Your kidneys, each just the size of a computer mouse, filter all the blood in your body every 30 minutes. They work hard to remove 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.

Kidneys that function properly are critical for maintaining good health, however, more than one in seven American adults are estimated to have chronic kidney disease (CKD).

About Chronic Kidney Disease

CKD is a condition in which the kidneys are damaged and cannot filter blood as well as they should. Because of this, excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and stroke.

Some other health consequences of CKD include:

• Anemia or low number of red blood cells
• Increased occurrence of infections
• Low calcium levels, high potassium levels, and high phosphorus levels in the blood
• Loss of appetite or eating less
• Depression or lower quality of life

CKD has varying levels of seriousness. It usually gets worse over time though treatment has been shown to slow progression. If left untreated, CKD can progress to kidney failure and early cardiovascular disease. When the kidneys stop working, dialysis or kidney transplant is needed for survival. Kidney failure treated with dialysis or kidney transplant is called end-stage renal disease (ESRD). Learn more about ESRD.

Not all patients with kidney disease progress to kidney failure. To help prevent CKD and lower the risk for kidney failure, control risk factors for CKD, get tested yearly, make lifestyle changes, take medicine as needed, and see your health care team regularly.

CKD By the Numbers

• About 37 million US adults are estimated to have CKD and most are undiagnosed.
• Kidney diseases are the ninth leading causeof death in the United States.
• 48% of people with severely reduced kidney function and not on dialysis are not aware of even having CKD.
• Every 24 hours, about 340 people begin dialysis treatment for kidney failure.
• In the United States, diabetes and high blood pressure are the leading cause of kidney failure, representing about 3 out of 4 new cases.
• In 2017, treating Medicare beneficiaries with CKD cost over $84 billion, and treating people with ESRD cost an additional $36 billion.

Risk Factors

Talk to your doctor about getting tested if you have any of these risk factors:

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

Symptoms

People with CKD may not feel ill or notice any symptoms. The only way to find out for sure if you have CKD is through specific blood and urine tests. These tests include measurement of both the creatinine level in the blood and protein in the urine.

Quick Facts: CKD Snapshot

• Kidney diseases are the ninth leading cause of death in the United States.
• Early CKD has no signs or symptoms.
• Specific blood and urine tests are needed to check for CKD.
• CKD tends to get worse over time.
• CKD can be treated (the earlier treatment starts the better).
• CKD can progress to kidney failure.

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 control 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 dietician 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 angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, 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.
• Include a kidney doctor (nephrologist) on your health care team.

Costs

• Overall Medicare costs for people with CKD were over $84 billion in 2017, or more than $22,000 per person.
• Total Medicare spending (excluding prescription drugs) for patients with ESRD or kidney failure reached $36 billion in 2017, or nearly $80,000 per person, accounting for about 7% of the Medicare paid claims costs.

Feeling in Control

Do you ever feel like your life has taken a path of its own and you have no control? Dealing with any chronic illness can be a challenge. Having a doctor tell you that you have chronic kidney disease (CKD) can be a shock—even if you knew it was coming. It may sound like the end of the world, or at least the end of the world as you know it. Kidney disease is a lifestyle change. But, even if your kidneys fail, it’s not the end of your life. And, you have more control than you think!

The keys to a good life with kidney disease are to keep a positive attitude, learn all you can, and take an active role in your care. You’re getting a good start right now by visiting this site.

What Feelings are Normal?

It’s VERY normal to have strong feelings about kidney disease. You may feel afraid, worried, depressed, or angry. You might even have all of these feelings at the same time. These feelings may occur when you first learn of your illness, if you have a health setback, when you need to start treatment—or any other time. Your VA care team is here to treat YOU—not just your illness. Your emotional well-being is just as vital as your physical well-being. Your VA social worker and other members of your care team can talk with you about your feelings.

You CAN Have a Future

The most important thing to know is, you CAN have a future with kidney disease. Your kidneys aren’t working right. But, you are still you. You can choose to keep following your dreams. These photos are of real people with kidney failure who’ve had good lives on dialysis for decades.

Attitude

You may not always be able to choose what happens to you in life. But you can always choose how you think about it. How you look at things that happen to you is a frame—like a frame on a picture. That means that you can choose to re-frame how you think about something. Re-framing is a vital choice you can make to have a good life.

