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Chronic Kidney Disease

Key Points

More than 1 in 7 American adults has chronic kidney disease (CKD).

CKD is common among adults in the United States. More than 35.5 million American adults may have CKD.

As many as 9 in 10 don't know they have it.

Specific blood and urine tests are needed to check for CKD.

CKD can be treated (the earlier treatment starts the better).

Kidney diseases are a leading cause of death in the United States.

About 360 people begin treatment for kidney failure (dialysis or kidney transplant) every day.

National Kidney Month

March is National Kidney Month, a time when communities across the country raise awareness about kidney disease. This year’s focus is on taking charge of your health and the many factors that go into managing your kidney disease.

Chronic kidney disease (CKD) is a serious condition affecting around 35.5 million people. Often overlooked until symptoms appear, CKD is progressive and can put you at risk for serious health complications including heart attack, stroke, and kidney failure. Adopting a healthy lifestyle can help you manage CKD and its complications from progressing.

About your Kidneys and CKD

Your hard-working kidneys

Your kidneys, each just the size of a computer mouse, filter all the blood in your body every 30 minutes. They work hard to remove wastes, toxins, and excess fluid. They also:

Help control blood pressure.

Signal the body to make red blood cells.

Help keep your bones healthy.

Regulate blood chemicals that are essential to life.

Kidneys that function properly are critical for maintaining good health.

CKD

CKD is a condition in which the kidneys are damaged and can't filter blood as well as they should. Because of this, excess fluid and waste remain in the body and may cause health problems such as heart disease.

Other health problems related to CKD include:

Anemia or low number of red blood cells.

Increased occurrence of infections.

Low calcium levels, high potassium levels, and high phosphorus levels in the blood.

Loss of appetite or eating less.

Depression or lower quality of life.

CKD has varying levels of seriousness. It usually gets worse over time, though treatment has been shown to slow progression. CKD can progress to kidney failure and early cardiovascular disease.

When the kidneys stop working, dialysis or kidney transplant is needed for survival. Kidney failure treated with dialysis or kidney transplant is called end-stage kidney disease. Not all people with kidney disease progress to kidney failure.

Types of Kidney Disease

CKD is a condition where your kidneys can't filter toxins or extra fluid from your blood as well as they should. While the condition can vary in how serious it is, CKD usually gets worse over time. Treatment can slow the progression of the disease.

If left untreated, CKD may lead to kidney failure. At this stage, called end-stage renal disease (ESRD), the condition must be treated by dialysis or kidney transplant. Diabetes and high blood pressure are the leading causes of CKD.

It's estimated that 1 in 7 adult Americans have the condition. But 40% of those with serious chronic kidney disease aren't aware they have the condition.

Other common forms of kidney disease include:

Polycystic kidney disease. This genetic disorder causes cysts (fluid-filled sacs) to grow on your kidneys, limiting their ability to filter waste from your blood.

Lupus nephritis. Lupus is an autoimmune disease, meaning your immune system attacks healthy cells. Lupus nephritis is when your immune system attacks your kidneys.

Interstitial nephritis. This condition happens when you have a bad reaction to a medicine that limits your kidneys' ability to filter toxins. If you stop the medicine, your kidney health should improve.

Glomerulonephritis (glomerular disease). Glomeruli are the thousands of tiny filters that remove waste from your blood in your kidneys. This condition damages them, and your kidneys can't function as well. Inflammation in the glomeruli can happen after a strep infection, as well.

APOL1-mediated kidney disease. Normally, the APOL1 gene helps make an immune system protein, but if you inherit a mutated version of the gene from both parents, you may be more at risk for kidney disease. You may be more likely to have this gene mutation if you identify as Black, African American, Afro-Caribbean, or Latina/Latino.

Long-lasting viral illnesses. HIV and AIDS, hepatitis B, and hepatitis C may cause kidney disease.

Pyelonephritis. This is a urinary tract infection within the kidneys, which can result in scarring as the infection heals. It can lead to kidney damage if it happens several times.

