Healthy Kidneys

Healthy kidneys work 24 hours a day, 7 days a week. They clean your blood and keep water and minerals at the levels your body needs.

Where Your Kidneys are Located

Most people have two kidneys, each about the size of a fist. The kidneys are located in the back of the body above the waist. The rib cage protects them.

Each kidney has a ureter—a tube that brings urine from the kidneys to the bladder.

The Job of Healthy Kidneys is BALANCE

Your body works best when water and chemicals in your blood stay in a tight range all the time. To keep your blood in balance, healthy kidneys do three main things:

1. Kidneys remove wastes and excess water from your blood. Each time you eat, take medicine, or move your muscles, wastes build up in your blood. Your kidneys send these wastes (and extra water) to the “trash can”—your bladder. The wastes and water leave your body as urine.
2. Kidneys make messages, called hormones. Kidney hormones help you make red blood cells, have healthy bones, and control your blood pressure.
3. Kidneys control levels of electrolytes in your blood. In your body, electrolytes—such as potassium and calcium—carry nerve signals, help your blood to clot, and do many other key tasks.

Kidneys Help Blood Vessels and Nerves Stay Healthy

Because kidneys keep water and electrolytes in balance, they help control blood pressure and keep your blood vessels and heart healthy. And, kidneys clean wastes out of your blood so your body works the way it should.

Kidneys Help Control Acid Levels in the Blood

Healthy kidneys—along with your lungs—keep tight control on the level of acid wastes in your blood. They remove excess acid wastes from the blood. Having this balance thrown off can affect many organs.

The acid level of your blood is measured using pH values. A pH of 7.0 is neutral. In most people, blood pH is about 7.4. Your clinic may measure your blood pH.

Kidneys Help Your Blood Carry Oxygen

Healthy kidneys check the number of red blood cells in your blood. If there are not enough, they send a hormone (called erythropoietin, or EPO) to your bone marrow to say: "make more!"

Your red blood cells carry oxygen from your lungs to all the cells in your body.

Kidneys Help Build Strong Bones

Finally, healthy kidneys help your bones in 3 ways. They:

1. Turn Vitamin D in your body into its active form. Your gut needs active Vitamin D to absorb calcium from what you eat and drink. Without it, it doesn’t matter how much calcium you get.
2. Control levels of calcium and phosphorus in your blood.
3. Keep levels of parathyroid hormone (PTH) in check by having the right levels of calcium and phosphorus in your bones. If PTH levels get too high, your bones could become weak.

Kidneys play a big role in your overall health.

Kidney Disease Throws the Body Out of Balance

When the kidneys don’t work as they should, your whole body can feel the impact.

Acute Kidney Injury = Sudden Damage

Why do kidneys fail?

There are two kinds of kidney failure: acute and chronic.

Acute kidney injury is caused by sudden harm to the kidneys. Some common causes are a severe loss of blood, a severe drop in blood pressure, or a toxin, such as a medicine. Toxins that can cause acute kidney injury include:

• Some pain pills (non-steroidal anti-inflammatory drugs, or NSAIDs)
• IV contrast dye from X-ray tests
• Some antibiotics, like gentamycin or vancomycin

If someone lives through acute kidney injury, their kidneys may get some function back—but they may not. Having function come back may take as long as a year.

Some people who live through acute kidney injury are left with chronic kidney disease.

Chronic Kidney Disease = Slow Process of Damage

Chronic kidney disease gets worse over time. It can lead to kidney failure (the loss of kidney function). Damage happens so slowly that you will likely not feel a thing until it becomes severe. This is why some people have a hard time believing that they really have a kidney problem.

If your kidneys fail, with treatment you can turn the hourglass over and start a new life. Even with kidney failure your life CAN still be good.

Stages of Chronic Kidney Disease

Chronic kidney disease, or CKD, has five stages:

• In stages 1 and 2, the kidneys work but there is some damage and protein in the urine.
• Most people find out that they have CKD in stage 3 or 4, when kidney function starts to drop. (Some never have stages 1 or 2.)
• During stage 5 CKD, the kidneys hardly work at all. This is kidney failure, or end-stage renal disease (ESRD). If the kidneys reach end-stage due to CKD, there is no way to make them work again. You only need about 10% of your kidney function to live—and if you have less than that, there are treatments that can keep you alive and let you have a good life.

A marker called eGFR is used to see how well your kidneys are working. eGFR may drop a little each year just due to normal aging. eGFR tells you what percent kidney function you have. Most healthy people have an eGFR of 90 or higher (90% function). The good news is, there’s a lot you can do to protect your kidneys once you know you have a problem.

Kidneys that function properly are important for maintaining good health. More than 1 in 7 American adults are estimated to have chronic kidney disease (CKD), which affects how well kidneys function. Find out what you should know if you are diagnosed with CKD.

Your kidneys work hard. Every 30 minutes, they filter all your blood to remove wastes, poisons, and excess fluid from your body. Kidneys also help control blood pressure and produce several vital hormones. Kidneys that function properly are important for maintaining good health.

CKD refers to the loss of kidney function over time. This means that the kidneys are not able to filter fluids as well as they should. The excess fluid and waste that aren’t filtered remain in the body. This may cause other health problems, including heart disease and stroke.

The two main causes of CKD are diabetes and high blood pressure. About 1 in 3 adults with diabetes and 1 in 5 adults with high blood pressure have CKD.

