Chronic Kidney Disease

Overview

Chronic kidney disease (CKD) is a long-term condition where the kidneys slowly lose their ability to work properly over time. Your kidneys are two bean-shaped organs that filter your blood, remove waste and extra fluid, and help control blood pressure and the balance of minerals in your body. When they are damaged, waste can build up and cause problems throughout your whole body. 'Chronic' simply means it develops gradually and lasts a long time — it is not something that appears overnight. CKD is staged from 1 to 5, with stage 1 being very mild and stage 5 meaning the kidneys are working at a very low level. Many people live well for years, especially when CKD is caught early and managed carefully.

CKD is very common worldwide. It is estimated to affect around 1 in 10 people globally. In the UK, the NHS estimates that around 3 million people are living with moderate to severe CKD. Many more may have early-stage CKD without knowing it. It is one of the leading causes of serious illness worldwide, which is why awareness and early detection matter so much.

CKD can affect anyone, but it is most common in people over the age of 60. It is more frequently seen in people who have diabetes, high blood pressure, or a family history of kidney disease. People from certain ethnic backgrounds — including South Asian, Black African, and Black Caribbean communities — have a higher risk. Men and women are both affected, though the risk can differ slightly depending on the underlying cause.

Symptoms

Common symptoms

• Feeling very tired or lacking energy, even after rest
• Needing to urinate (pass water) more often, especially at night
• Swelling in your ankles, feet, or hands — caused by fluid building up in the body
• Shortness of breath, especially with light activity or when lying flat
• Feeling sick (nausea) or being sick (vomiting)
• Loss of appetite or a metallic taste in your mouth
• Itchy skin that is hard to relieve
• Muscle cramps, especially in the legs
• Difficulty concentrating or feeling mentally 'foggy'
• Urine that looks foamy, bubbly, or darker than usual
• Puffiness around the eyes, especially in the morning

Symptoms in children

• Poor growth or being smaller than expected for their age
• Bedwetting or changes in how often they pass urine
• Tiredness and low energy, affecting school or play
• Swelling around the eyes, face, or legs
• Headaches that come back often
• Poor appetite and slow weight gain

Symptoms in older adults

• Fatigue that may be mistaken for normal ageing
• Confusion or memory problems that seem to be getting worse
• Increased falls or loss of balance, sometimes linked to low blood pressure
• Worsening control of blood pressure despite treatment
• More frequent urinary infections or other urinary changes
• Symptoms that overlap with other common conditions, making diagnosis more complex

Causes

Main causes

• Diabetes (type 1 and type 2) — high blood sugar over time damages the tiny blood vessels inside the kidneys. This is the most common cause worldwide.
• High blood pressure (hypertension) — puts extra strain on the kidney's filtering units and, over time, causes scarring and damage.
• Glomerulonephritis — inflammation of the kidney's filtering units (called glomeruli), which can be caused by infections or immune system problems.
• Polycystic kidney disease — an inherited (genetic) condition where cysts (fluid-filled sacs) grow in the kidneys and disrupt their function over time.
• Recurrent kidney infections (pyelonephritis) — repeated infections can scar kidney tissue.
• Blockages in the urinary tract — such as kidney stones, an enlarged prostate, or tumours that cause long-term back pressure on the kidneys.
• Certain medications taken over a long time — some pain relievers and other drugs can harm the kidneys when used heavily over many years.
• Lupus and other autoimmune conditions — where the immune system mistakenly attacks healthy kidney tissue.

Risk factors

• Having diabetes or poorly controlled blood sugar
• Having high blood pressure that is not well managed
• A family history of kidney disease or inherited kidney conditions
• Being over 60 years of age
• Being from a South Asian, Black African, or Black Caribbean ethnic background
• Obesity (being significantly overweight)
• Smoking
• A history of heart disease or cardiovascular problems
• Previous acute kidney injury (a sudden episode of kidney damage)
• Long-term use of certain medications, especially high-dose or frequent use of non-prescription pain relievers
• Recurrent urinary tract infections or kidney stones

When to see a doctor

See a doctor urgently if:

• You notice a significant change in how much or how often you urinate
• You develop sudden, noticeable swelling in your legs, ankles, or face
• You feel extremely fatigued and unwell in a way that is new or getting worse quickly
• You have blood in your urine (which may look pink, red, or brown)
• Your blood pressure is very high and is not responding to your usual treatment

Book a routine appointment if:

• You have diabetes or high blood pressure and have not had a kidney function check recently
• You have a family history of kidney disease and have never been tested
• You have been told you have protein in your urine at a previous test
• You are experiencing persistent fatigue, itching, or changes in urination that are bothering you
• You want to understand your risk and whether you should be screened

Diagnosis

CKD is diagnosed through a combination of blood tests, urine tests, and sometimes imaging scans. Your doctor will look at how well your kidneys are filtering your blood and whether there are signs of damage such as protein leaking into your urine. There are no symptoms that can confirm CKD on their own — tests are needed. Once CKD is confirmed, it is 'staged' from 1 to 5 based on how well the kidneys are functioning. This helps your healthcare team understand how advanced it is and plan the right care for you.

