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This topic provides information about chronic kidney disease. If you are looking for information about sudden kidney failure, see the topic Acute Renal Failure.
Having chronic kidney disease means that for some time your kidneys have not been working the way they should. Your kidneys have the important job of filtering your blood. They remove waste products and extra fluid and flush them from your body as urine. When your kidneys don't work right, wastes build up in your blood and make you sick.
Chronic kidney disease may seem to have come on suddenly. But it has been happening bit by bit for many years as a result of damage to your kidneys.
Each of your kidneys has about a million tiny filters, called nephrons. If nephrons are damaged, they stop working. For a while, healthy nephrons can take on the extra work. But if the damage continues, more and more nephrons shut down. After a certain point, the nephrons that are left cannot filter your blood well enough to keep you healthy.
One way to measure how well your kidneys are working is to figure out your glomerular filtration rate (GFR). The GFR is usually calculated using results from your blood creatinine (say "kree-AT-uh-neen") test. Then the stage of kidney disease is figured out using the GFR. There are five stages of kidney disease, from kidney damage with normal GFR to kidney failure.
There are things you can do to slow or stop the damage to your kidneys. Taking medicines and making some lifestyle changes can help you manage your disease and feel better.
Chronic kidney disease is also called chronic renal failure or chronic renal insufficiency.
Chronic kidney disease is caused by damage to the kidneys. The most common causes of this damage are:
Other things that can lead to chronic kidney disease include:
You may start to have symptoms only a few months after your kidneys begin to fail. But most people don't have symptoms early on. In fact, many don't have symptoms for as long as 30 years or more. This is called the "silent" phase of the disease.
How well your kidneys work is called kidney function. As your kidney function gets worse, you may:
Your doctor will do blood and urine tests to help find out how well your kidneys are working. These tests can show signs of kidney disease and anemia. (You can get anemia from having damaged kidneys.) You may have other tests to help rule out other problems that could cause your symptoms.
Your doctor will do tests that measure the amount of urea (BUN) and creatinine in your blood. These tests can help measure how well your kidneys are filtering your blood. As your kidney function gets worse, the amount of nitrogen and creatinine in your blood increases. The level of creatinine in your blood is used to find out the glomerular filtration rate (GFR). The GFR is used to show how much kidney function you still have. The GFR is also used to find out the stage of your kidney disease and to guide decisions about treatment.
Your doctor will ask questions about any past kidney problems. He or she will also ask whether you have a family history of kidney disease and what medicines you take, both prescription and over-the-counter drugs.
You may have a test that lets your doctor look at a picture of your kidneys, such as an ultrasound or CT scan. These tests can help your doctor measure the size of your kidneys, estimate blood flow to the kidneys, and see if urine flow is blocked. In some cases, your doctor may take a tiny sample of kidney tissue (biopsy) to help find out what caused your kidney disease.
Chronic kidney disease is usually caused by another condition. So the first step is to treat the disease that is causing kidney damage.
Diabetes and high blood pressure cause most cases of chronic kidney disease. If you keep your blood pressure and blood sugar in a target range, you may be able to slow or stop the damage to your kidneys. Losing weight and getting more exercise can help. You may also need to take medicines.
Kidney disease is a complex problem. You will probably need to take a number of medicines and have many tests. To stay as healthy as possible, work closely with your doctor. Go to all your appointments. And take your medicines just the way your doctor says to.
Lifestyle changes are an important part of your treatment. Taking these steps can help slow down kidney disease and reduce your symptoms. These steps may also help with high blood pressure, diabetes, and other problems that make kidney disease worse.
Always talk to your doctor before you take any new medicine, including over-the-counter remedies, prescription drugs, vitamins, or herbs. Some of these can hurt your kidneys.
When kidney function falls below a certain point, it is called kidney failure. Kidney failure affects your whole body. It can cause serious heart, bone, and brain problems and make you feel very ill. Untreated kidney failure can be life-threatening.
When you have kidney failure, you will probably have two choices: start dialysis or get a new kidney (transplant). Both of these treatments have risks and benefits. Talk with your doctor to decide which would be best for you.