You Can Look at Things in More Than One Way

Here is an example of what we mean by “re-frame.” Many things can be looked at in more than one way. Like this picture. Maybe you’ve seen it before. Can you see a vase and two faces? (HINT: The vase is white. The faces are black.) Both the vase and the faces are part of the picture. You can choose to focus on one or the other. Or, you can look at both. It’s up to you.

Stubborn or Persistent?

When we choose to think about things in a different way, it can help us to feel better about them. If this was your little girl or granddaughter, would it help you more to think of her as stubborn or persistent? The look on her face is the same either way. But, you may look at her in a new way when you give her behavior a more positive label. This is re-framing in action. Re-framing can help you see things in a more hopeful way.

Re-frame kidney disease

How do you re-frame what seems like a very bad thing, like kidney disease? It may help you to know that treatments for kidney failure are very different today than they were years ago. In fact, until the 1970s, there were not enough dialysis machines to help everyone who had kidney failure. Many people with kidney failure died. The VA began to offer dialysis in 1964 and transplant soon after—and it is still here for you today.

Now, there are enough machines for all. The treatments are more comfortable and there are more ways to do dialysis than ever before. There are newer drugs that can help kidney transplants last longer, too.

So, you can choose to look at kidney failure as a terrible fate. Or, you can choose to be grateful that you live at a time when science can help you to have a good life.

Living a Good Life

Nancy was 19 years old when she started dialysis in 1966. Today, she still works full-time as a nurse. She’s a grandma of two. And she’s still skiing! Over the years, Nancy has done many kinds of dialysis and she is now on her fourth kidney transplant. She’s having a good life after kidney failure—and you can, too.

Try Not to Look Backwards

It’s very normal to want to turn back the clock or step into a time machine and go back to a time when you didn’t have CKD. But, when you can point yourself into the future, you’ll have a better chance for a good life. There can be good times ahead of you—not just behind you.

We all look back sometimes, but try not to dwell on the past. When you catch yourself saying things like, “I wish I had…,” or, “if only I would have…,” those are clues that you are looking backward.

Focus on Looking Forward

Think about what you can do. Don’t limit yourself in ways you don’t have to! Never assume that you can’t do something you love. Assume that you can, and check with your care team if you’re not sure.

You Have Coped Before—Use Those Skills

You haven’t gotten to the age you are without facing some losses in your life—a job, a friend, a loved one, a home. You have coped before and made it through some tough times. If you need help coping, talk to a social worker, chaplain, or therapist. The VA has individual, group, and other therapy services to help you. Don’t be afraid to ask for the help you need to feel better.

If you see a therapist now, talk to him or her about kidney disease and your feelings. If you don’t have one but would like to see one, your doctor can refer you. Just ask.

Find Support—In Person or Online

Did you know that about 1 in 9 Americans has CKD? You are not alone. Having someone to talk to can help you feel less alone. There are other people in the same boat—in your town and around the world. Ask around. There may be a support group in your area. If not, maybe you could start one. Also, look online. The internet is there for you 24/7. Check out organizations like:

• The American Association of Kidney Patients
• The Renal Support Network
• Medicare
• The National Kidney Foundation

TEAM stands for “together everyone achieves more.” In your life, support may come from a spouse, child, parent, sibling, friend, or neighbor. Be sure your care partner’s needs are met, too, if you have one.

How well are your kidneys working? Explaining your kidney test results

What is GFR?

GFR stands for glomerular filtration rate. GFR is a measure of how well your kidneys filter blood.

• A GFR of 60 or higher is in the normal range.
• A GFR below 60 may mean kidney disease.
• A GFR of 15 or lower may mean kidney failure.

What is urine albumin?

Albumin is a protein found in the blood. A healthy kidney does not let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine. The less albumin in your urine, the better.

• A urine albumin result below 30 is normal.
• A urine albumin result above 30 may mean kidney disease.

What your kidneys do

How your kidneys are checked

Two tests are used to check for kidney disease.

• A blood test checks your GFR, which tells how well your kidneys are filtering.
• A urine test checks for albumin in your urine, a sign of kidney damage.

