More than 37 million Americans (one in seven adults) have chronic kidney disease (CKD), damage to their kidneys that can drastically affect their quality of life.
If you have CKD, there are things you can do to slow the progression of the disease. And, if necessary, you can prepare for the next steps in your treatment options.
What Is CKD?
Your kidneys have a vital role in filtering your blood to remove waste and extra fluid from your body. They basically flush them from your body as urine. If you have CKD, your kidneys don’t filter as well as they should. As a result, waste builds up in your blood and that can make you sick.
“Chronic kidney disease is when the kidneys are not doing their job,” says Manisha Jhamb, MD, MPH, a nephrologist with UPMC. “The main function in the body is cleaning the blood and getting rid of excess water. When, over time, the kidneys are not performing their function, we call it chronic kidney disease.”
As the disease progresses, CKD can:
- Cause other health problems, like anemia or bone disease. The kidneys secrete a hormone that stimulates bone marrow to produce blood cells. If enough of the hormone is not secreted, anemia may develop.
- Further increase your blood pressure, leading to heart disease or stroke.
- Lead to end-stage kidney disease.
That’s why preventing kidney disease and getting regular testing are so important. A blood test can find the problem long before you have any symptoms — and perhaps in time to stop any serious damage.
CKD Symptoms and Diagnosis
Early-stage CKD often has no symptoms. In fact, many don’t have symptoms for as long as 30 years or more, during which time damage is slowly being done to the kidneys. This is called the “silent” phase of the disease.
“Kidney disease is a silent disease,” says Dr. Jhamb. “A lot of people don’t really feel that they have any symptoms until the kidney disease is very, very advanced.”
As CKD gets worse, you may start to notice that you:
- Feel extremely tired.
- Lose your appetite or feel nauseous.
- Have headaches or problems concentrating.
- Have trouble sleeping.
- Have changes in how often you urinate — more or less often than normal.
- Have swollen feet or ankles.
- Have dry, itchy skin.
- Experience severe weight loss without trying.
If you have any or all of these symptoms, speak with your primary care provider. They may order tests or refer you to a kidney specialist called a nephrologist.
Causes and Risk Factors of CKD
High blood pressure and diabetes over many years are the two most common conditions that cause people to develop CKD, accounting for two-thirds of cases. Sometimes, CKD can also be the result of an injury to the kidneys.
Other conditions are also common causes of kidney damage:
- Glomerulonephritis — swelling of the filtering part of your kidneys.
- Systemic lupus erythematosus, an autoimmune system disease that can attack the kidneys, or drugs that damage the kidneys.
- Malformed kidneys, or a genetic condition called polycystic kidney disease, which causes cysts to grow in the kidneys.
- A narrowed or blocked renal artery. The renal artery carries blood to the kidneys.
- Kidney stones or chronic urinary tract infections.
- An enlarged prostate gland in men.
- Long-term use of medicines that can damage the kidneys. Examples include nonsteroidal anti-inflammatory drugs (NSAIDs), such as celecoxib and ibuprofen.
“The prevalence of kidney disease is going to rise over the next few years,” says Dr. Jhamb. “The main reason for this is some of the risk factors that lead to development of this disease are on the rise. Most common ones are high blood pressure and diabetes. Also, as we get older and as our population is getting older, the risk for developing these kidney diseases rises.”
While CKD can affect anyone, the risk is higher for people with diabetes or high blood pressure, anyone with a family history of kidney failure, and older adults.
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To diagnose CKD and check your kidney function, your doctor will order a few tests. These tests can show signs of kidney disease and anemia (a sign of kidney damage).
These may include blood tests to measure:
- Glomerular filtration rate (GFR). The amount of blood your kidneys can filter.
- Blood urea nitrogen (BUN). Urea nitrogen is a waste product that increases in your blood when your kidneys aren’t working properly.
- Creatinine. Creatinine is also a waste product and it builds up in your body if your kidneys are not working properly.
Your doctor may also check your urine for albumin, a protein that spills into the urine when the kidneys aren’t working right.
Your doctor will ask questions about any past kidney problems. They will also ask whether you have a family history of kidney disease and what medicines you take, both prescription and over-the-counter drugs.
Your doctor may also want do an ultrasound or CT scan to look at your kidneys. They can 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 (a biopsy) to help find out what caused your kidney disease.
There’s no cure for CKD. But if you catch the disease early, you can manage it with lifestyle changes — such as a new diet — and medicine, if needed. Your treatments may change over time if your condition changes, but treatment will be lifelong.
