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CKD is initially without symptoms, and is usually detected on routine screening blood work by either an increase in [[Creatinine#Serum creatinine|serum creatinine]], or [[proteinuria|protein in the urine]]. As the kidney function decreases, more unpleasant symptoms may emerge:
* [[Blood pressure]] is increased due to fluid overload and production of vasoactive hormones created by the kidney via the renin–angiotensin system, increasing the risk of developing [[hypertension]] and [[heart failure]]. People with CKD are more likely than the general population to develop [[atherosclerosis]] with consequent [[cardiovascular disease]], an effect that may be at least partly mediated by uremic toxins. People with both CKD and cardiovascular disease have significantly worse prognoses than those with only cardiovascular disease.
* [[Urea]] accumulates, leading to [[azotemia]] and ultimately [[uremia]] (symptoms ranging from [[lethargy]] to [[pericarditis]] and [[encephalopathy]]). Due to its high systemic concentration, urea is excreted in eccrine sweat at high concentrations and crystallizes on skin as the sweat evaporates ("[[uremic frost]]").
* [[Potassium]] accumulates in the blood ([[hyperkalemia]] with a range of symptoms including [[malaise]] and potentially fatal [[cardiac arrhythmia]]s). Hyperkalemia usually does not develop until the [[glomerular filtration rate]] falls to less than 20–25 mL/min/1.73 m2, when the kidneys have decreased ability to excrete potassium. Hyperkalemia in CKD can be exacerbated by acidemia (which leads to extracellular shift of potassium) and from lack of [[insulin]].
* [[Fluid balance|Fluid overload]] symptoms may range from mild [[edema]] to life-threatening [[pulmonary edema]].
* [[Hyperphosphatemia]] results from poor phosphate elimination in the kidney, and contributes to increased cardiovascular risk by causing vascular calcification. Circulating concentrations of [[Fibroblast growth factor 23|fibroblast growth factor-23]] (FGF-23) increase progressively as the kidney capacity for phosphate excretion declines, which may contribute to left ventricular hypertrophy and increased mortality in people with CKD .
* [[Hypocalcemia]] results from [[1,25 dihydroxyvitamin D3|1,25 dihydroxyvitamin D3]] deficiency (caused by high [[Fibroblast growth factor 23|FGF-23]] and reduced kidney mass) and resistance to the action of parathyroid hormone. Osteocytes are responsible for the increased production of [[Fibroblast growth factor 23|FGF-23]], which is a potent inhibitor of the enzyme [[25-Hydroxyvitamin D3 1-alpha-hydroxylase|1-alpha-hydroxylase]] (responsible for the conversion of [[25-hydroxycholecalciferol]] into [[1,25-dihydroxyvitamin D3|1,25 dihydroxyvitamin D3]]). Later, this progresses to [[secondary hyperparathyroidism]], [[renal osteodystrophy|kidney osteodystrophy]], and vascular calcification that further impairs cardiac function. An extreme consequence is the occurrence of the rare condition named [[calciphylaxis]].
* Changes in mineral and bone metabolism that may cause 1) abnormalities of [[calcium]], [[phosphorus]] ([[phosphate]]), [[parathyroid hormone]], or [[vitamin D]] metabolism; 2) abnormalities in [[bone turnover]], [[Mineralization of bone|mineralization]], volume, linear growth, or strength ([[renal osteodystrophy|kidney osteodystrophy]]); and 3) vascular or other soft-tissue calcification. [[Chronic kidney disease-mineral and bone disorder|CKD-mineral and bone disorders]] have been associated with poor outcomes.
* [[Metabolic acidosis]] may result from decreased capacity to generate enough [[ammonia]] from the cells of the proximal tubule.
* [[Iron deficiency anemia|Anemia]] is common and is especially prevalent in those requiring haemodialysis. It is multifactorial in cause, but includes increased inflammation, reduction in [[erythropoietin]], and hyperuricemia leading to bone-marrow suppression. Hypoproliferative anemia occurs due to inadequate production of erythropoietin by the kidneys.
* In later stages, [[cachexia]] may develop, leading to unintentional weight loss, muscle wasting, weakness, and anorexia.
* Cognitive decline in patients experiencing CKD is an emerging symptom revealed in research literature. Current research suggests that patients with CKD face a 35-40% higher likelihood of cognitive decline and or dementia. This relation is dependent on the severity of CKD in each patient; although emerging literature indicates that patients at all stages of CKD will have a higher risk of developing these cognitive issues.
* [[Sexual dysfunction]] is very common in both men and women with CKD. A majority of men have a reduced [[libido|sex drive]], [[erectile dysfunction|difficulty obtaining an erection]], and reaching orgasm, and the problems get worse with age. Most women have trouble with sexual arousal, and [[dysmenorrhea|painful menstruation]] and problems with performing and enjoying sex are common.

Translations:Chronic kidney disease/6/en - Revision history

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