You have two kidneys, each about the size of your fist. They are near the middle of your back, just below the rib cage. Inside each kidney there are about a million tiny structures called nephrons. They filter your blood. They remove wastes and extra water, which become urine. The urine flows through tubes called ureters. It goes to your bladder, which stores the urine until you go to the bathroom.

Most kidney diseases attack the nephrons. This damage may leave kidneys unable to remove wastes. Causes can include genetic problems, injuries, or medicines. You have a higher risk of kidney disease if you have diabetes, high blood pressure, or a close family member with kidney disease. Chronic kidney disease damages the nephrons slowly over several years. Other kidney problems include

• Cancer
• Cysts
• Stones
• Infections

Your doctor can do blood and urine tests to check if you have kidney disease. If your kidneys fail, you will need dialysis or a kidney transplant.

Did you know that if your kidneys start to struggle, they will automatically work harder? Because of this increased effort, around 90% of people with kidney disease won’t know they have it until it’s advanced.

Kidneys remove waste from your blood, balance fluid, and make hormones. Kidney disease becomes noticeable when your kidneys can’t keep up. Swelling in your body, reduced trips to urinate, or dry, itchy skin may be your first sign of kidney disease. That’s why early detection is key.

You can lose up to 60% of your kidney function before you notice problems. Take steps to adopt a healthy lifestyle today and talk with your doctor about getting tested for kidney disease.

You may not regain lost function, but you may be able to prevent or slow the progression of kidney disease.

Data are for the U.S.

Morbidity

• Number of adults aged 18 and over with diagnosed kidney disease: 6.0 million
• Percent of adults aged 18 and over with diagnosed kidney disease: 2.4%

Source: Summary Health Statistics Tables for U.S. Adults: National Health Interview Survey, 2018, Table A-4b, A-4c

Mortality

• Number of deaths from nephritis, nephrotic syndrome and nephrosis: 54,358
• Deaths per 100,000 population: 16.4
• Cause of death rank: 10

Source: National Vital Statistics System – Mortality Data (2021) via CDC WONDER

People of all ages and races can be affected by kidney disease. And African Americans, Hispanics, and American Indians have a greater risk for developing kidney failure.

Early kidney disease usually has no symptoms, and can lead to kidney failure. And, the only way to find out if you have kidney disease is to get tested.

So how do you know if you should get tested? You should get tested if you have any of these risk factors for kidney disease.

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

Talk to your family and friends about these risk factors. You could help them to prevent or delay kidney failure.

Talk to Your Doctor About Symptoms

Even if a doctor has told you that chronic kidney disease is harming your kidneys, you may not feel the effects. Many people don’t notice any symptoms until their kidneys hardly work at all. Or, you may have symptoms and wonder if they might be caused by a kidney problem. The only way to know for sure is to see your doctor. Symptoms can be a clue, but the same symptoms can have many causes. Only a doctor can diagnose kidney disease, and this is done with blood and urine tests.

Not Sure if Your Kidneys are Healthy? Ask Your Doctor

If you are not sure about your kidney health, your VA health care team can help. They can do some simple lab tests to see how well your kidneys are working. They will want to check your blood pressure and test your urine for protein and other substances. They will take a small blood sample to measure kidney function by looking for a build-up of wastes. You may need an ultrasound or other tests as well.

Tell Your Care Team if You Have Any of These Symptoms

Some people say they felt “fine” right up until their kidneys stopped working. Maybe they didn’t have any symptoms. Or, maybe they didn’t know what to look for. Your care team will be able to help you feel better if you tell them about any symptoms you have. Here is a list of common symptoms of severe chronic kidney disease:

• I’m so tired!
• I feel cold all the time
• My feet are so swollen that my shoes don’t fit
• My fingers are so swollen that my rings don’t fit
• My face looks puffy
• It’s hard to breathe
• I itch all over
• The thought or smell of meat makes me sick to my stomach
• I feel sick to my stomach a lot
• I feel faint or dizzy, or pass out
• Food doesn’t taste right—it all tastes like metal
• I can’t think clearly
• My urine is foamy or bubbly, a dark color like cola, or I feel pressure when I have to go
• People tell me my breath smells like ammonia

Water and Salt Build Up in Your Body

Kidneys that don’t work well don’t remove all of the excess water and salt from the body. Think of your body as a bathtub. When your kidneys work well, you fill up the “tub” by drinking—and then the water and salt go down the drain as urine. But when your kidneys don’t work well, water and salt stay in the “tub” and only drain out slowly. If your kidneys fail, the water and salt don’t drain out at all, and you need treatment to live.

Swelling in the Hands, Feet, or Face

When the kidneys don’t work well, excess water and salt can build up in the hands, feet, or face (often under the eyes). This problem is most common in kidney diseases that cause protein to leak into the urine (called proteinuria).

Cutting back on salt in your diet will help because salt holds water in your body.

Medicines may help, too:

• Diuretics (water pills) prescribed by a doctor can help your body get rid of some excess water and salt (as long as your kidneys are still working).
• Blood pressure pills called ACE inhibitors or ARBs may help slow the types of kidney problems that cause swelling.

