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This topic provides
information about chronic kidney disease. If you are looking for information
about sudden kidney failure, see the topic
Acute Kidney Injury.

What is chronic kidney disease?

Having chronic
kidney disease means that for some time your
kidneys have not been working the way they should.
Your kidneys have the important job of filtering your blood. They remove waste
products and extra fluid and flush them from your body as urine. When your
kidneys don’t work right, wastes build up in your blood and make you
sick.

Chronic kidney disease may seem to have come on suddenly.
But it has been happening bit by bit for many years as a result of damage to
your kidneys.

Each of your kidneys has about a million tiny
filters, called nephrons. If nephrons are damaged, they stop working. For a
while, healthy nephrons can take on the extra work. But if the damage
continues, more and more nephrons shut down. After a certain point, the
nephrons that are left cannot filter your blood well enough to keep you
healthy.

One way to measure how well your kidneys are working is to figure out your glomerular filtration rate (GFR). The GFR is usually calculated using results from your blood creatinine (say “kree-AT-uh-neen”) test. Then the stage of kidney disease is figured out using the GFR. There are five stages of kidney disease, from kidney damage with normal GFR to kidney failure.

There are things you can do to slow or stop the damage to
your kidneys. Taking medicines and making some lifestyle changes can help you
manage your disease and feel better.

Chronic kidney disease is
also called chronic renal failure or chronic renal insufficiency.

What causes chronic kidney disease?

Chronic
kidney disease is caused by damage to the kidneys. The most common causes of
this damage are:

  • Uncontrolled high blood pressure over many years.
  • High blood sugar over many years. This happens in uncontrolled type 1 or type 2 diabetes.

Other things that can lead to chronic kidney disease
include:

  • Kidney diseases and infections, such as
    polycystic kidney disease, pyelonephritis, and
    glomerulonephritis, or a kidney problem you were born
    with.
  • A narrowed or blocked renal artery. A renal artery carries
    blood to the kidneys.
  • Long-term use of medicines that can damage the
    kidneys. Examples include
    nonsteroidal anti-inflammatory drugs (NSAIDs), such as celecoxib and ibuprofen.

What are the symptoms?

You may start to have
symptoms only a few months after your kidneys begin to fail. But most people don’t have symptoms early on. In fact, many don’t have symptoms for as long as
30 years or more. This is called the “silent” phase of the disease.

How well your kidneys work is called kidney function. As your kidney
function gets worse, you may:

  • Urinate less than normal.
  • Have
    swelling and weight gain from fluid buildup in your tissues. This is called edema (say
    “ih-DEE-muh”).
  • Feel very tired or sleepy.
  • Not feel
    hungry, or you may lose weight without trying.
  • Often feel sick to
    your stomach (nauseated) or vomit.
  • Have trouble sleeping.
  • Have headaches or trouble
    thinking clearly.

How is chronic kidney disease diagnosed?

Your
doctor will do blood and urine tests to help find out how well your kidneys are
working. These tests can show signs of kidney disease and
anemia. (You can get anemia from having damaged
kidneys.) You may have other tests to help rule out other problems that could
cause your symptoms.

Your doctor will do tests that measure the amount of urea (BUN) and creatinine in your blood. These tests can help measure how well your kidneys are filtering your blood. As your kidney function gets worse, the amount of nitrogen (shown by the BUN test) and creatinine in your blood increases. The level of creatinine in your blood is used to find out the glomerular filtration rate (GFR). The GFR is used to show how much kidney function you still have. The GFR is also used to find out the stage of your kidney disease and to guide decisions about treatment.

Your doctor will ask questions about any
past kidney problems. He or she will also ask whether you have a family history of kidney disease and
what medicines you take, both prescription and over-the-counter drugs.

You may have a test that lets your doctor look at a picture of your
kidneys, such as an
ultrasound or
CT scan. These tests can help your doctor measure the
size of your kidneys, estimate blood flow to the kidneys, and see if urine flow
is blocked. In some cases, your doctor may take a tiny sample of kidney tissue
(biopsy) to help find out what caused your kidney
disease.

How is it treated?