Stages of CKD

There are five stages of chronic kidney disease. The stages are based on how well your kidneys are able to filter out waste from your blood. Blood and urine tests determine which stage of CKD you’re in.

The stages range from very mild (stage 1) to kidney failure (stage 5). Healthcare providers determine the stage of your kidney function according to the glomerular filtration rate (eGFR). Your eGFR is a number based on the amount of creatinine, a waste product, found in your blood.

Stage	eGFR (mL/min)	What It Means	Symptoms
Stage 1	90 and higher	Your kidneys are working well but you have signs of mild kidney damage.	Typically asymptomatic
Stage 2	60 to 89	Your kidneys are working well but you have more signs of mild kidney damage.	Typically asymptomatic
Stage 3a	45 to 59	Your kidneys aren’t working as well as they should and show mild to moderate damage. This is the most common stage. You may notice symptoms at this stage.	Fatigue Weakness
Stage 3b	30 to 44	Your kidneys show moderate damage and don’t work as well as they should. With the right treatment, many people can stay in this stage and never advance to stage 4.	Kidney pain Foamy urine Restless legs Muscle cramps Itchy skin Swelling of hands or feet Sleep problems
Stage 4	15 to 29	You have very poor kidney function; your kidneys are severely damaged and close to not working.	Headache Urinating more or less often Loss of appetite Blood in your urine Inability to concentrate Swelling around eyes and ankles Easy bruising
Stage 5	Less than 15	Your kidneys are very close to failing or have stopped working. You may need kidney dialysis or a kidney transplant at this stage.	Shortness of breath Chest pain or pressure Nausea or vomiting Bone pain Weight loss Skin and nail changes Irregular heartbeats Little or no urination

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.

As the disease worsens, symptoms may include:

A need to pee more often.

Tiredness, weakness, low energy level.

Loss of appetite.

Swelling of your hands, feet and ankles.

Shortness of breath.

Foamy or bubbly pee.

Puffy eyes.

Dry and itchy skin.

Trouble concentrating.

Trouble sleeping.

Numbness.

Nausea or vomiting.

Muscle cramps.

High blood pressure.

Darkening of your skin.

Keep in mind that it can take years for waste to build up in your blood and cause symptoms.

Reducing Risk

Keep your blood pressure below 140/90 mm Hg (or the target your doctor sets for you).

If you have diabetes, stay in your target blood sugar range as much as possible.

Get active. Physical activity helps control blood pressure and blood sugar levels.

Lose weight if needed.

Get tested for CKD regularly if you're at risk.

If you have CKD, meet with a dietician to create a kidney-healthy eating plan. The plan may need to change as you get older or if your health status changes.

Take medicines as instructed and ask your doctor about blood pressure medicines called angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, which may protect your kidneys in addition to lowering blood pressure.

If you smoke, make a plan to quit. Smoking can worsen kidney disease and interfere with medication that lowers blood pressure.

Include a kidney doctor (nephrologist) on your health care team.

CKD by the numbers

Kidney diseases are a leading cause of death in the United States.

CKD is most common among people ages 65 or older (34%), followed by people ages 45 to 64 (12%), and people ages 18 to 44 (6%).

CKD is slightly more common in women (14%) than in men (12%).

About 35.5 million US adults are estimated to have CKD, and most are undiagnosed.

About 20% of non-Hispanic Black adults have CKD.

40% of people with severely reduced kidney function (not on dialysis) are not aware of having CKD.

Every 24 hours, 360 people begin dialysis treatment for kidney failure.

In the United States, diabetes and high blood pressure are the leading causes of kidney failure, accounting for 2 out of 3 new cases.

In 2019, treating Medicare beneficiaries with CKD cost $87.2 billion, and treating people with end-stage kidney disease cost an additional $37.3 billion.

Medicare spending for beneficiaries with CKD (not including ESKD) ages 66 or older was nearly $77 billion in 2021, representing 24.1% of Medicare spending in this age group.

