Chronic Kidney Disease (CKD)
Chronic kidney disease is a long-term condition where the kidneys do not work as well as they should. It is more common than most people realise. In Ireland, around one in ten adults has some degree of CKD, and many are unaware of it because the early stages cause few symptoms. Specialist care matters because the right treatment, started at the right stage, can slow progression dramatically, prevent complications, and protect quality of life for decades.
Dr Rory McQuillan is a Consultant Nephrologist based in Dublin, with full-time private practice across Blackrock Clinic, The Beacon Hospital, Bon Secours Dublin, Hermitage Medical Centre, and St Vincent’s Private Hospital. He provides specialist outpatient consultations and inpatient admissions for CKD by GP referral.
What is chronic kidney disease?
Chronic kidney disease describes any condition that damages the kidneys over time. The kidneys filter waste and excess fluid from the blood, regulate blood pressure, balance minerals and electrolytes, support red blood cell production, and keep bones healthy. When kidney function declines, all of these systems are affected.
CKD is classified into five stages based on how well the kidneys are filtering, measured by the estimated glomerular filtration rate (eGFR). Stage 1 is mild, with normal or near-normal filtration but other evidence of kidney damage. Stage 5 is severe, with very low filtration that may require dialysis or transplantation.
Most people with CKD are in stages 1 to 3 and never progress to advanced disease. The goal of specialist management is to keep it that way.
Stages of CKD explained
Each stage of CKD is defined by the eGFR, expressed as millilitres per minute per 1.73m². Specialist input becomes increasingly important as the eGFR falls.
- Stage 1: eGFR 90 or above, with other evidence of kidney damage such as protein in the urine
- Stage 2: eGFR 60–89, with other evidence of kidney damage
- Stage 3a: eGFR 45–59, mild to moderate reduction in kidney function
- Stage 3b: eGFR 30–44, moderate to severe reduction in kidney function
- Stage 4: eGFR 15–29, severe reduction in kidney function
- Stage 5: eGFR below 15, kidney failure (sometimes called end-stage renal disease)
Causes of chronic kidney disease
Most CKD in Ireland is caused by a small number of conditions. Identifying and treating the underlying cause is the single most important step in slowing progression.
- Diabetes (the leading cause worldwide)
- High blood pressure (hypertension)
- Glomerulonephritis (inflammation of the kidney filters)
- Polycystic kidney disease and other inherited conditions
- Recurrent kidney infections
- Long-term use of medications that affect kidney function
- Vascular disease and reduced blood flow to the kidneys
Symptoms of chronic kidney disease
Early CKD often has no symptoms. As the condition progresses, patients may notice tiredness, swelling around the ankles, breathlessness on exertion, changes in urination, itchy skin, poor appetite, or difficulty concentrating. Because these symptoms are non-specific, CKD is often picked up on routine blood tests rather than from how a patient feels.
How CKD is diagnosed
Diagnosis is based on blood tests, urine tests, and imaging. The main tests are:
- Estimated glomerular filtration rate (eGFR) from a blood test
- Urine albumin-to-creatinine ratio (ACR) to detect protein leakage
- Urinalysis to check for blood or infection in the urine
- Kidney ultrasound to assess size, shape, and structure
- Specialist tests such as kidney biopsy in selected cases
How chronic kidney disease is treated
There is no single treatment for CKD. The aim is to slow progression, manage complications, and protect cardiovascular health. A specialist consultation will typically cover:
- Blood pressure optimisation, often with ACE inhibitors or ARBs
- Tight glycaemic control if diabetes is present
- Newer kidney-protective medications such as SGLT2 inhibitors
- Cholesterol management to reduce cardiovascular risk
- Dietary review, with input from a renal dietitian where appropriate
- Treatment of anaemia, bone disease, and acidosis as kidney function declines
- Vaccinations including pneumococcus, influenza, hepatitis B, and COVID-19
- Planning for advanced therapies (dialysis or transplantation) if needed
Why specialist care matters
GPs do an excellent job of managing early CKD, and most patients with stage 1 or 2 disease do not need a specialist. The threshold for specialist referral typically includes a falling eGFR, significant proteinuria, uncontrolled blood pressure, or an unexplained cause. Specialist input adds value by identifying causes that primary care testing cannot detect, optimising kidney-protective therapy, and planning ahead so that any future need for dialysis or transplant is anticipated rather than reactive.
Appointments and GP referrals
Appointments are arranged via GP referral only. Dr McQuillan sees patients at Blackrock Clinic, The Beacon Hospital, Bon Secours Dublin, Hermitage Medical Centre, and St Vincent’s Private Hospital. GPs can refer using the practice referral pathway.
Frequently Asked Questions
CKD is a long-term condition that generally cannot be reversed once established, but with the right treatment its progression can be slowed dramatically. Many patients live a normal lifespan with stable kidney function.
An eGFR below 30 (stage 4 CKD) warrants specialist input. An eGFR below 15 (stage 5) usually requires planning for dialysis or transplantation, although timing depends on symptoms and complications.
Most people with CKD never need dialysis. The risk depends on the stage at diagnosis, the underlying cause, and how well the condition is managed. Specialist care substantially reduces the chance of progressing to dialysis.
Yes. Regular moderate exercise is encouraged and is beneficial for blood pressure, weight, mood, and overall cardiovascular health. Patients with advanced CKD should discuss exercise plans with their consultant.
The right diet depends on the stage of CKD and other conditions like diabetes. In general, a Mediterranean-style diet, moderate protein intake, reduced salt, and avoidance of ultra-processed foods are helpful. A renal dietitian can provide personalised advice.
Frequency of review depends on the stage and stability of CKD. Stable stage 3 patients are typically reviewed every six to twelve months. More advanced or unstable disease may require review every one to three months.
Have a Question?
If you’d like more information about Dr. McQuillan’s services or need assistance from the practice team, please get in touch below.
Please note: Appointments are arranged via GP referral.