Chronic kidney disease

Chronic kidney disease (CKD) is when your kidneys don’t work as well as they should. It’s often caused by health issues like diabetes or high blood pressure. CKD is usually mild, but for some people, it can get worse over time. There’s no cure, but early treatment can help slow it down.

About chronic kidney disease (CKD)

Most people have two kidneys. They’re shaped like beans and located in your lower back – one on either side of your spine. Your kidneys have lots of important jobs. They filter waste products and excess water from your blood and get rid of them in your pee (urine). They also help to make red blood cells, regulate your blood pressure, and keep your body’s fluids under control. But if your kidneys become damaged, these waste products can build up in your body and lead to problems with your health.

In medical terms, the word chronic tends to mean something lasts for a long time and gradually gets worse. If you’re diagnosed with chronic kidney disease (CKD), it means your kidneys haven’t been working properly, or there’s been too much protein in your pee , for at least three months. For more information on this, see our diagnosis section below.

CKD can affect anyone. Almost 1 in 10 people have the condition. But you’re more likely to develop kidney issues as you get older, or if you have diabetes or high blood pressure . It’s also more common in Black or Asian communities.

Chronic kidney disease stages

If you’re diagnosed with chronic kidney disease (CKD), your doctor will let you know what stage of CKD you have. They’ll use the results of blood and urine (pee) tests to figure this out. There are five CKD stages, depending on whether your condition is mild, moderate, or severe. At stage one, your kidneys are still working properly and you don’t have kidney disease. But tests might show other early signs of kidney damage. At this point, your doctor will help you manage any underlying health conditions and suggest lifestyle changes to try and stop kidney disease from developing later on.

But kidney disease can get worse over time and may eventually lead to stage five kidney failure. This means your kidneys have stopped, or almost stopped, working completely and you’ll need life-saving treatment called dialysis, or a kidney transplant. If there’s a chance this could happen, you’ll be referred to a kidney specialist called a nephrologist for support.

Chronic kidney disease causes

Chronic kidney disease (CKD) often develops if you have another health condition that damages your kidneys. CKD can be caused by the following.

• Diabetes. High blood sugar can slowly damage the tiny filters (called glomeruli) inside your kidneys.
• High blood pressure. Too much pressure on the blood vessels inside your kidneys can impact how well they work.
• Glomerulonephritis. This is an inflammation of the filters inside your kidneys, which can damage them.
• Some medications. Regular use of drugs like non-steroidal anti-inflammatories (NSAIDs) or lithium can harm your kidneys over time.
• Polycystic kidney disease. This genetic condition causes fluid-filled cysts to grow inside your kidneys and reduce how well they work.
• A blocked urinary tract. Blockages like kidney stones or an enlarged prostate can damage your kidneys by slowing or stopping the flow of pee (urine).
• Abnormal kidney structure. Being born with unusually shaped or sized kidneys increases your chance of developing CKD.
• Family history. Having a biological family history of CKD also increases your likelihood of developing it.
• History of kidney problems. You’re more likely to develop CKD if you previously had a sudden decline in kidney function, for example from a severe illness. This is known as an acute kidney injury.

Chronic kidney disease symptoms

You might not know that you have chronic kidney disease (CKD) at first, because it doesn’t always cause symptoms in the early stages. CKD is often discovered during a routine blood or urine (pee) test for something else.

But if your CKD has developed into severe kidney disease or kidney failure, symptoms may include:

• feeling sick or being sick
• blood in your pee (urine)
• peeing more or less often than usual
• peeing at night
• losing your appetite and losing weight
• swelling in your hands, feet, or ankles
• muscle cramps, which may be worse at night
• feeling tired and weak
• itchy skin
• trouble sleeping
• difficulty concentrating
• feeling out of breath
• a bad smell or taste in your mouth
• aching in your bones
• pale skin or a skin rash
• restless legs syndrome

Speak to your doctor if you have any of these symptoms. Finding and treating CKD early improves your chances of slowing it down.

Chronic kidney disease diagnosis

Chronic kidney disease (CKD) is often caused by other health conditions. So if you’re at a high risk for kidney issues, your doctor will invite you for regular check-ups. High-risk factors include high blood pressure, diabetes, heart disease, or a family history of CKD. These check-ups help monitor how well your kidneys are working and find CKD early.

CKD is usually diagnosed with blood and urine (pee) tests. But your doctor might recommend you have several tests to figure out if you have CKD, what could be causing it, and what stage it’s at. These could include the following.

Blood tests

Your doctor will take a sample of your blood and send it off to a lab for testing. They’ll check the levels of important vitamins and minerals, as well as how much creatinine is in your blood. Creatinine is a waste product produced by your muscles as they break down energy. Normally, your kidneys filter creatinine out of your blood and it leaves your body through urine (pee). But if your kidneys aren’t working properly, creatinine builds up in your blood.