Why your kidneys are being checked

You need to have your kidneys checked because you can't feel kidney disease. Kidney tests are very important for people who have diabetes, high blood pressure, or heart disease. These conditions can hurt your kidneys.

What happens if you have kidney disease

Kidney disease can be treated. The sooner you know you have kidney disease, the sooner you can get treatment to help delay or prevent kidney failure. Treating kidney disease may also help prevent heart disease.

Treatment goals are to:

• Keep your GFR from going down
• Lower your urine albumin

No matter what your results are:

• Keep your blood pressure, blood glucose and blood cholesterol in your target range.
• Choose foods that are healthy for your heart and cut back on salt.
• Be more physically active.
• If you smoke, take steps to quit.
• Take medicines the way your provider tells you to.

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.

You may need to change what you eat to manage your chronic kidney disease (CKD). Work with a registered dietitian to develop a meal plan that includes foods that you enjoy eating while maintaining your kidney health.

The steps below will help you eat right as you manage your kidney disease. The first three steps (1-3) are important for all people with kidney disease. The last two steps (4-5) may become important as your kidney function goes down.

The first steps to eating right

Step 1: Choose and prepare foods with less salt and sodium

Why? To help control your blood pressure. Your diet should contain less than 2,300 milligrams of sodium each day.

• Buy fresh food often. Sodium (a part of salt) is added to many prepared or packaged foods you buy at the supermarket or at restaurants.
• Cook foods from scratch instead of eating prepared foods, “fast” foods, frozen dinners, and canned foods that are higher in sodium. When you prepare your own food, you control what goes into it.
• Use spices, herbs, and sodium-free seasonings in place of salt.
• Check for sodium on the Nutrition Facts label of food packages. A Daily Value of 20 percent or more means the food is high in sodium.
• Try lower-sodium versions of frozen dinners and other convenience foods.
• Rinse canned vegetables, beans, meats, and fish with water before eating.

Look for food labels with words like sodium free or salt free; or low, reduced, or no salt or sodium; or unsalted or lightly salted.

Step 2: Eat the right amount and the right types of protein

Why? To help protect your kidneys. When your body uses protein, it produces waste. Your kidneys remove this waste. Eating more protein than you need may make your kidneys work harder.

• Eat small portions of protein foods.
• Protein is found in foods from plants and animals. Most people eat both types of protein. Talk to your dietitian about how to choose the right combination of protein foods for you.

Animal-protein foods:

• Chicken
• Fish
• Meat
• Eggs
• Dairy

A cooked portion of chicken, fish, or meat is about 2 to 3 ounces or about the size of a deck of cards. A portion of dairy foods is ½ cup of milk or yogurt, or one slice of cheese.

Plant-protein foods:

• Beans
• Nuts
• Grains

A portion of cooked beans is about ½ cup, and a portion of nuts is ¼ cup. A portion of bread is a single slice, and a portion of cooked rice or cooked noodles is ½ cup.

Step 3: Choose foods that are healthy for your heart

Why? To help keep fat from building up in your blood vessels, heart, and kidneys.

• Grill, broil, bake, roast, or stir-fry foods, instead of deep frying.
• Cook with nonstick cooking spray or a small amount of olive oil instead of butter.
• Trim fat from meat and remove skin from poultry before eating.
• Try to limit saturated and trans fats. Read the food label.

Heart-healthy foods:

• Lean cuts of meat, such as loin or round
• Poultry without the skin
• Fish
• Beans
• Vegetables
• Fruits
• Low-fat or fat-free milk, yogurt, and cheese

Limit alcohol
Drink alcohol only in moderation: no more than one drink per day if you are a woman, and no more than two if you are a man. Drinking too much alcohol can damage the liver, heart, and brain and cause serious health problems. Ask your health care provider how much alcohol you can drink safely.

The next steps to eating right

As your kidney function goes down, you may need to eat foods with less phosphorus and potassium. Your health care provider will use lab tests to check phosphorus and potassium levels in your blood, and you can work with your dietitian to adjust your meal plan.

Step 4: Choose foods and drinks with less phosphorus

Why? To help protect your bones and blood vessels. When you have CKD, phosphorus can build up in your blood. Too much phosphorus in your blood pulls calcium from your bones, making your bones thin, weak, and more likely to break. High levels of phosphorus in your blood can also cause itchy skin, and bone and joint pain.

