CONDITIONS

Chronic Kidney Disease

What Is Chronic Kidney Disease

Chronic Kidney Disease (CKD) is characterized by the gradual loss of kidney function over time. The kidneys are the body’s blood-filtering organs, removing waste from the blood and sending it to be excreted from the body. When the kidneys aren’t functioning properly, waste builds up in the blood and can cause high blood pressure, anemia, malnutrition, and nerve damage. An estimated 26 million American adults—more than one in ten—have been diagnosed with chronic kidney disease. Incidence rates of CKD have jumped nearly 6 percent in the last 3 decades. Early detection is key to proper treatment for chronic kidney disease. If left untreated, chronic kidney disease can lead to kidney failure, necessitating a kidney transplant and/or causing death.

What Causes Chronic Kidney Disease

Approximately 60% of chronic kidney disease cases are caused by one or both of the following conditions:

  • Diabetes, in which the body is unable to regulate blood sugar levels.
  • High blood pressure, in which a variety of factors cause the blood stream to put increased pressure on blood vessel walls.

Individuals with malformed kidneys or certain kidney-related illnesses such as polycystic kidney disease (in which cysts form in the kidneys) can give individuals a pre-disposition to develop CKD.

Risk Factors For Chronic Kidney Disease

The following factors can influence the risk of developing chronic kidney disease (CKD):

  • Diabetes and high blood pressure.  Approximately 60% of CKD cases are caused by diabetes and high blood pressure.
  • Family history. A family history of kidney disease or failure greatly increases the risk of developing CKD.
  • Ethnicity. African Americans are three times more likely to experience kidney failure than other populations. Hispanic Americans, Asian, Pacific Islanders, and American Indians are also at a higher risk.
  • Age. The likelihood of developing CKD increases with age. Most cases of CKD occur in patients ages 65 and over, though younger adults can also develop the disease.

Diagnosing Chronic Kidney Disease

In making a chronic kidney disease (CKD) diagnosis, your doctor will most likely use a combination of the following tests:

  • Physical exam, to assess the physical symptoms of the disease such as swollen feet and ankles.
  • Medical history, to understand pre-existing conditions that may make you a more likely candidate for CKD, such as diabetes and high blood pressure
  • Family history, to assess your risk of CKD based on heredity.
  • Blood creatinine test. This is the most definitive test available to measure kidney function.  It measures blood creatinine levels in order to determine the glomerular filtration rate (GFR), a measure of overall kidney function. A GFR of under 90 indicates an increased risk of developing CKD, while a GFR of less than 15 indicates kidney failure. To calculate your GFR, click here.
  • Urine analysis to measure albumin creatinine ratio (ACR), an approximation of the amount of albumin (protein) that is in urine.
  • Ultrasound/CT scan. These imaging techniques allow doctors to see the kidneys and help to reveal any kidney enlargement or shrinkage.
  • Kidney biopsy, in which a small portion of the kidney is harvested and examined in the lab to determine the type and extent of kidney disease.

Symptoms of Chronic Kidney Disease

Chronic kidney disease often has no symptoms, especially during the early stages of the disease.

The following are symptoms of chronic kidney disease:

  • Fatigue
  • Loss of appetite
  • Insomnia
  • Difficulty concentrating
  • Swollen feet/ankles
  • Puffiness around eyes
  • Dry/itchy skin
  • Frequent urination
  • Frequent muscle cramps (especially at night)

Prognosis

The prognosis for chronic kidney disease depends largely on when the disease is detected. Survival rates for CKD are approximately 90% at one year after the diagnosis. This number decreases to 65-75% at five years after the diagnosis, and 35-45% 10 years after the diagnosis.

Living With Chronic Kidney Disease

The following steps can help you manage living with chronic kidney disease:

Keep a healthy, balanced diet low in fat, cholesterol, sodium, and potassium. This will help maintain a healthy body weight and prevent CKD risk factors such as diabetes and high blood pressure.

Exercise regularly. Regular exercise can help reduce stress and improve overall health. Remember to always stay within the limitations of your body.

Take all prescribed medications including supplements. If you feel you should not be taking a medication, talk to your doctor about it first. Stopping a medication without first consulting your doctor can have a negative effect.

Screening

Though CKD may not be specifically screened for at a doctor’s visit, tests performed by the doctor at a typical visit, such as blood pressure, blood sugar, and urine analysis, can help determine your risk of CKD and detect early stages of the disease. Visit your doctor regularly to best monitor yourself for CKD.

