What are the 10 complications of CKD?

CKD core articles', Other renal conditions

What are the 10 complications of CKD?

1. Acute kidney injury (AKI)
2. Fluid overload and high potassium level
3. High blood pressure and high cholesterol
4. Heart and brain disease
5. Renal anaemia
6. Renal bone disease
7. Renal acidosis (and malnutrition)
8. Peripheral neuropathy and myopathy
9. Malignancy (cancer)
10. End-stage renal failure (ESRF) and all-cause mortality.

We will now go through the 10 complications of CKD. We will focus on the physical complications. This article is linked to another on 10 CKD symptoms.

Symptoms and complications

The symptoms of CKD relate to the complications, but it is not a one-to-one relationship, i.e. each symptom may have 2 or more complications that cause (e.g. tiredness). And some complications have no symptoms at least initially (high blood pressure).

Note. CKD – and especially advanced CKD (Stage 4-5 CKD) – are also complicated by major mental health and social issues, which are as (or more) important that the physical ones.

1. Acute kidney injury (AKI)

AKI usually ‘gets better’. But in some patients, AKI may cause (or accelerate the progression) of CKD. Occasionally it leads to ESRF.

Symptoms: dominated by cause of AKI, e.g. pneumonia or post-cardiac surgery.

2. Fluid overload (extra water in the body) and high blood potassium level (hyperkalaemia)

Fluid overload and hyperkalaemia are two of the main indications for dialysis.

Symptoms: fluid overload (ankle swelling, shortness of breath); hyperkalaemia (usually no symptoms).

3. High blood pressure (hypertension) and high cholesterol

Hypertension also accelerates the progression of CKD.

Almost all people with CKD have hypertension. High cholesterol can also be caused by nephrotic syndrome with urinary albumin:creatinine ratio (ACR) levels greater than 220 mg/mmol) with normal kidney function.

Symptoms: high blood pressure and high cholesterol are usually ‘silent’ with no symptoms (as is CKD, usually until Stage 4 CKD).

Other resources

These are the articles on CKD Explained that concern high blood pressure.

4. Heart (cardiovascular) and brain (cerebral) disease

Such as ischaemic heart disease (IHD), peripheral arterial disease (PVD), chronic heart failure (CHF), and strokes.

Symptoms: chest pain (IHD); shortness of breath (CHF); pain in legs on walking or poor circulation to feet (PVD); and one-sided weakness or speech or visual disturbance (stroke).

5. Renal anaemia

Renal anaemia is due to reduced production of erythropoietin (EPO) by the kidney, reduced red blood cell survival, and iron deficiency.

Treatment with EPO is recommended when haemoglobin is less than 110 g/L

Symptoms: tiredness, shortness of breath, lethargy, and palpitations.

Other resources

These are the articles on CKD Explained that concern renal anaemia.

6. Renal bone disease

Renal bone disease is caused by disturbed vitamin D, calcium/phosphate, and parathyroid hormone (PTH) metabolism.

Serum calcium is low initially, with vitamin D deficiency; and raised serum phosphate and parathyroid hormone levels.

Symptoms: usually no symptoms; when more severe, bone pain and weakness (and fractures eventually). When severe, it occasionally causes calciphylaxis. This is serious but fortunately rare.

Other resources

These are the articles on CKD Explained that concern renal bone disease.

7. Renal acidosis (and malnutrition)

Malnutrition is common in advanced CKD and ESRF, thought to be due to renal acidosis (high acid levels in the blood), poor dietary intake and hypoalbuminaemia (low protein levels in the blood).

Symptoms: can be none in early stages; later in CKD, patients lose appetite and lose weight, especially muscle weight (and power).

Other resources

These are the articles on CKD Explained that concern acidosis (high acid levels in the blood).

8. Peripheral neuropathy and myopathy

Symptoms: this may present with paraesthesia, sleep disturbance, and restless legs syndrome.

9. Malignancy

People with ESRF may have an excess cancer risk, particularly affecting the urinary tract and thyroid gland. The exact cause is not known, but risk factors may include exposure to immunosuppressive agents, and immune dysregulation caused by CKD.

Kidney transplant recipients have an overall risk of cancer about three times compared to the general population; with an overall risk for males of about double, and for females over triple.

There are significantly increased risks in both sexes of Kaposi’s sarcoma, lymphomas, leukaemias, anogenital and skin cancers. All are thought to be secondary to immunosuppression.

Here is more information on cancer risk in transplant patients: Letto, 2023.

10. End-stage renal failure (ESRF) and all-cause mortality

1 in 100 people with CKD progress to Stage 5 CKD (kidney failure, or ERSF) – i.e. fortunately this is rare. These patients will require renal replacement therapy (RRT; dialysis or kidney transplantation) or supportive care (no dialysis or transplant).

The risk of all-cause mortality significantly increases with progressive CKD.

Note. People with CKD are 5-10 times more likely to die prematurely, than they are to progress to end-stage renal failure (ESRF). The risk of death rises exponentially as renal function worsens, and is largely secondary to heart disease.

Other complications

Gout (pain and swelling in big toe)
Itching and other skin problems
Platelet dysfunction (leading to bleeding tendency)
Decreased sex drive and erectile dysfunction (ED)
Encephalopathy/seizures
Pericarditis, pleuritis
Pregnancy complications, e.g. pre-eclampsia
Note. Most of these complications occur in advanced CKD.

Summary

We have described what are the 10 complications of CKD. We hope it has been helpful.

Other resource

Complications of CKD overview
More information on the complications of CKD on NICE here.

Last Reviewed on 23 June 2024

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