Chronic kidney disease is
usually caused by another condition. So the first step is to treat the disease
that is causing kidney damage.

Diabetes and high blood pressure
cause most cases of chronic kidney disease. If you keep your blood pressure and
blood sugar in a target range, you may be able to slow or stop the damage to your
kidneys. Losing weight and getting more exercise can help. You may also need to
take medicines.

Kidney disease is a complex problem. You will
probably need to take a number of medicines and have many tests. To stay as
healthy as possible, work closely with your doctor. Go to all your
appointments. And take your medicines just the way your doctor says to.

Lifestyle changes are an important part of your treatment. Taking these
steps can help slow down kidney disease and reduce your symptoms. These steps may also
help with high blood pressure, diabetes, and other problems that make kidney
disease worse.

  • Follow a diet that is easy on your kidneys.
    A dietitian can help you make an eating plan with the right amounts of salt
    (sodium) and protein. You may also need to watch how much fluid you drink each
    day.
  • Make exercise a routine part of your life. Work with your
    doctor to design an exercise program that is right for you.
  • Do
    not smoke or use tobacco.
  • Do not drink alcohol.

Always talk to your doctor before you take
any new medicine, including over-the-counter remedies,
prescription drugs, vitamins, or herbs. Some of these can hurt your kidneys.

What happens if kidney disease gets worse?

When
kidney function falls below a certain point, it is called
kidney failure. Kidney failure affects your whole
body. It can cause serious heart, bone, and brain problems and make you feel
very ill. Untreated kidney failure can be life-threatening.

When you have kidney failure, you will probably have
two choices: start
dialysis or get a new kidney (transplant). Both of
these treatments have risks and benefits. Talk with your doctor to decide which
would be best for you.

  • Dialysis is a process that filters your
    blood when your kidneys no longer can. It is not a cure, but it can help you
    feel better and live longer.
  • Kidney transplant may be the best
    choice if you are otherwise healthy. With a new kidney, you will feel much
    better and will be able to live a more normal life. But you may have to wait
    for a kidney that is a good match for your blood and tissue type. And you will
    have to take medicine for the rest of your life to keep your body from
    rejecting the new kidney.

Making treatment decisions when you are very ill is hard.
It is normal to be worried and afraid. Discuss your concerns with your loved
ones and your doctor. It may help to visit a dialysis center or transplant
center and talk to others who have made these choices.

Frequently Asked Questions

Learning about chronic kidney disease:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with chronic kidney disease:

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

Cause

The cause of
chronic kidney disease isn’t always known. But any
condition or disease that damages blood vessels or other structures in the
kidneys can lead to kidney disease. The most common causes of chronic kidney
disease are:

  • Diabetes.
    High blood sugar
    levels caused by diabetes damage blood vessels in the kidneys. If the blood
    sugar level remains high over many years, this damage gradually reduces the function of the
    kidneys.
  • High blood pressure (hypertension). Uncontrolled high blood pressure damages blood vessels, which can lead to damage in the kidneys. And blood pressure often rises with chronic kidney disease,
    so high blood pressure may further damage kidney function even when another
    medical condition initially caused the disease.

Other conditions that can damage the kidneys and cause
chronic kidney disease include:

  • Kidney diseases and infections, such as
    polycystic kidney disease, pyelonephritis,
    glomerulonephritis, or a kidney problem you were born
    with.
  • Having a narrowed or blocked renal artery. A renal
    artery carries blood to the kidneys.
  • Long-term use of
    medicines that can damage the kidneys. Examples
    include
    nonsteroidal anti-inflammatory drugs (NSAIDs), such as
    celecoxib and ibuprofen, and certain
    antibiotics.

Diabetes and high blood pressure are the most common causes
of chronic kidney disease that leads to
kidney failure. Diabetes or high blood pressure may
also speed up the progression of chronic kidney disease in someone who already
has the disease.

Symptoms

Many people who develop
chronic kidney disease don’t have symptoms at first.
This is known as the “silent” phase of the disease.