Prevention

The following steps can help you prevent CKD:

Keep a healthy diet. A balanced, healthy diet low in cholesterol can help you maintain a healthy body weight, cholesterol level, and blood pressure. It can also help prevent the development of type 2 diabetes.

Visit the doctor regularly to monitor for early warning signs of CKD such as high blood pressure and diabetes.

Drink plenty of water. Chronic dehydration can put added stress on the kidneys. Women need on average 2.7 liters of water per day while men may require around 3.7 liters per day. However, be careful not to drink too much water. Excess fluids, especially for someone at-risk for CKD or in early stages of CKD, can put added stress on the kidneys.

Exercise. Regular exercise can help maintain a healthy body weight and protect against CKD risk factors such as high blood pressure and diabetes.

Medication And Treatment

Unfortunately, there are no approved treatments to reverse damage to the kidneys once it has been done. Treatment for chronic kidney disease (CKD) focuses primarily on the maintenance of kidney health and the prevention of disease progression.

Medications that your doctor may prescribe to prevent the worsening of CKD include:


High blood pressure medication, including:

  • Diuretics, to help the kidneys eliminate sodium and water from the body
  • Anti-adrenergics, to limit the action of hormones epinephrine and norepinephrine, relaxing the blood vessels and reducing the speed and force of the heart’s contraction.
  • Direct-acting vasodilators, to relax the arteries (often used in emergency settings).
  • Calcium channel blockers, to weaken heart contractions and dilate blood vessels.
  • Angiotensin-converting enzyme (ACE) inhibitors, to take stress off the heart muscle by lowering blood pressure levels. This is among the most commonly prescribed high blood pressure medication for CKD patients.
  • Angiotensin-receptor blockers (ARBs), to dilate blood vessels and stimulate salt and water retention.
  • Direct renin inhibitors, to control blood vessel dilation.

For more information on high blood pressure treatment and medication, visit the High Blood Pressure/Hypertension condition center.


Diabetes-management medications to help manage blood sugar levels, including:

  • Alpha-glucosidase inhibitors
  • Biguanides
  • DPP IV inhibitors
  • Insulin
  • Meglitinides
  • Sulfonylureas
  • Thiazolidinediones

For more information on diabetes treatment and medication, visit the Diabetes condition center [NOTE: hyperlink to Diabetes condition center]


Phosphate inhibitors, to regulate blood phosphate levels.


Nutritional supplements such as:

  • Iron
  • Calcium
  • Vitamin D

In addition to medication, your doctor may suggest lifestyle changes. These include:

  • Quitting smoking
  • Regularly exercising
  • Monitoring blood sugar and blood pressure
  • Eating a diet low in cholesterol, fat, sodium, and potassium.
  • Limiting fluid intake

Complementary and Alternative Treatment

The following treatments may be effective in the treatment of CKD:

  • Stress reduction practices such as meditation, yoga, tai chi, deep breathing, and guided meditation. Reducing stress helps to decrease the risk of heart attack and can help relieve CKD-related symptoms such as fatigue.
  • Acupuncture.  Acupuncture is a form of traditional Chinese medicine in which small needles are inserted into the body at specific points designed to restore the flow of bodily energy. Studies have shown that acupuncture treatments are effective at stress and pain relief.

**Warning: patients with CKD are not recommended to take herbal supplements. Herbal supplements are largely unregulated by the FDA and often contain minerals such as phosphorous that can be harmful to the kidneys. Consult a doctor and use your discretion before taking herbal supplements for CKD.

When To Contact A Doctor

If you experience any of the symptoms of chronic kidney disease or if your symptoms worsen, schedule an appointment with your doctor.

If you are taking medications and experience any of the following symptoms, call your doctor immediately:

  • Nausea
  • Vomiting
  • Worsened fatigue
  • Shortness of breath**
  • Chest pain**
  • Lightheadedness
  • Headache
  • Excessive sweating
  • Rapid weight gain/loss
  • Changes in sleep pattern
  • Loss of ability to concentrate

** Call emergency services. These may be signs of a heart attack.

Questions For A Doctor

You may want to ask your doctor the following questions:

  • What stage is my CKD?
  • What are the available treatments?
  • What are the side effects for those treatments?
  • Can I prevent disease progression?
  • What is my prognosis?
  • What can I do to help improve my condition?
  • Should I make any lifestyle changes? If so, what changes should I make?
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