Changes in Urine

Some kidney problems can cause changes in the color or amount of your urine. Diseases that damage the filters in the kidneys can let protein from the blood leak out into the urine.

If this happens, you might notice that your urine looks bubbly, foamy, or dark. You might also make more or less urine than usual, or have blood in your urine.

Anemia: Too Few Red Blood Cells

Healthy kidneys tell your bone marrow to make red blood cells. How? They make a chemical message. The kidneys send a hormone called erythropoietin, or EPO, to the bone marrow where red blood cells are made.

Kidneys that don’t work right make less EPO. This can mean that you don’t have enough red blood cells—a problem called anemia. Slight anemia is okay when you have a kidney problem. You might not even know you have it. But severe anemia causes many of the symptoms of chronic kidney disease, like:

• Fatigue
• Feeling cold all the time
• Fuzzy thinking

The good news is anemia can be treated so you have more energy.

Working? Don’t Quit Because You’re Tired!

Anemia from kidney disease can make people so tired that they feel like they have to quit their jobs. But, if you work, think twice before you quit. Taking disability may not be your best choice. Why?

• Disability does not pay as much as your job—you will get only about ¹⁄₃ of your income.
• If you quit, you may find it hard to find a new job.
• Work can give you a sense of pride and help you feel valued.

Anemia can be treated and you can have more energy to do things you want to do.

The treatment for anemia can take three forms:

1. Iron, which your body needs as a building block to make red blood cells.
2. Manmade erythropoietin, or EPO.
3. Blood transfusion, as a last resort.

If you feel too tired to work, talk to your care team. Ask to be tested for anemia. The test is a blood count for hemoglobin—your level of red blood cells.

Shortness of Breath

If you feel like you get winded easily, it might be a symptom of kidney disease. Shortness of breath in people with kidney problems can be caused by a build-up of excess fluid or by anemia. Both of these can be treated—and you can feel better.

Itching Can Be Treated—Ask How

Late stage chronic kidney disease can make you itch! It may be that your skin is dry. Try a lotion. In many cases, the cause is a build-up of phosphorus in your blood. As kidney function drops, the kidneys remove less phosphorus. You take in phosphorus each time you eat. It’s one of the most common minerals in our food supply. Nearly all foods have at least some. Foods with the most phosphorus include:

• Meats
• Dairy
• Nuts
• Beans
• Whole grains
• Chocolate
• Cola drinks

Trying to limit foods with phosphorus can be a challenge, but there are ways to do it.

Itching Treatment: Phosphate Binders

Your doctor may prescribe medicines for you called phosphate binders. Like a magnet, binders attract and hold phosphorus before it can get into your bloodstream. The phosphorus passes through your gut and is removed in your stool. Most binders are prescribed by your doctor. Taking phosphate binders and watching what you eat go hand in hand to help you feel your best.

You take phosphate binders:

• WITH food—while you are eating, so they are in your gut with your food
• With ALL food—meals and snacks
• ONLY with food—if you forget, wait until your next meal or snack

Can’t Eat Protein? Talk to Your Care Team

If you find that you can’t face eating protein foods like meat—or can’t eat much at all—see your health care team right away. Nausea and loss of appetite can occur with kidney problems, or can be a symptom of another illness.

Kidney disease can cause many kinds of symptoms—or no symptoms at all:

• If you worry that you might have a kidney problem, please set up a time to see your health care team.
• If you know you have a kidney problem and you now feel nausea or don’t want to eat, ask your care team to check your level of kidney function. Keeping track of your symptoms can help you get the care you need to feel your best.

Diabetes and Kidney Failure

Diabetes, or high blood sugar, is the number one cause of kidney failure in the U.S. If you have diabetes and kidney problems, there are steps you can take to keep your kidneys working as long as possible. The goal is to help your kidneys live as long as you do.

Two Types of Diabetes

Your body needs insulin to use sugar as energy. Having diabetes means not having enough insulin or not being able to use it:

• In type 1 diabetes, the body's immune system attacks and kills the cells in the pancreas that make insulin, so there is not enough. Injections of insulin are needed to live.
• Type 2 diabetes occurs when the body's cells can't use insulin the way they should. Increased body fat can make it hard for the body to use insulin. Weight loss and exercise can help. Many people with type 2 can take pills to treat it, but most will need injections of insulin as time goes on.

Both types of diabetes harm blood vessels all over the body. These include large blood vessels in the heart, brain, and limbs—and small blood vessels in the eyes and kidneys.

Test Your Sugar and Know How it Reacts to What You Eat

The good news is, only about one in four people with diabetes ever has kidney problems. And, if you do have kidney problems, you can be treated.

If you have diabetes, good blood sugar control can help protect your kidneys—and the rest of you. Knowing what your blood sugar is and how it reacts to what you do and what you eat is the first step to keeping it in control. With test strips and a glucometer, you can check your blood sugar daily and track the results. The VA provides these for you at no charge. Your care team will tell you what blood sugar targets to aim for.

