Managing Early Onset of Lowered eGFR and Chronic Kidney Disease (CKD)
Chronic Kidney Disease (CKD) is a progressive condition that affects kidney function, often developing silently until significant damage occurs. Early detection and management are crucial to slowing its progression and maintaining quality of life. In this article, we explore the causes, symptoms, and lifestyle adjustments for CKD, along with evidence-based Traditional Chinese Medicine (TCM) approaches to support kidney health and enhance well-being.
What is Chronic Kidney Disease and how does it affect me?
Chronic Kidney Disease (CKD) is a term that encompasses all degrees of decreased kidney function, from mild, moderate, severe and finally kidney failure. CKD involves a progressive loss of kidney function over time. The guidelines stated by the group Kidney Disease Improving Global Outcomes (KDIGO) define CKD as either kidney damage or a decreased glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 for at least 3 months. CKD is a potentially serious condition that can progress slowly over time.
Causes for Chronic Kidney Disease
Chronic Kidney Disease can result from various factors, including:
Diabetes Mellitus (uncontrolled high blood sugar levels): Each kidney is made up of millions of tiny filters called nephrons. Over time, high blood sugar from diabetes can damage blood vessels in the kidneys as well as nephrons so they don't work as well as they should.
Hypertension (high blood pressure): High blood pressure can constrict and narrow the blood vessels in the kidneys, which eventually damages and weakens them.
Glomerulonephritis (inflammation of the kidney's filtering units): Glomerulonephritis involves damage to the glomeruli (tiny filters) inside your kidneys which can cause it to have trouble removing waste and fluid from your body.
Polycystic kidney disease (PKD): PKD is an inherited condition that causes numerous cysts to grow in the kidneys. If too many cysts grow or if they get too big, the kidneys can become damaged. PKD cysts can slowly replace much of the kidneys, reducing kidney function and leading to kidney failure.
Kidney infections: Kidney infections can cause kidney injury by either direct invasion, or indirectly by immune-mediated mechanisms, which manifest as post-infectious glomerulonephritis.
Autoimmune diseases: Autoimmune conditions like lupus nephritis or IgA nephropathy can lead to production of autoantibodies that affect parts of the kidneys that filter out waste. This causes kidney inflammation that might lead to decreased kidney function.
Prolonged use of certain medications: Certain medications can cause crystal formation that can block your urine flow. Others have substances that are toxic to kidney cells during the filtration process.
What are the symptoms of Chronic Kidney Disease?
In the early stages, CKD may not present noticeable symptoms. As the condition progresses, the following symptoms can occur:
Fatigue: A severe decrease in kidney function can lead to a buildup of toxins and impurities in the blood. This can cause people to feel tired, weak and can make it hard to concentrate.
Water retention (edema): Damage to the tiny filtering nephrons can result in declining levels of the protein albumin in your blood and increasing levels in the urine, causing fluid to build up resulting in edema.
Increased or decreased urination: Damage to the urinary tubules in CKD can cause urine production to be affected resulting in decreased urinary volume
Blood in urine: Blood in urine, also known as hematuria can sometimes appear when there is inflammation and damage to the tissues in the kidneys especially in conditions like IgA nephropathy.
Foamy or bubbly urine: When your kidneys are damaged, they can allow too much protein to pass through into your urine. This is called proteinuria. High levels of protein in urine can cause it to be foamy.
Muscle cramps: Electrolyte imbalances can result from impaired kidney function. For example, low calcium levels and poorly controlled phosphorus may contribute to muscle cramping.
Nausea and vomiting: Progressive kidney damage can cause toxin build-up, retention of certain medications as well as constipation, all of which can lead to nausea and vomiting.
Poor appetite: Poor kidney filtration can lead to build-up of toxin thus decreasing ghrelin levels (AKA hunger hormone) leading to decreased appetite.
Itchy skin: Histamine released by cells in the body due to toxin build-up due to decreased filtration can cause itchy skin.
Hypertension: Electrolyte dysregulation and increased sympathetic nervous system from poor kidney function leads to elevated blood pressure.
Self Help Tips for Chronic Kidney Disease
If you noticed any of the symptoms mentioned above, immediately see a doctor to get properly diagnosed. Do not self-medicate. If CKD is diagnosed, certain lifestyle changes are necessary to help slow down disease progression.
Manage underlying conditions like diabetes and hypertension: Managing a normal blood sugar and blood pressure will slow down progression of CKD.
Maintain a healthy diet with limited sodium, and potassium: As the kidneys fail to regulate the electrolytes in the blood, it is crucial not to consume food that might result in large swings in the internal electrolyte balance in the body.
Maintain a healthy weight: Weight control may also preserve kidney function. Losing weight can help control high blood pressure and reduce the risk of diabetes and heart disease[1].
