The Silent Progression of Chronic Kidney Disease
Kidney disease rarely announces itself with dramatic symptoms. It builds slowly, often without any pain, and gradually reduces kidney function over many years. Chronic Kidney Disease (CKD) affects nearly 10% of the global population, making it a significant public health concern. While many people associate CKD only with diabetes and high blood pressure, these are just part of a broader, more complex story.
Expert Insights on the Global CKD Crisis
Dr Mohammed S. Khan, Associate Consultant in the Department of Nephrology at KIMSHEALTH in Thiruvananthapuram, told TOI Health, "Chronic Kidney Disease affects 10% of the population worldwide and is driven mainly by the 'Big two' villains—diabetes and blood pressure. However, the global kidney diseases crisis forces us to look beyond the usual suspects onto the emerging threats caused by environment, lifestyle and genetics."
Dr Gireesh M. S., HOD and Consultant in the Department of Nephrology at Ramaiah Memorial Hospital, adds, "According to studies, nearly one in four adults may have some degree of chronic kidney disease. This does not necessarily mean complete kidney failure, but it does indicate that kidney function is already compromised in a significant portion of the population."
Seven Critical and Lesser-Known Risk Factors
Here are seven lesser-known but critical risk factors that deserve more attention from the public and healthcare providers.
1. Obesity: More Than Just a Diabetes Risk
Obesity does not merely lead to diabetes; it can directly injure the kidneys. When body weight increases, the kidneys must work harder to filter blood, a condition known as hyperfiltration. Over time, this overwork scars kidney tissue and reduces filtering ability. Younger adults are now showing early signs of kidney stress linked to obesity.
Dr Khan notes, "Rather than just a precursor to diabetes, obesity directly harms the kidneys. Kidneys struggle to overwork, eventually get scarred and fail to filter properly." The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) confirms that obesity increases CKD risk through direct and indirect pathways, highlighting weight control as a protective factor.
2. Smoking: A Silent Accelerator of Kidney Damage
Smoking harms more than just the lungs and heart; it damages blood vessels, including those inside the kidneys. Nicotine reduces blood flow to kidney tissue, while toxins in cigarette smoke promote inflammation and scarring. In individuals with existing kidney disease, smoking accelerates progression.
Dr Khan states simply, "Smoking can choke your kidneys and speeds up renal damage." The US Centers for Disease Control and Prevention (CDC) also links smoking to faster kidney function decline, emphasizing that quitting can slow damage even after diagnosis.
3. The Mystery of CKDu in Rural Hotspots
Chronic Kidney Disease of Unknown Etiology (CKDu) is a concerning trend. Dr Khan explains, "Various studies have pointed towards another emerging endemic renal disease called CKDu. Initially identified as 'Mesoamerican nephropathy', it now ranges to many newly identified hotspots worldwide including regions in India like Andhra Pradesh, Telangana, Odisha, Goa, Maharashtra, Chhattisgarh, and Kerala."
Unlike traditional CKD, CKDu often affects young farmers and laborers without diabetes or hypertension. Possible triggers include repeated dehydration, heat stress, agrochemical exposure, and heavy metals in water. Early screening camps in these areas have shown that many cases can be detected before severe damage occurs.
4. Painkillers and "Natural" Medicines
Over-the-counter painkillers, especially NSAIDs, can quietly injure the kidneys if taken frequently. Dr Khan warns, "Frequent use of over the counter pain killers, especially NSAIDs when taken regularly for headache or joint pain can permanently damage the kidneys." Dr Gireesh reinforces this, noting that prolonged unsupervised use can significantly impair function.
The "natural" label can also mislead. Dr Khan explains, "Behind the 'natural' label hides the undisclosed contents in many traditional and indigenous medications and it plays a part in kidney injury." Heavy metal contamination and unsafe dosages in unregulated preparations increase risk with long-term use.
5. Supplements for Muscle and Weight Loss
The fitness culture has normalized supplement use, but not all products are safe. Dr Gireesh says, "The growing use of supplements for bodybuilding or weight loss, particularly those taken without prescription, poses another emerging risk." High-protein supplements, creatine misuse, and fat-burning compounds may stress kidneys, especially in those with undiagnosed problems.
The US Food and Drug Administration (FDA) has issued warnings about certain bodybuilding supplements linked to kidney injury, underscoring the need for caution and medical guidance.
6. Recurrent Infections and Kidney Stones
Repeated urinary tract infections can spread upward and scar the kidneys. Dr Gireesh notes, "Recurrent urinary tract infections, untreated or frequent kidney stones, and a family history of kidney disease can all contribute to the development and progression of CKD." Kidney stones cause repeated obstruction and inflammation, leading to permanent damage over time if ignored.
7. Genetics and Autoimmune Diseases
Family history is central to kidney health. Dr Khan states, "Genetic diseases contribute to 20–25% of CKD." Many genetic conditions present as early or stubborn high blood pressure. Autoimmune diseases like systemic lupus erythematosus can directly attack kidney filters. Dr Gireesh explains, "Autoimmune diseases must also be considered. Conditions such as Systemic lupus erythematosus and other systemic autoimmune disorders can directly affect the kidneys and lead to chronic kidney damage."
The Importance of Early Detection
Kidney disease progresses without obvious warning signs—no pain, fever, or dramatic symptoms. Dr Gireesh concludes, "The most important step in protecting kidney health is regular health check-ups. Early detection allows us to intervene promptly and prevent further progression of the disease." Regular screening is crucial for those with obesity, family history, frequent painkiller use, or occupational exposure.
Medical experts consulted: This article includes expert inputs from Dr Mohammed S. Khan and Dr Gireesh M. S., used to explain unnoticed risk factors for kidney disease.