• Many packaged foods have added phosphorus. Look for phosphorus—or for words with “PHOS”—on ingredient labels.
• Deli meats and some fresh meat and poultry can have added phosphorus. Ask the butcher to help you pick fresh meats without added phosphorus.

Your health care provider may talk to you about taking a phosphate binder with meals to lower the amount of phosphorus in your blood. A phosphate binder is a medicine that acts like a sponge to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into your blood. Instead, your body removes the phosphorus through your stool.

Step 5: Choose foods with the right amount of potassium

Why? To help your nerves and muscles work the right way. Problems can occur when blood potassium levels are too high or too low. Damaged kidneys allow potassium to build up in your blood, which can cause serious heart problems. Your food and drink choices can help you lower your potassium level, if needed.

• Salt substitutes can be very high in potassium. Read the ingredient label. Check with your provider about using salt substitutes.
• Drain canned fruits and vegetables before eating.

Some medicines also can raise your potassium level. Your health care provider may adjust the medicines you take.

As CKD worsens over time, related health problems become more likely. However, CKD-related health problems can improve with treatment.

 Heart Disease and Stroke

• Having CKD increases the chances of having heart disease and stroke.
• Managing high blood pressure, blood sugar, and cholesterol levels—all factors that increase the risk for heart disease and stroke—is very important for people with CKD.

Early Death

Adults with CKD are at a higher risk of dying earlier than adults of similar age without CKD.

Health Problems Due to Low Kidney Function

• Anemia or low red blood cell count, which can cause fatigue and weakness.
• Extra fluid in the body, which can cause high blood pressure, swelling in the legs, or shortness of breath.
• A weakened immune system, which make it easier to develop infections.
• Loss of appetite or nausea.
• Decreased sexual response.
• Confusion, problems with memory and thinking, or depression.
• Low calcium levels and high phosphorus levels in the blood, which can cause bone disease and heart disease.
• High potassium levels in the blood, which can cause an irregular or abnormal heartbeat and lead to death.

Definition of Renal

Renal is a medical term meaning “having to do with the kidneys.”

Kidney Failure

Kidney failure happens when kidney damage is severe and kidney function is very low. Dialysis or a kidney transplant is then needed for survival. Kidney failure treated with dialysis or a kidney transplant is called end-stage renal disease (ESRD). CKD is more likely to lead to kidney failure, especially in older adults, if the kidneys are damaged by the inability to manage risk factors, repeated kidney infections, or drugs or toxins that are harmful to the kidneys. Social factors such as lower income and related factors of food insecurity and poorer access to quality health care are also associated with worsening CKD. However, not everyone with CKD develops kidney failure. If CKD is detected early, treatment may slow the decline in kidney function and delay kidney failure. In some cases, kidney failure develops even with treatment.

Talk to a kidney doctor about treatment options if CKD is severe and kidney function is very low.

Facts About ESRD

• In 2018, about 131,600 people in the United States started treatment for ESRD.
• Nearly 786,000 people in the United States, or 2 in every 1,000 people, are currently living with ESRD: 71% are on dialysis and 29% are living with a kidney transplant.
• For every 2 women who develop ESRD, 3 men develop ESRD.
• For every non-Hispanic White person who develops ESRD, 3 non-Hispanic Black people develop ESRD.
• For every 3 non-Hispanic people who develop ESRD, 4 Hispanic people develop ESRD.
• Among adults aged 18 years or older in the United States, diabetes and high blood pressure are the main causes of ESRD.
• Among children and adolescents younger than 18 years in the United States, polycystic kidney disease and glomerulonephritis (inflammation of the kidneys) are the main causes of ESRD.

Reported Causes of End-Stage Renal Disease in the United States

Find out how these chronic conditions are connected and how to prevent or manage all three.

The body is complicated! While organs in your body each have a specific job to do to keep you healthy, they still rely on each other to function well. When one organ isn’t working the way it should, it can put stress on other organs, causing them to stop working properly as well.

The relationship between chronic kidney disease (CKD), diabetes, and heart disease is one example of the ways our organs are connected.