As your kidney
function gets worse, you may:

  • Urinate less than normal.
  • Have
    swelling and weight gain from fluid buildup in your tissues (edema).
  • Feel very
    tired.
  • Lose your appetite or have an unexpected weight loss.
  • Feel nauseated or vomit.
  • Be either very sleepy or unable to sleep.
  • Have
    headaches, or have trouble thinking clearly.
  • Have a metallic taste in your mouth.
  • Have severe
    itching.

What Happens

At first with chronic kidney disease, your kidneys are still able to regulate the balance of fluids, salts, and
waste products in your body. But as kidney function decreases, you will start to have other problems, or complications. The worse your kidney function gets, the more complications you’ll have and the more severe they will be.

When kidney function falls below a certain point, it is called
kidney failure. Kidney failure has harmful effects
throughout your body. It can cause serious heart, bone, and brain problems and
make you feel very ill.

After you have kidney failure, either
you will need to have dialysis or you will need a new kidney. Both choices have
risks and benefits.

Complications of chronic kidney disease

  • Anemia. You may feel weak, have pale skin, and feel tired, because the kidneys can’t produce enough of the hormone (erythropoietin) needed to make new red blood cells.
  • Electrolyte imbalance. When the kidneys can’t filter out certain chemicals, such as potassium, phosphate, and acids, you may have an irregular heartbeat, muscle weakness, and other problems.
  • Uremic syndrome. You may be tired, have nausea
    and vomiting, not have an appetite, or not be able to sleep when substances build up in your blood. The substances can be
    poisonous (toxic) if they reach high levels. This syndrome can
    affect many parts of your body, including the intestines, nerves, and heart.
  • Heart disease. Chronic
    kidney disease speeds up hardening of the arteries (atherosclerosis) and increases the risk of
    stroke, heart attack,
    and heart failure. Heart disease is the most common cause
    of death in people with kidney failure.
  • Bone disease (osteodystrophy). Abnormal levels of substances, such as calcium, phosphate, and vitamin D, can lead to bone
    disease.
  • Fluid buildup (edema). As kidney function gets worse, fluids and salt build up in the body. Fluid buildup can lead to heart failure and pulmonary edema.

What Increases Your Risk

Some of the things that lead
to
chronic kidney disease are related to your age and
your genetic makeup. You may be able to control other things that increase your
risk, such as dietary habits and exercise.

Things you cannot control

The main risk factors
for chronic kidney disease are:

  • Age. The kidneys begin
    to get smaller as people get older.
  • Race. African-Americans
    and Native Americans are more likely to get chronic kidney disease.
  • Being male. Men have a
    higher risk for chronic kidney disease than women do.
  • Family history. Family history is a factor in the development
    of both
    diabetes and
    high blood pressure, the major causes of chronic
    kidney disease.
    Polycystic kidney disease is one of several inherited
    diseases that cause kidney failure.

Things you may be able to control

You may be able
to slow the progression of chronic kidney disease and prevent or delay kidney failure by controlling things that increase
your risk of kidney damage, such as:

  • High blood pressure,
    which gradually damages the tiny blood vessels in the kidneys.
  • Diabetes. A persistently high
    blood sugar level can damage blood vessels in the kidneys. Over time, kidney
    damage can progress, and the kidneys may stop working altogether.
  • Eating protein and fats. Eating a diet
    low in protein and fat may reduce your risk for kidney
    disease.
  • Certain medicines. Avoid long-term
    use of
    medicines that can damage the kidneys, such as pain
    relievers called
    NSAIDs and certain
    antibiotics.

When To Call a Doctor

Call 911 or other emergency services if you have
chronic kidney disease and you develop:

  • A very slow heart rate (less than 50 beats a
    minute).
  • A very rapid heart rate (more than 120 beats a
    minute).
  • Chest pain or severe shortness of
    breath.
  • Severe muscle weakness.

To check your heart rate, see the
instructions for
taking a pulse.

Call your doctor immediately
if you:

  • Have symptoms of
    uremic syndrome, such as increasing fatigue, nausea
    and vomiting, loss of appetite, or inability to sleep.
  • Vomit blood
    or have blood in your stools.

