Chronic Kidney Disease (CKD) includes all medical conditions causing renal function impairment. It is characterised by progressive and complete loss of renal function or complications resulting from reduced renal function

Even the presence of kidney damage is a warning sign. It can be detected through specific lab, instrumental or anatomical pathology tests or by reduced renal function persisting for at least 3 months, regardless of the underlying condition

The natural consequence of CKD is chronic kidney failure (CKF), i.e. the progressive and irreversible loss of renal function

There can be two types of CKF:
Primary, when there are renal diseases associated with the presence of glomerular inflammatory damage (glomerulonephritis). However, causes and symptoms are very different. Genetic diseases like polycystic kidney disease can be included in this type
Secondary, it can occur as a result of other conditions like diabetes, hypertension, lithiasis, kidney infections and urinary tract obstructions

Important warning signs of the diseases can be:

• The appearance of fluid retention (oedemas), electrolyte imbalance can cause dangerous cardiac disorders and severe acidosis
• Presence of nitrogen, uric acid and creatinine retention with severe effects on the digestive tract and the nervous system (central or peripheral) or drug intoxication
• Development of severe anaemia, hypotension or hypertension, alterations of the bone status

This happens because the kidneys have four essential functions:

• Regulating the amount of water and electrolytes contained in the body
• Regulating the acid-alkaline balance (they help maintain the right pH in the blood)
• Eliminating some substances produced by the body (urea or nitrogen, creatinine, uric acid) or introduced from outside (drugs and toxic elements)
• Hormone production; among the most important are renin, involved in regulating blood pressure, erythropoietin, which stimulates red blood cells production, and prostaglandins, which help regulate blood flow in the kidneys. Additionally, the kidneys are responsible for activating vitamin D

The main aspects to consider are: 

• Certification of the disease status
• Clinical/therapeutic prescriptions
• Logistical organisation of any dialysis sessions, which are the responsibility of the reference nephrology centre

It is important to stress the presence and importance of professionals like social workers and psychologists

Associations
ANED (Associazione Nazionale Emodializzati Dialisi e Trapianto - Italian Association for Haemodialysis Patients, Dialysis and Transplant)
Kidney Patient Association
ANTR (Associazione Nazionale Trapiantati di Rene - Italian Association for Kidney Transplant Patients)
AIRP (Associazione Italiana Rene Policistico - Italian Polycystic Kidney Association)

A special mention should be made about the SCOPE European project, funded by the EU in the context of the HORIZON 2020 programme, which deals with CKF screening in elderly subjects
The purpose is to study the decline of renal function and the incidence of terminal renal disease in subjects aged 75 years or more. Participants live in 7 European countries and in one non-EU country
During the study, blood and urine samples will be collected to assess genetic markers, i.e., known DNA sequences of chronic kidney diseases and ageing