The body uses a hormone called insulin to get blood sugar into the body’s cells to be used as energy. If someone has diabetes, their pancreas either doesn’t make enough insulin or can’t use the insulin it makes as well as it should.

If someone has CKD, their kidneys are not able to filter out toxins and waste from their blood as well as they should.

Heart disease refers to several types of heart conditions. The most common condition, coronary artery disease, leads to changes in blood flow to the heart, which can cause a heart attack.

Make the Connection

So how are these three conditions connected? Risk factors for each condition are similar and include high blood sugar, high blood pressure, family history, obesity, unhealthy diet, and physical inactivity.

High blood sugar can slowly damage the kidneys, and, over time, they can stop filtering blood as well as they should, leading to CKD. Approximately 1 in 3 adults with diabetes has CKD.

When the kidneys don’t work well, more stress is put on the heart. When someone has CKD, their heart needs to pump harder to get blood to the kidneys. This can lead to heart disease, the leading cause of death in the United States. Change in blood pressure is also a CKD complication that can lead to heart disease.

Luckily, preventing or managing one condition can help you prevent and manage the others and lower the risk for more complications.

Show Your Body Some Love

What’s the good news in all of this? You can manage or prevent CKD, diabetes, and heart disease all at once!

Look at these five tips to get started:

1. Getting active is one of the best ways to help you prevent or manage CKD, diabetes, and heart disease. Find an activity you like, start small, and get moving!
2. Choosing healthy foods and drinks is an important way to give your body the fuel it needs to function properly. Adding more fruits and veggies to your plate can also help you keep a healthy weight, another great way to prevent or manage these conditions.
3. Quitting smoking is one of the best things you can do for your health. Quitting will help you prevent CKD, type 2 diabetes, and heart disease and improve these conditions if you have them. You don’t have to do it alone!
4. Find out where you stand by taking this 1-minute prediabetes risk test. If your risk score is high, talk to your doctor about taking action to prevent or delay type 2 diabetes.
5. Get your annual flu shot. People with chronic diseases are more likely to have health complications if they catch the flu. These complications can worsen an existing condition and can even be fatal. Learn more about the benefits of flu vaccination.

CKD: Protect Your Heart

Over time, CKD often gets worse and can lead to kidney failure. A person with kidney failure will need regular dialysis (a treatment that filters the blood) or a kidney transplant to survive.

Although dialysis is needed because of CKD, heart disease is the most common cause of death for someone on dialysis. This is because when kidneys don’t function properly, the heart has to work harder to circulate blood, leading to high blood pressure and possibly heart disease.

If you or a loved one needs dialysis, look at these tips to help protect your heart:

• Choose foods that are healthiest for your heart and your kidneys. Ask your doctor for a referral to a dietitian who’s trained in CKD nutrition to understand which foods and beverages are best for you. You can learn more about dialysis and a healthy diet here.
• Regular physical activity helps to lower your blood pressure and improve your heart health. Moving more doesn’t have to be strenuous! Some great ways to get active are gardening, yoga, or a brisk walk around the block. Ask your doctor about which activities are best for you and if there are any you should avoid.
• Manage your weight and blood sugar—this can be done with diet and exercise! Meet with a dietitian to create an eating plan that works for you and your kidneys or check out these resources to help you manage your blood sugar.

Get Support

Living with a chronic condition can be stressful. Remember to call on your health care team for help and guidance in taking care of your health. Joining a support group is also a great way to connect with others who share your experience.

If you have chronic kidney disease (CKD) you may have problems with your sexual health. Medicine, dialysis, and hormones can all affect sexual functioning. But know that you’re not alone. It’s time to talk about C-K-D and S-E-X.

Up to 80% of people with CKD—that’s about 8 in 10—report having sexual problems. Like other health conditions, if left untreated, sexual problems can have a negative effect on your life. The good news is that many things can be done to help.

CKD Factors That Affect Sexual Health

At first, you may notice subtle changes, such as loss of interest in sex. But as CKD progresses and kidney function gets worse, sexual problems can get worse. Some causes of sexual problems include:

• Side effects from medicine.
• Hormonal changes.
• Nerve and blood vessel damage.
• Side effects from dialysis.
• Depression and anxiety.