Call your doctor if you:

  • Are feeling more tired or
    weak.
  • Have swelling of the arms or
    feet.
  • Bruise often or
    easily or have unusual bleeding.
  • Are being treated with
    dialysis and you:

    • Have belly pain while you are being treated with peritoneal
      dialysis.
    • Have
      signs of infection at your catheter or
      dialysis access site, such as pus draining from the
      area.
    • Have any other problem that your dialysis instruction manual
      or nurse’s instructions say you should call about.

If you have uncontrolled weight loss, discuss this with
your doctor during your next visit.

Watchful waiting

A wait-and-see approach is not a good idea if
you could have chronic kidney disease. See your doctor. If you have been
diagnosed with chronic kidney disease, follow your treatment plan. And call
your doctor if you notice any new symptoms.

Who to see

Health professionals who can diagnose and treat
chronic kidney disease include:

If you are diagnosed with chronic kidney
disease, you will likely be referred to a nephrologist for treatment.

You may also be referred to
a:

  • Surgeon, if you need a
    dialysis access site or if you are being
    considered for a kidney transplant.
  • Dietitian, who can help you with meal
    planning and choosing foods that are best for people with this disease.
  • Psychologist or
    social worker, who can help you and your family with
    emotional stress or financial issues.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Tests for
chronic kidney disease are vital to help find out:

  • Whether kidney disease happened suddenly
    or has been happening over a long time.
  • What
    is causing the kidney damage.
  • Which treatment is best to help
    slow kidney damage.
  • How well treatment is
    working.
  • When to begin
    dialysis or have a
    kidney transplant.

After you are diagnosed with chronic kidney disease, blood
and urine tests can help you and your doctor monitor the disease.

Tests to check kidney function

When kidney
function is decreased, substances such as
urea,
creatinine, and certain
electrolytes begin to build up in the blood. The
following tests measure levels of these substances to show how well your kidneys are working.

  • A blood creatinine test helps to estimate the glomerular filtration rate (GFR) by measuring the level of creatinine in your blood. The doctor can use the GFR to regularly check how well the kidneys are working and to stage your kidney disease.
  • A blood urea nitrogen (BUN) test measures how much nitrogen from the waste product urea is in your blood.

    BUN level rises when the kidneys aren’t working well enough to remove urea from the blood.

  • A fasting blood glucose test is done to measure your
    blood sugar. High blood sugar levels damage blood vessels in the
    kidneys.
  • Blood tests measure levels of waste products and
    electrolytes in your blood that should be removed by your kidneys.
  • A blood test for
    parathyroid hormone (PTH) checks the level of PTH, which helps control calcium and phosphorus levels.
  • Urinalysis (UA) and a urine test for
    microalbumin, or other urine tests, can measure protein in your
    urine. Normally there is little or no protein in urine.

Tests for anemia

If the kidneys don’t produce
enough of the hormone
erythropoietin needed to make red blood cells,
anemia can develop. The following tests help monitor anemia:

Other tests

Your doctor may use other tests to
monitor kidney function or to find out whether another kidney disease
or condition is contributing to reduced kidney function.

  • An
    ultrasound of the kidney (renal ultrasound) helps estimate how long you may have had chronic
    kidney disease. It also checks whether urine flow from the
    kidneys is blocked. An ultrasound also may help find causes
    of kidney disease, such as obstruction or
    polycystic kidney disease.
  • A
    duplex Doppler study or
    angiogram of the kidney may be done to check for
    problems caused by restricted blood flow (renal artery stenosis).
  • A
    kidney biopsy may help find out the cause of chronic
    kidney disease. After a kidney transplant, a doctor may use this test if he or she suspects the organ is being rejected by your body.

Early screening for chronic kidney disease

Experts
recommend screening tests for chronic kidney disease in high-risk groups, such
as people with
diabetes or
high blood pressure. Kidney disease runs in families, so close
family members may also want to have their kidney function tested. Being diagnosed with kidney
disease before it has progressed gives you the best chance to control the
disease.

To learn more about screening if you already have diabetes or high blood pressure, see:

Treatment Overview

The goal of treatment for
chronic kidney disease is to prevent or slow
further damage to your kidneys. Another condition such as
diabetes or
high blood pressure usually causes kidney disease, so
it is important to identify and manage the condition that is causing your
kidney disease. It is also important to prevent diseases and avoid situations
that can cause kidney damage or make it worse.