Your doctor will use your creatinine result to estimate the glomerular filtration rate (GFR) of your blood. Glomeruli are tiny filters inside your kidneys. This is a measure of how much fluid your kidneys filter. A low GFR is a sign your kidneys might not be working as well as they should, and doctors use this to determine the stage of CKD.

Urine tests

Your doctor will also ask you to provide a urine (pee) sample for testing. They’ll check the albumin-to-creatinine ratio (ACR) of your pee. Albumin is a protein that’s usually found in your blood. But if albumin leaks into your pee, it indicates kidney damage. Knowing the albumin-to-creatinine ratio (ACR) helps your doctor to assess just how much protein is leaking into your urine and monitor your kidney health over time.

Imaging tests

Your doctor might recommend you have an ultrasound, CT scan, MRI scan or X-ray so they can get a better look at the size, shape, and structure of your kidneys. This will help your doctor to see if there’s anything blocking your kidneys, like a cyst, kidney stone, tumour or other structural problem.

Kidney biopsy

Sometimes, your doctor might want to take a tiny sample of tissue from your kidney to examine it more closely under a microscope. This helps them to get a closer look at the damage inside your kidney, so they can find out how far advanced it is and plan your treatment. During the biopsy, a fine needle is used to remove the tissue and you’ll be given a local anaesthetic to numb the area.

Self-help for chronic kidney disease

Although you can’t reverse kidney damage, there are lots of things you can do to live well with chronic kidney disease (CKD) and help prevent it from getting worse. It’s a good idea to make some lifestyle changes to help your kidneys work at their best, such as:

• eating less than 6g of salt a day
• limiting your alcohol intake to no more than 14 units a week
• keeping as active as you can
• maintaining a healthy weight
• stopping smoking , if you smoke
• taking any medication prescribed by your doctor
• keeping your annual vaccinations up-to-date
• attending regular check-ups with your healthcare team
• not taking dietary supplements like creatine
• avoiding taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, unless your doctor has prescribed them

Chronic kidney disease treatment

The type of treatment you’ll need for chronic kidney disease (CKD) will depend on the stage of your CKD. Treatment aims to help you live well, slow down the progression of CKD and keep your kidneys working well for as long as possible.

Medication

Medications can help to treat the underlying cause of your CKD and help prevent further complications from developing. Depending on what’s causing your CKD, your doctor might recommend you take:

• ACE (angiotensin converting enzyme) inhibitors or ARB (angiotensin receptor blockers) to lower your blood pressure
• statins or antiplatelets to lower your risk of heart disease or stroke
• SGLT-2 inhibitors (sodium–glucose cotransporter inhibitors) to keep diabetes and ACR levels under control
• diuretics to help you pee more and reduce swelling
• hormone injections or tablets that help your body make red blood cells if you have anaemia
• supplements to maintain a healthy level of vitamins and minerals in your body

Dialysis

If you have severe, end-stage kidney disease or kidney failure, you’ll need to have dialysis or a kidney transplant. Dialysis is a treatment that works like an artificial kidney to remove waste and excess water from your blood. There are two types of dialysis.

• Haemodialysis. This is when a machine filters your blood outside your body. Blood flows through a tube to the machine, which removes waste and extra fluid before returning clean blood to your body. It’s usually done three times a week for about four hours, though you can choose to have it more often. You can have haemodialysis done at home or in hospital.
• Peritoneal dialysis. This type of dialysis uses your peritoneum – the thin lining on the inside of your tummy – as a filter. A cleansing fluid is passed into your tummy using a tube. The fluid absorbs waste from inside your body and is then drained out. You can have peritoneal dialysis at home and you or a relative or carer can be trained to do it. But it must be done several times a day manually, or with a machine at night while you sleep.

Kidney transplant

If you have end-stage kidney disease, a kidney transplant may be another option. This involves placing a healthy kidney from a donor into your body. But a transplant is major surgery and isn’t suitable for everyone. So, your healthcare team will assess if you’re eligible for one first.

If you’re approved, you’ll usually be put on the waitlist for a kidney to become available from someone who has died. Or sometimes, a living relative, friend, or even stranger might choose to donate their kidney to you. Not only can a kidney transplant be life-saving, but it can also improve the quality of your life because you might not need dialysis anymore.

After a kidney transplant, you’ll need to take medicines called immunosuppressants to stop your body rejecting the kidney and go for regular check-ups for the rest of your life.

If you choose not to have dialysis or a transplant, or you’re not a suitable candidate, your healthcare team will help manage your symptoms. They’ll also focus on keeping you as comfortable as possible.