A test called hemoglobin A1c can check your 3-month blood sugar average. It can help you see if you are on the right track for blood sugar control.

Know Your Blood Pressure and How it Reacts

Having diabetes and high blood pressure at the same time is a "double whammy" for the kidneys. Both damage the blood vessels and the tiny filters inside the kidneys.

Have your blood pressure checked—or check it yourself with a home blood pressure cuff. You can get a home blood pressure cuff from the VA. Ask your care team for one. If your blood pressure is high, talk with your care team about treatment options to get it under control.

Limit Sweets and Starchy Foods

Staying in the target range your care team gives you for blood sugar can help protect your kidneys. Sweets and starchy foods can raise your blood sugar. These include:

• Candy
• Ice cream
• Cakes, pies, doughnuts, cookies
• Bread, bagels, muffins, crackers
• Pasta, rice, potatoes
• Cornbread, corn chips

Eating less of these foods can help you stay in the target range. This can be a hard change to make! Take small steps. Try changing one thing at a time.

Eat Lots of Vegetables and Get Exercise

Eating right and staying active can help you stay in your target range. These things are in your control. No one else can eat or exercise for you.

Based on your kidney function, you may need to limit foods that are high in potassium—like coffee, milk, bananas, orange juice, tomatoes, and potatoes. Talk to a VA dietitian about the best food choices for you.

Find a Healthy Weight for You

In some cases, people with type 2 diabetes who lose weight can stop taking diabetes medicines. Losing weight, if you are overweight, can also help lower your blood pressure so you may not need as many blood pressure pills.

Get a Urine Test Once a Year

Protein in your urine is an early sign of kidney problems. If you have diabetes, get your eyes and your urine checked each year. Ask your health care team to check your urine for protein. A test for albuminuria can find kidney disease.

If you have protein in your urine, certain blood pressure pills can help protect your kidneys, even if your blood pressure is not high. These pills are in the ACE-inhibitor or ARB class. ACE-inhibitors can cause a dry cough. If this is a problem for you, your doctor can switch you to an ARB instead.

Treat High Blood Sugar

If you have type 2 diabetes, your doctor may prescribe medicines to lower your blood sugar. These only work if you take them. Talk to your care team if you need help to think of a way to remind yourself to take your medicines.

If you need insulin, knowing how to use it can help you stay in your target range. Tell your care team that you would like to learn more about how to manage your blood sugar.

Some Diabetes Medicines Are Not Safe if You Have Kidney Disease

Metformin is NOT SAFE for you if your kidney disease is severe or if you have heart failure. Metformin can have many names. Look for the generic name on your pill bottle or ask your pharmacist if what you are taking is a biguanide.

If the answer is yes, talk to your doctor about when to switch to a medicine that is safer for people with kidney disease.

Talk to your doctor before you start or stop taking any prescribed drug.

Kidney Disease Can Change Your Diabetes Control

Kidneys that don’t work well can change your diabetes control. Diabetes pills and insulin can last longer in your bloodstream when your kidneys don’t work well. This can cause more low blood sugar. Stay in close touch with your health care team. They can help you manage your diabetes.

High Blood Pressure and Kidney Disease

High blood pressure is the number two cause of kidney failure in the U.S., after diabetes. If you have high blood pressure and kidney problems, there are steps you can take. The goal is to help your kidneys live as long as you do.

Arteries, Veins, and Blood Pressure

You have two types of blood vessels. Arteries, shown in the picture in red, take blood from your heart (with oxygen from your lungs) to the rest of your body. Veins, shown in the picture in blue, bring blood back to the lungs to pick up more oxygen. Arteries are strong and flexible. But, as we age, they can become stiff. This is one cause of high blood pressure.

When blood pressure is high, the force of blood against the walls of your arteries can harm small blood vessels—like a tire blowout. The tiny filters inside the kidneys are small blood vessels. This is why high blood pressure can harm them.

High Blood Pressure and Your Kidneys

High blood pressure can harm kidneys. And, damaged kidneys can stop doing a good job of keeping blood pressure under control. Like the chicken and the egg, doctors can't always tell which came first.

In most cases it is possible to lower blood pressure and protect the kidneys from more damage. Good blood pressure control also helps reduce your risk of a heart attack or stroke.

Know Your Blood Pressure and How it Reacts

Knowing your blood pressure is the first step to getting it in control. Ask your care team what your blood pressure goal should be. A home blood pressure cuff is a great tool to have, and your VA care team can give you one. Then you can:

• Check your blood pressure when you are sitting quietly at rest.
• Check your blood pressure if you feel faint or have a headache.
• Write down the results and look for patterns. These can help your doctor.
• Let your care team know your numbers.
• Bring a record of your numbers to your next care team visit.

Put Away the Salt Shaker

If you are salt sensitive, eating less salt, or sodium, can help you bring down your blood pressure. Sea salt is just the same—and just as harmful for you—as table salt. Salt substitutes may be high in potassium, which is dangerous for you if your kidneys can't remove it from your body. It's better to use herbal seasonings, which come in lots of low-salt flavors.

