15096 Chronic Kidney Disease

Overview

Chronic kidney disease (CKD) is a long-term condition where the kidneys slowly lose their ability to filter waste and extra fluid from the blood. This can lead to a build-up of waste in the body and other health problems over time.

Yes, chronic kidney disease is very common. It is estimated that around 1 in 10 adults worldwide has some degree of CKD, and the number is rising, particularly among people with diabetes and high blood pressure.

CKD can affect anyone, but it is more common in people over 60, and in those with diabetes, high blood pressure, a family history of kidney disease, or a history of heart disease or stroke. It also occurs more often in people who are overweight or who smoke.

Symptoms

Common symptoms

• Feeling more tired than usual and lacking energy
• Swelling in the ankles, feet, or hands (fluid retention)
• Shortness of breath, especially during mild activity
• Changes in urination, such as needing to urinate more often, especially at night
• Foamy or bubbly urine, or blood in the urine
• Persistent itchiness or dry skin
• Muscle cramps, especially in the legs
• Poor appetite or unintended weight loss

Symptoms in children

• Poor growth or slow weight gain
• Bedwetting beyond the expected age
• Feeling unusually tired or irritable
• Swelling around the eyes, feet, or ankles
• Frequent urinary tract infections
• High blood pressure (found by a doctor)

Symptoms in older adults

• Confusion or trouble concentrating
• Feeling sick or vomiting
• Loss of appetite
• Swelling in the legs or feet
• Needing to urinate more or less than usual
• Fatigue and weakness that makes daily activities harder

Causes

Main causes

• Diabetes (high blood sugar damages the kidneys' filters over time)
• High blood pressure (damages the small blood vessels in the kidneys)
• Glomerulonephritis (inflammation of the kidney's filtering units)
• Polycystic kidney disease (an inherited condition causing fluid-filled cysts in the kidneys)
• Long-term blockage of the urinary tract, such as from an enlarged prostate or kidney stones
• Repeated kidney infections or damage from certain medicines, such as long-term use of pain relievers (NSAIDs)

Risk factors

• Being over 60 years old
• Having diabetes or high blood pressure
• Having a family history of kidney disease
• Smoking or using tobacco
• Being overweight or obese
• Having heart disease or peripheral artery disease
• Having had acute kidney injury in the past

When to see a doctor

See a doctor urgently if:

• You have sudden, severe swelling or a big drop in your urine output.
• You see blood in your urine.
• You have severe back or side pain.
• You are unable to keep fluids down due to vomiting.

Book a routine appointment if:

• You have a condition that increases your risk, such as diabetes or high blood pressure, and you haven't had a kidney check in the last year.
• You notice symptoms like persistent tiredness, swelling, or changes in urination.
• You are starting a new medicine that could affect your kidneys, and you want to talk about your kidney health.
• You have a family member with kidney disease, and you want to be checked.

Diagnosis

CKD is diagnosed with simple blood and urine tests. The blood test measures a waste product called creatinine and is used to calculate your estimated glomerular filtration rate (eGFR), which shows how well your kidneys are filtering. The urine test checks for protein or blood in the urine.

Tests that may be done

• Blood test to measure eGFR and creatinine levels
• Urine test to check for albumin or protein (called albuminuria or proteinuria)
• Blood pressure measurement
• Imaging tests, such as an ultrasound of the kidneys, to look for structural problems
• Sometimes a kidney biopsy (a small sample of kidney tissue) is needed to find the exact cause

What to expect at your appointment

The tests are quick and painless — usually just a blood draw and a urine sample. Your doctor will likely repeat them to confirm the result, because kidney function can change from day to day. Based on your eGFR and urine protein level, your doctor will tell you what stage of CKD you have and what plan is best for you.

Treatment

Treatment for CKD focuses on slowing down the damage to your kidneys, treating the underlying cause (like diabetes or high blood pressure), and managing complications. In the early stages, lifestyle changes and medicines are the main treatment. In more advanced stages, you may need dialysis or a kidney transplant.