Treatment to control kidney disease

Control the disease that’s causing the kidney damage

One of the most important parts of treatment is to control the disease that
is causing kidney damage. You and your doctor
will create a plan to aggressively treat and manage your condition to help
slow any more damage to your kidneys.

If you have
diabetes, it is important to control your blood sugar
levels with diet, exercise, and medicines. A persistently high blood sugar
level can damage the blood vessels in the kidneys. For more information about kidney disease caused by diabetes, see the topic
Diabetic Nephropathy.

If you have high blood pressure, it is also important to keep your blood pressure in your target range, for example less than 130/80. To learn ways to help control your blood pressure, see the topic High Blood Pressure.

If other conditions or diseases are causing kidney damage,
such as a blockage (obstruction) in the urinary tract or long-term use of
medicines that can damage the kidneys, you and your doctor will work out a treatment plan.

Take medicines if prescribed

You may be prescribed a blood pressure
medicine, such as an
ACE inhibitor or an
angiotensin II receptor blocker (ARB). These medicines
are used to reduce protein in the
urine and help manage high blood pressure.

Have a healthy lifestyle

You can take steps at home to
help control your kidney disease. For example:

  • Follow a diet that is healthy for your kidneys.
    A dietitian can help you make an eating plan with the right amounts of salt
    (sodium), fluids, and protein.

  • Make exercise a routine part of your life. Work with your
    doctor to make an exercise program that’s right for you.
  • Don’t use substances that can harm your kidneys, such as alcohol, any kind of tobacco, or illegal drugs. Also, be sure
    that your doctor knows about all prescription medicines, over-the-counter medicines,
    and herbs that you are taking.

Go to all follow-up visits

Your doctor
will use blood and urine tests to regularly check how well your kidneys are
functioning and whether changes to your treatment plan are needed. These tests are critical to help monitor your disease. The tests
include:

Treat any complications

As the disease gets worse, your symptoms-such as fatigue, nausea, and loss of appetite-may occur more often or
become more severe. Work with your doctor to create a treatment plan to help
control these symptoms.

If you develop anemia, you may need to take medicine called
erythropoietin (EPO). It helps your body make new red
blood cells and may help improve your appetite and
general sense of well-being.

You may also need an iron supplement if you have an
iron deficiency.

If you develop uremic syndrome (uremia), you will need to have wastes and fluids removed through dialysis or
your kidney replaced through a kidney transplant.

Treatment for kidney failure

When your
kidney function has fallen below a certain point, it is called
kidney failure. Kidney failure has harmful effects
throughout your body. It can cause serious heart, bone, and brain problems and
can make you feel very ill.

After you have kidney failure, either
you will need to have dialysis or you will need a new kidney. Both choices have
risks and benefits.

Dialysis

Dialysis is a process that does the work of healthy
kidneys by clearing wastes and extra fluid from the body and restoring the
proper balance of chemicals (electrolytes) in the blood. You may use
dialysis for many years, or it may be a short-term measure while you are
waiting for a kidney transplant.

To learn more about dialysis, see Other Treatment.

Kidney transplant

Kidney transplant is often a better treatment option than dialysis for kidney failure,
because it may allow you to live a fairly normal life. But there are some
drawbacks. For example, you will probably need to have dialysis
while you wait for a kidney.

To learn more about kidney transplants, see Surgery.

Making treatment
decisions when you are very ill is difficult. It is normal to be fearful and
worried about the risks involved. Discuss your concerns with your family and
your doctor. It may be helpful to visit the dialysis center or transplant
center and talk to others who have chosen these options.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It’s different from care to cure your illness. Its goal is to improve your quality of life-not just in your body but also in your mind and spirit.

You can have palliative care along with treatment to cure your illness. You can also have it if treatment to cure your illness no longer seems like a good choice.

Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don’t want. And they can help your loved ones understand how to support you.

If you’re interested in palliative care, talk to your doctor.

For more
information, see the topic
Palliative Care.

