You have two kidneys, each about the size of your fist. Their main job is to filter your blood. They remove wastes and extra water, which become urine. They also keep the body's chemicals balanced, help control blood pressure, and make hormones.

Chronic kidney disease (CKD) means that your kidneys are damaged and can't filter blood as they should. This damage can cause wastes to build up in your body. It can also cause other problems that can harm your health. Diabetes and high blood pressure are the most common causes of CKD.

The kidney damage occurs slowly over many years. Many people don't have any symptoms until their kidney disease is very advanced. Blood and urine tests are the only way to know if you have kidney disease.

Treatments cannot cure kidney disease, but they may slow kidney disease. They include medicines to lower blood pressure, control blood sugar, and lower cholesterol. CKD may still get worse over time. Sometimes it can lead to kidney failure. If your kidneys fail, you will need dialysis or a kidney transplantation.

You can take steps to keep your kidneys healthier longer:

• Choose foods with less salt (sodium)
• Control your blood pressure; your health care provider can tell you what your blood pressure should be
• Keep your blood sugar in the target range, if you have diabetes
• Limit the amount of alcohol you drink
• Choose foods that are healthy for your heart: fruits, vegetables, whole grains, and low-fat dairy foods
• Lose weight if you are overweight
• Be physically active
• Don't smoke

Chronic kidney disease (CKD) means your kidneys are damaged and can’t filter blood the way they should. The disease is called “chronic” because the damage to your kidneys happens slowly over a long period of time. This damage can cause wastes to build up in your body. CKD can also cause other health problems.

The kidneys’ main job is to filter extra water and wastes out of your blood to make urine. To keep your body working properly, the kidneys balance the salts and minerals—such as calcium, phosphorus, sodium, and potassium—that circulate in the blood. Your kidneys also make hormones that help control blood pressure, make red blood cells, and keep your bones strong.

Kidney disease often can get worse over time and may lead to kidney failure. If your kidneys fail, you will need dialysis or a kidney transplant to maintain your health.

The sooner you know you have kidney disease, the sooner you can make changes to protect your kidneys.

How common is CKD?

CKD is common among adults in the United States. More than 37 million American adults may have CKD.

You are at risk for kidney disease if you have

• Diabetes. Diabetes is the leading cause of CKD. High blood glucose, also called blood sugar, from diabetes can damage the blood vessels in your kidneys. Almost 1 in 3 people with diabetes has CKD.
• High blood pressure. High blood pressure is the second leading cause of CKD. Like high blood glucose, high blood pressure also can damage the blood vessels in your kidneys. Almost 1 in 5 adults with high blood pressure has CKD.
• 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 kidney failure. 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.

Your chances of having kidney disease increase with age. The longer you have had diabetes, high blood pressure, or heart disease, the more likely that you will have kidney disease.

African Americans, Hispanics, and American Indians tend to have a greater risk for CKD. The greater risk is due mostly to higher rates of diabetes and high blood pressure among these groups. Scientists are studying other possible reasons for this increased risk.

Diabetes and high blood pressure are the most common causes of chronic kidney disease (CKD). Your health care provider will look at your health history and may do tests to find out why you have kidney disease. The cause of your kidney disease may affect the type of treatment you receive.

Diabetes

Too much glucose, also called sugar, in your blood damages your kidneys’ filters. Over time, your kidneys can become so damaged that they no longer do a good job filtering wastes and extra fluid from your blood.

Often, the first sign of kidney disease from diabetes is protein in your urine. When the filters are damaged, a protein called albumin, which you need to stay healthy, passes out of your blood and into your urine. A healthy kidney doesn’t let albumin pass from the blood into the urine.

Diabetic kidney disease is the medical term for kidney disease caused by diabetes.

High blood pressure

High blood pressure can damage blood vessels in the kidneys so they don’t work as well. If the blood vessels in your kidneys are damaged, your kidneys may not work as well to remove wastes and extra fluid from your body. Extra fluid in the blood vessels may then raise blood pressure even more, creating a dangerous cycle.

Other causes of kidney disease

Other causes of kidney disease include

• a genetic disorder that causes many cysts to grow in the kidneys, polycystic kidney disease (PKD).
• an infection
• a drug that is toxic to the kidneys
• a disease that affects the entire body, such as diabetes or lupus. Lupus nephritis is the medical name for kidney disease caused by lupus
• IgA glomerulonephritis
• disorders in which the body’s immune system attacks its own cells and organs, such as Goodpasture syndrome
• heavy metal poisoning, such as lead poisoning
• rare genetic conditions, such as Alport syndrome
• hemolytic uremic syndrome in children
• Henoch-Schönlein purpura
• renal artery stenosis

Early CKD may not have any 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.