Making treatment decisions when you are very ill is hard. It is normal to be worried and afraid. Discuss your concerns with your loved ones and your doctor. It may help to visit a dialysis center or transplant center and talk to others who have made these choices.
Learning about chronic kidney disease:
Living with chronic kidney disease:
Health Tools help you make wise health decisions or take action to improve your health.
|Decision Points focus on key medical care decisions that are important to many health problems.|
|Kidney Failure: Should I Start Dialysis?|
|Kidney Failure: What Type of Dialysis Should I Have?|
|Kidney Failure: When Should I Start Dialysis?|
|Actionsets are designed to help people take an active role in managing a health condition.|
|Diabetes: Checking Your Blood Sugar|
|High Blood Pressure: Checking Your Blood Pressure at Home|
|Kidney Disease: Changing Your Diet|
The cause of chronic kidney disease isn't always known. But any condition or disease that damages blood vessels or other structures in the kidneys can lead to kidney disease. The most common causes of chronic kidney disease are:
Other conditions that can damage the kidneys and cause chronic kidney disease include:
Diabetes and high blood pressure are the most common causes of chronic kidney disease that leads to kidney failure. Diabetes or high blood pressure may also speed up the progression of chronic kidney disease in someone who already has the disease.
Many people who develop chronic kidney disease don't have symptoms at first. This is known as the "silent" phase of the disease.
As your kidney function gets worse, you may:
At first with chronic kidney disease, your kidneys are still able to regulate the balance of fluids, salts, and waste products in your body. But as kidney function decreases, you will start to have other problems, or complications. The worse your kidney function gets, the more complications you'll have and the more severe they will be.
When kidney function falls below a certain point, it is called kidney failure. Kidney failure has harmful effects throughout your body. It can cause serious heart, bone, and brain problems and make you feel very ill.
After you have kidney failure, either you will need to have dialysis or you will need a new kidney. Both choices have risks and benefits.
Some of the things that lead to chronic kidney disease are related to your age and your genetic makeup. You may be able to control other things that increase your risk, such as dietary habits and exercise.
The main risk factors for chronic kidney disease are:
You may be able to slow the progression of chronic kidney disease and prevent or delay kidney failure by controlling things that increase your risk of kidney damage, such as:
Call 911 or other emergency services if you have chronic kidney disease and you develop:
To check your heart rate, see the instructions for taking a pulse.
Call your doctor immediately if you:
Call your doctor if you:
If you have uncontrolled weight loss, discuss this with your doctor during your next visit.
A wait-and-see approach is not a good idea if you could have chronic kidney disease. See your doctor. If you have been diagnosed with chronic kidney disease, follow your treatment plan. And call your doctor if you notice any new symptoms.
Health professionals who can diagnose and treat chronic kidney disease include:
If you are diagnosed with chronic kidney disease, you will likely be referred to a nephrologist for treatment.
You may also be referred to a:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Tests for chronic kidney disease are vital to help find out:
After you are diagnosed with chronic kidney disease, blood and urine tests can help you and your doctor monitor the disease.
When kidney function is decreased, substances such as urea, creatinine, and certain electrolytes begin to build up in the blood. The following tests measure levels of these substances to show how well your kidneys are working.
Your doctor may use other tests to monitor kidney function or to find out whether another kidney disease or condition is contributing to reduced kidney function.
Experts recommend screening tests for chronic kidney disease in high-risk groups, such as people with diabetes or high blood pressure. Kidney disease runs in families, so close family members may also want to have their kidney function tested. Being diagnosed with kidney disease before it has progressed gives you the best chance to control the disease.
To learn more about screening if you already have diabetes or high blood pressure, see:
The goal of treatment for chronic kidney disease is to prevent or slow further damage to your kidneys. Another condition such as diabetes or high blood pressure usually causes kidney disease, so it is important to identify and manage the condition that is causing your kidney disease. It is also important to prevent diseases and avoid situations that can cause kidney damage or make it worse.
