About kidney disease Types of kidney disease Chronic Kidney Disease (CKD) Chronic kidney disease If you would like to discuss your kidney diagnosis with our trained members of staff, ring the free to call number 0800 169 0936. The Helpline is open Mon-Fri 9am to 5pm. Or you can email us [email protected]. KEY POINTS Chronic Kidney Disease is very common, but less than 1 in 10 people with CKD ever require dialysis (artificial kidney treatment) or a kidney transplant Someone with CKD is at increased risk of heart attack or stroke, especially if they smoke or are overweight People with CKD should have regular checks of their kidney function and blood pressure, and have treatment if their blood pressure is elevated. WHAT IS CHRONIC KIDNEY DISEASE (CKD)? Kidney disease is a term used by doctors to include any abnormality of the kidneys, even if there is only very slight damage. ‘Chronic’ means a condition that does not get completely better and lasts over a long time. Chronic does not mean ‘severe’. HOW COMMON IS CKD? Recent research suggests that around 1 in 10 of the population may have CKD, but it is less common in young adults, being present in 1 in 50 people. In those aged over 75 years, CKD is present in 1 out of 2 people. However, many of the elderly people with CKD may not have ‘diseased’ kidneys, but have normal ageing of their kidneys. Although severe kidney failure will not occur with normal ageing of the kidneys, there is an increased chance of high blood pressure and heart disease or stroke, so medical checks will be helpful. HOW DOES SOMEONE KNOW IF THEY HAVE CKD? In most cases CKD does not cause any symptoms, and is detected because tests are abnormal. These may be urine tests for blood or protein leak, or a blood test to measure kidney function or scan of the kidneys. WHAT CAUSES CKD? There are many causes of CKD, and the commonest causes include diabetes, high blood pressure and ageing of the kidneys. Very few of the causes of CKD are completely curable, so it is often not necessary to do extensive tests to find a cause, so long as blood tests show the kidney function is stable. If someone has markedly reduced kidney function, declining kidney function, or associated problems such as kidney pain, a scan of the kidneys will be performed. Some people will also have tests such as a cystoscopy (flexible tube to look inside the bladder), or a kidney biopsy (a small piece of kidney is removed with a needle and looked at under the microscope). MEASURING KIDNEY FUNCTION - EGFR A test called the eGFR (estimated glomerular filtration rate) is used to measure kidney function. The eGFR is calculated by the laboratory from the level of a chemical called creatinine in the blood. Refer to page on GFR. A normal eGFR is about 100 ml/min in young adults, so the eGFR is sometimes referred to as the percentage of normal kidney function. Some young adults with normal kidneys will have an eGFR as low as 75 ml/min, and this falls by about 1 ml/min per year as people get older, so many healthy people aged 75 will have an eGFR of 50-60 ml/min. Most laboratories now report eGFR alongside their measurements of blood creatinine levels and this is the most reliable way to obtain an eGFR result. It is possible to use on-line calculator by putting in age, sex, blood level of creatinine and racial origin. However, different laboratories use different methods to measure serum creatinine, and each of these methods gives slightly different answers. The eGFR that the laboratory reports takes account of these differences, but the on-line calculators do not; so the results that they give are not quite as accurate. WHAT ARE THE STAGES OF CKD? CKD is divided into 5 stages:- CKD stage 1is eGFR greater than 90 mls/min, which is normal but there are some signs of kidney damage on other tests (eg. Blood or protein leak in urine, multiple cysts in the kidneys, single kidney). CKD stage 2is eGFR 60-90 This is mildly decreased with some sign of kidney damage on other tests CKD stage 3ais eGFR 45-59 ml/min, a mild to moderate reduction in kidney function CKD stage 3bis eGFR 30-44 ml/min, a moderate to severe reduction in kidney function CKD stage 4is eGFR 15-29 ml/min, a severe reduction in kidney function. You may need additional medications to support loss of certain functions of the kidneys. CKD stage 5is e GFR less than 15 ml/min, established kidney failure. Very likely to experience symptoms of kidney failure, when dialysis or a kidney transplant may be needed. PROTEINURIA Leakage of protein into the urine increases the risk of any kidney disease. Everyone with CKD should therefore have a urine test to measure the amount of protein in the urine, and if this level is high, they will receive more careful treatment and possibly more extensive investigations. This is also divided into categories depending on whether it is mildy increased, moderately increased or severely increased. Factors