Self-care at home

• Take all prescribed medicines exactly as your doctor tells you, and ask before taking any new medicines or supplements.
• Check your blood pressure at home if your doctor recommends it, and keep a record to share with your healthcare team.
• Stay well hydrated by drinking water when you are thirsty, but not in excess — your doctor can tell you the right amount for you.
• Avoid using nonsteroidal anti-inflammatory drugs (NSAIDs) — like ibuprofen or naproxen — without first talking to your doctor, as these can harm kidneys.
• If you smoke, stop. If you drink alcohol, try to keep to safe limits — ask your doctor what is safe for you.
• Monitor your blood sugar if you have diabetes, and aim for a healthy weight.

Medical treatments

Your doctor may prescribe medicines to lower blood pressure, control blood sugar (if you have diabetes), reduce protein in the urine, or help lower cholesterol. Some of these medicines are called 'kidney-protective' because they can slow down the loss of kidney function. In later stages, you may need medicine to treat anemia (low blood count), bone disease, or fluid buildup. If your kidneys fail completely, treatment options include dialysis (a machine that filters your blood) or a kidney transplant.

When is surgery considered?

A kidney transplant may be an option if your kidneys stop working completely. This is a surgical procedure where a healthy kidney from a donor is placed into your body. It is not right for everyone, and your healthcare team will discuss whether it is suitable for you. Sometimes surgery is also needed to create an access point for dialysis, such as a fistula in the arm.

Living with this condition

Living with CKD means having regular check-ups with your doctor and kidney specialist. You will need to monitor your blood pressure, take medicines as prescribed, and adjust your diet. Most people can continue work, travel, and daily activities, but you may need to plan ahead for appointments and rest when you need it.

Lifestyle tips

• Quit smoking — it slows the loss of kidney function and protects your heart.
• Limit alcohol to what your doctor says is safe, as too much can strain your kidneys.
• Stay active — aim for at least 30 minutes of gentle exercise on most days, like walking or swimming.
• Get enough sleep and manage stress with relaxation techniques like deep breathing or meditation.
• Stay up to date with vaccines, especially flu, pneumonia, and COVID-19, because kidney disease can weaken your immune system.

Diet and exercise

Your diet can make a big difference. Your doctor or a kidney dietitian can help you plan meals that may include eating less salt, controlling protein intake, and limiting foods high in potassium or phosphorus if your levels are too high. Regular exercise, such as walking, cycling, or water aerobics, helps control blood pressure, weight, and blood sugar — all good for your kidneys.

Mental health and emotional wellbeing

CKD can be stressful to live with, and it is common to feel anxious, sad, or overwhelmed. It may feel like a burden to manage appointments, medicines, and diet. These feelings are normal and nothing to be ashamed of. Talk with your healthcare team about how you are feeling — they can connect you to counseling or mental health support.

Prevention

You cannot always prevent CKD, but you can lower your risk by keeping your blood pressure healthy, managing diabetes, staying at a healthy weight, being physically active, not smoking, and drinking alcohol in moderation. Regular checks are especially important if you have risk factors.

Vaccines

People with CKD — especially those in later stages — should stay up to date on vaccines, including the flu vaccine, pneumococcal (pneumonia) vaccine, and COVID-19 vaccines. Tell your doctor if you have kidney disease before getting any vaccine.

Screening programmes

If you are at risk for CKD, you should have a blood and urine test regularly — at least once a year. This includes people with diabetes, high blood pressure, heart disease, or a family history of kidney failure.

Complications

If left untreated

• Progression to kidney failure, which requires dialysis or a transplant
• Heart disease and stroke — CKD increases your risk of cardiovascular problems
• Anemia (low red blood cells, causing fatigue and weakness)
• Bone disease and weak bones
• High potassium levels in the blood, which can be dangerous for the heart
• Fluid buildup, leading to swelling and breathing trouble

Long-term outlook

Many people live well with CKD for decades, especially if it is found early and managed carefully. With the right treatment, you can slow down the damage and protect your kidneys for as long as possible. Even if kidney failure develops, modern treatments like dialysis and transplantation can help people live long, full lives. Your healthcare team will work with you every step of the way.

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