People may not feel sick or notice any symptoms until CKD is advanced. The only way people find out if they have CKD is through simple blood and urine tests. The blood test checks for creatinine (a waste product) in the blood to see how well the kidneys work. The urine test checks for protein in the urine (an early sign of kidney damage).

Know Your Kidney Numbers

Your kidney numbers include two tests:

• Estimated glomerular filtration rate (eGFR)—a measure of how much blood your kidneys filter each minute. This tells you how well they’re working. If your eGFR is low, your kidneys are not working as well as they should. As kidney disease progresses, your eGFR goes down.

• A urine test to check for albumin. Albumin is a protein that can pass into the urine when the kidneys are damaged. Too much albumin in your urine is an early sign of kidney damage.

Stages of CKD

There are five stages of CKD, with kidney failure as the final stage. When kidney damage is severe and kidney function is very low, you’ll need dialysis or a kidney transplant to live.

Take Care of Your Kidneys

Not all people with kidney disease progress to kidney failure. Follow these tips to help lower your risk for developing kidney failure:

• Keep your blood pressure below 140/90 (or the goal your doctor sets for you).
• If you have diabetes, stay in your blood sugar range as much as possible.
• Work with your health care team to monitor your kidney health.
• Take medicines as prescribed.
• Work with a dietitian to develop a kidney-healthy eating plan. If you have diabetes, find tips on how to eat well to manage both diabetes and CKD.
• Get active—physical activity helps control blood pressure and blood sugar levels. Learn about the many benefits of physical activity.
• Aim for a healthy weight. Find tips on maintaining a healthy weight.
• Understand how lack of sleep affects your health. Find more on sleep basics.
• If you smoke, quit. Smoking can worsen kidney disease and interfere with medication that lowers blood pressure. Find resources to help you quit.
• Mental health is an important part of your overall well-being. Find healthy ways to cope with stress and depression.
• Avoid conditions or exposures that can harm the kidneys or cause kidney function to suddenly get worse. Check with a doctor about what things you should avoid.

Don’t Delay

Work with your doctor to help monitor your kidney health and make a treatment plan that’s right for you. Your doctor may refer you to a kidney specialist (nephrologist). If you are diagnosed with stage 4 CKD, work with your health care team to learn about treatment options for kidney failure.

You can protect your kidneys by preventing or managing health conditions that cause kidney damage, such as diabetes and high blood pressure. The steps described below may help keep your whole body healthy, including your kidneys.

During your next medical visit, you may want to ask your health care provider about your kidney health. Early kidney disease may not have any symptoms, so getting tested may be the only way to know your kidneys are healthy. Your health care provider will help decide how often you should be tested.

See a provider right away if you develop a urinary tract infection (UTI), which can cause kidney damage if left untreated.

Your kidneys aren’t very big—each is about the size of your fist—but they do important work. They keep you healthy by maintaining just the right balance of water and other substances inside your body.

Unfortunately, if your kidneys start to malfunction, you might not realize it for a long while. Kidney disease usually doesn’t make you feel sick until the problem becomes serious and irreversible. March is National Kidney Month, a perfect time to learn more about how to keep your kidneys healthy and how to catch problems early.

Your kidneys are 2 reddish, bean-shaped organs located on either side of your spine in the middle of your back. Their main job is to filter your blood. Each kidney contains about a million tiny filters that can process around 40 gallons of fluid every day—about enough to fill a house’s hot water heater. When blood passes through the kidney, the filters sift and hold onto the substances your body might need, such as certain nutrients and much of the water. Harmful wastes and extra water and nutrients are routed to the nearby bladder and flushed away as urine.

Your kidneys also produce several hormones . These hormones help to control your blood pressure, make red blood cells and activate vitamin D, which keeps your bones strong.

We all lose a little of our kidney function as we get older. People can even survive with just one kidney if they donate the other to a friend or family member.

But when kidney function drops because of an underlying kidney disease, it’s something to be concerned about. Toxins and extra water can build up in your blood. Falling hormone production can cause other problems. About 1 in 10 adults nationwide, or about 20 million people, have at least some signs of kidney damage.

There are different types of kidney disease. Most strike both kidneys at the same time, harming the tiny filters—called nephrons—and reducing their filtering ability. When damage to nephrons happens quickly, often because of injury or poisoning, it’s known as acute kidney injury. It’s more common, though, for nephrons to worsen slowly and silently for years or even decades. This is known as chronic kidney disease.

“Most people have few or no symptoms until chronic kidney disease is very advanced,” says Dr. Andrew Narva, a kidney specialist at NIH. “You can lose up to three-fourths of your kidney function and essentially have no symptoms.”

Chronic kidney disease can strike people of any race, but African Americans are especially at risk. African Americans also tend to have high rates of diabetes and high blood pressure, the 2 leading causes of kidney disease. Other risk factors for kidney disease include heart disease and a family history of kidney failure—a severe form of kidney disease.

If you have these risk factors, it’s important to be screened for kidney disease,” says Narva. “That usually involves simple laboratory tests: a urine test to look for kidney damage, and a blood test to measure how well the kidneys are working.”

The urine test checks for a protein called albumin, which isn’t routinely detected when your kidneys are healthy. The blood test checks your GFR—glomerular filtration rate. GFR is an estimate of your kidney’s filtering ability. A GFR below 60 is a sign of chronic kidney disease. A GFR below 15 is described as kidney failure.