Limit alcohol consumption: Alcohol is a toxin that decreases the function of the kidneys. Its diuretic function(promotes urination) causes it to dry out the body and dysregulate the balance of fluid and electrolytes in the body. In addition, alcohol can disrupt hormones that affect kidney function.
Stop smoking: Studies have found that smokers with diabetes and/or high blood pressure increase their risk of getting CKD. Not only does smoking increase the chances of getting renal disease, it also accelerates the occurrence of kidney disease[2].
Exercise regularly: Exercise benefits those with kidney disease by improving muscle function, lowering blood pressure, lowering cholesterol and improving sleep[3].
Evidence-Based TCM Approaches for Managing Chronic Kidney Disease
In Traditional Chinese Medicine (TCM), although there isn’t a disease that translates directly to CKD, its associated symptoms can be likened to 水肿(Shui Zhong), 癃闭(Long Bi) or 关格(Guan Ge) etc. According to TCM classification, CKD broadly falls into three categories: Excess, deficiency, and a combination of the two. In the excess category, there are sub-categories like "Damp-heat Congestion, Bladder Damp-Heat, Liver Qi Stagnation etc." In the deficiency category, there are sub-categories like "Kidney Yin deficiency, Kidney Yang deficiency, Spleen Qi Sinking, Spleen-Kidney Yang deficiency, etc." Lastly, an individual can have both excess and deficiency combined together in a unique way like “Yin deficiency excess Fire”. Consequently, formulas or herbs that address these imbalances can be useful in the management of CKD.
Herbal Medicine
Modern TCM research into CKD has discovered that a combination approach of utilising both conventional medicine together with Chinese medical herbs simultaneously can have a significant effect on the kidney function in patients. A formula called 益气清利化瘀方(YiQi QingLi HuaYu prescription) was found to be able to improve the hemodynamics in the kidneys through increasing glomerular blood perfusion, reducing blood flow resistance index, and protecting renal function[4]. After a period of 2 months, improvements were seen in serum creatinine, urea nitrogen, glomerular filtration rate and urine albumin compared to the control. Taking into consideration the specific constitution of your body as well as the western medication that you are already on, a qualified TCM practitioner can create a personalised formula tailored to you.
Acupuncture
You can also look into getting TCM acupuncture in Singapore. Acupuncture has been shown to aid in slowing the progress of renal dysfunction, and improving patient symptoms. It is believed that through blocking or reversing the critical risk factors of CKD (e.g. hyperglycemia, hypertension, hyperlipidemia, obesity, aging, and anemia) progression, acupuncture could improve the survival of patients with CKD. The survival enhancing mechanisms were believed to include oxidative stress inhibition, reducing inflammatory effects, improving hemodynamics, maintaining podocyte structure, and increasing energy metabolism[5]. Thus, acupuncture is an inexpensive and safe way to prolong kidney function with minimal to no side effects. An experienced physician that is highly capable conducting acupuncture in Singapore will also be able to kill two birds with one stone by addressing any concurrent physical or mental issues simultaneously in addition to CKD management.
The above illustration shows the acupuncture points 合谷，足三里，太溪. According to a study investigating changes in renal function in patients with CKD, it was discovered that acupuncture done on 合谷(He Gu), 足三里(Zu San Li) and 太溪(Tai Xi) was able to reduce creatinine levels in the blood and increase estimated glomerular filtration rates (eGFR). He Gu point is an important point when it comes to regulation of Qi in the body, Zu San Li is a commonly-used point to boost Qi and energy and Tai Xi acupoint is a source point of the Kidney meridian used to help manage kidney issues[6].
How many sessions do I need?
Management of CKD is an ongoing process, it might take anything between 3 to 9 months to see verifiable improvements in the kidney function as well as a decrease in symptoms. Improvements obtained also have to be maintained and treatment has to continue albeit at a more gradual pace. At Common TCM, your physician will review your medical history and determine the optimal frequency of visits based on your current health, lifestyle, and any presenting symptoms. With improvement, your physician will proceed to tailor your treatment plan to suit your present situation.
Who is this suitable for?
Treatment is generally safe for those with eGFR of 15 and above, otherwise known as stage 1 through 4 of CKD. Those with stage 5 CKD should be on dialysis before seeking any TCM treatment. Furthermore, many aspects of health and well-being remain undetected until pointed out during our well-being consultation. This consultation can be an opportunity to review your well-being status, stress levels, and personalise your healthcare journey.
Most importantly, do your research and seek advice from reputable professionals for an elevated healing experience from the best TCM in Singapore. For more information, visit our website to learn more about our treatments and physicians or to book an appointment. Your well-being is our priority, and we are here to support you on your journey towards better health.
[1]
https://www.kidney.org/news/kidneyCare/spring11/WaistSize
[2]
[3]
[4]
[5]
https://www.frontiersin.org/journals/nephrology/articles/10.3389/fneph.2022.1006506/full
[6]