Tests that may be done

• eGFR blood test (estimated glomerular filtration rate) — measures how well your kidneys are filtering your blood. A normal result is above 90. This is the main test used to diagnose and stage CKD.
• Urine albumin-to-creatinine ratio (uACR) — checks for albumin (a protein) in your urine. Protein in the urine is an early sign of kidney damage.
• Blood pressure measurement — high blood pressure is both a cause and a result of CKD and is closely monitored.
• Full blood count — checks for anaemia (low red blood cells), which is common in CKD.
• Blood electrolyte tests — measures minerals like potassium, sodium, and bicarbonate, which the kidneys help to regulate.
• Kidney ultrasound scan — uses sound waves to look at the size and shape of your kidneys and check for blockages, cysts, or scarring.
• Kidney biopsy (in some cases) — a small sample of kidney tissue is taken using a fine needle and examined under a microscope to identify the specific cause of kidney damage.

What to expect at your appointment

At your appointment, your doctor will ask about your symptoms, medical history, and any medications you take. They will check your blood pressure and arrange blood and urine tests. Results usually come back within a few days. If tests suggest CKD, you may be referred to a kidney specialist (called a nephrologist) for further assessment. Regular monitoring — usually every 6 to 12 months, depending on your stage — is a normal part of living with CKD. Try to bring a list of any medicines or supplements you take, as some can affect the kidneys.

Treatment

There is currently no cure for CKD caused by permanent kidney damage, but the right treatment can slow its progression significantly, reduce complications, and help you feel much better day to day. Treatment is tailored to you — your stage of CKD, its underlying cause, and your overall health all play a role. The goal is to protect your remaining kidney function for as long as possible and to keep the rest of your body healthy. For those who reach the most advanced stage, kidney replacement therapy — such as dialysis or a transplant — becomes an option.

Self-care at home

• Keep all your follow-up appointments and blood/urine tests — regular monitoring is essential to catch changes early
• Take any prescribed medications exactly as directed and tell your doctor about all supplements or over-the-counter medicines you use
• Monitor your blood pressure at home if your doctor recommends it
• Follow any dietary advice given by your healthcare team or dietitian, including guidance on salt, potassium, and phosphate intake
• Stay well hydrated unless your doctor has advised you to limit fluids
• Avoid smoking — it speeds up CKD progression and raises the risk of heart disease
• Limit alcohol to within recommended guidelines
• Maintain a healthy weight through balanced eating and regular activity
• Avoid taking non-prescription pain relievers (like anti-inflammatory drugs) regularly without first checking with your doctor, as these can harm the kidneys

Medical treatments

Your doctor will focus on treating the underlying cause of CKD — for example, managing blood sugar tightly if diabetes is the cause, or controlling blood pressure carefully. Certain classes of blood pressure-lowering medicines are particularly good at protecting the kidneys and are commonly used in CKD. Medicines may also be prescribed to manage complications such as anaemia (low red blood cells), bone health problems, high phosphate levels, or fluid retention. Newer medication classes have shown promising results in slowing CKD progression and protecting the heart at the same time, and your specialist will discuss what is appropriate for you. For people whose kidneys stop working adequately — known as kidney failure or end-stage kidney disease — kidney replacement therapy is discussed. This includes haemodialysis (filtering blood through a machine, usually several times a week), peritoneal dialysis (a gentler method using the lining of the abdomen as a filter, often done at home), or a kidney transplant (receiving a healthy kidney from a donor). Your care team will explain all options clearly and involve you in every decision.

When is surgery considered?

Surgery is not usually part of routine CKD management. However, if CKD is caused or worsened by a blockage — such as kidney stones or an enlarged prostate — a procedure to relieve that blockage may be recommended. If CKD progresses to end-stage kidney disease and a kidney transplant is chosen, this involves a surgical procedure to place a donated kidney into your body. Preparation for transplant listing can begin before kidney failure is complete. Your kidney specialist will guide you through what is right for your situation.

Living with this condition

Living with CKD is a long-term journey, and it is natural to have good days and harder days. Many people with early to moderate CKD continue to work, travel, care for their families, and enjoy hobbies. As the condition progresses, some adjustments may be needed — particularly around diet, fluid intake, and managing tiredness. Building a good relationship with your healthcare team, understanding your own test results, and knowing what changes to watch for can make a real difference. You are not alone — millions of people around the world are managing CKD successfully every day.