“I tell my patients they should know their numbers,” says NIH kidney expert Dr. Jeffrey B. Kopp. “We usually cannot cure chronic kidney disease, but if we catch it early, we can slow down its progression.”

Without treatment, kidney disease often gets worse. If your GFR drops below 15, you may feel tired and weak, with nausea, vomiting and itching. By that point, you may need a kidney transplant or dialysis. It’s a good idea to talk with your doctor about the possibility of these therapies long before they’re needed. It takes time to understand your options, and it’s easier to figure things out when you’re feeling healthy.

“In general, the preferred therapy for kidney failure is to have a kidney transplant, but not everyone can have a transplant,” says Kopp. Some obstacles include long waiting lists for healthy kidneys and finding a well-matched donor.

Dialysis is a treatment that filters wastes and water from the blood, allowing patients with kidney failure to feel better and continue with everyday activities. NIH kidney specialist Dr. Paul Kimmel leads an NIH program to improve the lives of patients on dialysis. “Although dialysis is a life-saving therapy, it can be challenging for patients and families,” Kimmel says. “We’re encouraging researchers to explore innovative ways to improve the quality of life and long-term outcome for these patients.”

You can take many steps to avoid or delay reaching the point of kidney failure. The best thing you can do is control your blood pressure. A healthy lifestyle, including physical activity and a heart-healthy diet, can help to normalize blood pressure and also slow kidney disease.

“Most Americans eat more sodium and protein than the body needs. It’s your kidneys’ job to filter and get rid of the leftovers 24 hours a day, 7 days a week,” says registered dietitian Theresa Kuracina, who advises NIH on kidney health and nutrition. Healthy kidneys can generally handle the workload. “But if you have kidney damage, too much sodium and protein can have a negative effect,” Kuracina says. “We generally recommend eating less sodium and more fruits, vegetables and whole grains. To reduce fats, choose lean meats and low-fat or fat-free dairy products.”

If you have kidney disease, your health care provider may recommend additional changes to your diet. And if lifestyle changes aren’t enough to slow down kidney damage, your doctor may prescribe medications to reduce blood pressure, control blood glucose and lower your cholesterol.

Don’t wait to take the first step to keep your kidneys healthy. Talk to your health care provider about your kidneys, and ask if you should be tested for kidney disease.

Protect Your Kidneys

If you’re at risk for kidney disease—especially if you have diabetes, high blood pressure, or a family history of kidney failure—talk to your health care provider to choose the best steps for you.

• Get your blood and urine checked for kidney disease.
• Learn to manage your diabetes, high blood pressure or heart disease.
• Take medicines the way your provider advises.
• Cut back on salt. Aim for less than 1,500 mg of sodium daily.
• Choose foods that are healthy for your heart.
• Be physically active.
• Lose weight if you’re overweight.
• Limit alcohol.
• If you smoke, take steps to quit.

Choose foods that are healthy for your heart and your entire body: fresh fruits, fresh or frozen vegetables, whole grains, and low-fat or fat-free dairy products. Eat healthy meals, and cut back on salt and added sugars. Aim for less than 2,300 milligrams of sodium each day. Try to have less than 10 percent of your daily calories come from added sugars.

Tips for making healthy food choices

• Cook with a mix of spices instead of salt.
• Choose veggie toppings such as spinach, broccoli, and peppers for your pizza.
• Try baking or broiling meat, chicken, and fish instead of frying.
• Serve foods without gravy or added fats.
• Try to choose foods with little or no added sugar.
• Gradually work your way down from whole milk to 2 percent milk until you’re drinking and cooking with fat-free (skim) or low-fat milk and milk products.
• Eat foods made from whole grains—such as whole wheat, brown rice, oats, and whole-grain corn—every day. Use whole-grain bread for toast and sandwiches; substitute brown rice for white rice for home-cooked meals and when dining out.
• Read food labels. Choose foods low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
• Slow down at snack time. Eating a bag of low-fat popcorn takes longer than eating a slice of cake. Peel and eat an orange instead of drinking orange juice.
• Try keeping a written record of what you eat for a week. It can help you see when you tend to overeat or eat foods high in fat or calories.

Research has shown that the DASH eating plan may help you lower your blood pressure. If you have diabetes, high blood pressure, or heart disease, you may want to locate and work with a dietitian to create a meal plan that meets your needs.

Be active for 30 minutes or more on most days. If you are not active now, ask your health care provider about the types and amounts of physical activity that are right for you. Add more activity to your life with these tips to help you get active.

You don’t need to be an athlete or have special skills or equipment to make physical activity part of your life. Many types of activities you do every day, such as walking your dog or going up and down steps at home or at work, may help improve your health.

Try different activities you enjoy. If you like an activity, you’re more likely to stick with it. Anything that gets you moving around, even for a few minutes at a time, is a healthy start to getting fit.

Walking

Walking is free and easy to do—and you can do it almost anywhere. Walking will help you

• burn calories
• improve your fitness
• lift your mood
• strengthen your bones and muscles

If you are concerned about safety, try walking in a shopping mall or park where it is well lit and other people are around. Many malls and parks have benches where you can take a quick break. Walking with a friend or family member is safer than walking alone and may provide the social support you need to meet your activity goals.

If you don’t have time for a long walk, take several short walks instead. For example, instead of a 30-minute walk, add three 10-minute walks to your day. Shorter spurts of activity are easier to fit into a busy schedule.

