Chronic kidney disease (CKD) is currently a major global health burden with high economic costs for healthcare systems. In Vietnam, approximately 0.012% of the population has end-stage chronic kidney disease, and this rate is increasing by 8.1% per year, with about 21,000 people receiving renal replacement therapy. Therefore, providing health education and counseling to maintain and improve knowledge for patients and their families is both essential and critically important at present.

What is Chronic Kidney Failure?

Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function lasting for more than 3 months, regardless of the cause, with implications for a patient’s health.

CKD is identified by:

  • Kidney damage lasting longer than 3 months, demonstrated by structural or functional abnormalities, with or without reduced glomerular filtration rate (GFR), manifested by:
    • Abnormal laboratory results (blood urea, creatinine)
    • Urine abnormalities (albumin, red blood cells, casts)
    • Imaging findings (abnormal renal parenchymal structure)
  • GFR < 60 mL/min/1.73 m² for more than 3 months, with or without evidence of kidney damage.

Stages of Chronic Kidney Disease

Based on glomerular filtration rate or estimated creatinine clearance (Cockcroft–Gault formula):

StageDescriptionGFR (mL/min/1.73 m²)
1Kidney damage with normal or increased GFR>=90
2Kidney damage with mildly decreased GFR89
3Moderately decreased GFR30-59
4Severely decreased GFR29
5Kidney failure< 15 or dialysis

Chronic kidney failure usually progresses silently and is often not detected until the disease has advanced. Its symptoms are often nonspecific and can easily be confused with those of other diseases.

Causes of Chronic Kidney Failure

The three main causes are:

  • Glomerular diseases
  • Hypertension
  • Diabetes

Other causes include:

  • Renal vascular diseases
  • Tubulointerstitial kidney diseases
  • Urinary tract diseases
  • Urinary tract infections
  • Urinary tract obstruction
  • Urinary stones
  • Nephrotoxic drugs
  • Obesity

Common Symptoms

  • Weight loss, nausea, vomiting
  • Fatigue, headache
  • Frequent hiccups
  • Itching
  • Increased or decreased urine output, nocturia (need to wake up during the night to urinate)
  • Generalized edema, easy bruising or bleeding
  • Vomiting blood, black stools
  • Ammonia-like breath odor
  • Drowsiness, lethargy
  • Skin hyperpigmentation
  • Muscle cramps, spasms

Treatment Approach

  • Good control of the underlying causes to reduce factors that impair kidney function
  • Slowing the progression of kidney failure
  • Prevention and treatment of complications
  • Treatment of comorbid conditions
  • Avoidance of nephrotoxic drugs and medications affecting renal hemodynamics
  • Preparation for renal replacement therapies

Care and Monitoring

  • Monitor vital signs and body weight
  • Control blood pressure
  • Control blood glucose
  • Monitor 24-hour urine volume, color, and characteristics
  • Observe stool color and characteristics
  • Monitor for abnormal signs

Nutrition for Patients with Chronic Kidney Failure

  • Energy requirement: 25–35 kcal/kg/day, depending on age, sex, physical activity, body composition, disease stage, and comorbidities or acute conditions.
  • Control intake of protein, fat, potassium; restrict sodium and phosphate.
  • Ensure adequate intake of four essential nutrient groups: carbohydrates, proteins, fats, vitamins, and minerals.
  • Daily fluid intake should equal urine output in 24 hours plus 300–500 ml.
  • Avoid red meat, seafood, animal skin, and organ meats. Increase intake of foods rich in vitamins and minerals to protect cells, support tissue repair, maintain electrolyte balance, reduce acidosis, provide sufficient calcium, and limit phosphate.
  • Limit salt intake to control blood pressure and preserve kidney function.
  • Limit high-potassium foods such as dried fruits, durian, apricots, oranges, bananas, coconut water, etc.

Prevention of Chronic Kidney Disease

Since chronic kidney failure cannot be completely cured, the best strategy is prevention through healthy lifestyle habits:

  • Avoid excessive alcohol consumption
  • Control blood pressure and blood glucose
  • Exercise regularly and eat a healthy diet
  • Maintain a healthy body weight
  • Use over-the-counter painkillers cautiously (some may harm the kidneys if used improperly)
  • Do not smoke

Follow-up and Monitoring

  • Attend monthly follow-up visits as scheduled
  • Take medications exactly as prescribed
  • Visit the appropriate medical specialty
  • Do not stop, add, or change medication doses without medical advice
  • Monitor for abnormal symptoms such as fatigue, dizziness, nausea, loss of appetite, pallor, edema, shortness of breath, arrhythmia, or cognitive disturbances, and seek immediate medical attention if they occur
  • Receive counseling on renal replacement therapies or preparation for arteriovenous fistula (AVF) surgery