that worsen leak of protein in urine include poorly controlled blood pressure, weight gain and poorly controlled diabetes. WHAT IS THE TREATMENT FOR CKD? There are some things that everyone with CKD should try to do. These are:- Lose weight (if overweight), and take regular exercise Stop smoking Reduce the amount of salt in the diet in order to help control the blood pressure. Try the Foodswitch app to help identify high salt foods Foodswitch Eat a healthy balanced diet Drink about 2 litres of fluid a day (2 litres is about 10 cups or 6 mugs), unless your eGFR is less than 15ml/min. There is no benefit in drinking larger amounts of fluid, except in people who get lots of urine infections, or in a few other special cases Consider buying an automatic blood pressure monitor to check the blood pressure at home, at least twice a week. Stay uptodate with National vaccinations, including an annual ‘flu jab (influenza vaccination), and have the pneumonia (pneumococcal) vaccine once (talk to your GP about this). If you are on medications that weaken the immune system then speak to your kidney doctor as you shouldn’t take certain vaccinations. Avoid taking medications which can harm the kidney and increase blood pressure, such as anti-inflammatory medications (eg. Ibuprofen, diclofenac), herbal medications, recreational drugs. The blood pressure should be treated carefully. If it is above 140/85, tablets are usually needed, and the aim is to get the blood pressure down to 140/90 or lower if you have proteinuria or have diabetes. The cholesterol level should be checked, and some people will be advised to take a daily aspirin tablet. A blood test to check eGFR should be performed at least once a year, depending on your CKD stage. If the urine tests show a lot of protein in the urine, or the kidney function is declining over time, the case will be discussed with a kidney specialist, or a referral may be made to a kidney specialist. TREATMENT FOR CKD STAGE 3A AND 3B Treatment as in CKD stages 1 and 2, but with more careful monitoring for declining kidney function. TREATMENT FOR CKD STAGES 4 AND 5 Treatment as for CKD stages 1-3. Additionally, any medications should be reviewed, as the dose may need to be altered and some drugs may need to be avoided as they could damage the kidneys further. This should include prescribed drugs and any drugs bought at the chemist and complementary therapies. In CKD stages 4 and 5 it is usually necessary to get advice from a kidney specialist, as you may need additional medications to replace loss of certain functions of the kidneys. And you may have to start planning for kidney transplant, dialysis or supportive care. CKD AND DIABETES CKD does not cause diabetes, but CKD can be a complication of diabetes. If someone with CKD also has diabetes, extra care to control the blood pressure, blood sugar levels and cholesterol levels is required. More intensive monitoring will be performed, including extra urine tests to look for protein in the urine, as poorly controlled diabetes can make kidneys fail faster. WHAT IF THE KIDNEY FUNCTION KEEPS ON GETTING WORSE AND WORSE? In people with declining kidney function, a treatment plan should be made with a kidney specialist team well before CKD stage 5 is reached. There are also several books and other aids that give information and help make a decision about the best treatment, some of which are available from the National Kidney Federation (for a FREE copy of Help I’ve got Kidney Failure by Dr Rob Higgins, phone the NKF Helpline on 0800 169 09 36) LEADING A NORMAL LIFE WITH CKD Most people with CKD should be able to lead normal lives. CKD does not normally run in families and routine family screening is not necessary if one person is affected. However, some specific types of kidney disease do run in families, and people should check with their health care team to see if testing of family members is needed. CKD AND PREGNANCY It is important to plan pregnancy and contact your GP/kidney doctor promptly if you become pregnant unplanned. This is because in some patients, pregnancy can be an added strain on their kidneys and they require closer monitoring. Certain medications can be toxic to the unborn baby or passed in breastmilk so have them clarified. A very small number of patients with CKD can be at a slightly increased risk of other pregnancy-associated complications, including impaired growth of baby and pre-term delivery. You may be asked to start aspirin, may need frequent pre-natal scans and may be referred to a specialist centre for clinics that have both a kidney doctor and an obstetrician. A lot of people with CKD do have successful pregnancies but just needs planning, education and close monitoring. Last reviewed March 2022Next review March 2025 Reviewed by Dr Oshini Shivakumar 'Specialist Renal Registrar' Download this Information in PDF The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.