End-of-life issues

Chronic kidney disease progresses to
kidney failure when damage to the kidneys is so severe
that
dialysis or a kidney transplant is needed to control
symptoms and prevent complications and death. Many people have successful
kidney transplants or live for years using dialysis. But at this point you may
wish to talk with your family and doctor about health care and other legal
issues that arise near the end of life.

A time may come when your
goals or the goals of your loved ones may change from treating or curing your
disease to maintaining comfort and dignity. You may find it helpful and
comforting to state your health care choices in writing (with an
advance directive such as a living will) while you are
still able to make and communicate these decisions. Think about your treatment
options and which kind of treatment will be best for you.
You may wish to write
a
durable power of attorney or choose a
health care agent, usually a family member or loved
one, to make and carry out decisions about your care if you become unable to
speak for yourself. You also have the option to refuse or stop treatment. For
more information, see the topic
Care at the End of Life.

Prevention

Chronic kidney disease may sometimes be prevented by controlling the other diseases or
factors that can contribute to kidney disease. People who have
already developed
kidney failure also need to focus on these things to
prevent the complications of kidney failure.

  • Keep your blood pressure below 130/80. Learn to
    check your blood pressure at home.

  • If you have diabetes, keep your blood sugar within a target range. Talk with your doctor how often to check your
    blood sugar.

  • Stay at a healthy weight. This can help you
    prevent other diseases, such as diabetes, high blood pressure, and heart
    disease. For more information, see the topic
    Weight Management.
  • Control your cholesterol levels. For more information, see the topic
    High Cholesterol.
  • Don’t smoke or use
    other tobacco products. Smoking can lead to
    atherosclerosis, which reduces blood flow to the
    kidneys and increases blood pressure. For more information on how to quit, see
    the topic
    Quitting Smoking.

Home Treatment

There are many things you can do at
home to slow the progression of chronic kidney disease.

Lifestyle changes

  • Keep your blood pressure below 130/80. Learn
    to check your blood pressure at home.

  • If you have
    diabetes, keep your blood sugar within a target range.

  • Stay at a healthy weight. This can also reduce
    your risk for
    coronary artery disease, diabetes,
    high blood pressure, and
    stroke. For more information, see the topic
    Weight Management.
  • Follow the eating plan your dietitian created for you. Your
    eating plan will balance your need for calories with your need to limit certain
    foods, such as sodium, fluids, and
    protein.

  • Make exercise a routine part of your life. Work
    with your doctor to design an exercise program that is right for you. Exercise
    may lower your risk for diabetes and high blood pressure.
  • Don’t smoke or use other
    tobacco products. Smoking can lead to
    atherosclerosis, which reduces blood flow to the
    kidneys and increases blood pressure. For more information on how to quit, see
    the topic
    Quitting Smoking.
  • Don’t drink alcohol or
    use illegal drugs.

What to avoid

  • Avoid taking
    medicines that can harm your kidneys. Be sure that
    your doctor knows about all prescription drugs, over-the-counter drugs, and herbs you are taking.
  • Avoid
    dehydration by promptly treating illnesses, such as
    diarrhea, vomiting, or fever, that cause it. Be especially careful when you
    exercise or during hot weather. For more information, see the topic
    Dehydration.
  • Avoid products containing magnesium, such as
    antacids like Mylanta or Milk of Magnesia or laxatives like Citroma. These products increase your risk of
    having abnormally high levels of magnesium (hypermagnesemia), which may
    cause vomiting, diarrhea, or both.
  • Avoid X-ray tests that require IV
    dye (contrast material), such as an angiogram, an
    intravenous pyelogram (IVP), and some CT scans. IV dye
    can cause more kidney damage. Make sure that your doctor knows about any tests that you are scheduled to have.

Medications

Although medicine cannot reverse
chronic kidney disease, it is often used to help treat
symptoms and complications and to slow further kidney damage.

Medicines to treat high blood pressure

Most people who have chronic kidney disease have problems with high blood pressure at some time during their disease. Medicines that lower blood pressure help to keep it in a target range and stop any more kidney damage.

