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Don’t underestimate the seriousness of this! In 2017, over 1.2 million people died due to kidney disease.  A “big data” study published in 2020 on the global, regional, and national burden of chronic kidney disease (CKD) revealed a truly astonishing global prevalence of 697.5 million chronic kidney disease cases – around 9% of the global population. With these shocking statistics, you know that chronic kidney disease is not something you can take likely.
As with any chronic, debilitating illness, prevention is the key. Popular education channel Bright Side lists ten signs that you kidneys may be crying for help. We fact checked this video in depth and it gets the thumbs up. Here are the 10 signs, together with our detailed notes and 23 scientific / research references:
1. Trouble Sleeping
Insomnia can manifest as trouble falling asleep, staying asleep, or early waking combined with being unable to go back to sleep.  Chronic insomnia has been linked to various chronic illnesses, kidney disease included, with a study reporting that nighttime and early wakefulness were commonly seen in patients undergoing hemodialysis.  In 2018, Sasaki, et. al. published a study that found link between insomnia and the development of CKD, wherein the study participants who experienced awakening during the night developed a moderately increased risk for chronic kidney disease.  The exact mechanism for this is still unknown, but it could be due to the increased toxins in the blood as the kidneys are unable to filter them out, as well as anemia (a hallmark symptom of CKD).
Bright Side specifically mentions sleep apnea was one of the causes of insomnia. According to Lin, chronic kidney disease patients have an increased prevalence of obstructive sleep apnea and central sleep apnea compared with the general population.  This can be due to the build up of fluid in the lungs (affecting respiration) and again, the build up of toxins in the blood. 
2. Headache, Fatigue, General Weakness
Weakness, fatigue, and headaches may also be signs that your kidneys are having problems. Various studies have reported chronic fatigue among people suffering from kidney disease, with statistics of about 70 to 97 percent according to the research of Joshwa and Campbell.  These symptoms are attributed to kidney disease-associated anemia, caused by decreased oxygen delivery to the cells. 
This happens because the kidneys are responsible for the production of a hormone called erythropoietin (EPO), which stimulates the production of red blood cells. Damaged kidneys produce less EPO, which causes the bone marrow to produce less red blood cells – leading to anemia.  Bright Side mentions anemia occurs when there is about 20 to 50% of kidney function left, which is about right – according to the National Institutes of Health, anemia is less common in early kidney disease, with symptoms typically appearing in later stages of the condition.
3. Dry And Itchy Skin
An imbalance of minerals and nutrients can also cause your skin to feel dry and itchy. In kidney disease, this is a condition called uremic pruritus, or itchiness of the skin due to the build-up of toxins in the blood. More than 40% of people with end-stage kidney disease who undergo dialysis complain of chronic pruritus, which the pathophysiology of the condition being linked to a build-up of parathyroid hormone (PTH), histamine, magnesium salts and calcium salts in the blood.  If you are experiencing these symptoms, make sure to stay hydrated and not to self-medicate: If your kidneys are damaged, taking anti-histamines and other medications to stop the itching may do more harm than good.
4. Bad Breath, Metallic Taste
Bad breath and a metallic taste can also be signs that your kidneys are damaged and that toxins are building up in your blood. Similar to uremic pruritus, there is a condition called uremia fetor which is characterized by the smell of ammonia in exhaled breath, very similar to the smell of urine.  This is also due to the build-up of toxins in the blood as your kidneys are unable to filter them out. This is typically a sign of severe kidney damage already and can lead to weight loss and poor appetite.
5. Shortness Of Breath
One cause of difficulty of breathing is anemia, which was previously discussed in section 2 on fatigue. With less oxygen reaching the cells, blood oxygen levels can run low which can manifest as shortness of breath on top of weakness and fatigue. Another cause is the build-up of excess fluid in the blood or fluid overload. This can happen in cases of acute kidney injury and chronic kidney disease, both characterized by sodium and fluid retention.  In both acute and chronic cases the kidneys are unable to excrete excess fluid and sodium, and “where sodium goes, fluid follows”, leading to fluid overload. 
6. Swelling Of The Hands And Feet
Sodium and fluid retention caused by kidney problems often lead to swelling of the hands and feet. Bipedal edema, or edema in both feet, is more common than swelling in the upper extremities.  Of course, not all swelling in the hands and feet means that you have failing kidneys. Dependent edema can also be caused by problems in the valves in your extremities, causing fluid build-up in just those areas.
7. Back Pain
Back pain, or more specifically, direct tenderness over the flank area, is a more direct sign of kidney problems. This is typically caused by a kidney stone or nephrolithiasis but can also be caused by a kidney infection, trauma, or even an infarct, as the tissue becomes inflamed or worse, necrotic.  Kidney-associated flank pain may also be accompanied by fever, frequent urination, and even vomiting. 
8. Puffy Eyes
Edema around the orbital area is one of the signs of nephrotic syndrome, or a kidney condition where too much protein is excreted in the urine.  McCloskey and Maxwell cite both periorbital edema and dependent pitting edema in the lower extremities are common presentations of nephrotic syndrome.  When there is too much protein excreted by the body, it causes an imbalance in the cellular barrier in our blood vessels, causing fluid to leak into the interstitial spaces and lead to fluid build up and swelling.
