can play a role in developing certain kidney conditions.
  • Obesity: obesity is associated with an increased risk of both diabetes and hypertension, which are both significant risk factors for CKD.
  • Smoking: smoking is a risk factor that may contribute to the development and progression of CKD.
  • Dietary and lifestyle factors: poor dietary choices, such as a high intake of salt, processed foods, and sugar, can increase the risk of diabetes, hypertension, and CKD. Sedentary lifestyles and lack of physical activity can also contribute to obesity, diabetes, and hypertension, which may lead to CKD over time. 
  • Certain medications: prolonged use of certain medications can potentially harm the kidneys and lead to CKD.
high blood pressure kidneys
Uncontrolled high blood pressure can cause kidney damage, which may eventually lead to chronic kidney disease.

How is Chronic Kidney Disease diagnosed?

Chronic kidney disease is often diagnosed through various methods, depending on the symptoms, severity, and stage. In general, this is the diagnostic process for CKD: 

  • Medical history and physical examination: if your urologist suspects CKD, they may take a detailed medical history that involves asking about your lifestyle, symptoms, risk factors, and medications that you take. A physical examination may also be carried out to check for signs of kidney disease. 
  • Blood tests: blood tests are crucial in diagnosing and determining the stage of CKD. These include: 
    • Serum creatinine: high levels of creatinine in the blood are often an indicator of kidney dysfunction. The glomerular filtration rate (GFR), a measure of kidney function, can be estimated based on the serum creatinine level.
    • Electrolyte levels: levels of electrolytes like potassium, sodium, and calcium can become imbalanced in those with CKD.
    • Haemoglobin and haematocrit: anaemia (a low red blood cell count) is a common complication of CKD, so haemoglobin and haematocrit levels may be checked.
  • Urinalysis: a urine sample is examined for abnormalities, including red blood cells, white blood cells, and protein. Urinalysis can also assess the specific gravity and pH of the urine.
  • Imaging tests: imaging tests like ultrasound , computed tomography scans (CT scans), or magnetic resonance imaging (MRI) may be ordered to visualise the kidneys and look for structural abnormalities.

What are the treatment options for Chronic Kidney Disease in Singapore?

Treatment options for chronic kidney disease (CKD) in Singapore depend on the stage of CKD, its underlying causes, and the individual’s general health. Often, the main goals of CKD treatment are to slow disease progression, manage symptoms, prevent complications, and improve the overall quality of life. Here are some common treatment options for CKD in Singapore:

  • Lifestyle changes and preventative measures: dietary changes, weight management, and cessation of smoking may help slow the progression of CKD and alleviatesymptoms. They may also be preventive measures to prevent CKD from developing if you are at a higher risk. 
  • Blood pressure and diabetes management: as CKD is linked to blood pressure and diabetes, medications, monitoring, and management of these diseases may be advised. 
  • Medications: medications like erythropoiesis-stimulating agents (ESAs) and iron supplements may be prescribed to manage anaemia associated with CKD.
  • Dialysis: in advanced CKD (Stage 5) cases, dialysis treatment may be necessary when the kidneys can no longer function properly.
  • Kidney transplant: for those with end-stage renal disease (ESRD) due to CKD, kidney transplantation is a treatment option.
prevent chronic kidney disease
Although chronic kidney disease cannot be cured or reversed, lifestyle changes such as exercise and diet management can improve quality of life or prevent deterioration of CKD.

Individuals with CKD must work closely with their doctor to develop and follow a comprehensive treatment plan that addresses their unique needs and goals. 

Make an appointment with Aare Urocare, where we cater to our patients’needs with accurate diagnosis and personalised treatment.

Frequently asked questions

CKD is not reversible in most cases, but early intervention and proper management can slow its progression and improve quality of life.

Dialysis is a medical treatment that filters waste and excess fluids from the blood when the kidneys can no longer perform this function adequately. It is typically needed in advanced CKD (stage 5 or end-stage renal disease).

The frequency of check-ups depends on your risk factors and the stage of CKD. Those at risk, such as those with diabetes, hypertension, or a family history of CKD, should have more frequent check-ups.

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Dr. Fiona Wu 2

Dr Fiona Wu
Consultant Urologist

MBBS (S'pore), MRCS (Edin), MMED (Surg),
MMED (Clinical Investigation),
FRCS (Urol) (RCPSG), FAMS (Urology)

Dr Fiona Wu is an experienced Consultant Urologist and is the Medical Director of Aare Urocare.

Prior to her private practice, she spent 15 years in public service. She was a Consultant in the Department of Urology at National University Hospital (NUH), Alexandra Hospital and Ng Teng Fong General Hospital.

She believes in treating urinary incontinence in a holistic way using minimally invasive methods – this ranges from laser treatment, neurotoxin injections, electromagnetic nerve stimulation to minimally invasive surgeries, etc. She worked closely with the gynaecology and colorectal departments to treat complex pelvic floor conditions and continues to do so in her own practice.

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