Common blood pressure medicines include:

You may need to try several blood pressure medicines
before you find the medicine that controls your blood pressure well without
bothersome side effects. Most people need to take a combination of medicines to
get the best results. Your doctor may order blood tests 3 to 5 days after
you start or change your medicines. The tests help your doctor make sure that your medicines are working
correctly.

Medicines to treat symptoms and complications of chronic kidney disease

Medicines may be used to treat symptoms and complications of
chronic kidney disease. These medicines include:

  • Erythropoietin (EPO) therapy and
    iron replacement therapy (iron pills or intravenous iron) for
    anemia.
  • Medicines for
    electrolyte imbalances.
  • Diuretics to
    treat fluid buildup caused by chronic kidney disease.
  • ACE inhibitors and ARBs. These may be used if you have protein in your urine (proteinuria) or have heart failure. Regular blood tests are required to make sure that these
    medicines don’t raise potassium levels (hyperkalemia) or make kidney function
    worse.

Medicines used during dialysis

Both
erythropoietin (EPO) therapy and iron replacement therapy may also be used
during dialysis to treat anemia, which often develops in advanced chronic
kidney disease.

  • Erythropoietin (EPO) stimulates the
    production of new red blood cells and may decrease the need for blood
    transfusions. This therapy may also be started before dialysis is needed, when
    anemia is severe and causing symptoms.
  • Iron therapy can help increase levels
    of iron in the body when EPO therapy alone is not effective.
  • Vitamin D helps keep bones strong and healthy.

What to think about

Talk with your doctor about what
types of
immunizations you should have if you have chronic
kidney disease, such as hepatitis B, flu (influenza), and pneumococcal vaccines.

Also, be sure to discuss
medicine precautions. Make sure to tell your doctor
about all prescription drugs, over-the-counter drugs, and herbs you are
taking.

Surgery

Kidney transplant

If you have
chronic kidney disease that progresses, you may have
the option of a
kidney transplant. Most experts agree that it is the
best option for people with
kidney failure. In general, people who have kidney
transplants live longer than people treated with dialysis.

You will probably be considered a good candidate if
you don’t have significant heart, lung, or liver disease or other diseases, such as
cancer, which might decrease your life span.

There are some drawbacks. You may have to wait for a kidney to be donated. If so, you will need to
have dialysis while you wait. Also, it may be hard to find a good
match for your blood and tissue types. Sometimes, even when the match is good,
the body rejects the new kidney.

After a kidney
transplant, you will have to take medicines called immunosuppressants.
These medicines, such as cyclosporine or tacrolimus, help prevent your body
from
rejecting your new kidney.

  • It is very important to take your medicines
    exactly as prescribed. This will help keep your body from rejecting your new
    kidney.
  • You will need to take medicines for the rest of your
    life.
  • Because these medicines weaken the function of your
    immune system, you will have an increased risk for serious infections or cancer.

Even if you take your medicines, there is a chance that
your body will reject your new kidney. If this happens, you will have to resume
dialysis or have another kidney transplant.

The success of the transplant also depends on what kind of donor kidney
you are receiving. The closer the donor kidney matches your genetic makeup, the
better the chances that your body will not reject it.

For more general information about transplant, see the
topic
Organ Transplant.

What to think about

A kidney transplant doesn’t
guarantee that you will live longer than you would have without a new
kidney.

Other Treatment

Dialysis

Dialysis is a
mechanical process that performs the work that healthy kidneys would do. It
clears wastes and extra fluid from the body and restores the proper balance of
chemicals (electrolytes) in the blood. When
chronic kidney disease becomes so severe that your
kidneys are no longer working properly, you may need dialysis. You may use
dialysis to replace the work of the kidneys for many years. Or dialysis may be a
short-term measure while you are waiting for a kidney transplant.

The
two types of dialysis used to treat severe chronic kidney disease are
hemodialysis and
peritoneal dialysis.

