What Is Chronic Kidney Disease (CKD)?

CKD is often managed successfully with lifestyle changes, but it can lead to irreversible damage that will require dialysis or a kidney transplant.

• Stage 1 You have mild kidney damage, but your kidneys are working well.
• Stage 2 You have more kidney damage, but your kidneys are still working well.
• Stage 3 You have moderately decreased kidney function, and you may show some symptoms of CKD.
• Stage 4 You have poor kidney function with moderate to severe kidney damage. You almost certainly have symptoms of CKD.
• Stage 5 You have, or nearly have, kidney failure. You need dialysis or a kidney transplant to stay alive.

Chronic kidney disease may not cause symptoms until severe damage has occurred. Early CKD symptoms can also be nonspecific and may appear to be symptoms of another health condition.

• Fatigue or loss of energy
• Difficulty concentrating
• Loss of appetite
• Muscle cramps (especially at night)
• Swelling in your feet and ankles
• Dry or itchy skin
• More or less frequent urination
• Nausea or vomiting
• Chest pain
• Shortness of breath

• Diabetes (type 1 or type 2)
• High blood pressure
• Heart disease
• Glomerulonephritis, which involves damage to the kidney’s filtering units
• Polycystic kidney disease, a genetic disorder that causes cysts to form in the kidneys
• Lupus
• Urinary tract obstruction, potentially due to an enlarged prostate, kidney stones, or cancer
• Vesicoureteral reflux, a backup of urine in your kidneys
• Recurrent kidney infections

Blood and Urine Tests

• Glomerular Filtration Rate (GFR) This blood test estimates how efficiently your kidneys are filtering your blood.
• Urine Albumin Test This test looks at how much protein and blood are in your urine, which can indicate kidney damage.

Imaging Tests

• Ultrasound, which uses sound waves to make picture of the kidneys
• Magnetic resonance imaging (MRI), which uses magnets and radio waves to make 3D pictures
• Computerized tomography (CT), which uses X-rays and computer technology to create detailed images

Kidney Biopsy

Medications

Depending on the specific causes and stage of your CKD, your doctor may prescribe one or more of the following medications to help preserve kidney function and lower your risk of developing heart disease:

• Angiotensin-Converting Enzymes (ACE) Inhibitors or Angiotensin II Receptor Blockers (ARB) These drugs help lower your blood pressure and may help delay CKD progression.

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• GLP-1 Receptor Agonists These drugs, more commonly known as diabetes or weight loss meds, help slow CKD and lower heart disease risk for those who have type 2 diabetes or obesity.

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• SGLT2 Inhibitors Originally developed to treat type 2 diabetes, these drugs have also been found to help slow CKD progression. You don’t need to have diabetes to take these drugs for CKD.

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• Statins These medications help lower cholesterol levels, which reduces the risk of heart disease, a common complication of CKD.

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• Diuretics to reduce swelling and remove excess fluid
• Erythropoietin to treat anemia
• Calcium and vitamin D supplements to help prevent bone loss
• A phosphate binder to help protect your blood vessels from calcium deposits

Dialysis

• Hemodialysis In this process, your blood is sent through an artificial kidney machine (hemodialyzer) and returned to your body. Typically, each treatment lasts about four hours and takes place three times a week.
• Peritoneal Dialysis This process, which may be done at home, takes place inside your body, and involves filling your abdominal cavity with a solution (dialysate) that draws extra waste products and fluid from your blood. It can be done either manually or using a machine that pumps the solution in and out of your body.

Dialysis does not improve your kidney function, and you’ll need to continue with it for the rest of your life unless you receive a kidney transplant. While the average life expectancy for people on dialysis is 5 to 10 years, many people live much longer.

Kidney Transplantation

• Diabetes
• High blood pressure
• Gout
• Lupus
• Skin cancer

A transplanted kidney can come from either a deceased or living donor. You may decide, with your doctor, to get a transplant before you need dialysis or soon after starting on dialysis.

Your doctor or a dietitian may recommend certain lifestyle measures to help reduce damage to your kidneys. Recommended lifestyle changes may include dietary changes and other new healthy habits that can support better metabolic health.

Dietary Changes

• Minimize protein intake. This could help with CKD progression, since protein increases the workload of the kidneys.

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• Decrease intake of sodium. This can lower blood pressure and lessen the strain on the kidneys to filter out excess sodium.

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• Watch potassium intake. Monitor this if advised to do so by your doctor. When kidney function falls below a certain level, there’s a risk of potassium levels getting too high.

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• Minimize phosphorus intake. Do this in the later stages of CKD, since the kidneys can’t remove this mineral very well.

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Other Lifestyle Changes

The general lifestyle recommendations for people with CKD are similar to anyone who’s seeking to follow a healthy lifestyle.

• Get a regular amount of physical activity. However, there is mixed data on whether this helps slow down CKD progression.

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   Exercise might need to be modified depending on factors like fatigue.

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• Stop smoking if you still do. Cigarettes may make CKD worsen faster, while quitting may help slow disease progression down.

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• Get to and maintain a healthy weight. Obesity may contribute to CKD progressing faster.

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  People in earlier stages of CKD may have different goals for weight than people in end-stage kidney disease when there is more risk for malnutrition.

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• Avoid excessive alcohol consumption. The relationship between alcohol and CKD is complicated, but binge drinking may increase the odds of CKD getting worse.

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The prognosis for CKD can vary wildly, depending on factors such as your age, overall health, the type of treatment you receive, and how well you follow your treatment plan. Most people with CKD will never progress to more severe stages or kidney failure.

• Pulmonary edema, or fluid in the lungs
• Hyperkalemia, or high blood potassium levels
• Anemia
• Hyperphosphatemia, a high blood phosphorus level
• Low bone mineral density, known as osteopenia
• High blood pressure
• Heart disease
• Insulin resistance

CKD is also more common in people older than 65 and slightly more common in women.

National Kidney Foundation

This group advocates for improving treatment for kidney disease and addressing health disparities. They also foster community connection and provide online information about kidney disease treatment and living with kidney disease. They do fundraising events, like the Kidney Walk, which involves events throughout the country to raise money for kidney disease research.

American Kidney Fund

This group advocates for kidney patients at various stages of diagnosis. They help fund over 130 monthly kidney transplants and support nephrology research. The group is passionate about health equity and also seeks to advocate for governmental policy for people with kidney disease.

• Chronic kidney disease (CKD) occurs when the kidneys gradually lose their ability to filter waste. It is most common in people with diabetes and high blood pressure, and may have no symptoms in its early stages.
• CKD is classified into five stages based on kidney function. Symptoms like fatigue, swelling, nausea, and urinary changes may emerge in more advanced stages.
• CKD can be diagnosed with blood, urine, and imaging tests, and treatment may involve medications or lifestyle changes. There is no cure for this condition.
• Following healthy habits like reducing salt and protein intake, staying active, and managing blood pressure and weight can slow the progression of CKD.