Medicare-related spending for beneficiaries with ESKD totaled $52.3 billion in 2021.

In 2021, annual per-person spending attributable to Medicare Parts A, B, and D was more than double for beneficiaries ages 66 or older with CKD ($28,162) compared with those without CKD ($13,604).

CKD and Kidney Testing

CKD happens when your kidneys become damaged over time and can't filter your blood as well. Diabetes is a leading cause of CKD, and there are often no symptoms until your kidneys are badly damaged.

If you find and treat kidney disease early, you may be able to manage CKD and prevent other health complications. But the only way to know how well your kidneys are working is to get tested.
Urine Tests

One of the earliest signs of kidney disease is when protein leaks into your urine (proteinuria). Urine testing can check for this. There are two types of urine tests that can check your protein levels.

Dipstick urine test. A dipstick is a chemically treated paper placed in your urine sample. It changes color if your levels are above normal. This test is often done as part of overall urine testing. It can also be done as a quick test to look for albumin (a protein produced by your liver) in your urine.

A dipstick urine test doesn't provide an exact measurement of albumin but does let your doctor know if your levels are normal. If you have abnormal albumin levels, your doctor may want to run further tests.

Urine albumin-to-creatinine ratio (UACR). This test measures the amount of albumin and compares it to the amount of creatinine (a normal waste product from your muscles) in your urine. A UACR test lets the doctor know how much albumin passes into your urine over a 24-hour period. A urine albumin test result of 30 or above may mean kidney disease.

It's important to know that:

The test may be repeated once or twice to confirm the results.

If you have kidney disease, your albumin level in your urine helps your doctor determine the best treatment option.

If your urine albumin level stays the same or goes down, it means your treatment is working.

Serum Creatinine

Because your kidneys remove waste, toxins, and extra fluid from the blood, blood tests can check your kidney function. They will show how well and how quickly your kidneys are doing their job to remove waste.

A serum creatinine blood test measures the amount of creatinine in your blood. If your kidneys aren't working well, your creatinine level goes up. Normal levels for you will depend on your sex, age, and muscle mass.

Usually a creatinine level more than 1.2 for women and 1.4 for men may mean the kidneys aren't working well.
Estimated Glomerular Filtration Rate (eGFR)

The eGFR is a blood test that measures how well your kidneys remove waste, toxins, and extra fluid from your blood. Your serum creatinine level, age, and sex are used to calculate your eGFR number. Like other kidney tests, a normal eGFR number for you will depend on your age and sex.

If your eGFR is low, your kidneys are likely not working as they should. As kidney disease progresses, your eGFR goes down. The results of your test can mean the following:

If your eGFR is 60 or more together with a normal urine albumin test, you are in the normal range. But you'll still want to talk to your doctor about when you should be checked again.

If your eGFR is less than 60, it may mean you have kidney disease. You'll want to talk to your doctor about treatment options that are best for you.

If your eGFR is less than 15, it may mean your kidneys are failing. If your results show kidney failure, you'll likely need dialysis or a kidney transplant. If your eGFR level is less than 20 over 6 to 12 months, your doctor may consider a kidney transplant.
Blood Urea Nitrogen (BUN)

A BUN is a blood test that measures the amount of urea nitrogen in your blood. Urea nitrogen is a waste product your body makes from the breakdown of protein in the foods you eat. Healthy kidneys filter urea nitrogen out of your blood, which leaves your body through your urine. This process helps keep your BUN level within a normal range.

A normal BUN level depends on your age and other health conditions, but usually ranges from 7 to 20. If your BUN level is higher than normal, this may be a sign that your kidneys aren't working well. As kidney disease progresses, your BUN level goes up.

Other Tests

Your doctor may also perform other tests to check your kidneys. These could include monitoring your blood pressure, running imaging tests, or performing a kidney biopsy. Kidney testing helps you and your doctor determine the best treatment plan for you.