Lifestyle tips

• Stop smoking — this is one of the most powerful steps you can take to slow CKD and protect your heart
• Keep physically active in a way that suits your energy levels — even gentle walking has real benefits
• Manage stress where possible, as chronic stress can raise blood pressure
• Get enough sleep — fatigue is common in CKD, and good sleep hygiene helps
• Attend regular kidney monitoring appointments and keep a record of your results
• Stay up to date with vaccinations — people with CKD have a weaker immune response and benefit from certain vaccines
• Avoid dehydration, particularly during hot weather or illness
• Discuss any new medicines — including herbal or natural remedies — with your doctor before starting them

Diet and exercise

Diet in CKD needs to be tailored to your individual test results, so working with a registered dietitian who specialises in kidney disease is strongly recommended. In general, reducing salt helps control blood pressure. Depending on your blood test results, you may need to watch your intake of potassium (found in bananas, potatoes, and tomatoes) and phosphate (found in dairy, nuts, and cola drinks), as damaged kidneys struggle to balance these minerals. Protein intake guidance varies depending on your stage of CKD and whether you are on dialysis. Regular physical activity — anything from gentle walking to swimming or cycling — is beneficial for blood pressure, weight, mood, and heart health. Always check with your healthcare team before starting a new exercise routine. NHS guidance supports aiming for at least 150 minutes of moderate activity per week, adapted to what your body can manage.

Mental health and emotional wellbeing

Living with a long-term condition like CKD can take a real emotional toll. Feelings of anxiety, worry about the future, frustration, sadness, or even depression are all completely understandable responses. Fatigue caused by CKD can also make low mood worse. It is important not to dismiss these feelings. Talk to your doctor or nurse if you are struggling emotionally — support is available, including talking therapies and counselling. If you are feeling very low, hopeless, or having thoughts of harming yourself, please reach out to a mental health crisis service or call your local emergency number right away. You deserve support for your emotional health just as much as your physical health.

Prevention

Not all cases of CKD can be prevented — some causes, like inherited genetic conditions, are outside our control. However, a large proportion of CKD is linked to diabetes and high blood pressure, and managing these conditions well can dramatically reduce the risk of kidney damage — or slow its progression if CKD is already present. Living a healthy lifestyle, avoiding smoking, staying active, maintaining a healthy weight, and drinking alcohol in moderation all help protect your kidneys over the long term. If you have risk factors for CKD, regular check-ups and early detection are the most powerful tools you have.

Vaccines

People with CKD have a higher risk of complications from certain infections because the immune system may not work as well as it should. Vaccinations recommended for people with CKD typically include the annual flu (influenza) vaccine, the pneumococcal vaccine (to protect against a type of pneumonia), the hepatitis B vaccine (especially important for people who may need dialysis), and COVID-19 vaccines. Talk to your GP or kidney team about which vaccines are right for you and when to have them. The NHS provides specific guidance on vaccinations for people with kidney disease.

Screening programmes

If you have known risk factors — such as diabetes, high blood pressure, obesity, or a family history of kidney disease — your doctor may recommend regular screening even if you feel well. This usually involves a blood test to check your eGFR and a urine test for protein. The NHS Health Check (available in England for adults aged 40 to 74) includes blood pressure and urine tests that can pick up early signs of CKD. If you are in a higher-risk group, speak to your GP about how often you should be checked.

Complications

If left untreated

• Cardiovascular disease — CKD significantly increases the risk of heart attack and stroke, and heart disease is the leading cause of death in people with CKD
• Anaemia — the kidneys produce a hormone that tells the body to make red blood cells; when kidneys are damaged, anaemia (low red blood cells) can cause severe fatigue and breathlessness
• Bone disease — damaged kidneys struggle to keep calcium and phosphate in balance, weakening bones and raising the risk of fractures
• High potassium levels (hyperkalaemia) — can cause dangerous heart rhythm problems if not managed
• Fluid overload — the body retains too much fluid, causing swelling, breathlessness, and raised blood pressure
• Malnutrition — loss of appetite and dietary restrictions can lead to weight loss and nutrient deficiencies
• Peripheral neuropathy — nerve damage causing tingling, numbness, or pain in the hands and feet
• End-stage kidney disease (kidney failure) — at this stage, the kidneys can no longer sustain life without replacement therapy such as dialysis or a transplant

Long-term outlook

A CKD diagnosis can feel overwhelming, but there is real reason for hope. Many people with CKD — especially those diagnosed at an early stage — never progress to kidney failure. With good medical care, lifestyle changes, and regular monitoring, it is very possible to slow CKD significantly and live a full, active life. Even for those with more advanced CKD, modern treatments including dialysis and kidney transplantation have transformed what is possible. Transplanted kidneys can function well for many years, and advances in dialysis technology continue to improve quality of life. The key is staying engaged with your care team, being informed, and taking it one step at a time.

Find support

International organisations

• International Society of Nephrology — Patient Resources ↗
• World Kidney Day ↗
• Global Kidney Foundation ↗

Local organisations

• Kidney Care UK ↗ · United Kingdom
• NHS — Chronic Kidney Disease ↗ · United Kingdom
• National Kidney Foundation ↗ · United States
• Kidney Health Australia ↗ · Australia
• Kidney Foundation of Canada ↗ · Canada
• European Kidney Health Alliance (EKHA) ↗ · Europe

Helplines

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