Walking tips

• Wear comfortable, well-fitting walking shoes with a lot of support, and socks that absorb sweat.
• Dress for the weather if you are walking outdoors. In cold weather, wear layers of clothing you can remove if you start getting too warm. In hot weather, protect yourself against the sun and heat.
• Warm up by walking more slowly for the first few minutes. Cool down by slowing your pace.

Dancing

Dancing can be a lot of fun while it tones your muscles, strengthens your heart and lungs, and boosts your mood. You can dance at a health club, dance studio, or even at home. Just turn on some lively music and start moving. You also can dance to a video on your TV or computer.

If you have trouble standing on your feet for a long time, try dancing while sitting down. Chair dancing lets you move your arms and legs to music while taking the weight off your feet.

Bicycling

Riding a bicycle spreads your weight among your arms, back, and hips. For outdoor biking, you may want to try a mountain bike. Mountain bikes have wider tires and are sturdier than bikes with thinner tires. You can buy a larger seat to make biking more comfortable.

For indoor biking, you may want to try a recumbent bike. On this type of bike, you sit lower to the ground with your legs reaching forward to the pedals. Your body is in more of a reclining position, which may feel better than sitting straight up. The seat on a recumbent bike is also wider than the seat on a regular bike.

If you decide to buy a bike, check how much weight it can support to make sure it is safe for you.

Workout clothing tips

• Clothes made of fabrics that absorb sweat are best for working out.
• Comfortable, lightweight clothes allow you to move more easily.
• Tights or spandex shorts are the best bottoms to wear to prevent inner-thigh chafing.
• Women should wear a bra that provides extra support during physical activity.

Water workouts

Swimming and water workouts put less stress on your joints than walking, dancing, or biking. If your feet, back, or joints hurt when you stand, water activities may be best for you. If you feel self-conscious about wearing a bathing suit, you can wear shorts and a T-shirt while you swim.

Exercising in water

• lets you be more flexible. You can move your body in water in ways you may not be able to on land.
• reduces your risk of hurting yourself. Water provides a natural cushion, which keeps you from pounding or jarring your joints.
• helps prevent sore muscles.
• keeps you cool, even when you are working hard.

You don’t need to know how to swim to work out in water. You can do shallow- or deep-water exercises at either end of the pool without swimming. For instance, you can do laps while holding onto a kickboard and kicking your feet. You also can walk or jog across the width of the pool while moving your arms.

For shallow-water workouts, the water level should be between your waist and chest. During deep-water workouts, most of your body is underwater. For safety and comfort, wear a foam belt or life jacket.

Tips for protecting your hair

If you’re worried that pool water will damage or mess up your hair, try these tips:

• Use a swim cap to help protect your hair from pool chemicals and getting wet.
• Wear a natural hairstyle, short braids, locs, or twists, which may be easier to style after a water workout.
• Buy a shampoo to remove chlorine buildup, available at most drug stores, if your hair feels dry or damaged after a pool workout.

Strength training

Strength training involves using free weights, weightlifting machines, resistance bands, or your own body weight to make your muscles stronger. Lower-body strength training will improve your balance and prevent falls.

Strength training may help you

• build and maintain strong muscles as you get older
• continue to perform activities of daily living, such as carrying groceries or moving furniture
• keep your bones strong, which may help prevent osteoporosis and fractures

If you are just starting out, using a weightlifting machine may be safer than dumbbells. As you get fit, you may want to add free-weight exercises with dumbbells.

You do not need a weight bench or large dumbbells to do strength training at home. You can use a pair of hand weights to do bicep curls. You can also use your own body weight: for example, get up and down from a chair.

Proper form is very important when lifting weights. You may hurt yourself if you don’t lift weights properly. You may want to schedule a session with a certified fitness professional to learn which exercises to do and how to do them safely. Check with your health insurer about whether your health plan covers these services.

If you decide to buy a home gym, check how much weight it can support to make sure it is safe for you.

Strength-training tips

• Aim for at least 2 days per week of strengthen-training activities.
• Try to perform each exercise 8 to 12 times. If that’s too hard, the weight you are lifting is too heavy. If it’s too easy, your weight is too light.
• Try to exercise all the major muscle groups. These groups include the muscles of the legs, hips, chest, back, abdomen, shoulders, and arms.
• Don’t work the same muscles 2 days in a row. Your muscles need time to recover.

Mind and body exercise

Your local hospital or fitness, recreation, or community center may offer classes such as yoga, tai chi, or Pilates. You also may find some of these workouts online and can download them to a computer, smart phone, or other device. These types of activities may help you

• become stronger and more flexible
• feel more relaxed
• improve balance and posture

These classes also can be a lot of fun and add variety to your workout routine. If some movements are hard to do or you have injuries you are concerned about, talk with the instructor about how to adapt the exercises and poses to meet your needs—or start with a beginner’s class.

Daily life activities

Daily life activities, such as cleaning out the attic or washing the car, are great ways to get moving. Small changes can add more physical activity to your day and improve your health. Try these:

• Take 2- to 3-minute walking breaks at work several times a day, if possible.
• Stand, walk, or stretch in place during TV commercials.
• Take the stairs instead of the elevator or escalator whenever you can.
• Park farther from where you are going and walk the rest of the way.

Even a shopping trip can be exercise because it provides a chance to walk and carry your bags. Chores such as mowing the lawn, raking leaves, and gardening also count.