Most sodium comes from processed foods that come in cans, bags, or boxes. Food from restaurants also tends to be much higher in sodium than fresh foods that are cooked at home.

The American Heart Association says we should ALL limit sodium in our diets to 1,500 milligrams (mg) per day. Many people find that once they get used to eating less salt, food tastes better.

Avoid High-Salt Fast and Processed Foods

Did you know that many Americans eat fast food every day? A lot of fast food is very high in salt—along with fat, trans fats, starch, and calories. It's cheap and tasty, but not good for you OR your kidneys. You can get a whole day's worth of salt, sugar, and fat with just one menu item! At restaurants where they cook to order, you can ask for food with no added salt, MSG, salty sauces, or cheese on top. This can help you control your blood pressure.

About ¾ of all salt in most people's diets comes from processed foods. These have been changed in some way—cooked, frozen, dehydrated. Soups often have a lot of sodium—look for low sodium soups. Most processed meats, like bacon, cold cuts, and salami have too much salt to be good choices.

Read ingredient lists on ALL meats. Some fresh meats are injected with salt or potassium. You don't want to see the word enhanced on the label. Avoid these. Condiments, like ketchup and soy sauce, have a lot of salt. Boxed side dishes and "helper" foods have too much salt. If you have high blood pressure, these are not a good choice.

Read Food Labels to Look for Sodium

Does the food in this label look like a good choice to protect your kidneys? There is almost 1,500 mg of sodium in one serving of this food—a whole day's worth.

Most foods have labels like this to help you make good choices. Keep a close eye on serving sizes:

• A serving size may be in grams or ounces
• A food that comes in a bag could be two or three servings, not one
• If you eat more than one serving, you get more salt

Treat High Blood Pressure with Lifestyle Changes

Eating right and staying active can help you stay in your target blood pressure range. Weight loss if you are overweight can help lower your blood pressure. These things are in your control. No one else can eat or exercise for you.

Based on your kidney function, you may need to limit foods that are high in potassium—like coffee, milk, bananas, orange juice, tomatoes, and potatoes. Talk to a VA dietitian about the best food choices for you.

Relaxing Can Help Lower Blood Pressure

Some types of relaxation can help lower high blood pressure. These might be things like:

• Yoga
• Tai Chi
• Chi Gong
• Meditation

None of these will hurt you, and they may help.

Diuretics ("Water Pills") Are Often the First Type of Blood Pressure Pills Used

Blood pressure pills are often prescribed to help lower blood pressure. The first line of treatment is often diuretics (water pills). These help your kidneys get rid of extra water and sodium in your body by helping you make more urine. Diuretics only work while your kidneys still have some function.

Of course, pills only work if you take them. If side effects or cost keep you from taking meds, talk to your health care team. You may be able to take your pills at a time of day that will be less of a problem for you (so you don't have to wake up at night to use the bathroom). Or, there may be other drugs that will not cause problems for you.

Some Blood Pressure Pills Can Help Protect the Kidneys

Two types of blood pressure pills can help protect the kidneys:

• ACE-inhibitors – the generic name ends in “pril”
• Angiotensin receptor blockers (ARBs) – the generic name ends in “sartan”

These are very helpful in diabetes or diseases where there is protein in the urine. An ACE-inhibitor can cause a nagging, dry cough. If this happens, you may need to switch to an ARB. Not on an ACE-inhibitor or an ARB? Ask your doctor if one might help you. If you have side effects from blood pressure pills (like erectile dysfunction), tell your doctor. There may be others you can try.

1. Kidneys, CKD, and your risk

What is CKD? CKD (chronic kidney disease) means the kidneys are damaged and may no longer filter blood well. This damage happens over many years. As more damage occurs, the kidneys are unable to keep the body healthy - then dialysis or a kidney transplant may be needed to maintain health.

How can I lower my risk for CKD? The steps you take to manage your diabetes and high blood pressure also help protect your kidneys. Choosing healthy foods, quitting smoking, and being more physically active are all important steps.

2. Importance of testing and how CKD is diagnosed

What are the symptoms of CKD? Most people with CKD have no symptoms until their kidneys are about to fail. The only way to know if you have kidney disease is to get tested. The sooner kidney disease is found, the sooner you can take steps to begin treatment and keep your kidneys healthier longer.

How do you check for CKD? A blood test and a urine test are used to find kidney disease. Because you are at risk, you should get these tests regularly:

• GFR - A blood test measures how much blood your kidneys filter each minute, which is known as your glomerular filtration rate (GFR).
• Urine Albumin - A urine test checks for albumin in your urine. Albumin is a protein that can pass into the urine when the filters in the kidneys are damaged.

3. The progressive nature of CKD and the basics of treatment

Can CKD get better? CKD usually will not get better and is likely to get worse. Treatment helps slow kidney disease and keep the kidneys healthier longer.