CKD Treatment

The treatment of CKD varies by the stage of the disease, the underlying causes, and other factors.

Lifestyle

Lifestyle changes are recommended at every stage of CKD to keep you healthy and slow the progression of the disease.

These include:

Limiting salt intake: People with CKD and hypertension should consume no more than 2,400 milligrams (mg) of sodium from all sources daily.

Limiting protein intake: Talk to your healthcare provider about the appropriate amount of protein for your stage of CKD and how to balance your diet.

Quitting cigarettes: Cigarette smoking causes the narrowing of arteries and veins, further restricting blood flow to the kidneys. Smokers with diabetes also have a harder time controlling their blood sugar, even with insulin injections.

Maintaining a healthy weight: This includes eating a balanced diet and exercising at least 150 minutes weekly. Shedding excess pounds helps lower blood pressure and blood sugar.

Medications

Different medications may be prescribed to manage the underlying causes and complications of CKD, including:

ACE (angiotensin-converting enzyme) inhibitors like Altace (ramipril) and Vasotec (enalapril) that reduce blood pressure

Antidiabetic drugs like Farxiga (dapagliflozin) that reduce blood sugar

Loop diuretics like Lasix (furosemide) that treat fluid overload

Statin drugs like Lipitor (atorvastatin) and Zocor (simvastatin) that lower cholesterol

Potassium binders like Lokelma (sodium zirconium cyclosilicate) that treat high potassium

Iron supplements or erythropoietin infections that treat anemia

Calcium supplements that replace lost calcium and protect bones

Dialysis

For the small proportion of people who progress to ESRD, dialysis may be needed to remove waste from your body when the kidneys can no longer do so.

There are two types commonly used:

Hemodialysis involves a machine that removes wastes and fluids from your blood. It is performed in a center three times weekly, with each treatment lasting four hours. There are also home units you can connect yourself to four to five times weekly.

Peritoneal dialysis is a procedure performed at home using the lining of the abdomen as a filter. Fluids are manually pumped into and suctioned out of the abdomen several times a day to remove waste. Newer continuous cycling machines allow you to do so while you are asleep.

Kidney Transplant

A kidney transplant is another treatment option for ESRD. Typically, when a person with CKD has an eGFR of 20, they are assessed to determine if they are a candidate for a transplant and placed on a waiting list.

The kidney may come from a deceased or living donor. The donor is "matched" so that their blood and tissue types are compatible, minimizing the risk of organ rejection.

A transplant can be performed without dialysis if the kidney failure is progressing slowly and the symptoms can be controlled with diet and medications. If not, a person may be placed on dialysis until a donor kidney is received.

Daily CKD Management

Managing CKD requires a commitment to good health. In addition to making lifestyle changes, the National Institutes of Health recommend that you aim for the following goals in your daily life:

Control your blood pressure: The blood pressure goal is less than 140/90 millimeters of mercury (mm Hg) for most people. If you cannot do so with diet and exercise, speak with your healthcare provider about ACE inhibitors and other drugs that can help.

Meet your blood sugar goals: You must regularly check your blood glucose (sugar) levels and A1C (the average blood glucose levels over the past three months). The A1C goal for many people with diabetes is under 7%.

Build a sustainable diet: Building a healthy, balanced diet when foods are restricted is important. To better meet your daily nutritional needs, ask your healthcare provider for a referral to a dietitian certified in managing CKD.

Manage your stress: Depression is common among people with CKD and can make the disease harder to manage. If you have trouble coping, speak with a mental health professional, connect with a support group, or reach out to friends or family members. Avoid drugs and alcohol, and try to get at least seven to eight hours of sleep per night.

It is also important to stay in touch with your care team. Your kidney specialist (nephrologist) monitors your lab results and adjusts treatment if there are changes in your kidney function. Let your nephrologist and care team know about any changes in your health or treatment, including those unrelated to your kidneys.

Can You Prevent Chronic Kidney Disease?