If you are overweight or have obesity, work with your health care provider or dietitian to create a realistic weight-loss plan.

To reach and stay at a healthy weight over the long term, you must focus on your overall health and lifestyle habits, not just on what you eat. Successful weight-loss programs should promote healthy behaviors that help you lose weight safely, that you can stick with every day, and that help you keep the weight off.

Safe and successful weight-loss programs should include

• behavioral treatment, also called lifestyle counseling, that can teach you how to develop and stick with healthier eating and physical activity habits—for example, keeping food and activity records or journals
• information about getting enough sleep, managing stress, and the benefits and drawbacks of weight-loss medicines
• ongoing feedback, monitoring, and support throughout the program, either in person, by phone, online, or through a combination of these approaches
• slow and steady weight-loss goals—usually 1 to 2 pounds per week (though weight loss may be faster at the start of a program)
• a plan for keeping the weight off, including goal setting, self-checks such as keeping a food journal, and counseling support

The most successful weight-loss programs provide 14 sessions or more of behavioral treatment over at least 6 months—and are led by trained staff.

Some commercial weight-loss programs have all of these components for a safe and successful weight-loss program. Check for these features in any program you are thinking about trying.

Although these diets may help some people lose a lot of weight quickly—for example, 15 pounds in a month—they may not help people keep the weight off long term. These diets also may have related health risks, the most common being gallstones.

For people who are overweight or have obesity, experts recommend a beginning weight-loss goal of 5 to 10 percent of your starting weight within 6 months. If you weigh 200 pounds, that would amount to a loss of 10 pounds, which is 5 percent of starting weight, to 20 pounds, which is 10 percent of starting weight, in 6 months.

Changing your lifestyle isn’t easy, but adopting healthy habits that you don’t give up after a few weeks or months may help you maintain your weight loss. Read how to change your habits for better health.

Aim for 7 to 8 hours of sleep each night. If you have trouble sleeping, take steps to improve your sleep habits.

Getting enough sleep is important for people of all ages to stay in good health. Learn how much sleep you need.

People often cut back on their sleep for work, for family demands, or even to watch a good show on television. But if not getting enough sleep is a regular part of your routine, you may be at an increased risk for obesity, type 2 diabetes, high blood pressure, heart disease and stroke, poor mental health, and even early death.

Even one night of short sleep can affect you the next day. Not only are you more likely to feel sleepy, you’re more likely to be in a bad mood, be less productive at work, and be involved in a motor vehicle crash.

How much sleep you need changes as you age. The American Academy of Sleep Medicine and the Sleep Research Society recommend:

Habits to Improve Your Sleep

• Be consistent. Go to bed at the same time each night and get up at the same time each morning, including on the weekends.
• Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature.
• Remove electronic devices such as TVs, computers, and phones from the bedroom.
• Avoid large meals, caffeine, and alcohol before bedtime.
• Don’t use tobacco.
• Get some exercise. Being physically active during the day can help you fall asleep more easily at night.

What About Sleep Quality?

Getting enough sleep is important, but good sleep quality is also essential. Signs of poor sleep quality include feeling sleepy or tired even after getting enough sleep, repeatedly waking up during the night, and having symptoms of a sleep disorder (such as snoring or gasping for air). Better sleep habits may improve the quality of your sleep. If you have symptoms of a sleep disorder, such as snoring or being very sleepy during the day after a full night’s sleep, make sure to tell your doctor.

If you smoke or use other tobacco products, stop. Ask for help so you don’t have to do it alone. You can start by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669.

Each Quit Attempt Is a Step Forward

If you or a loved one are among the 34 million U.S. adults who smoke cigarettes in this country, and want to quit smoking, either for the first time or to make another attempt, do not give up, and know that you are not alone. 

Cigarette smoking remains the leading cause of preventable death and disease in the United States, accounting for 480,000 premature deaths per year. While knowledge of the negative health effects of tobacco use can be helpful on the path to quitting smoking, it’s also important to be aware that many people who smoke do not quit for good on their first attempt and need several tries before they succeed. 

What keeps people smoking even when they know cigarettes are harmful to their health? Nicotine, the highly addictive drug present in tobacco products. Cigarettes are designed to deliver nicotine quickly to the brain and is the main reason that people continue to use tobacco even when they want to quit.

In 2015, nearly 70 percent of current adult smokers in the United States said they wanted to quit.⁴ In 2018, about 55 percent of adult smokers had made a quit attempt in the past year, but only about 8 percent were successful in quitting for 6-12 months.

While it may take several attempts to quit for good, remember that even small successes are wins. For instance, you may find that the next time you try to quit, you are able to go longer without a cigarette than the last time; or you might discover exercise helps to stave off your cravings. Each time you make a quit attempt, you learn new techniques to implement and move one step closer to being able to call yourself a “former smoker.”

The First Couple Days After Quitting

It’s a good idea to talk to your doctor about your quit plan as they may have advice on how to quit smoking that’s best for your situation. However, here’s a couple of things to keep in mind during the first few days after quitting smoking. 

Tobacco Education Resource Library

When you first quit smoking, you may feel some discomfort as the nicotine leaves your system. Having an awareness of the symptoms you could experience will help you to know what to expect and plan for ways you might handle them. After quitting smoking, you may experience temporary depression; disrupted sleep patterns; irritability; anxiety; difficulty concentrating; increased appetite. While uncomfortable, these symptoms should only last a few weeks. 

