Understanding Chronic Kidney Disease

What is chronic kidney disease?

Chronic kidney disease, also called CKD, means that your kidneys have been damaged or are not working as well as they should for at least three months.

Your kidneys normally:

• Remove waste and extra fluid from your blood
• Help control blood pressure
• Balance minerals such as potassium and phosphorus
• Help your body make red blood cells
• Help keep your bones healthy

CKD often develops slowly. Many people feel well and have no symptoms during its early stages. Blood and urine tests are the best ways to monitor kidney health.

What causes CKD?

The two most common causes of CKD in adults are:

• Diabetes
• High blood pressure

Other causes may include heart disease, inherited kidney conditions, inflammation of the kidneys, repeated kidney infections, urinary blockage, autoimmune disease, and certain medications.

Understanding your kidney tests

eGFR

The estimated glomerular filtration rate, or eGFR, is calculated from a blood test. It estimates how well your kidneys filter your blood.

An eGFR below 60 does not always mean CKD after only one test. Your healthcare provider will look at whether the abnormality has continued for at least three months and consider your other test results.

Urine albumin

A urine test checks whether protein called albumin is leaking into your urine. Protein in the urine can be an early sign of kidney damage, even when the eGFR is normal.

Ask your healthcare team:

• What is my eGFR?
• Is there protein in my urine?
• Has my kidney function changed?
• What is my blood pressure goal?

Can CKD be treated?

Kidney damage may not always be reversible, but treatment can often slow further loss of kidney function, lower the risk of kidney failure, and protect your heart.

Your treatment plan may include:

• Controlling blood pressure
• Managing diabetes
• Taking kidney-protective medications
• Reducing sodium
• Staying physically active
• Maintaining a healthy weight
• Avoiding tobacco
• Treating anemia, swelling, abnormal potassium, or bone and mineral problems
• Completing blood and urine tests as recommended

Take medications exactly as prescribed. Do not stop a blood pressure or kidney medication because of something you read online without speaking with your healthcare provider.

Protect your kidneys every day

Limit sodium

Too much sodium can raise blood pressure and cause swelling.

A common goal is less than 2,300 milligrams of sodium per day, although your healthcare provider may recommend a different amount.

Helpful steps include:

• Choose fresh foods more often
• Limit canned soups, frozen meals, fast food and processed meats
• Check Nutrition Facts labels
• Look for foods labeled “low sodium” or “no salt added”
• Season food with herbs, spices, lemon or vinegar instead of salt

Avoid salt substitutes unless your healthcare provider approves them. Many contain potassium.

Follow an individualized kidney diet

There is no single diet that is right for everyone with CKD.

Depending on your kidney function and laboratory results, you may need to adjust:

• Sodium
• Protein
• Potassium
• Phosphorus
• Fluids

Do not automatically stop eating fruits, vegetables, dairy products or other nutritious foods. Potassium and phosphorus restrictions are not needed for every person with CKD. Ask your healthcare provider or kidney dietitian what is appropriate for you.

Monitor your blood pressure

• Check your blood pressure at home if instructed.
• Sit quietly for about five minutes before checking it.
• Keep your feet flat on the floor.
• Rest your arm at heart level.
• Record your readings and bring them to appointments.

Your personal blood pressure goal should be determined by your healthcare provider.

Manage diabetes

If you have diabetes:

• Check your blood sugar as directed
• Take medications as prescribed
• Know your A1C goal
• Follow your meal plan
• Report frequent low or high blood sugar readings

Good diabetes control can help protect your kidneys.

Stay active

Regular activity supports blood pressure, heart health, strength and weight management.

A common goal is about 150 minutes of moderate activity each week, when medically appropriate. Walking is an excellent place to start. Ask your healthcare provider what level of exercise is safe for you.

Avoid tobacco

Smoking and other tobacco use can damage blood vessels, increase cardiovascular risk and worsen kidney disease. Ask your healthcare team for help quitting.

Be careful with medications

Some medications and supplements can damage the kidneys or build up when kidney function is reduced.

Avoid NSAID pain relievers unless approved

NSAIDs can reduce blood flow to the kidneys and may cause sudden kidney injury, especially in people with CKD.

Examples include:

• Ibuprofen: Advil® or Motrin®
• Naproxen: Aleve®
• Diclofenac
• Meloxicam
• Celecoxib

Some cold, flu, headache and combination medicines also contain NSAIDs. Read the Drug Facts label and ask your healthcare provider or pharmacist before taking them.

Review all medications

Tell every healthcare professional that you have CKD. Before starting a new medicine, vitamin, herbal product or supplement, ask whether it is safe for your kidneys.

Some medications require a lower dose when kidney function is reduced.

Protect yourself during illness

Vomiting, diarrhea, fever or poor fluid intake can cause dehydration and may temporarily reduce kidney function.

Contact your healthcare team if you:

• Cannot keep fluids down
• Have ongoing vomiting or diarrhea
• Are producing much less urine
• Feel dizzy, weak or dehydrated
• Are unsure whether to continue your medications while ill

Do not stop medications on your own unless you have already received specific instructions.

Possible symptoms of worsening kidney disease

Early CKD often causes no symptoms. As kidney function becomes more reduced, symptoms may include:

• Tiredness or weakness
• Swelling of the feet, ankles, legs or face
• Shortness of breath
• Loss of appetite
• Nausea or vomiting
• Itching
• Muscle cramps
• Difficulty concentrating
• Changes in urination
• Foamy or bloody urine

These symptoms may also have causes unrelated to the kidneys. Report new or worsening symptoms to your healthcare provider.

When should I seek urgent care?

Contact your healthcare provider promptly or seek urgent medical attention for:

• New or rapidly worsening shortness of breath
• Chest pain
• Severe weakness, confusion or fainting
• Very little or no urine
• Rapidly increasing swelling
• Persistent vomiting or inability to drink
• Blood in the urine
• A sudden major increase or decrease in blood pressure
• Rapid weight gain with swelling or breathing difficulty

Will everyone with CKD need dialysis?

No. Many people live for years with stable CKD and never need dialysis.

The risk depends on the cause of kidney disease, the eGFR, the amount of protein in the urine, other health conditions, and how kidney function changes over time.

If CKD becomes advanced, your kidney specialist may discuss treatment options early. These may include:

• Kidney transplantation
• Hemodialysis
• Peritoneal dialysis
• Medical management without dialysis

Learning about these options does not mean that dialysis must begin immediately. Early education allows you and your family to make informed decisions.

Keep your appointments and laboratory testing

Regular monitoring helps your healthcare team:

• Track changes in kidney function
• Check potassium and other minerals
• Monitor anemia
• Review blood pressure and diabetes control
• Adjust medication doses
• Identify complications before they become serious

Bring an updated medication list and your home blood pressure readings to each appointment.