Chronic kidney disease

• Diabetes. Diabetes is the leading cause of CKD. High blood glucose, also called blood sugar, from diabetes can damage the blood vessels in your kidneys. Almost 1 in 3 people with diabetes has CKD.1

• High blood pressure. High blood pressure is the second leading cause of CKD. Like high blood glucose, high blood pressure also can damage the blood vessels in your kidneys. Almost 1 in 5 adults with high blood pressure has CKD.1

• Heart disease. Research shows a link between kidney disease and heart disease. People with heart disease are at higher risk for kidney disease, and people with kidney disease are at higher risk for heart disease. Researchers are working to better understand the relationship between kidney disease and heart disease.

• Family history of kidney failure. If your mother, father, sister, or brother has kidney failure, you are at risk for CKD. Kidney disease tends to run in families. If you have kidney disease, encourage family members to get tested. Use tips from the family health reunion guide and speak with your family during special gatherings.

Early CKD may not have any symptoms

You may wonder how you can have CKD and feel fine. Our kidneys have a greater capacity to do their job than is needed to keep us healthy. For example, you can donate one kidney and remain healthy. You can also have kidney damage without any symptoms because, despite the damage, your kidneys are still doing enough work to keep you feeling well. For many people, the only way to know if you have kidney disease is to get your kidneys checked with blood and urine tests.

As kidney disease gets worse, a person may have swelling, called edema. Edema happens when the kidneys can’t get rid of extra fluid and salt. Edema can occur in the legs, feet, or ankles, and less often in the hands or face.

• chest pain

• dry skin

• itching or numbness

• feeling tired

• headaches

• increased or decreased urination

• loss of appetite

• muscle cramps

• nausea

• shortness of breath

• sleep problems

• trouble concentrating

• vomiting

• weight loss

People with CKD can also develop anemia, bone disease, and malnutrition.

Kidney disease can lead to other health problems, such as heart disease. If you have kidney disease, it increases your chances of having a stroke or heart attack.

High blood pressure can be both a cause and a result of kidney disease. High blood pressure damages your kidneys, and damaged kidneys don’t work as well to help control your blood pressure.

If you have CKD, you also have a higher chance of having a sudden change in kidney function caused by illness, injury, or certain medicines. This is called acute kidney injury (AKI).

As a first step toward diagnosis of kidney disease, your doctor discusses your personal and family history with you. Among other things, your doctor might ask questions about whether you've been diagnosed with high blood pressure, if you've taken a medication that might affect kidney function, if you've noticed changes in your urinary habits, and whether you have any family members who have kidney disease.

Next, your doctor performs a physical exam, also checking for signs of problems with your heart or blood vessels, and conducts a neurological exam.

For kidney disease diagnosis, you may also need certain tests and procedures, such as:

• Blood tests. Kidney function tests look for the level of waste products, such as creatinine and urea, in your blood.

• Urine tests. Analyzing a sample of your urine may reveal abnormalities that point to chronic kidney failure and help identify the cause of chronic kidney disease.

• Imaging tests. Your doctor may use ultrasound to assess your kidneys' structure and size. Other imaging tests may be used in some cases.

• Removing a sample of kidney tissue for testing. Your doctor may recommend a kidney biopsy to remove a sample of kidney tissue. Kidney biopsy is often done with local anesthesia using a long, thin needle that's inserted through your skin and into your kidney. The biopsy sample is sent to a lab for testing to help determine what's causing your kidney problem.

Depending on the underlying cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure.

Treatment usually consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. If your kidneys become severely damaged, you may need treatment for end-stage kidney disease.

Treatment options vary, depending on the cause. But kidney damage can continue to worsen even when an underlying condition, such as high blood pressure, has been controlled.

Kidney disease complications can be controlled to make you more comfortable. Treatments may include:

• High blood pressure medications. People with kidney disease may experience worsening high blood pressure. Your doctor may recommend medications to lower your blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers — and to preserve kidney function. High blood pressure medications can initially decrease kidney function and change electrolyte levels, so you may need frequent blood tests to monitor your condition. Your doctor will likely also recommend a water pill (diuretic) and a low-salt diet.

• Medications to lower cholesterol levels. Your doctor may recommend medications called statins to lower your cholesterol. People with chronic kidney disease often experience high levels of bad cholesterol, which can increase the risk of heart disease.

• Medications to treat anemia. In certain situations, your doctor may recommend supplements of the hormone erythropoietin (uh-rith-roe-POI-uh-tin), sometimes with added iron. Erythropoietin supplements aid in production of more red blood cells, which may relieve fatigue and weakness associated with anemia.

Anemia is a frequent complication of chronic kidney disease (CKD) and it is associated with a decrease in the quality of life of patients, it causes an increase in morbidity and mortality and accelerates the rate of progression of CKD. In patients with CKD, anemia is defined as the situation in which the concentration of hemoglobin (Hb) in the blood is below 2 times the SD of the mean Hg of the general population, corrected for age and sex.

• Medications to relieve swelling. People with chronic kidney disease may retain fluids. This can lead to swelling in the legs, as well as high blood pressure. Medications called diuretics can help maintain the balance of fluids in your body.

• Medications to protect your bones. Your doctor may prescribe calcium and vitamin D supplements to prevent weak bones and lower your risk of fracture. You may also take medication known as a phosphate binder to lower the amount of phosphate in your blood, and protect your blood vessels from damage by calcium deposits (calcification).

• A lower protein diet to minimize waste products in your blood. As your body processes protein from foods, it creates waste products that your kidneys must filter from your blood. To reduce the amount of work your kidneys must do, your doctor may recommend eating less protein. Your doctor may also ask you to meet with a dietitian who can suggest ways to lower your protein intake while still eating a healthy diet.

If your kidneys can't keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure, you have end-stage kidney disease. At that point, you need dialysis or a kidney transplant.

As part of your treatment for chronic kidney disease, your doctor may recommend a special diet to help support your kidneys and limit the work they must do. Ask your doctor for a referral to a dietitian who can analyse your current diet and suggest ways to make your diet easier on your kidneys.

Depending on your situation, kidney function and overall health, your dietitian may recommend that you:

• Avoid products with added salt. Lower the amount of sodium you eat each day by avoiding products with added salt, including many convenience foods, such as frozen dinners, canned soups and fast foods. Other foods with added salt include salty snack foods, canned vegetables, and processed meats and cheeses.

• Choose lower potassium foods. Your dietitian may recommend that you choose lower potassium foods at each meal. High-potassium foods include bananas, oranges, potatoes, spinach and tomatoes. Examples of low-potassium foods include apples, cabbage, carrots, green beans, grapes and strawberries. Be aware that many salt substitutes contain potassium, so you generally should avoid them if you have kidney failure.

• Limit the amount of protein you eat. Your dietitian will estimate the appropriate number of grams of protein you need each day and make recommendations based on that amount. High-protein foods include lean meats, eggs, milk, cheese and beans. Low-protein foods include vegetables, fruits, breads and cereals.

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References

1. Centers for Disease Control and Prevention. National Chronic Kidney Disease Fact Sheet, 2017.  (PDF, 1.32 MB) . Accessed June 7, 2017.

2. Race, ethnicity, and kidney disease. NIDDK website. Published June 13, 2017. Accessed June 13, 2017.
   June 2017