  • Hemodialysis uses a man-made membrane
    called a dialyzer to clean your blood. You are connected to the dialyzer by
    tubes attached to your blood vessels. Before hemodialysis treatments can begin,
    a surgeon creates a site where blood can flow in and out of your body. This is
    called the dialysis access. Usually the doctor creates the access by joining an
    artery and a vein in the forearm or by using a small tube to connect an artery
    and a vein. An access may be created on a short-term basis by putting a small
    tube into a vein in your neck, upper chest, or groin.
  • Peritoneal dialysis uses the lining of your belly, which is called the
    peritoneal membrane, to filter your blood. Before you
    can begin peritoneal dialysis, a surgeon needs to place a catheter in your
    belly to create the dialysis access.

What to think about

If
you have severe chronic kidney disease but have not yet developed
kidney failure, talk to your doctor about which type
of dialysis would be best for you.

Learning about dialysis (predialysis education) is an important step in
preparing for dialysis. Most dialysis clinics offer predialysis services to
help you know about your choices.

Other Places To Get Help

Organizations

National Kidney Foundation (U.S.)
www.kidney.org

National Kidney Disease Education Program (U.S.)
www.nkdep.nih.gov

References

Other Works Consulted

  • Barry JM, Conlin MJ (2012). Renal transplantation. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 2, pp. 1226-1253. Philadelphia: Saunders.
  • Correa-Rotter R, et al. (2012). Peritoneal dialysis. In MW Taal et al., eds., Brenner and Rector’s The Kidney, 9th ed., vol. 2, pp. 2347-2377. Philadelphia: Saunders.
  • Fouque D, Laville M (2009). Low protein diets for chronic kidney disease in nondiabetic adults. Cochrane Database of Systematic Reviews (3).
  • Fouque D, Mitch WE (2012). Dietary approaches to kidney disease. In MW Taal et al., eds., Brenner and Rector’s The Kidney, 9th ed., vol. 2, pp. 2170-2204. Philadelphia: Saunders.
  • Kendrick J, et al, (2015). Kidney disease and maternal and fetal outcomes in pregnancy. American Journal of Kidney Diseases, 66(1): 55-59. DOI: http://dx.doi.org/10.1053/j.ajkd.2014.11.019. Accessed August 26, 2015.
  • Kidney Disease: Improving Global Outcomes CKD Work Group (2013). KDIGO 2012 clinical practice guidelines for the evaluation and management of chronic kidney disease. Kidney International Supplements, 3(1): 1-150. Also available online: http://www.kdigo.org/clinical_practice_guidelines/ckd.php.
  • Kopple JD (2014). Nutrition, diet, and the kidney. In AC Ross et al., eds., Modern Nutrition in Health and Disease, 11th ed., pp. 1330-1371. Philadelphia: Lippincott, Williams, and Wilkins.
  • Levey AS, et al. (2003). National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Annals of Internal Medicine, 139(2): 137-147.
  • National Kidney Foundation (2015). KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. American Journal of Kidney Diseases, 66(5): 884-930. DOI: 10.1053/j.ajkd.2015.07.015. Accessed January 8, 2016.
  • U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.
  • Van Wyck DB, et al. (2006). Clinical Practice Guidelines for Anemia in Chronic Kidney Disease. New York: National Kidney Foundation. Available online: http://www.kidney.org/professionals/KDOQI/guidelines_anemia/index.htm.
  • Van Wyck DB, et al. (2007). KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease: 2007 Update of Hemoglobin Target. New York: National Kidney Foundation. Available online: http://www.kidney.org/professionals/kdoqi/guidelines_anemiaUP/guide1.htm.
  • Whelton PK, et al. (2017). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults.
    Journal of the American College of Cardiology, published online November 13, 2017. DOI: 10.1016/j.jacc.2017.11.006.
    Accessed November 20, 2017.
  • Wilkens KG, et al. (2012). Medical nutrition therapy for renal disorders. In LK Mahan et al., eds., Krause’s Food and the Nutrition Care Process, 13 ed., pp. 799-831. St Louis: Saunders.
  • Yeun JY, et al. (2012). Hemodialysis. In MW Taal et al., eds., Brenner and Rector’s The Kidney, 9th ed., vol. 2, pp. 2294-2346. Philadelphia: Saunders.

Credits

ByHealthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD – Internal Medicine
E. Gregory Thompson, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Tushar J. Vachharajani, MD, FASN, FACP – Nephrology

Current as ofDecember 19, 2017