One other thing to be aware of as you begin your quit journey is that many people who used to smoke find that certain places, occasions, and behaviors—such as drinking coffee, going out with friends, or particularly stressful events—can bring up an urge to smoke even after withdrawal symptoms have ended. Noticing these situations and making a plan to divert your urge to smoke can help you on your way to living a completely smoke-free life.

Quitting is possible. Each quit attempt is not in vain, but rather, can be thought of as practice for quitting for good. With every attempt, you learn more about yourself, including what techniques work for you to help you stave off cravings. Each of these practice tries gets you that much closer to quitting cigarettes forever.

Nicotine Replacement Therapy

When talking with your doctor, they may mention something called nicotine replacement therapy, also referred to as NRT. You may know them better as the FDA-approved therapies such as nicotine skin patches, gum, and lozenges that can help you through the initial part of quitting, by relieving cravings and lessening withdrawal symptoms. 

When you use NRTs, you receive measured amounts of nicotine without the toxic chemicals from cigarette smoke. When used properly, NRTs are safe and effective cessation methods and can double the chances of quitting cigarettes successfully.

Even if you’ve attempted to quit smoking with NRTs before, you may consider trying again because experimenting with different NRT options could help in finding what works for you. NRTs are considered safe enough that multiple methods—for instance the patch and the gum—can be used at the same time. You may start using NRT prior to quitting cigarettes, which could help you avoid some of the initial symptoms that sometimes occur when first quitting. 

NRTs are available both by prescription and over-the-counter for adults age 18 and over, and include:

• Skin patches that deliver nicotine through the skin
• Nicotine gum that releases nicotine as you chew it
• Nicotine lozenges that dissolve in your mouth

Telephone quit line counseling is another effective strategy, and combining counseling with NRTs can be more successful for quitting smoking than nicotine replacement therapy alone.

Drinking too much alcohol can increase your blood pressure and add extra calories, which can lead to weight gain. If you drink alcohol, limit yourself to one drink per day if you are a woman and two drinks per day if you are a man. One drink is:

• 12 ounces of beer
• 5 ounces of wine
• 1.5 ounces of liquor

How much alcohol is too much? It could mean drinking too much at one time, drinking too often, or both. It’s important to be aware of how much you are drinking, whether your drinking pattern is risky, the harm that some drinking patterns can cause, and ways to reduce your risks.

What's a "standard" drink?

Many people are surprised to learn what counts as a “standard” drink. In the United States, a standard drink is any drink that contains about 0.6 fluid ounces or 14 grams of pure alcohol (also known as an alcoholic drink-equivalent). Although the drinks pictured here are different sizes, each contains approximately the same amount of alcohol and counts as one U.S. standard drink or one alcoholic drink-equivalent.

The examples above serve as a starting point for comparison. For different types of beer, wine, or malt liquor, the alcohol content can vary greatly. Some differences are smaller than you might expect, however. Many light beers, for example, have almost as much alcohol as regular beer—about 85 percent as much, or 4.2 percent versus 5.0 percent alcohol by volume (alc/vol), on average.

If you want to know the alcohol content of a canned or bottled beverage, start by checking the label. Not all beverages are required to list the alcohol content, so you may need to search online for a reliable source of information, such as the bottler's Web site. For fact sheets about how to read wine, malt beverage, and distilled spirits labels, visit the consumer corner of the U.S. Alcohol and Tobacco Tax and Trade Bureau.

Although the U.S. standard drink (alcoholic drink-equivalent amounts) are helpful for following health guidelines, they may not reflect customary serving sizes. In addition, while the alcohol concentrations listed are "typical," there is considerable variability in alcohol content within each type of beverage (e.g., beer, wine, distilled spirits).

What's "low-risk" drinking for AUD?

A major nationwide survey of 43,000 U.S. adults by the National Institutes of Health shows that only about 2 in 100 people who drink within both the single-day and weekly limits below have alcohol use disorder. How do these "low-risk" levels compare with your drinking pattern?

“Low risk” is not “no risk.” Even within these limits, alcohol can cause problems if people drink too quickly, have health problems, or are older (both men and women over 65 are generally advised to have no more than 3 drinks on any day and 7 per week). Based on your health and how alcohol affects you, you may need to drink less or not at all.

When is "low-risk" drinking still too much?

It's safest to avoid alcohol altogether if you are:

• Taking medications that interact with alcohol
• Managing a medical condition that can be made worse by drinking
• Underage
• Planning to drive a vehicle or operate machinery
• Pregnant or trying to become pregnant

Why are women's low-risk limits different from men's?

Research shows that women start to have alcohol-related problems at lower drinking levels than men do. One reason is that, on average, women weigh less than men. In addition, alcohol disperses in body water, and pound for pound, women have less water in their bodies than men do. So after a man and woman of the same weight drink the same amount of alcohol, the woman's blood alcohol concentration will tend to be higher, putting her at greater risk for harm.

What's "at-risk" or "heavy" drinking?

For healthy adults in general, drinking more than these single-day or weekly limits is considered "at-risk" or "heavy" drinking:

• Men: More than 4 drinks on any day or 14 per week
• Women: More than 3 drinks on any day or 7 per week

About 1 in 4 people who exceed these limits already has alcohol use disorder, and the rest are at greater risk for developing these and other problems. Again, individual risks vary. People can have problems drinking less than these amounts, particularly if they drink too quickly.