One of the most important parts of treatment is to control the disease that is causing kidney damage. You and your doctor will create a plan to aggressively treat and manage your condition to help slow any more damage to your kidneys.
If you have diabetes, it is important to control your blood sugar levels with diet, exercise, and medicines. A persistently high blood sugar level can damage the blood vessels in the kidneys. For more information about kidney disease caused by diabetes, see the topic Diabetic Nephropathy.
If you have high blood pressure, it is also important to control your blood pressure with diet, exercise, and any medicines your doctor prescribes. The goal is to keep your blood pressure less than 130/80.1 To learn ways to help control your blood pressure, see the topic High Blood Pressure.
If other conditions or diseases are causing kidney damage, such as a blockage (obstruction) in the urinary tract or long-term use of medicines that can damage the kidneys, you and your doctor will work out a treatment plan.
You may be prescribed a blood pressure medicine, such as an ACE inhibitor or an angiotensin II receptor blocker (ARB). These medicines are used to reduce protein in the urine and help manage high blood pressure.
You can take steps at home to help control your kidney disease. For example:
Your doctor will use blood and urine tests to regularly check how well your kidneys are functioning and whether changes to your treatment plan are needed. These tests are critical to help monitor your disease. The tests include:
As the disease gets worse, your symptoms—such as fatigue, nausea, and loss of appetite—may occur more often or become more severe. Work with your doctor to create a treatment plan to help control these symptoms.
If you develop anemia, you may need to take medicine called human recombinant erythropoietin (rhEPO). It helps your body make new red blood cells and may help improve your appetite and general sense of well-being.
You may also need an iron supplement if you have an iron deficiency.
When your kidney function has fallen below a certain point, it is called kidney failure. Kidney failure has harmful effects throughout your body. It can cause serious heart, bone, and brain problems and can make you feel very ill.
After you have kidney failure, either you will need to have dialysis or you will need a new kidney. Both choices have risks and benefits.
Dialysis is a process that does the work of healthy kidneys by clearing wastes and extra fluid from the body and restoring the proper balance of chemicals (electrolytes) in the blood. You may use dialysis for many years, or it may be a short-term measure while you are waiting for a kidney transplant.
To learn more about dialysis, see Other Treatment.
Kidney transplant is often a better treatment option than dialysis for kidney failure, because it may allow you to live a fairly normal life. But there are some drawbacks. For example, you will probably need to have dialysis while you wait for a kidney.
To learn more about kidney transplants, see Surgery.
Making treatment decisions when you are very ill is difficult. It is normal to be fearful and worried about the risks involved. Discuss your concerns with your family and your doctor. It may be helpful to visit the dialysis center or transplant center and talk to others who have chosen these options.
As your disease gets worse, you may want to think about palliative care. Palliative care is a kind of care for people who have diseases that don't go away and that often get worse over time. It is different from care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life—not just in your body but also in your mind and spirit. Some people combine palliative care with curative care, but usually this means they don't want dialysis treatments in order to sustain their lives.
Palliative care may help you manage symptoms or side effects from treatment. It could also help you cope with your feelings about living with a long-term disease, make future plans around your medical care, or help your family better understand your disease and how to support you.
If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.
For more information, see the topic Palliative Care.
Chronic kidney disease progresses to kidney failure when damage to the kidneys is so severe that dialysis or a kidney transplant is needed to control symptoms and prevent complications and death. Many people have successful kidney transplants or live for years using dialysis. But at this point you may wish to talk with your family and doctor about health care and other legal issues that arise near the end of life.
A time may come when your goals or the goals of your loved ones may change from treating or curing your disease to maintaining comfort and dignity. You may find it helpful and comforting to state your health care choices in writing (with an advance directive such as a living will) while you are still able to make and communicate these decisions. Think about your treatment options and which kind of treatment will be best for you. You may wish to write a durable power of attorney or choose a health care agent, usually a family member or loved one, to make and carry out decisions about your care if you become unable to speak for yourself. You also have the option to refuse or stop treatment. For more information, see the topic Care at the End of Life.
