Chronic Kidney Disease (CKD)is the slow loss of kidney function over time. The main function of the kidneys is to remove wastes and excess water from the body.
Chronic kidney disease (CKD) slowly gets worse over time. In the early stages, there may be no symptoms. The loss of function usually takes months or years to occur. It may be so slow that symptoms do not occur until kidney function is less than one-tenth of normal.
The final stage of chronic kidney disease is called end-stage renal disease (ESRD). The kidneys no longer function and the patient needs dialysis or a kidney transplant.
Chronic kidney disease and ESRD affect more than 2 out of every 1,000 people in the United States.
Diabetes and high blood pressure are the two most common causes and account for most cases.
Many other diseases and conditions can damage the kidneys, including:
- Problems with the arteries leading to or inside the kidneys
- Caucasian or Asian ethnicity birth defects of the kidneys (such as polycystic kidney disease)
- Some pain medications and other drugs
- Certain toxic chemicals
- Autoimmune disorders (such as systemic lupus erythematosus and scleroderma)
- Injury or trauma
- Kidney stones and infection
- Reflux nephropathy (in which the kidneys are damaged by the backward flow of urine into the kidneys)
- Other kidney diseases
Chronic kidney disease leads to a buildup of fluid and waste products in the body. This condition affects most body systems and functions, including red blood cell production, blood pressure control, and vitamin D and bone health.
More than 1 in 7, that is 15% of US adults or 37 million people, are estimated to have CKD
As many as 9 in 10 adults with CKD do not know they have CKD
About 2 in 5 adults with severe CKD do not know they have CKD
The early symptoms of chronic kidney disease often occur with other illnesses, as well. These symptoms may be the only signs of kidney disease until the condition is more advanced.
Symptoms may include:
- General ill feeling and fatigue
- Generalized itching (pruritus) and dry skin
- Weight loss without trying to lose weight
- Appetite loss
Other symptoms that may develop, especially when kidney function has worsened:
- Abnormally dark or light skin
- Bone pain
- Brain and nervous system symptoms
- Drowsiness and confusion
- Problems concentrating or thinking
- Numbness in the hands, feet, or other areas
- Muscle twitching or cramps
- Breath odor
- Easy bruising, bleeding, or blood in the stool
- Excessive thirst
- Frequent hiccups
- Low level of sexual interest and impotence
- Menstrual periods stop (amenorrhea)
- Sleep problems, such as insomnia, restless leg syndrome, and obstructive sleep apnea
- Swelling of the feet and hands (edema)
- Vomiting, typically in the morning
Controlling blood pressure is the key to delaying further kidney damage.
- Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are used most often.
- The goal is to keep blood pressure at or below 130/80 mmHg
Other tips for protecting the kidneys and preventing heart disease and stroke:
- Do not smoke.
- Eat meals that are low in fat and cholesterol
- Get regular exercise (talk to your doctor or nurse before starting).
- Take drugs to lower your cholesterol, if necessary.
- Keep your blood sugar under control.
Always talk to your kidney doctor before taking any over-the-counter medicine, vitamin, or herbal supplement. Make sure all of the doctors you visit know you have chronic kidney disease.
Other treatments may include:
- Special medicines called phosphate binders, to help prevent phosphorous levels from becoming too high
- Treatment for anemia, such as extra iron in the diet, iron pills, special shots of a medicine called erythropoietin, and blood transfusions
- Extra calcium and vitamin D (always talk to your doctor before taking)
You may need to make changes in your diet. See: Diet for chronic kidney disease for more details.
- You may need to limit fluids.
- Your health care provider may recommend a low-protein diet.
- You may have to restrict salt, potassium, phosphorous, and other electrolytes.
- It is important to get enough calories when you are losing weight.
Different treatments are available for problems with sleep or restless leg syndrome.
Everyone with chronic kidney disease should be up-to-date on important vaccinations, including:
- Pneumococcal polysaccharide vaccine (PPV)
- Influenza vaccine
- H1N1 (swine flu) vaccine
- Hepatitis B vaccine
- Hepatitis A vaccine
When loss of kidney function becomes more severe, you will need to prepare for dialysis or a kidney transplant.
- When you start dialysis depends on different factors, including your lab test results, severity of symptoms, and readiness.
- You should begin to prepare for dialysis before it is absolutely necessary. The preparation includes learning about dialysis and types of dialysis, therapies, and placement of a dialysis access.
- Even those who are candidates for a kidney transplant will need dialysis while waiting for a kidney to become available.