Too much + too often = too risky

It makes a difference both how much you drink on any day and how often you have a "heavy drinking day," that is, more than 4 drinks on any day for men or more than 3 drinks for women.

In short, the more drinks on any day and the more heavy drinking days over time, the greater the risk—not only for alcohol use disorder, but also for other health and personal problems.

What are the risks?

Injuries. Drinking too much increases your chances of being injured or even killed. Alcohol is a factor, for example, in about 60 percent of fatal burn injuries, drownings, and homicides; 50 percent of severe trauma injuries and sexual assaults; and 40 percent of fatal motor vehicle crashes, suicides, and fatal falls.

Health problems. Drinking can cause a number of health problems. Studies have shown that one drink a day increases the risk of breast cancer in women. Research has also shown that people who drink excessively have a greater risk of liver disease, heart disease, depression, stroke, and stomach bleeding, as well as cancers of the oral cavity, esophagus, larynx, pharynx, liver, colon, and rectum. They may also have problems managing conditions such as diabetes, high blood pressure, pain, and sleep disorders. And they may increase their chances for contracting sexually transmitted infections from unsafe sex.

Birth defects. Drinking during pregnancy can cause brain damage and other serious problems in the baby. Because it is not yet known whether any amount of alcohol is safe for a developing baby, women who are pregnant or may become pregnant should not drink.

Alcohol use disorder. Alcohol use disorder is a medical condition that doctors can diagnose when a patient's drinking causes distress or harm. In the United States, about 17 million people have alcohol use disorder.

Beyond these physical and mental health risks, frequent heavy drinking also is linked with personal problems, including losing a driver's license and having relationship troubles.

What are symptoms of alcohol use disorder?

A few mild symptoms — which you might not see as trouble signs — can signal the start of a drinking problem. It helps to know the signs so you can make a change early. If heavy drinking continues, then over time, the number and severity of symptoms can grow and add up to "alcohol use disorder." Doctors diagnose alcohol use disorder when a patient's drinking causes distress or harm. See if you recognize any of these symptoms in yourself. And don't worry — even if you have symptoms, you can take steps to reduce your risks.

• Had times when you ended up drinking more, or longer, than you intended?
• More than once wanted to cut down or stop drinking, or tried to, but couldn't?
• More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
• Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
• Spent a lot of time drinking? Or being sick or getting over other aftereffects?
• Continued to drink even though it was causing trouble with your family or friends?
• Found that drinking—or being sick from drinking—often interfered with taking careof your home or family? Or caused job troubles? Or school problems?
• Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
• More than once gotten arrested, been held at a police station, or had other legal problems because of your drinking?
• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?

Learning how to manage stress, relax, and cope with problems can improve emotional and physical health. Physical activity can help reduce stress, as can mind and body practices such as meditation, yoga, or tai chi.

It’s hard to avoid stress. Work, money, current events, and the hassles of everyday life are just a few of the things that can cause stress. Long-term, or chronic, stress is linked to several health conditions like heart disease, high blood pressure, diabetes, depression, and anxiety.

It’s important to learn how to manage stress so it doesn’t overwhelm you. The first step is to recognize your body’s signals. These could include headaches, poor concentration, or feeling on edge. Once you identify these signs, work to counter their effects. Some people benefit from deep breathing, going for a walk, or writing down their thoughts.

Whatever works for you, make taking care of yourself part of your daily routine. Work in time to exercise, eat healthy foods, and get good quality sleep. This will help make you more resilient to life’s stresses.

Experts also recommend staying socially connected. Being in touch with family and friends can combat stress and depression. Video chats and other technology make staying in touch easier than ever.

If you can, also try to see problems a different way. Experts call this “reframing.” Stuck in traffic? It may be an opportunity to enjoy some music or catch up on a podcast. Practice reframing the situation and you’ll likely get better at it over time.

Finally, if stress is affecting your well-being, talk to a health professional. They can help guide you through times of severe stress.

If you have diabetes, high blood pressure, or heart disease, the best way to protect your kidneys from damage is to

Keep blood glucose numbers close to your goal. Checking your blood glucose, or blood sugar, level is an important way to manage your diabetes. Your health care team may want you to test your blood glucose one or more times a day.

Keep your blood pressure numbers close to your goal. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Read more about high blood pressure.

Take all your medicines as prescribed. Talk with your health care provider about certain blood pressure medicines, called ACE inhibitors and ARBs, which may protect your kidneys. The names of these medicines end in –pril or –sartan.

Be careful about the daily use of over-the-counter pain medications. Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can damage your kidneys. Learn more about over-the-counter medicines and your kidneys.

To help prevent heart attacks and stroke, keep your cholesterol levels in the target range. There are two kinds of cholesterol in your blood: LDL and HDL. LDL or “bad” cholesterol can build up and clog your blood vessels, which can cause a heart attack or stroke. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels. A cholesterol test also may measure another type of blood fat called triglycerides.

Ask your health care provider the following key questions about your kidney health during your next medical visit. The sooner you know you have kidney disease, the sooner you can get treatment to help protect your kidneys.

Key questions for your health care provider:

• What is my glomerular filtration rate (GFR)?
• What is my urine albumin result?
• What is my blood pressure?
• What is my blood glucose (for people with diabetes)?
• How often should I get my kidneys checked?