Diabetes and high blood pressure are the number one and two causes of CKD, respectively. By avoiding (or properly managing) these chronic diseases, you may reduce your risk of CKD. This includes eating right, exercising routinely, maintaining your ideal weight, and quitting cigarettes.

What are common causes of kidney disease?

Kidney diseases happen when your kidneys are damaged and can’t filter your blood. With chronic kidney disease, the damage tends to happen over the course of several years.

High blood pressure (hypertension) and diabetes are the two most common causes of chronic kidney disease. Other causes and conditions that affect kidney function and can cause chronic kidney disease include:

Glomerulonephritis. This type of kidney disease involves damage to the glomeruli, which are the filtering units inside your kidneys.

Polycystic kidney disease. This is a genetic disorder that causes many fluid-filled cysts to grow in your kidneys, reducing the ability of your kidneys to function.

Membranous nephropathy. This is a disorder where your body’s immune system attacks the waste-filtering membranes in your kidney.

Obstructions of the urinary tract from kidney stones, an enlarged prostate or cancer.

Vesicoureteral reflux. This is a condition in which pee flows backward back up your ureters to your kidneys.

Nephrotic syndrome. This is a collection of symptoms that indicate kidney damage.

Recurrent kidney infection (pyelonephritis).

Diabetes-related nephropathy. This is damage or dysfunction of one or more nerves, caused by diabetes.

Lupus and other immune system diseases that cause kidney problems, including polyarteritis nodosa, sarcoidosis, Goodpasture syndrome and Henoch-Schönlein purpura.

Is kidney disease hereditary?

Yes, kidney disease can run in biological families. Risk factors for CKD, like diabetes, also tend to run in families.

Risk Factors

Diabetes

CKD is common in people with diabetes. Approximately 1 in 3 adults with diabetes has CKD.

Each kidney is made up of millions of tiny filters called nephrons. High blood sugar from diabetes can damage blood vessels in the kidneys and nephrons so they don't work well.

High blood pressure

Approximately 1 in 5 adults with high blood pressure has CKD. High blood pressure can make blood vessels narrower, reducing blood flow. Over time, blood vessels throughout the body weaken, including in the kidneys.

Damaged blood vessels in the kidneys may no longer work properly. When this happens, the kidneys can't remove all wastes and extra fluid from your body. Extra fluid can raise your blood pressure even more.

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 CKD

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.

Obesity

Having overweight or obesity raises your risk for high blood pressure and diabetes, the two biggest causes of CKD. This means that having overweight or obesity puts you at greater risk for CKD.

Medicare Costs

In 2019, treatment for Medicare beneficiaries with CKD cost $87.2 billion, and treatment for people with ESKD cost an additional $37.3 billion.

Costs can be reduced by preventing:

CKD in people at risk.

CKD progressing to ESKD.

Other chronic conditions such as type 2 diabetes and heart disease, which can lead to CKD.

Who is part of my health care team?

The following health care providers may be part of the health care team involved in your treatment:

Primary care provider. Your primary care provider (PCP)—doctor, nurse practitioner, or physician assistant—is the person you see for routine medical visits. Your PCP may monitor your kidney health and help you manage your diabetes and high blood pressure. A PCP also prescribes medicines and may refer you to specialists.

Nurse. A nurse may help with your treatment and teach you about monitoring and treating kidney disease, as well as managing your health conditions. Some nurses specialize in kidney disease.

Registered dietitian. A registered dietitian is a food and nutrition expert who helps people create a healthy eating plan when they have a health condition such as kidney disease. Dietitians can help you by creating an eating plan based on how your kidneys are doing. “Renal dietitians” often work in dialysis centers and are specially trained to work with people with kidney failure.

Diabetes educator. A diabetes educator teaches people with diabetes how to manage their disease and handle diabetes-related problems.

Pharmacist. A pharmacist educates you about your medicines and fills your prescriptions. An important job for the pharmacist is to review all of your medicines, including over-the-counter (OTC) medicines, and supplements, to avoid unsafe combinations and side effects.