Symptoms of advanced CKD

• chest pain
• dry skin
• itching or numbness
• feeling tired
• headaches
• increased or decreased urination
• loss of appetite
• muscle cramps
• nausea
• shortness of breath
• sleep problems
• trouble concentrating
• vomiting
• weight loss

People with CKD can also develop anemia, bone disease, and malnutrition.

How can I tell if I have kidney disease?

Early kidney disease usually doesn’t have any symptoms. Testing is the only way to know how well your kidneys are working. Get checked for kidney disease if you have

• diabetes
• high blood pressure
• heart disease
• a family history of kidney failure

If you have diabetes, get checked every year. If you have high blood pressure, heart disease, or a family history of kidney failure, talk with your health care provider about how often you should get tested. The sooner you know you have kidney disease, the sooner you can get treatment to help protect your kidneys.

What tests do doctors use to diagnose and monitor kidney disease?

To check for kidney disease, health care providers use

• a blood test that checks how well your kidneys are filtering your blood, called GFR. GFR stands for glomerular filtration rate.
• a urine test to check for albumin. Albumin is a protein that can pass into the urine when the kidneys are damaged.

If you have kidney disease, your health care provider will use the same two tests to help monitor your kidney disease and make sure your treatment plan is working.

Blood test for GFR

Your health care provider will use a blood test to check your kidney function. The results of the test mean the following:

• a GFR of 60 or more is in the normal range. Ask your health care provider when your GFR should be checked again.
• a GFR of less than 60 may mean you have kidney disease. Talk with your health care provider about how to keep your kidney health at this level.
• a GFR of 15 or less is called kidney failure. Most people below this level need dialysis or a kidney transplant. Talk with your health care provider about your treatment options.

You can’t raise your GFR, but you can try to keep it from going lower.

Creatinine. Creatinine is a waste product from the normal breakdown of muscles in your body. Your kidneys remove creatinine from your blood. Providers use the amount of creatinine in your blood to estimate your GFR. As kidney disease gets worse, the level of creatinine goes up.

Urine Test for Albumin

If you are at risk for kidney disease, your provider may check your urine for albumin.

Albumin is a protein found in your blood. A healthy kidney doesn’t let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine. The less albumin in your urine, the better. Having albumin in the urine is called albuminuria.

A health care provider can check for albumin in your urine in two ways:

Dipstick test for albumin. A provider uses a urine sample to look for albumin in your urine. You collect the urine sample in a container in a health care provider’s office or lab. For the test, a provider places a strip of chemically treated paper, called a dipstick, into the urine. The dipstick changes color if albumin is present in the urine.

Urine albumin-to-creatinine ratio (UACR). This test measures and compares the amount of albumin with the amount of creatinine in your urine sample. Providers use your UACR to estimate how much albumin would pass into your urine over 24 hours. A urine albumin result of

• 30 mg/g or less is normal
• more than 30 mg/g may be a sign of kidney disease

If you have albumin in your urine, your provider may want you to repeat the urine test one or two more times to confirm the results. Talk with your provider about what your specific numbers mean for you.

If you have kidney disease, measuring the albumin in your urine helps your provider know which treatment is best for you. A urine albumin level that stays the same or goes down may mean that treatments are working.

How do I know if my kidney disease is getting worse?

You can keep track of your test results over time. You can tell that your treatments are working if your

• GFR stays the same
• urine albumin stays the same or goes down

Your health care provider will work with you to manage your kidney disease.

If you have chronic kidney disease (CKD), you can take steps to protect your kidneys from more damage.

The sooner you know you have kidney disease, the better. The steps you take to protect your kidneys from damage also may help prevent heart disease—and improve your health overall. Making these changes when you have no symptoms may be hard, but it’s worthwhile.

Control your blood pressure

The most important step you can take to treat kidney disease is to control your blood pressure. High blood pressure can damage your kidneys. You can protect your kidneys by keeping your blood pressure at or less than the goal set by your health care provider. For most people, the blood pressure goal is less than 140/90 mm Hg.

Work with your health care provider to develop a plan to meet your blood pressure goals. Steps you can take to meet your blood pressure goals may include eating heart-healthy and low-sodium meals, quitting smoking, being active, getting enough sleep, and taking your medicines as prescribed.