How is CKD treated? Treatment includes keeping blood pressure at the level set by your provider, eating foods with less salt and the right amount of protein, and controlling blood sugar if you have diabetes.

Are there medications for CKD? People with CKD often take medicines to lower blood pressure, control blood sugar, and lower blood cholesterol. Two types of blood pressure medications - ACE inhibitors and ARBs - can slow CKD and delay kidney failure, even in people who do not have high blood pressure.

4. Dialysis and transplantation

Will I ever need dialysis? With proper management, you may never need dialysis or, at least, not for a very long time. But if your kidneys fail, we will need to choose a treatment that can replace the job of your kidneys to maintain health. There are two types of dialysis - one is done at home daily and the other is done in a dialysis center three times a week.

Is kidney transplant an option? You may be able to receive a kidney transplant. The donated kidney can come from an anonymous donor who has recently died or from a living person. A kidney transplant is a treatment - not a cure.

You may have a strong stomach and your heart may be in the right place, but how well are your kidneys working? If you have risk factors for kidney disease, ask your doctor about getting tested to find out your kidney health.

Your kidneys aren’t very large—each is just the size of a computer mouse—but they’re hard-working. They filter all the blood in your body every 30 minutes, removing wastes, toxins, and excess fluid. They also help control blood pressure, stimulate production of red blood cells, keep your bones healthy, and regulate blood chemicals that are essential to life.

Each kidney is made up of millions of tiny filters called nephrons. Over time, nephrons can become damaged by diabetes, high blood pressure, or other causes and stop working, a condition called chronic kidney disease, or CKD. Healthy nephrons can make up the difference for a while, but if not treated, CKD usually gets worse. CKD can lead to kidney failure, also known as end-stage renal disease (ESRD) or Stage 5 CKD. A person with ESRD will need regular dialysis (a treatment that filters the blood) or a kidney transplant to survive.

CKD and Women

Chronic kidney disease (CKD) is more common in women than men, but fewer women are on kidney dialysis. Why?

One reason is that CKD progresses more slowly in women so they don’t need dialysis as soon as men. But awareness may play an even bigger role. Women are less likely to know they have moderate to severe CKD than men, so they often start dialysis later or receive no dialysis at all.

If you think a friend or family member might be at risk for CKD, encourage her to put a kidney checkup on her calendar. Treatment can improve her kidney health!

Could This Be You?

Approximately 15% of US adults (37 million people) are estimated to have CKD, but because early CKD has no signs or symptoms, most don’t know they have it. If you have any of these risk factors for CKD, talk to your doctor about getting tested:

• Diabetes
• High blood pressure
• Heart disease
• Family history of CKD

It’s also important to note that African Americans, Hispanic/Latino Americans, and American Indians are at higher risk for CKD.

Your Mileage May Vary

High blood pressure and diabetes are the leading causes of CKD. Approximately 1 in 3 adults with diabetes and 1 in 5 adults with high blood pressure could have CKD. Also, the number of young people with type 2 diabetes is increasing. That’s important because having diabetes for a longer time means more time to develop diabetes complications, including CKD.

Diabetes is the most common cause of end-stage renal disease (ESRD), accounting for 44% of new cases. African Americans are about 3 times more likely to develop ESRD than whites. Hispanics are about 35% more likely to develop ESRD than non-Hispanics. And there’s a gender gap: men are nearly 65% more likely than women to progress to ESRD.

Find it Early, Treat it Early

If you’re at risk for kidney disease, get your kidneys checked regularly, which is done by your doctor with simple blood and urine tests. Regular testing is your best chance for identifying CKD early if you do develop it. Early treatment is most effective and can help prevent additional health problems.

Your treatment and management plan may include taking medications and making lifestyle changes—including choosing healthy foods and getting physically active—as well as working to keep your blood sugar and blood pressure numbers as close to target as you can.

Kidney-Friendly Tips

• Keep your blood pressure below 140/90 mm Hg (or the target your doctor establishes for you).
• If you have diabetes, stay in your target blood sugar range as much as possible.
• Get active—physical activity helps manage blood pressure and blood sugar levels.
• Lose weight if you’re overweight.
• Get tested for CKD regularly if you’re at risk.
• If you have CKD, meet with a dietitian to create a kidney-healthy eating plan. The plan may need to change as you get older or if your health status changes.
• Take medications as instructed, and ask your doctor about blood pressure medicines called ACE inhibitors and ARBs, which may protect your kidneys in addition to lowering blood pressure.
• If you smoke, quit. Smoking can worsen kidney disease and interfere with medication that lowers blood pressure.
• If you have diabetes, include a kidney doctor (nephrologist) on your health care team.

Prediabetes and CKD Prevention

With prediabetes, blood sugar levels are higher than normal, but not high enough yet to be diagnosed as diabetes. Prediabetes puts people at increased risk of developing type 2 diabetes, heart disease, and stroke. If you have prediabetes, preventing or delaying type 2 diabetes can also help prevent kidney disease. Visit DoIHavePrediabetes.org to find out your prediabetes risk. The website features a short quiz, lifestyle tips, and links to prevention programs across the country that are recognized by CDC as part of the National Diabetes Prevention Program.