Common Sexual Problems

Although sexual problems can happen to anyone, you’re at higher risk if you have CKD, especially if you also receive dialysis treatment. Know that it’s not a “you” problem, it’s a CKD problem. The more you know about it, the more you can do to manage your sexual health. Here are a few problems you may have.

Decreased libido (urge to have sex). CKD affects how your pituitary gland (a pea-sized gland at the base of your brain) releases a type of hormone called luteinizing hormone (LH). LH plays an important part in sexual development and functioning. Abnormal LH levels decrease the release of testosterone in the testicles and estrogen in the ovaries, leading to problems with sexual arousal.

Erectile dysfunction (in men). Diabetes is one of the main causes of CKD. Over time, high blood sugar may damage nerves and blood vessels throughout your body. This damage can reduce blood flow to the penis, causing problems getting or keeping an erection.

Premature menopause (in women). Premature menopause is common in women with CKD. Although not clearly understood, it’s known that CKD affects how your body makes and releases hormones. Women with CKD tend to have lower estrogen levels because the ovaries slow or even stop making this hormone. This can lead to irregular periods, vaginal dryness, and painful sex.

Low energy and depression. It’s common to feel tired and depressed at some point in life, especially while you’re dealing with a serious health condition, such as CKD. Living with CKD can be challenging. Many people with CKD often report feelings of depression and fatigue, which may lead to less interest and enjoyment in sex.

Medicine side effects. Besides CKD medicine, you might take medicines to manage other health problems related to CKD, such as diabetes, high blood pressure, high cholesterol, or heart disease. These medicines may cause erectile dysfunction, decreased arousal, and orgasm dysfunction.

Treatment Options

Sexual problems may be caused by several factors. Talking to your doctor about these problems can help identify a treatment plan that’s best for you. Some treatment options include:

• Hormonal therapy. Your doctor may prescribe medicine that helps increase hormone levels. Increasing estrogen in women and testosterone in men may increase sexual arousal.
• Changing or prescribing medicines. Blood pressure medicines, such as diuretics (water pills), and antidepressants may affect sexual health. Your doctor may suggest different brands or dosage levels, or prescribe a new medicine. Make sure to let your doctor know if you have any side effects when your medicines are changed.
• Talk therapy. Sexual problems can be both physically and mentally challenging. Talking with a mental health professional about sexual problems can help you deal with depression and anxiety. Make sure that both your nephrologist (kidney doctor) and your mental health professional know your treatment plan so that they can work together to manage your health.

It may not be easy to talk about your sexual health, but it’s an important part of your overall health. Working with your health care team to manage and treat your CKD can help slow its progression and reduce complications, such as problems with sexual health.

People with chronic kidney disease (CKD) are at high risk of developing serious flu complications, which can result in hospitalization and even death. This is because CKD weakens immune response, which can make the immune system less able to fight infections. People with CKD at any stage, people who have had a kidney transplant, and people who are undergoing dialysis treatment are all at increased risk of severe illness from flu.

A Flu Vaccine is the Best Protection Against Flu

Flu vaccination is especially important for people with CKD because they are at high risk of developing serious flu complications. Flu vaccines are updated each season as needed to keep up with changing viruses. Immunity lessens over time, so vaccination every year is recommended for the best possible protection against flu. A flu vaccine protects against the flu viruses that research indicates will be most common during the upcoming season. This season’s flu vaccine has been updated from last season’s vaccine to better match circulating viruses. Immunity from vaccination sets in after about two weeks.

• Flu vaccination has been shown to reduce the risk of getting sick with flu or reduce the severity of illness if a person does get sick. Some studies show that vaccinated people have lower risk of having a serious flu outcome like requiring a stay in the hospital or even being admitted to the intensive care unit (ICU).
• Among people with CKD, flu vaccination has been associated with reduced hospitalizations. See “What are the benefits of flu vaccination?” for more information.

CDC recommends that everyone 6 months and older get a flu vaccine each year by the end of October.

Flu Vaccines for People With CKD

• Injectable influenza vaccines (flu shots) are recommended for use in people with CKD and other health conditions. The flu shot has a long, established safety record in people with CKD.
• The live attenuated influenza vaccine (LAIV), also known as the nasal spray vaccine, is not recommended for people with some kinds of chronic health conditions because the safety and effectiveness of this vaccine in people with those conditions has not been established. The nasal spray vaccine is not recommended for people with CKD.