9. High Blood Pressure
High blood pressure or hypertension often goes hand in hand with kidney problems. However, it is hard to diagnose which came first – high blood pressure or kidney disease. When a person has uncontrolled high blood pressure, it can cause kidney problems because the persistent strain on the circulatory system damages the delicate blood vessels of the kidneys; this is called hypertensive kidney disease.  However, hypertension can be aggravated by an existing kidney problem, because of the sodium and fluid overload in the body. The more fluid the body retains, the higher the blood pressure.
Bright Side mentions folic acid supplementation to help manage high blood pressure and there are quite a few studies supporting this claim. Folic acid has been studied as a potential preventative agent against preeclampsia and eclampsia amongst pregnant women, helping keep the blood pressure levels low during the pregnancy.  In a 2015 article published in the Journal of the American Medical Association, folic acid was found to significantly reduce the risk for stroke or a cerebrovascular event by controlling blood pressure. 
10. Changes In Urination
The tenth sign is the most obvious sign that your kidneys are crying for help — changes in your urination. Changes in the smell, color, and frequency of urination can mean that your kidneys are having trouble; it can be an infection, a kidney stone, or even the beginning stages of kidney disease. Hematuria, or blood in the urine, is a significant warning sign can also be caused by trauma to your kidneys.  Cloudy urine can signify the presence of bacteria or crystals in the urine, indicative of an infection. Foamy urine can mean proteinuria, or protein in your urine, which is a sign of significant kidney damage. 
Any one of these ten signs or a combination of them can indicate that your kidneys are have problems and that you need to seek medical attention. The first step will typically be testing in order to form an accurate diagnosis of your kidney health. Being diagnosed with any stage of kidney disease means drastic lifestyle changes, not mention the financial and emotional burden associated with this kind of condition. Prevention is very important, so learning to understand when your body is telling you something can make a big difference.
 GBD Chronic Kidney Disease Collaboration (2017). Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. https://www.thelancet.com/article/S0140-6736(20)30045-3/fulltext
 Mayo Clinic. Insomnia. https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167
 Ancoli-Israel, S. (2006). The Impact and Prevalence of Chronic Insomnia and Other Sleep Disturbances Associated With Chronic Illness. https://www.ajmc.com/view/may06-2308ps221-s229
 Sasaki, S., et. al. (2018). A prospective cohort study of insomnia and chronic kidney disease in Japanese workers. https://pubmed.ncbi.nlm.nih.gov/28534280/
 Lin, C., et. al. (2020). Sleep Apnea and Chronic Kidney Disease: A State-of-the-Art Review. https://pubmed.ncbi.nlm.nih.gov/31542452/
 Hui, L. & Benca, R. (2021). The Bidirectional Relationship Between Obstructive Sleep Apnea and Chronic Kidney Disease. https://pubmed.ncbi.nlm.nih.gov/33608118/
 Joshwa, B. & Campbell, M. (2017). Fatigue in Patients with Chronic Kidney Disease: Evidence and Measures. https://pubmed.ncbi.nlm.nih.gov/29160968/
 Gregg, L., et. al. (2021). Fatigue in CKD: Epidemiology, Pathophysiology, and Treatment. https://pubmed.ncbi.nlm.nih.gov/33858827/
 National Institute of Diabetes and Digestive and Kidney Diseases. Anemia in Chronic Disease. https://www.niddk.nih.gov/health-information/kidney-disease/anemia
 Mettang, T. & Kremer, A. (2015). Uremic pruritus. https://pubmed.ncbi.nlm.nih.gov/24402092/
 Cleveland Clinic. Uremia. https://my.clevelandclinic.org/health/diseases/21509-uremia
 Claure-Del Granado, R. & Mehta, R. (2016). Fluid overload in the ICU: evaluation and management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970195/
 Borrelli, S. et. al. (2020). Sodium Intake and Chronic Kidney Disease. https://pubmed.ncbi.nlm.nih.gov/32635265/
 Bourgault, M., et. al. (2013). Acute renal infarction: a case series. https://pubmed.ncbi.nlm.nih.gov/23204242/
 Mount Sinai. Flank pain. https://www.mountsinai.org/health-library/symptoms/flank-pain
 Mayo Clinic. Nephrotic syndrome. https://www.mayoclinic.org/diseases-conditions/nephrotic-syndrome/symptoms-causes/syc-20375608
 McCloskey, O. & Maxwell, A. (2017). Diagnosis and management of nephrotic syndrome. https://pubmed.ncbi.nlm.nih.gov/29020719/
 Stompor, T. & Perkowska-Ptasinska, A. (2020). Hypertensive kidney disease: a true epidemic or rare disease? https://pubmed.ncbi.nlm.nih.gov/31964856/
 Yang, et. al. (2016). Periconceptional folic acid fortification for the risk of gestational hypertension and pre‐eclampsia: a meta‐analysis of prospective studies. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6860089/
 Liu, C., et. al. (2018). Supplementation of folic acid in pregnancy and the risk of preeclampsia and gestational hypertension: a meta-analysis. https://pubmed.ncbi.nlm.nih.gov/29978414/
 Huo, et. al. (2015). Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. https://pubmed.ncbi.nlm.nih.gov/25771069/
 National Institute of Diabetes and Digestive and Kidney Diseases. Hematuria. https://www.niddk.nih.gov/health-information/urologic-diseases/hematuria-blood-urine
 Mayo Clinic. Foamy urine: What does it mean? https://www.mayoclinic.org/foamy-urine/expert-answers/faq-20057871
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