Social worker. When you are close to needing dialysis, you may have a chance to meet with a social worker. A dialysis social worker helps people and their families deal with the life changes and costs that come with having kidney disease and kidney failure. A dialysis social worker also can help people with kidney failure apply for help to cover treatment costs.

Nephrologist. A nephrologist is a doctor who is a kidney specialist. Your PCP may refer you to a nephrologist if you have a complicated case of kidney disease, your kidney disease is quickly getting worse, or your kidney disease is advanced.

Outlook

The prognosis (outlook) of acute kidney injury is generally good if treated appropriately. In some cases, AKI may be a one-off event without impacting your long-term health or life expectancy.

The prognosis of chronic kidney disease can vary by the individual. With that said, most people with CKD do not progress to ESRD because symptoms tend to develop in later life and can usually be managed with medications and diet. The most common cause of death in people with CKD is heart disease rather than kidney failure.

The risk of death is largely influenced by the stage of CKD. According to a 2017 study in Pediatric Nephrology, a 30-year-old male with an eGFR of 60 and over can expect to live to 79, while a counterpart with an eGFR under 15 may only live to 45.

Prognosis for End-Stage Renal Failure

For those who progress to ESRD, dialysis and kidney transplantation are the only options for survival. If neither is pursued, death usually occurs within several days or weeks.

Those pursuing dialysis have a far better outlook, with an average life expectancy of five to 10 years.

Success rates for kidney transplants are equally optimistic, with 78.2% of those who received a kidney from a deceased donor living for at least five years. Around 88.1% of those who received a kidney from a living donor surviving for a least five years.

Even recipients in their 60s can expect to live anywhere from 11 to 15 years after a transplant.

Additional Common Questions

How do you know if your kidneys are struggling?

You may not know your kidneys are struggling. Most people don’t have symptoms of kidney disease in the early stages. That’s why it’s important to attend annual wellness exams with your primary care provider to manage chronic conditions like diabetes or high blood pressure that can lead to kidney disease.

What foods are bad for kidneys?

In people with healthy kidneys, there aren’t necessarily bad foods or foods that hurt your kidneys. But, if you have CKD, your healthcare provider may recommend a kidney-friendly diet. Elements of a kidney-friendly diet may include:

Avoiding foods that are high in salt. This also helps control blood pressure.

Eating the right amount of protein. Protein creates more waste than other food groups. So, since your kidneys remove waste, lowering protein can help preserve their function.

Eating heart-healthy foods.

Eating foods low in phosphorus. This includes fresh fruits and vegetables and whole grains. Foods like dairy and beans are high in phosphorus.

Avoiding foods high in potassium like bananas, oranges and potatoes.

Since following a kidney-friendly diet is hard to understand and to do, it’s always a good idea to consult a dietitian as part of your treatment plan. They can help make sure you’re eating the right types of food if you have chronic kidney disease.

What color is urine when your kidneys are failing?

Your pee shouldn’t change color, but may be foamy or frothy, which means there’s excess protein in your pee. Excess protein means your kidneys aren’t filtering toxins from your body.

Will my kidneys get better?

Kidney disease is often “progressive”, which means it gets worse over time. The damage to your kidneys causes scars and is permanent.

You can take steps to protect your kidneys, such as managing your blood pressure and your blood glucose, if you have diabetes.

What happens if my kidneys fail?

Kidney failure means that your kidneys have lost most of their ability to function—less than 15 percent of normal kidney function. If you have kidney failure, you will need treatment to maintain your health.

One Final Note..

A CKD diagnosis can make a profound impact on your life. Treatment for the condition is lifelong, and it takes time and patience. Don’t be afraid to ask your healthcare providers any questions you have. Try to take comfort in the fact that managing kidney disease is possible. In fact, many people live many years with kidney disease. Lean on your family members or friends to help you cope. There are also online and in-person support groups available to help people with CKD connect with each other. Seek support from those who love you, so that together, you can work through treatment for CKD.

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