CKD is usually caused by another condition. The first step is to treat the disease that is causing kidney damage. Diabetes and high blood pressure cause most cases of CKD. 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.
Lifestyle changes are an important part of your treatment and can help slow the progress of CKD and reduce your symptoms. These steps may also help with high blood pressure, diabetes, and other problems that make kidney disease worse.
Your doctor may ask you to:
- Quit smoking, limit alcohol use, and reduce stress.
- Follow a diet that is easy on your kidneys. That may mean restricting certain nutrients, like protein, phosphorus, or potassium. Because your kidneys may be unable to filter excess amounts of those nutrients from your blood, they can build to dangerous levels. You may also need to restrict sodium (salt) and watch how much fluid you drink each day.
- Make exercise a routine part of your life. Work with your doctor to design an exercise program that is right for you.
Medicine to treat CKD
You might need medicine if you have high blood pressure, high blood sugar, or albumin in your urine.
What Happens if Kidney Disease Gets Worse?
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 very ill. Left 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 options have risks and benefits. Talk with your doctor to decide which is best for you.
Dialysis is a process that filters your blood when your kidneys no longer can. It is not a cure, but it can help you feel better and live longer. During dialysis, a machine cleans waste from your blood and helps control your blood pressure.
There are two common types of dialysis:
- Hemodialysis — done at a dialysis clinic or at home 3 times a week for about 3 hours.
- Peritoneal dialysis — done nightly from the comfort of your home.
For most people, dialysis is a short-term treatment. In time, you may need a kidney transplant.
If you have CKD, a kidney transplant may be the key to getting back your health. With a new kidney, you will feel much better and will be able to live a more normal life. However, you will need to wait for a kidney that is a good match for your blood and tissue type. And you will have to take medicine for the rest of your life to keep your body from rejecting the new kidney.
You can receive a kidney from a deceased kidney donor or a living donor. The wait time for a deceased donor kidney transplant in our region is four to six years. The call for the transplant can come any time of the day or night. In most cases, the patient needs to be ready to leave home within a few hours. The surgery typically lasts three hours. You are usually in the hospital for five days, depending upon the recovery process.
A living donor transplant is another option. This type of transplant occurs when a living person volunteers to donate one of their kidneys to someone in need. Any person that is in good health can be evaluated as a potential living donor. Living donor transplantation has several advantages including reduced waiting time, longer organ life, and convenience for the transplant recipient.
Paired Donor Exchange Transplant
Paired exchange transplant is an excellent option for living donor and recipient pairs who are biologically incompatible or who seek a better-matched donor
In a paired donor exchange, also known as a kidney swap, two kidney recipients essentially “swap” willing donors. While medically eligible to donate, each donor has an incompatible blood type or antigens to his or her intended recipient. By agreeing to exchange recipients — giving the kidney to an unknown but compatible individual — the donors can provide two patients with healthy kidneys where no transplant would have been possible. Paired exchange transplants can take place between pairs within a single transplant center or between pairs at different transplant centers.
How to prevent CKD
The best way to treat CKD is to prevent it. The best way to do that is to take care of your health. Maintain a healthy weight and manage any health conditions that can increase your risk for the disease.
Here are some tips to protect the overall health of your kidneys:
- Eat a healthy diet with lots of fruits and veggies. They’re high in potassium, which promotes healthy blood pressure.
- Limiting salt from both the shaker and processed foods also help reduce your blood pressure.
- Aim for at least 30 minutes of moderate intensity physical activity most days of the week.
- Limit alcohol to one drink a day for women and two drinks per day for men.
- Take steps to manage stress and get at least seven to eight hours of sleep each night.
- Quit smoking (cigarettes or marijuana).
- Get your blood pressure and blood sugar checked routinely.
- See a doctor for regular care if you have diabetes or high blood pressure.
- Tell your doctor if you routinely take over-the-counter drugs or herbal supplements.
CKD is a serious health condition, but there are treatment options to help manage the disease and live a fuller life. Take the next step and find a nephrologist near you.
Editor's Note: This article was originally published on , and was last reviewed on .
About Transplant Services
For more than four decades, UPMC Transplant Services has been a leader in organ transplantation. Our clinicians have performed more than 20,000 organ transplant procedures, making UPMC one of the foremost organ transplant centers in the world. We are home to some of the world’s foremost transplant experts and take on some of the most challenging cases. Through research, we have developed new therapies that provide our patients better outcomes — so organ recipients can enjoy better health with fewer restrictions. Above all, we are committed to providing compassionate, complete care that can change – and save – our patients’ lives. Visit our website to find a provider near you.