Your doctor or other health care professional can answer any questions you might have about the flu vaccine.

Get pneumococcal vaccines.

• Pneumococcal pneumonia is an example of a serious flu-related complication that can cause death.
• People who have CKD should also be up to date with pneumococcal vaccination to protect against pneumococcal disease, such as pneumonia, meningitis (swelling of the brain due to infection), and blood infections.
• You can get either Pneumococcal conjugate vaccine or Pneumococcal polysaccharide vaccine (but not both) when you get the flu vaccine.
• Talk to your doctor to find out which pneumococcal vaccines are recommended for you.

Also, talk with your doctor about other vaccines, including the hepatitis B vaccine, you may need if you have CKD.

Flu Shot More Important Than Ever

CDC and the National Kidney Foundation (NKF) have joined forces to spread the word: this year it’s more important than ever to get a flu shot, especially for people with CKD. Vaccination will lower your chance of getting the flu and help lessen the impact on the medical system during the COVID-19 pandemic. Learn more from NKF.

Other Preventive Actions for People With CKD

Like everyone else, in addition to getting a flu shot, people with CKD should take everyday preventive actions, including avoiding people who are sick, covering coughs, and washing hands often.

Specific Health Actions for People With CKD

• Maintain a two-week supply of your regular medications during flu season.
• Do not stop taking your regular medications without first consulting your doctor, especially if you become sick with flu or another respiratory infection.

Symptoms and Treatment

If you get flu symptoms, call your doctor right away. There are antiviral drugs that can treat flu illness and may prevent serious flu complications. CDC recommends flu treatment as soon as possible for people who have flu infection or suspected flu infection and who are at high risk of serious flu complications, such as people with CKD.

Symptoms

Flu symptoms can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may also have vomiting and diarrhea, though this is more common in children. People may be infected with flu and have respiratory symptoms without a fever.

Treatment

• Treatment should begin as soon as possible because antiviral drug treatment works best when started early (within 48 hours after symptoms start).
• Antiviral drugs require a prescription from a doctor. These medicines fight against flu by keeping flu viruses from making more viruses in your body.
• Antiviral drugs can make your flu illness milder and make you feel better faster. They may also prevent serious health problems that can result from flu illness.
• There are four FDA-approved flu antiviral drugs recommended by CDC this season that can be used to treat flu.

When to Seek Emergency Medical Care

Anyone experiencing any of the following emergency warning signs of flu sickness, including people with CKD, should seek medical attention right away.

Emergency Warning Signs of Flu

In children

• Fast breathing or trouble breathing
• Bluish lips or face
• Ribs pulling in with each breath
• Chest pain
• Severe muscle pain (child refuses to walk)
• Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
• Not alert or interacting when awake
• Seizures
• Fever above 104°F
• In children less than 12 weeks, any fever
• Fever or cough that improves but then returns or worsens
• Worsening of chronic medical conditions

In adults

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest or abdomen
• Persistent dizziness, confusion, inability to arouse
• Seizures
• Not urinating
• Severe muscle pain
• Severe weakness or unsteadiness
• Fever or cough that improves but then returns or worsens
• Worsening of chronic medical conditions

These lists are not all inclusive. Please consult your medical provider for any other symptom that is severe or concerning.

Vaccines are especially critical for people with health conditions such as renal disease.

If you have renal disease or kidney failure, talk with your doctor about:

• Influenza vaccine each year to protect against seasonal flu
• Tdap vaccine to protect against whooping cough and tetanus
• Pneumococcal polysaccharide vaccine to protect against pneumonia and other pneumococcal diseases
• Hepatitis B vaccine series to protect against hepatitis B
• Zoster vaccine to protect against shingles if you are 60 years and older
• HPV vaccine to protect against cancers and genital warts caused by human papillomavirus if you are an adult through age 26 years (HPV vaccine is not recommended for everyone older than age 26 years, but some adults age 27 through 45 years who are not already vaccinated may decide to get HPV vaccine after speaking with their doctor about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit, as more people have already been exposed to HPV.)
• MMR vaccine to protect against measles, mumps, and rubella if you were born in 1957 or after and have not gotten this vaccine or do not have immunity to these diseases
• Varicella vaccine to protect against chickenpox if you were born in 1980 or after and have not gotten two doses of this vaccine or do not have immunity to this disease

Learn about CKD from a primary care doctor or a kidney doctor (nephrologist) to better understand treatment options and protect the kidneys. People with glomerulonephritis, polycystic kidney disease, or other kidney disease should talk about specific treatment options with a kidney doctor.