Chronic kidney disease may sometimes be prevented by controlling the other diseases or factors that can contribute to kidney disease. People who have already developed kidney failure also need to focus on these things to prevent the complications of kidney failure.
There are many things you can do at home to slow the progression of chronic kidney disease.
Although medicine cannot reverse chronic kidney disease, it is often used to help treat symptoms and complications and to slow further kidney damage.
Most people who have chronic kidney disease have problems with high blood pressure at some time during their disease. Medicines that lower blood pressure help to keep it in a target range and stop any more kidney damage. Common blood pressure medicines include:
You may need to try several blood pressure medicines before you find the medicine that controls your blood pressure well without bothersome side effects. Most people need to take a combination of medicines to get the best results. Your doctor may order blood tests 3 to 5 days after you start or change your medicines. The tests help your doctor make sure that your medicines are working correctly.
Medicines may be used to treat symptoms and complications of chronic kidney disease. These medicines include:
Both erythropoietin (rhEPO) therapy and iron replacement therapy may also be used during dialysis to treat anemia, which often develops in advanced chronic kidney disease.
Talk with your doctor about what types of immunizations you should have if you have chronic kidney disease. Also, be sure to discuss medicine precautions. Make sure to tell your doctor about all prescription drugs, over-the-counter drugs, and herbs you are taking.
If you have chronic kidney disease that progresses, you may have the option of a kidney transplant. Most experts agree that it is the best option for people with kidney failure. In general, people who have kidney transplants live longer than people treated with dialysis.
You will probably be considered a good candidate if you don't have significant heart, lung, or liver disease or other diseases, such as cancer, which might decrease your life span.
There are some drawbacks. You may have to wait for a kidney to be donated. If so, you will need to have dialysis while you wait. Also, it may be hard to find a good match for your blood and tissue types. Sometimes, even when the match is good, the body rejects the new kidney.
After a kidney transplant, you will have to take medicines called immunosuppressants. These medicines, such as cyclosporine or tacrolimus, help prevent your body from rejecting your new kidney.
Even if you take your medicines, there is a chance that your body will reject your new kidney. If this happens, you will have to resume dialysis or have another kidney transplant.
The success of the transplant also depends on what kind of donor kidney you are receiving. The closer the donor kidney matches your genetic makeup, the better the chances that your body will not reject it.
For more general information about transplant, see the topic Organ Transplant.
A kidney transplant doesn't guarantee that you will live longer than you would have without a new kidney.
Kidney transplant surgery is expensive but has been covered by Medicare since the 1970s. Check with your insurance company or Medicare about your coverage.
Dialysis is a mechanical process that performs the work that healthy kidneys would do. It clears wastes and extra fluid from the body and restores the proper balance of chemicals (electrolytes) in the blood. When chronic kidney disease becomes so severe that your kidneys are no longer working properly, you may need dialysis. You may use dialysis to replace the work of the kidneys for many years. Or dialysis may be a short-term measure while you are waiting for a kidney transplant.
If you have severe chronic kidney disease but have not yet developed kidney failure, talk to your doctor about which type of dialysis would be best for you.
Learning about dialysis (predialysis education) is an important step in preparing for dialysis. Most dialysis clinics offer predialysis services to help you know about your choices.
Both types of dialysis can be expensive. But Medicare or insurance may cover most of the costs. Check with your insurance company or Medicare about your coverage. The dialysis center or hospital can help you find the best way to pay for your treatment.
|Life Options c/o Medical Education Institute|
|414 D'Onofrio Drive|
|Madison, WI 53719|
Life Options is a program supporting research, education, and outreach for people living with kidney disease. They offer a toll-free helpline for people who have questions about kidney function, dialysis, keeping a job, Medicare, exercise, and more. The Web site has a link to Kidney School, an interactive kidney learning center. They also have free educational information, a message board, and links to other resources.
|National Kidney and Urologic Diseases Information Clearinghouse|
|3 Information Way|
|Bethesda, MD 20892-3580|
The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) provides information about diseases of the kidneys and urologic system to people with these problems and to their families, to health professionals, and to the public. NKUDIC answers inquiries; develops, reviews, and distributes publications; and works closely with professional and patient groups and government agencies to coordinate resources about kidney and urologic diseases.
