Chronic kidney disease (CKD)

Chronic kidney disease (CKD) means your kidneys have been losing function gradually — over months to years. India has the highest dialysis-need rate among major economies. In our region, the two biggest causes by far are uncontrolled diabetes and uncontrolled BP. By the time a patient first walks into our nephrology OPD, the disease is often well-advanced, because CKD is silent in the early stages.

The 5 stages

CKD is staged by eGFR — a calculated estimate of how well your kidneys are filtering. Normal eGFR is 90+.

• Stage 1 — eGFR ≥ 90 with some abnormal urine finding (protein, blood).
• Stage 2 — eGFR 60-89.
• Stage 3a / 3b — eGFR 30-59. This is where most patients first present.
• Stage 4 — eGFR 15-29. Pre-dialysis planning starts here.
• Stage 5 — eGFR < 15. Dialysis or transplant needed.

Most patients in our OPD are at stages 3 or 4. Catching CKD at stage 1 or 2 is unusual — and it is exactly the patients we are trying to find with proactive screening of every diabetic and hypertensive.

How we diagnose

A full CKD workup at Asian Hospital includes:

• Serum creatinine + eGFR — the basic kidney function number.
• Urine routine + urine ACR (albumin:creatinine ratio) — checks for early kidney damage (protein leak).
• Ultrasound of kidneys — looks for size, scarring, stones, obstruction.
• Blood pressure — both a cause and a consequence of CKD.
• HbA1c, lipid profile, calcium, phosphate, parathyroid — to manage the complications.

Sometimes a kidney biopsy is needed when the cause is unclear. We do biopsies in-house under ultrasound guidance, results in 2-3 weeks.

Treatment

The goal of CKD treatment is not "fix the kidneys" — once damaged, kidney tissue does not regenerate. The goal is to slow the slope, so that a patient diagnosed at stage 3 reaches stage 5 in 20 years instead of 5. The levers we use:

• BP control — target below 130/80, lower if there is proteinuria.
• Diabetes control — target HbA1c around 7%.
• ACE inhibitors / ARBs / SGLT2 inhibitors — these drugs are kidney-protective in their own right.
• Diet — low salt, moderate protein, controlled potassium and phosphorus in later stages. Our in-house dietitian works with each CKD patient on a personalised plan (vegetarian or non-vegetarian).
• Avoiding kidney-toxic drugs — painkillers (especially NSAIDs), some antibiotics, certain contrast scans. Always tell every doctor about your CKD before they prescribe.

When dialysis or transplant is needed

Around eGFR 10-15, with symptoms (fatigue, nausea, breathlessness, fluid overload), we start preparing for renal replacement. The two options are:

• Haemodialysis — 4 hours, 3 times a week, in our in-house unit. Most patients are on dialysis long-term.
• Kidney transplant — the gold standard. We do not currently perform transplant surgery on-site (that requires a designated transplant centre); we do complete pre-transplant workup + post-transplant follow-up + immunosuppression management. Patients are referred to partner centres in Bangalore / Hyderabad for the surgery itself.

In-house dialysis at Asian Hospital is ₹1,800–2,200 per session inclusive of consumables; cashless under most TPAs, Ayushman Bharat, and ESIC. See /procedures/dialysis for the detailed breakdown.