Tracking CKD

CKD has an enormous impact on health, quality of life, and health care costs and is a national public health priority. The CKD Surveillance System documents and monitors CKD and its risk factors in the United States and tracks progress in CKD prevention, detection, and management.

Manage Health Problems

There are steps you can take to protect your kidneys. These can range from keeping other health problems in control to changing some parts of your lifestyle. If you are overweight, losing weight can help protect your kidneys. The changes are worth it. Having even a little bit of kidney function is much better than not having any.

Two health problems cause most of the kidney failure in the U.S.: diabetes and high blood pressure.

To Slow Chronic Kidney Disease, Treat the Cause

As you can see in the pie chart on the right (click on the image to enlarge it) , there are many health problems that can damage the kidneys.

Most kidney failure in the U.S. is caused by either type 2 diabetes or high blood pressure—or both at the same time.

Test For and Treat High Blood Sugar and Blood Pressure

If you have diabetes, good blood sugar control can help protect your kidneys. Knowing what your blood sugar is and how it reacts to what you do and what you eat is the first step to keeping it in control. Your care team will tell you what blood sugar targets to aim for.

Keeping your blood pressure in the target range can also protect your kidneys. Like blood sugar, knowing your blood pressure is the first step to getting it in control.

Study YOUR Cause of Kidney Disease

Learn about the illness that caused your kidney problem. Look it up.

Talk to your care team about what you learn. You just might find your way to something that can help you.

Make Good Food and Drink Choices

People often want to know what they can eat or drink to keep their kidneys healthy. Good choices are foods that are healthful in general—like fruits and vegetables. Also, try to eat foods that are fresh and have few ingredients. Eat a rainbow!

To protect your kidneys you can also:

• Avoid salty, deep fried, and highly processed foods like “helpers,” canned soups, fast food, and soda.
• Drink water—not soda, juice, or diet drinks with artificial sweeteners.

NOTE: If your kidneys have failed, you may have limits on what you can eat and drink based on the type of treatment you choose. Talk to your dietitian to learn what’s best for you.

A Protein Serving is About the Size of a Deck of Cards

Some doctors may ask you to eat less protein to ease the burden on weak kidneys. Eating less protein may help slow kidney disease. But, you do have to eat SOME protein. Protein is a key building block for your body. If you limit it too much, your body may break down muscle.

A piece of meat the size of a deck of cards is about 4 oz of protein. This is one serving. You may need to adjust the amount of protein you eat during a meal. Small pieces in a kebab, salad, or stir-fry are a good way to get enough, but not too much.

Stay Active in Life

Being active can help protect your kidneys. Exercise helps your whole body work the way it should, and keeps you feeling good about your life and what you can do. If you have not been active, talk with your care team about an exercise plan. A referral to a physical therapist may help you get started.

Avoid NSAID Pain Pills

Non-steroidal anti-inflammatory pain pills, or NSAIDS, are a rare cause of kidney failure—most often if they are taken daily for a year or more. Or, they can make the disease progress faster. Most NSAIDS are over-the-counter, like:

• Ibuprofen
• Naproxen

Avoid NSAIDS as much as you can.

Other NSAIDS are prescribed by a doctor, like:

• Indomethacin
• Piroxicam
• Nabumetone
• Celecoxib

Talk to your care team about pain treatment that's safe for you to use and won't hurt your kidneys, like:

• Cold or heat
• Physical therapy
• TENS (electrical stimulation)
• Biofeedback
• Acupuncture

Avoid Substance Abuse

Kidney disease is not something to take lightly. Many street drugs and IV drugs can damage your kidneys. These include:

• Aerosols
• Cocaine and crack cocaine
• Ecstasy
• Heroin
• LSD
• Meth
• PCP
• Poppers

To find out if a street drug can harm your kidneys, put the drug name and the word "kidneys" into an Internet search engine.

If you use drugs and need help to stop, talk to your care team.

Smoking Makes Kidney Disease Get Worse FASTER

Most of us know that smoking is bad for us. It causes lung cancer and heart disease. Most people don't know that smoking speeds up kidney disease, too.

The tiny filters inside your kidneys are blood vessels, and smoking gums up blood vessels. If you smoke and have kidney problems, quitting is one of the best gifts you can give yourself.

Talk to your care team if you need help to stop smoking.

Protect Your Kidneys if You Need an X-ray Test with Dye

IV contrast dye given for some X-ray tests can harm your kidneys. If you have a kidney problem, tell the radiologist. The doctor may be able to:

• Not use contrast dye
• Do an ultrasound instead of an X-ray
• Dilute the dye so it is thinner and less likely to harm your kidneys
• Flush the dye out with lots of IV fluids

If you must have dye, your doctor may prescribe a drug called acetylcysteine to help protect your kidneys from harm. You would need to take it the day before an X-ray dye test.

