Your kidneys do extraordinary work — silently, continuously, without you ever thinking about them. Until something goes wrong. Chronic kidney disease (CKD) is a silent condition that affects millions of Filipinos, often only noticed when significant damage has already occurred. Understanding kidney health lets you protect these vital organs before damage begins.
How Your Kidneys Work
You have two kidneys, each about the size of a fist, located at the back of the abdomen just below your ribcage. Every minute, your kidneys filter approximately 1 litre of blood — processing your entire blood volume about 12 times per hour. Their key jobs:
- Filter waste: Remove creatinine, urea, and other metabolic waste products that would otherwise build up to toxic levels
- Regulate fluids: Balance the amount of water in your body
- Balance electrolytes: Control sodium, potassium, calcium, and phosphate levels
- Control blood pressure: Through the renin-angiotensin system and fluid balance
- Produce hormones: Erythropoietin (stimulates red blood cell production) and active Vitamin D (bone health)
- Regulate acid-base balance: Keep blood pH stable
Remarkably, you can lose up to 75% of kidney function before feeling any symptoms. This is why CKD is often not detected until it is advanced.
Risk Factors for Kidney Disease
The two biggest risk factors for chronic kidney disease are diabetes and hypertension — which together account for more than two-thirds of CKD cases. If you have either condition, protecting your kidneys requires active management.
- Diabetes: High blood sugar damages the delicate blood vessels (glomeruli) that filter blood in the kidneys. After 10–15 years of uncontrolled diabetes, kidney damage (diabetic nephropathy) may develop.
- Hypertension: High blood pressure puts excessive force on kidney blood vessels, progressively scarring and stiffening them.
- Chronic painkiller use: NSAIDs (ibuprofen, mefenamic acid, naproxen) — common in the Philippines — can damage kidneys when taken regularly over months or years. Always check with your doctor before taking pain relievers long-term.
- Family history: A first-degree relative with kidney disease, polycystic kidney disease, or kidney failure increases your risk.
- Recurrent kidney infections or stones: Untreated urinary tract infections that reach the kidneys, or kidney stones that cause repeated obstruction, can cause permanent damage.
- Smoking: Doubles the rate of CKD progression.
- Obesity: Puts extra metabolic demand on the kidneys and is strongly associated with kidney disease.
- Older age: Kidney function naturally declines with age — about 1% per year after age 40.
- Gout: High uric acid levels (very common in Filipino men) can deposit crystals in the kidney and impair function.
Early Warning Signs of CKD
Because kidneys are so efficient at compensating for damage, early CKD often has no symptoms. When symptoms do appear, they usually signal more advanced disease:
- Puffiness or swelling around the eyes in the morning, or ankle/leg swelling
- Foamy or bubbly urine (protein leaking into urine)
- Blood in the urine (brownish-red or pink urine)
- Urinating more frequently at night
- Persistent fatigue and weakness (from anaemia caused by low erythropoietin)
- Decreased urine output or difficulty urinating
- Persistent nausea, loss of appetite, or metallic taste in the mouth
- Itching (uraemic pruritis — from waste products in the blood)
- Shortness of breath from fluid retention
Understanding eGFR and Creatinine
Two blood test results are most important for kidney health:
Creatinine
Creatinine is a waste product produced by muscle activity. Healthy kidneys filter it out of the blood efficiently. When kidney function declines, creatinine builds up in the blood. Normal creatinine is approximately 0.7–1.3 mg/dL for men and 0.5–1.1 mg/dL for women, but these ranges vary. An elevated creatinine should prompt further evaluation.
Creatinine alone is not the most useful measure because it is affected by muscle mass — a very muscular person has higher creatinine naturally. This is why eGFR is more meaningful.
eGFR (Estimated Glomerular Filtration Rate)
eGFR is a calculation using creatinine, age, and sex (and sometimes race) to estimate how well your kidneys are filtering blood — measured in mL/min/1.73m². It is the most important number for assessing kidney function.
| eGFR (mL/min/1.73m²) | What It Means |
|---|---|
| 90 or above | Normal or high (if with kidney damage markers) |
| 60–89 | Mildly reduced |
| 45–59 | Mildly-to-moderately reduced (early CKD) |
| 30–44 | Moderately-to-severely reduced |
| 15–29 | Severely reduced (close to kidney failure) |
| Below 15 | Kidney failure — dialysis or transplant needed |
Urine Microalbumin
Albumin is a protein that healthy kidneys don't allow to pass into the urine. Tiny amounts (microalbuminuria) are the earliest sign of kidney damage from diabetes or hypertension — often detectable years before creatinine rises. All diabetics and hypertensive patients should have this test annually.
Stages of Chronic Kidney Disease
CKD is classified into 5 stages based on eGFR. Stages 1–3 often have no symptoms but can be detected with blood and urine tests. Stages 4–5 require active nephrology management. Stage 5 is kidney failure — without dialysis or a transplant, it is fatal.
The good news: with proper management, many people spend years in Stages 1–3 without progression to kidney failure. The key is catching it early and managing its underlying causes.
What Is Dialysis?
When kidneys can no longer filter waste adequately (typically at Stage 5 or when symptoms are severe), dialysis takes over the kidneys' filtering function:
- Haemodialysis: Blood is pumped out of the body, filtered through a dialysis machine, and returned. Usually done 3 times a week for 3–4 hours per session at a dialysis centre.
- Peritoneal dialysis: A catheter is implanted in the abdomen, and a dialysis fluid is used to filter waste through the peritoneum (abdominal lining). Can be done at home, including overnight (automated peritoneal dialysis).
Dialysis is life-sustaining but demanding. The best outcome is avoiding dialysis altogether through early detection and management of kidney disease.
Preventing Kidney Disease
- Control your blood sugar if you have diabetes — this is the single most important thing you can do to protect your kidneys
- Control your blood pressure — aim below 130/80 mmHg
- Avoid regular NSAID use — paracetamol is safer for routine pain relief
- Don't smoke — smoking doubles the speed of CKD progression
- Maintain a healthy weight
- Treat UTIs promptly — don't let a bladder infection ascend to a kidney infection
- Manage gout — high uric acid damages kidneys over time
- Get annual kidney function tests if you have diabetes, hypertension, or a family history of kidney disease
The Right Kind of Hydration
Good hydration is important for kidney health — it helps flush waste and prevents kidney stones. The target is 1.5–2 litres of water daily for most adults. However, if you already have kidney disease, your fluid intake may need to be restricted — your nephrologist will advise.
Water is best. Avoid excessive coffee (mild diuretic), avoid high-sugar drinks that worsen diabetes and weight, and be cautious with protein shakes and supplements — high protein intake puts extra burden on already-stressed kidneys.