Meet your blood glucose goal if you have diabetes

To reach your blood glucose goal, check your blood glucose level regularly. Use the results to guide decisions about food, physical activity, and medicines. Ask your health care provider how often you should check your blood glucose level.

Your health care provider will also test your A1C. The A1C is a blood test that measures your average blood glucose level over the past 3 months. This test is different from the blood glucose checks you do regularly. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months. Stay close to your daily blood glucose numbers to help you meet your A1C goal.

The A1C goal for many people with diabetes is below 7 percent. Ask your health care provider what your goal should be. Reaching your goal numbers will help you protect your kidneys.

Work with your health care team to monitor your kidney health

The tests that health care providers use to test for kidney disease can also be used to track changes to kidney function and damage. Kidney disease tends to get worse over time. Each time you get checked, ask your provider how the test results compare to the last results. Your goals will be to

• keep your GFR the same
• keep your urine albumin the same or lower

Your health care provider will also check your blood pressure and, if you have diabetes, your A1C level, to make sure you are meeting your blood pressure and blood glucose goals.

How can I prepare for visits with my health care provider?

The more you plan for your visits, the more you will be able to learn about your health and treatment options.

Make a list of questions
It’s normal to have a lot of questions. Write down your questions as you think of them so that you can remember everything you want to ask when you see your health care provider. You may want to ask about what tests are being done, what test results mean, or the changes you need to make to your diet and medicines.

Sample questions to ask your provider for people with kidney disease

About your tests

• What is my GFR? What does that mean?
• Has my GFR changed since last time?
• What is my urine albumin? What does it mean?
• Has my urine albumin changed since the last time it was checked?
• Is my kidney disease getting worse?
• Is my blood pressure where it needs to be?

About treatment and self-care

• What can I do to keep my disease from getting worse?
• Do any of my medicines or doses need to be changed?
• What time of day should I take each of my medicines?
• Do I need to change what I eat?
• Will you refer me to a dietitian for diet counseling?
• When will I need to see a nephrologist (kidney specialist)?
• Do I need to worry about dialysis or a kidney transplant?
• What do I need to do to protect my veins?

About complications

• What other health problems may I face because of my kidney disease?
• Should I be looking for any symptoms? If so, what are they?

Bring a friend or relative with you for support
A trusted friend or family member can take notes, ask questions you may not have thought of, offer support, and help remember what the provider said during the visit. Talk ahead of time about what you want to get out of the visit and the role you would like your friend or relative to play.

Take medicines as prescribed

Many people with CKD take medicines prescribed to lower blood pressure, control blood glucose, and lower cholesterol.

Two types of blood pressure medicines, ACE inhibitors and ARBs, may slow kidney disease and delay kidney failure, even in people who don’t have high blood pressure. The names of these medicines end in –pril or –sartan.

Many people need to take two or more medicines for their blood pressure. You may also need to take a diuretic, sometimes called a water pill. The aim is to meet your blood pressure goal. These medicines may work better if you limit your salt intake.

Know that your medicines may change over time

Your health care provider may change your medicines as your kidney disease gets worse. Your kidneys don’t filter as well as they did in the past, and this can cause an unsafe buildup of medicines in your blood. Some medicines can also harm your kidneys. As a result, your provider may tell you to

• take a medicine less often or take a smaller dose
• stop taking a medicine or switch to a different one

Your pharmacist and health care provider need to know about all the medicines you take, including OTC medicines, vitamins, and supplements.

Be careful about the over-the-counter medicines you take

If you take OTC or prescription medicines for headaches, pain, fever, or colds, you may be taking nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include commonly used pain relievers and cold medicines that can damage your kidneys and lead to acute kidney injury, especially in those with kidney disease, diabetes, and high blood pressure.

Ibuprofen and naproxen are NSAIDs. NSAIDs are sold under many different brand names, so ask your pharmacist or health care provider if the medicines you take are safe to use.

You also can look for NSAIDs on Drug Facts labels like the one below:

If you have been taking NSAIDs regularly to control chronic pain, you may want to ask your health care provider about other ways to treat pain, such as meditation or other relaxation techniques .

Tips for managing your medicines

The next time you pick up a prescription or buy an OTC medicine or supplement, ask your pharmacist how the product may

• affect your kidneys
• affect other medicines you take

Fill your prescriptions at only one pharmacy or pharmacy chain so your pharmacist can

• keep track of your medicines and supplements
• check for harmful interactions

Keep track of your medicines and supplements:

• Keep an up-to-date list of your medicines and supplements in your wallet. Take your list with you, or bring all of your medicine bottles, to all health care visits.