Monitor and Manage Blood Sugar and Blood Pressure

• Have blood sugar and blood pressure checked regularly.
• Use medicines if prescribed to lower blood sugar and blood pressure.

People with diabetes, high blood pressure, or CKD need to talk to their doctor about how to protect their kidneys.

Manage CKD

• Make lifestyle changes (e.g., healthy eating, physical activity) to prevent more kidney damage. Meet with a dietitian to create a kidney-healthy eating plan that is low in salt and fat and has the right amount and source of protein. As CKD gets worse, the plan may also include limiting phosphorus and potassium.
• Use medicines as directed to slow the decline in kidney function.
• Stop smoking or do not start smoking.
• Avoid exposures that can harm the kidneys or cause kidney function to suddenly get worse:
  • Certain medicines:
    • Over-the-counter pain medicines like ibuprofen and naproxen, which are also called non-steroidal anti-inflammatory drugs.
    • Some antibiotics.
  • Certain herbal supplements.
  • Excessive alcohol intake.
• Review with health care providers all prescription and over-the-counter medications to make sure they are safe for the kidneys. Always talk to a doctor before taking any supplements.
• Check with a doctor about other behaviors or substances that can harm the kidneys or about special precautions to take when doing medical tests or procedures, such as imaging studies or colonoscopies.

What is an Advance Directive?

An “Advance Directive” is a way for you to share your wishes for what medical treatment you do or don’t want with your loved ones and your heath care team. It’s called an “advance directive” because it lets you share your wishes in advance of a health crisis.

Rather than make a list of types of care that you do or don’t want, an Advance Directive is based on your values. This form lets you do two things:

• Name people to make health care choices for you
• Describe how you want to be treated

What if You Couldn’t Speak for Yourself?

It’s a good idea to put your wishes about your health care into an advance directive. You just never know when an accident or a health crisis like a heart attack or stroke might keep you from being able to say what kind of care YOU want. When you have a health problem like chronic kidney disease (CKD), you can have a good life. And, it’s also wise to plan ahead—just in case.

Types of Medical Care to Think About:

There are some questions that only you can answer. If you ever become too ill to speak for yourself, it is a comfort to your loved ones to know what you would want—and not have to guess. Take some time to think about what each of these treatments might mean for you.

• Oxygen from a mask
• Breathing tube (ventilator)
• Feeding tube
• Intravenous fluids
• Blood products
• Antibiotics
• Pain relief
• CPR
• Dialysis

Do you want aggressive medical care? Do you want care to stop at a certain point? There are no right or wrong answers. Your care team can answer questions for you about treatments. You might talk to your social worker or chaplain, too, if you’re not sure what you might want.

Living Will

A living will is one part of an advance directive. It is a legal document that takes effect if and when you are not able to speak for yourself. A living will states your wishes for what kind of treatment you do and don’t want. Some people have a lawyer help them make out a living will, but you don’t have to.

If you make out a living will, be sure to sign it, date it, and give a copy to your loved ones and your care team. A living will does no good if no one knows you have one. You will need to update your living will if you change your mind about what kind of care you want. If you change your living will, date the new form, share the new copy with your loved ones and care team, and ask them to tear up the old one.

Health Care Power of Attorney

A health care “proxy” or health care power of attorney is a form you sign that gives someone else the right to make health care choices for you if you can’t make them yourself.

It’s best not to spring this on someone! If you have a loved one you would like to ask, talk to him or her about it. Be sure that he or she is willing to take the responsibility and knows what your wishes would be. Give him or her a signed and dated copy of the power of attorney form and your living will—and share it with your health care team.

Focus on the Future!

When you know that you have shared your wishes with your loved ones, you can focus on living each day to its fullest.