Talk to your care team about how much to drink before an X-ray dye test and whether to skip a water pill if you take one. If you take some types of blood pressure pills, like ACE-inhibitors or ARBs, your doctor may ask you to stop taking them a few days before the test. (You would start taking them again after the test is done.)

Avoid gadolinium contrast dye (used for some MRI tests). It can cause a rare but severe problem called nephrogenic systemic fibrosis (NSF) when the kidneys don't work well. Ask the doctor to be sure you are not given this dye.

Ask a Pharmacist BEFORE You Take Any New Medicines

Wastes that build up when your body breaks down medicines can be cleaned out of your blood by your kidneys. When your kidneys don’t work well, you may need a lower dose of some medicines. Be sure to tell your health care team about ALL medicines you take. This includes:

• Over-the-counter products
• Drugs a doctor prescribes for you
• Herbal or folk remedies

Ask before you take a new medicine—just in case.

Taking Care of Yourself

Most of us don't give a lot of thought to our kidneys if they are working well. But if you are told that you have a kidney problem, all of a sudden your kidneys may be all you can think about!

When you have a chronic health problem, you have a new job. This job is to take care of yourself. Your care team members are experts in kidney problems. But YOU are the expert about you.

Keep a Positive Attitude

There is no question that it's scary to have a kidney problem. A lot of that fear comes from worrying that if your kidneys fail, your life will be over. Not true! People with kidney failure can live for decades with dialysis, kidney transplants, or both. They work, travel, volunteer, and do hobbies.

The first thing you need to know is that you can have a good life, even if your kidneys fail. But, people don't live for years with kidney failure by accident! It takes an active role on your part.

Knowledge is Your Life Raft

Your care team members are experts in kidney problems. But YOU are the expert about you. You are the only one who knows:

• How you feel
• How medicines affect you
• What symptoms you have

And, you are the only one who can take the steps to follow the treatment plan that you work out with your health care team.

You choose what to eat. You choose what to drink. You choose whether and how to take medicines. No one else can do these tasks for you. We call this self-management. And, to self-manage, you need to learn a lot. It's very normal to feel as if you are adrift at sea—but you'll feel better when you find out what's going on and what you can do about it.

Sources of Knowledge for You

Your primary care health team can answer your questions, too. Your doctor can refer you to a kidney disease specialist (nephrologist). Or, your doctor can ask questions of a nephrologist and get answers for you.

You may be seen in a special renal clinic ("renal" means kidneys). Or, your VA center may have a clinic for high blood pressure or other health concerns. Others who have kidney problems can also be good sources of knowledge. Just keep in mind that your health and that of someone else with the same problem can still differ.

Your Job: Ask Good Questions

Part of your job is asking good questions.

Before your clinic visit:

• Write down your questions so you can ask them.
• List your questions from most to least important, in case you can't get to them all.

At your clinic visit:

• Write down the answers you get.
• Ask your care team to spell medical terms so you can look them up.
• If you've been doing your homework tell your care team what you know, so they don't have to start at the beginning.
• Don't hold back! If you are not taking your medicines or you use street drugs, your care team needs to know.

It might also help to bring someone with you to clinic visits. An extra pair of ears may help in case you miss something. ASK if something does not make sense to you. Medical terms are hard to understand. It's okay to ask, "can you please say that in plain English?"

Tell your care team what you care about most—don't assume that they know you want to keep your job, or be able to take care of loved ones.

Stages of Chronic Kidney Disease (CKD)

Chronic kidney disease, or CKD, has five stages. These stages tell you about your percent of kidney function and are measured by eGFR (glomerular filtration rate). Your eGFR level is about the same as your percent kidney function. So, if your eGFR is 57, it means that you have about 57% kidney function. Healthy people have an eGFR of 90 or higher. But, it is normal to lose a bit of kidney function with age. As kidney function decreases the eGFR will be lower.

Most people never know if they have stage 1 or even stage 2 CKD. If you are told that you have stage 2 CKD, your doctor's job is to figure out how fast your kidney problem is moving and to slow other problems that CKD can cause. YOUR job is to:

• Take steps to protect your kidneys
• Work with your health care team to try to slow kidney disease

Get a Urine Test Once a Year

Protein in your urine is an early sign of kidney problems. If you have diabetes, get your eyes and your urine checked each year. Ask your health care team to check your urine for protein. A test for albuminuria can find kidney disease.

If you have protein in your urine, certain blood pressure pills can help protect your kidneys, even if your blood pressure is not high. These pills are in the ACE-inhibitor or ARB class. ACE-inhibitors can cause a dry cough. If this is a problem for you, your doctor can switch you to an ARB instead.

Manage Symptoms and Protect Your Heart

At any stage of CKD, your job is to manage your symptoms and keep your heart healthy, along with your kidneys. The kidneys and the heart work together. Protect your heart AND your kidneys so you can feel your best as long as you can. You can help protect your heart with:

• Exercise
• A heart-healthy diet
• Taking statin drugs to treat high cholesterol (if your doctor prescribes them for you)

If you smoke, quitting helps protect your heart and kidneys, too!