Other important questions:

• What should I do to keep my kidneys healthy?
• Do I need to be taking different medicines?
• Should I be more physically active?
• What kind of physical activity can I do?
• What can I eat?
• Am I at a healthy weight?
• Do I need to talk with a dietitian to get help with meal planning?
• Should I be taking ACE inhibitors or ARBs for my kidneys?
• What happens if I have kidney disease?

If you have chronic kidney disease (CKD), diabetes, or high blood pressure—or if you take certain blood pressure medicines that affect your kidneys—you should take steps to protect your kidneys from harm.

ACE inhibitors and ARBs are two types of blood pressure medicine that may slow the loss of kidney function and delay kidney failure. You can tell if you’re taking one of these medicines by its generic name. ACE inhibitors end in –pril and ARBs have generic names that end in –sartan; for example, lisinopril and losartan.

You may also take a diuretic, sometimes called a water pill, to meet your blood pressure goals.

Manage your medicines with help from your health care providers

At the pharmacy

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 or react with other medicines you take.

Fill your prescriptions at only one pharmacy or pharmacy chain so your pharmacist can monitor your medicines and supplements, and check for harmful interactions between your medicines.

At your doctor’s office

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

Be careful about using over-the-counter medicines

If you take OTC or prescription medicines for headaches, pain, fever, or colds, you may be taking a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs include popular pain relievers and cold medicines that can damage your kidneys if you take them for a long time, or lead to acute kidney injury if you take them when you are dehydrated or your blood pressure is low.

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.

Plan ahead to manage pain, flu, or other illness

Almost everyone gets sick once in a while. Your doctor or pharmacist can help you plan ahead to keep your kidneys safe until you get well. Prepare in advance so you know what to do if you have pain or a fever, diarrhea, nausea, or vomiting, which can lead to dehydration.

Before you get sick, ask your health care provider or pharmacist the following questions

• If I get sick, are there medicines I should not take while I’m sick?
• If I need to stop medicines when I’m sick, when can I restart them?
• What can I take or do to relieve a headache or other pain?
• What can I take to relieve a fever?
• If I have diarrhea or am vomiting, do I need to change how or when I take my blood pressure medicine?

If blood pressure medicines help my kidneys, why all this extra caution?

In normal, everyday circumstances, taking your blood pressure medicines as prescribed helps protect your kidneys. However, certain situations, such as when you’re dehydrated from the flu or diarrhea, can lower the blood flow to your kidneys and cause harm.

Factors that can add up to cause harm

When you get sick from something like the flu or diarrhea, or have trouble drinking enough fluids, the blood pressure in your body may decrease. As a result, the pressure in your kidneys can be low, too.

In most cases, healthy kidneys can protect themselves. However, if you keep taking your blood pressure medicines when you’re dehydrated or have low blood pressure, your kidneys might have a hard time protecting themselves. The pressure within your kidneys might drop so low that your kidneys won’t filter normally.

If you’re dehydrated, NSAIDs can also keep your kidneys from protecting themselves. As a result, taking NSAIDs when you’re sick and dehydrated can cause kidney injury.

Other ways to protect your kidneys

Read about what else you can do to keep your kidneys healthy. If you already have CKD, the steps you take to protect your kidneys also may help prevent heart disease—and improve your health overall.

If you have diabetes, ask your doctor about kidney disease.

Chronic kidney disease (CKD) often develops slowly and with few symptoms. Many people don’t realize they’re sick until the disease is advanced and they need dialysis (a treatment that filters the blood) or a kidney transplant to survive.

If you have diabetes, 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.

You can help keep your kidneys healthy by managing your blood sugar, blood pressure, and cholesterol levels. This is also very important for your heart and blood vessels — high blood sugar, blood pressure, and cholesterol levels are all risk factors for heart disease and stroke.

For data and trends, view diabetes-related indicators in the Chronic Kidney Disease Surveillance System.

Kidney Facts

• Kidney diseases are the 10th leading cause of death in the United States.
• Approximately 1 in 3 adults with diabetes has chronic kidney disease.
• Every 24 hours, 170 people with diabetes begin treatment for kidney failure.

Tips for Keeping Your Kidneys Healthy

• Check your blood pressure regularly and keep it below 140/90 mm/Hg, but check with your health care provider for your appropriate target. Talk to your doctor about medicines and other ways to lower your blood pressure.
• Stay in your target cholesterol range.
• Eat foods lower in sodium.
• Physical activity can help prevent kidney disease.
• Eat more fruits and vegetables.
• Stay physically active.
• Take your medications as directed.

If you have diabetes:

• Meet blood sugar targets as often as you can.
• Have an A1c test at least twice a year, but ideally up to four times a year. An A1c test measures the average level of blood sugar over the past three months.

Preventing type 2 diabetes is another important step in preventing kidney disease. Studies have shown that overweight people at higher risk for type 2 diabetes can prevent or delay the disease by losing 5 to 7 percent of their body weight, or 10 to 14 pounds for a 200-pound person. You can do that by eating healthier and getting 150 minutes of physical activity each week.

Early kidney disease usually has no symptoms, so you should get tested for kidney disease if you have any of these risk factors: diabetes, high blood pressure, heart disease, or a family history of kidney failure. Your doctor can test your blood and urine to find out if you have kidney disease. Ask your doctor how often you should get tested. Also, you should have your blood pressure checked because high blood pressure can be a sign of kidney disease.

If you find out that you do have early kidney disease, you can get treatment to help delay or prevent kidney failure. Treatment may include: changing your diet, exercising, and taking medication.