NKUDIC, a federal agency, is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services.
|National Kidney Disease Education Program (NKDEP)|
|3 Kidney Information Way|
|Bethesda, MD 20892|
|Phone:||1-866-4-KIDNEY (1-866-454-3639) toll-free|
NKDEP is a program from the National Institutes of Health (NIH) to help people who have kidney disease and to help their doctors. The program helps people understand kidney disease. NKDEP wants to help people who have diabetes, high blood pressure, or a family history of kidney failure understand why it is important to know about kidney health. They offer free educational materials and links to other resources.
|National Kidney Foundation|
|30 East 33rd Street|
|New York, NY 10016|
The National Kidney Foundation works to prevent kidney and urinary tract diseases and help people affected by these conditions. Its website has a lot of information about adult and child conditions. The site has interactive tools, donor information, recipes for kidney disease patients, and message boards for many kidney topics. Free materials, such as brochures and newsletters, are available.
|United Network for Organ Sharing (UNOS)|
|700 North 4th Street|
|Richmond, VA 23219|
The United Network for Organ Sharing (UNOS) is a nonprofit scientific and educational organization that administers the nation's only Organ Procurement and Transplantation Network (OPTN). It was established by the U.S. Congress in 1984. UNOS collects and manages data about every transplant event occurring in the United States, facilitates the organ matching and placement process, and brings together health professionals, transplant recipients, and donor families to develop organ transplantation policy. UNOS:
- Levey AS, et al. (2003). National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Annals of Internal Medicine, 139(2): 137–147.
Other Works Consulted
- Barry JM, Conlin MJ (2012). Renal transplantation. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 2, pp. 1226–1253. Philadelphia: Saunders.
- Correa-Rotter R, et al. (2012). Peritoneal dialysis. In MW Taal et al., eds., Brenner and Rector's The Kidney, 9th ed., vol. 2, pp. 2347–2377. Philadelphia: Saunders.
- Depner TA, et al. (2006). Clinical Practice Guidelines for Hemodialysis Adequacy, Peritoneal Dialysis Adequacy, and Vascular Access. New York: National Kidney Foundation. Available online: http://www.kidney.org/professionals/KDOQI/guideline_upHD_PD_VA/index.htm.
- Fouque D, Laville M (2009). Low protein diets for chronic kidney disease in nondiabetic adults. Cochrane Database of Systematic Reviews (3).
- Fouque D, Mitch WE (2012). Dietary approaches to kidney disease. In MW Taal et al., eds., Brenner and Rector's The Kidney, 9th ed., vol. 2, pp. 2170–2204. Philadelphia: Saunders.
- Kopple JD (2014). Nutrition, diet, and the kidney. In AC Ross et al., eds., Modern Nutrition in Health and Disease, 11th ed., pp. 1330–1371. Philadelphia: Lippincott, Williams, and Wilkins.
- U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.
- Van Wyck DB, et al. (2006). Clinical Practice Guidelines for Anemia in Chronic Kidney Disease. New York: National Kidney Foundation. Available online: http://www.kidney.org/professionals/KDOQI/guidelines_anemia/index.htm.
- Van Wyck DB, et al. (2007). KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease: 2007 Update of Hemoglobin Target. New York: National Kidney Foundation. Available online: http://www.kidney.org/professionals/kdoqi/guidelines_anemiaUP/guide1.htm.
- Wilkens KG, et al. (2012). Medical nutrition therapy for renal disorders. In LK Mahan et al., eds., Krause's Food and the Nutrition Care Process, 13 ed., pp. 799–831. St Louis: Saunders.
- Yeun JY, et al. (2012). Hemodialysis. In MW Taal et al., eds., Brenner and Rector's The Kidney, 9th ed., vol. 2, pp. 2294–2346. Philadelphia: Saunders.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Mitchell H. Rosner, MD - Nephrology|
|Last Revised||September 15, 2011|
Last Revised: September 15, 2011
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