Work with a dietitian to develop a meal plan

What you eat and drink can help you

• protect your kidneys
• reach your blood pressure and blood glucose goals
• prevent or delay health problems caused by kidney disease

As your kidney disease gets worse, you may need to make more changes to what you eat and drink.

A dietitian who knows about kidney disease can work with you to create a meal plan that includes foods that are healthy for you and that you enjoy eating. Cooking and preparing your food from scratch can help you eat healthier.

Nutrition counseling from a registered dietitian to help meet your medical or health goals is called medical nutrition therapy (MNT). If you have diabetes or kidney disease and a referral from your primary care provider, your health insurance may cover MNT. If you qualify for Medicare, MNT is covered.

Your health care provider may be able to refer you to a dietitian. You can also find a registered dietitian online through the Academy of Nutrition and Dietetics. Work closely with your dietitian to learn to eat right for CKD.

Make physical activity part of your routine

Be active for 30 minutes or more on most days. Physical activity can help you reduce stress, manage your weight, and achieve your blood pressure and blood glucose goals. If you are not active now, ask your health care provider about the types and amounts of physical activity that are right for you.

Aim for a healthy weight

Being overweight makes your kidneys work harder and may damage your kidneys. The NIH Body Weight Planner is an online tool to help you tailor your calorie and physical activity plans to achieve and stay at a healthy weight.

Get enough sleep

Aim for 7 to 8 hours of sleep each night. Getting enough sleep is important to your overall physical and mental health and can help you meet your blood pressure and blood glucose goals. You can take steps to improve your sleep habits.

Stop smoking

Cigarette smoking can make kidney damage worse. Quitting smoking may help you meet your blood pressure goals, which is good for your kidneys, and can lower your chances of having a heart attack or stroke.

Find healthy ways to cope with stress and depression

Long-term stress can raise your blood pressure and your blood glucose and lead to depression. Some of the steps that you are taking to manage your kidney disease are also healthy ways to cope with stress. For example, physical activity and sleep help reduce stress. Listening to your favorite music, focusing on something calm or peaceful, or meditating may also help you.

Depression is common among people with a chronic, or long-term, illness. Depression can make it harder to manage your kidney disease. Ask for help if you feel down. Seek help from a mental health professional. Talking with a support group, clergy member, friend, or family member who will listen to your feelings may help.

Preventing chronic kidney disease (CKD) and its complications is possible by managing risk factors and treating the disease to slow its progression and reduce the risk of complications. To keep healthy kidneys, it is important to control those risk factors for CKD that can be modified.

Get Tested for CKD

• If you are at risk, get tested for CKD regularly. Ask your doctor to test your blood or urine.
• Find it early. Treat it early.
• If you have diabetes, get tested yearly.

Healthy Kidney Tips

• Lose weight if you are overweight.
• Get active. Physical activity helps control blood sugar levels.
• Quit smoking.
• Getting a checkup? Make sure to get your kidneys checked too.
• Take medications as directed.
• Keep your blood pressure below 140/90, or ask your doctor what the best blood pressure target is for you.
• If you have diabetes, stay in your target blood sugar range as much as possible.
• Stay in your target cholesterol range.
• Eat foods lower in salt.
• Eat more fruits and vegetables.

Keep your kidneys healthy by controlling your blood sugar and blood pressure.

Managing Risk Factors for CKD

• Among people with diabetes and high blood pressure, blood sugar and blood pressure control have been shown to lower the risk of developing kidney disease.
• Several studies have shown the possibility for preventing or delaying the start of diabetic kidney disease by treating patients who have diabetes with blood pressure-lowering drugs. In addition to lowering blood pressure, these medications reduce protein in the urine, a risk factor for developing kidney disease.
• Managing blood sugar, blood pressure, and cholesterol levels is very important because these are all risk factors for heart disease and stroke.
• Because having kidney disease increases the chances of also having heart disease and stroke, early detection and treatment of kidney disease is important for people with diabetes to help prevent or delay cardiovascular death and kidney failure.
• Learn more about taking care of your kidneys

Managing CKD

Once detected, kidney disease may be addressed through:

• Improved lifestyle changes (e.g. healthy eating)
  • Meeting with a dietitian to make a kidney-healthy eating plan
• Proper use of medications (e.g. drugs to lower blood pressure)
• Avoiding conditions or exposures that can harm the kidneys or cause a sudden drop in kidney function (called acute kidney injury), such as:
  • Kidney infections
  • Medications
    • Over the counter pain medicines like ibuprofen and naproxen
    • Certain antibiotics
  • Herbal supplements
  • Dyes that are used to make the blood vessels or organs visible on X-rays or other imaging tests

Does CKD cause other health problems?