Choose a Treatment

At Stage 4 CKD, your job is to plan ahead. If your kidneys are failing, it's wise to think about your treatment options before you need one. This way, you can choose a treatment that's a good fit for your life and what you like to do.

For now, it may help to know that there are four main options.

• With a kidney transplant, a surgeon gives you one new, healthy kidney from a donor. A transplant can give you a lifestyle that is close to normal—but you need to take medicines to suppress your immune system for as long as the kidney lasts.
• Peritoneal dialysis, or PD, uses the lining of the inside of the belly as a filter. A kidney doctor or surgeon puts in a tube called a catheter. The tube is used to fill the belly with sterile fluid. Wastes and excess water from the blood flow into the fluid, then it is drained and replaced with fresh fluid. PD is easy to learn and do, and is done at home or work, on your own schedule. Most people use a machine to do PD at night while they sleep.
• Hemodialysis, or HD, cleans your blood by taking it out of your body, passing it through a filter, and then bringing it back to you. HD can be done at home or in a clinic, during the day or at night during sleep.
• Medical management without dialysis will treat your pain or other symptoms and give you comfort care. This option does not extend your life, but allows natural death to occur. Hospice services can help you and your family.

Protect Your Veins, Starting Right NOW!

If your kidneys work now, but there is any chance that they could fail one day, protect your veins. You might need them to reach your blood for dialysis (this is called an access).

One type of dialysis access, made of an artery plus a vein in your arm (called a fistula), may be your lifeline. You only have about 10 places on your body where one can be made. So, each one counts!

• Don't allow blood tests on the arm you don't write with. If you must have blood drawn on that arm, see if they can use your hand.
• Avoid IVs (intravenous lines) in the arm you don't write with.

Tell the lab tech that you have kidney problems and are saving your veins for dialysis. Some groups offer a wallet card or bracelet you can show medical staff.

Take Care of Yourself to Have a Good Life

Your role is important in taking care of your kidneys and heart. When you take good care of yourself with kidney disease, you can keep doing the things you love.

Your Job at Each Stage of CKD

At each stage of CKD, there is something that you can do to improve your health and quality of life.

Taking an active role in managing your chronic kidney disease (CKD) can improve your overall well-being. Learn what you can do to feel your best.

Kidneys that work properly are critical to keeping you healthy. If you have CKD, your kidneys can’t filter blood as well as they should, and this can lead to other health problems, such as heart disease and stroke.

While it’s not possible to reverse kidney damage, you can take steps to slow it down. Taking prescribed medicine, being physically active, and eating well will help. You’ll also feel better and improve your overall well-being.

Look After Yourself

Taking care of your health will keep you feeling your best. Here are some tips that can help you manage your CKD and stay healthy.

Take your medicine.

Some medicines are designed to prevent serious problems in the future. It’s very important that you take any prescribed medicine, even if you feel well.

Check with your care team if you plan to take any painkillers or nutritional supplements. These can sometimes affect your kidneys or interfere with your medicine. If you have concerns or side effects with medicine you’re taking, talk to your care team.

Get physically active.

Physical activity is good for anyone with kidney disease, whether you have mild, moderate, or severe CKD. It can boost your energy, help you sleep, strengthen your bones, and help prevent depression. It may also reduce your risk of problems such as heart disease.

If you have mild to moderate CKD, you should be able to do physical activity as often as someone the same age as you with healthy kidneys. If you have later-stage (or severe) CKD, you may become tired more quickly. Speak with your doctor about which physical activity is right for you.

A few other things you can do to help manage your CKD:

• Quit smoking or don’t start. Smoking can make kidney disease worse and interfere with medicine that lowers blood pressure.
• Limit how much alcohol you drink. Alcohol can increase your risk of high blood pressure.
• Keep your blood pressure below 140/90 mm Hg (or the target set by your doctor).
• If you have diabetes, stay in your target blood sugar range as much as possible.
• During flu season, get your flu shot.

Eat Well With CKD

A healthy, balanced diet can help improve your general health and reduce your risk of developing further problems.

While you should limit salt, your food doesn’t have to be bland! Get creative with herbs, spices, mustard, and flavored vinegars in your favorite recipes. Cooking food at home instead of eating out at restaurants will also help reduce your salt intake.

If you have diabetes and CKD, finding the best foods to eat can be challenging. Don’t be overwhelmed with a list of “can’t.” There are still plenty of foods you can enjoy. Some foods that work for both diabetes and CKD include:

• Fruits: berries, grapes, cherries, apples, plums
• Veggies: cauliflower, onions, eggplant, turnips
• Proteins: lean meats (poultry, fish), eggs, unsalted seafood
• Carbs: white bread, bagels, sandwich buns, unsalted crackers, pasta
• Drinks: water, clear diet sodas, unsweetened tea

Learn more about foods that work with diabetes and CKD and foods that you should limit or avoid.

Need a little extra help? A registered dietitian who specializes in diabetes and CKD can give you suggestions and help you find tasty recipes that work for both diets. Your dietitian can also give you the support and confidence you need to manage your meals and be your healthiest.