Kidney disease can lead to other health problems, such as heart disease. If you have kidney disease, it increases your chances of having a stroke or heart attack.

High blood pressure can be both a cause and a result of kidney disease. High blood pressure damages your kidneys, and damaged kidneys don’t work as well to help control your blood pressure.

If you have CKD, you also have a higher chance of having a sudden change in kidney function caused by illness, injury, or certain medicines. This is called acute kidney injury (AKI).

How can CKD affect my day-to-day life?

Many people are afraid to learn that they have kidney disease because they think that all kidney disease leads to dialysis. However, most people with kidney disease will not need dialysis. If you have kidney disease, you can continue to live a productive life, work, spend time with friends and family, stay physically active, and do other things you enjoy. You may need to change what you eat and add healthy habits to your daily routine to help you protect your kidneys.

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. 

Some people live with kidney disease for years and are able to maintain kidney function. Others progress quickly to kidney failure.

Kidney failure means that your kidneys have lost most of their ability to function—less than 15 percent of normal kidney function. If your kidney function drops to this level, you may have symptoms from the buildup of waste products and extra water in your body.

To replace your lost kidney function, you may have one of three treatment options:

• hemodialysis
• peritoneal dialysis
• kidney transplant

End-stage renal disease (ESRD) is kidney failure that is treated by dialysis or kidney transplant.

Some people with kidney failure choose not to have dialysis or a transplant but continue to receive care from their health care team, take medicines, and monitor their diet and lifestyle choices.

Work with your health care team and family to consider your options and choose a treatment that is right for you.

Dialysis treatment replaces the function of kidneys that have acute kidney failure or end-stage kidney failure, usually when they've lost 85-90% of their function. In some cases of acute kidney failure, dialysis is needed only temporarily until the kidneys heal. In chronic kidney failure or end-stage kidney failure, the kidneys do not get better and dialysis will be necessary for the rest of the person's life (unless they get a kidney transplant).

In hemodialysis, a dialysis machine filters blood from the body as it flows out from an access port (entrance), usually in the person's arm or leg. The "dirty" blood circulates through the dialysis machine, where artificial membranes filter and cleanse it. The purified blood is then returned through the port back into the person"s bloodstream.

Peritoneal dialysis uses the lining of your abdomen (peritoneum), which is rich in arteries and veins, as a filter. Dialysis fluid is placed into the abdominal cavity through a permanent access port in the abdomen. The fluid remains there long enough for wastes in the blood to transfer to it, and is then drained out of the abdomen.

Risks of Dialysis

The many risks associated with kidney dialysis may be related to the dialysis or to the underlying kidney disease. They include:

• Anemia
• Bone diseases
• Hypertension
• Fluid overload
• Inflammation of the membrane surrounding the heart (pericarditis)
• High potassium levels (hyperkalemia)
• Nerve damage
• Infection

When people's kidneys can no longer filter blood properly, they need to consider either dialysis or a kidney transplant. To receive a kidney transplant, the recipient must be healthy enough to endure the transplant operation, which can take several hours. Doctors evaluate the health of the patient by performing physical exams, ensuring that the lungs and lower gastrointestinal tract are clear and healthy and determining if the heart can handle the stresses of the operation.

There are two types of kidney transplants: cadaver, where the healthy matching kidney is provided by a deceased donor; and living donor, where a family member, friend or good Samaritan donates a healthy kidney. Cadaver transplants require being put on a transplant list, and waiting your turn, often for years, until a matching kidney becomes available. Living donor kidney transplants are preferred because they keep people off the transplant list, making more kidneys available for people without donors, and also because living donor kidneys tend to have higher function and last longer (20+ years). The success rate for kidney transplant is above 90%.

In the last decade, laparoscopic surgery, which requires only small incisions, has replaced conventional operations for kidney removal, which required a larger opening and therefore a longer recovery time. During the operation, the surgeon places the new kidney in the recipient's lower abdomen, leaving the patient with three kidneys in all. (The recipient's native kidneys will simply atrophy (shrink) as the new kidney takes over function.) The new location of the transplanted kidney allows it to be easily attached to blood vessels in the lower part of the abdomen, and for the ureter (the tube that carries urine from the kidney to the bladder) to be connected to the bladder.

The risks associated with kidney transplant surgery include rejection, infection, acute tubular necrosis (delayed graft function), hypertension, and cancer.