As with many health conditions —high blood pressure and high cholesterol, to name just two—chronic kidney disease (CKD) often flies under the radar until it becomes advanced. In fact, CKD affects an estimated 37 million adults in the US, and most don’t even know they have it. If left untreated, kidney function can drop to the point where dialysis is needed to do the work of the kidneys…or a kidney transplant becomes necessary. It also can have cardiovascular complications like hospitalization for heart failure.

But there is good news: When detected early, even if your kidney function has started to decline, you can take steps to slow or even stop further loss.

A Condition of Stages

Your kidneys are constantly removing waste and extra fluid from your blood as urine as well as filtering natural wastes from protein metabolism. If your kidneys aren’t working at optimal capacity, that waste and extra fluid can flow back into your bloodstream, causing swelling of your hands and feet, fatigue, itching, muscle cramps and more. Natural wastes in the blood stream also can contribute to these symptoms.

CKD has different degrees, or stages, depending on how much kidney function has been lost or how much albumin, a type of protein, is in the urine. There are two simple tests to determine your kidney function or filtration…

Urine test that measures the ratio of albumin to the waste product ­creatinine. A normal reading is 30 mg/g or under. Any protein in your urine signals the first stage of CKD, even if your eGFR test (see below) is within normal range.

Blood test that measures estimated glomerular filtration rate (eGFR)—how many milliliters of blood your kidneys are able to filter per minute. The higher your eGFR, the better your kidney function. In adults age 18 and over, a normal eGFR usually is between 90 and 120, but eGFR declines with age, even in people who do not have kidney disease. The stages of CKD are identified by your eGFR…

Stage 1: eGFR 90 or higher with an increase of albumin in the urine test means possible kidney damage with normal function.

Stage 2: eGFR 60 to 89 with an increase of albumin in the urine test means mild loss of kidney function.

Stage 3a: eGFR 45 to 59, mild-to-moderate loss of kidney function.

Stage 3b: eGFR 30 to 44, moderate-to-severe loss of kidney function.

Stage 4: eGFR 15 to 29, severe loss of kidney function.

Stage 5: eGFR under 15, kidney failure.

Managing CKD

A diagnosis of CKD doesn’t mean that dialysis is inevitable. In fact, that’s not the case for most people. Your first step is to make lifestyle changes that can preserve your kidney function and protect your heart. CKD is a risk factor for heart disease and heart attacks. Healthy lifestyle steps to take to reduce or prevent CKD…

Control blood pressure and blood glucose levels. Elevated levels harm the kidneys. You may need a comprehensive medical team to help you address all three chronic conditions. A nephrologist—a kidney specialist—can give you strategies to prevent further kidney function loss…a cardiologist will help manage high blood pressure…and an endocrinologist will guide your diabetes treatment.

Revise your diet. A registered dietitian can recommend a diet that reduces salt intake—to help manage high blood pressure—and manage levels of electrolytes, minerals including potassium and phosphorus. Having CKD can make you prone to imbalances in electrolytes, which can cause problems from muscle weakness to heart trouble. Also limit alcohol intake…avoid ultra-processed foods…and lose unwanted pounds. If you have diabetes, a certified diabetes educator (CDE) can help you with meal planning to keep your blood sugar under control.

Be more physically active. Aim for at least the recommended 150 minutes of moderate activity a week.

Get enough sleep. Your kidneys are influenced by the wake–sleep cycle.

Stop smoking if you smoke. Among its other ills, smoking is associated with worsening kidney function, heart disease and many cancers. (For more on the dangers of smoking, see page 11.)

Take your medications as prescribed—but avoid those that can hurt kidneys, such as naproxen, ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs). Review any drugs you take with your kidney-care team.

Create a support network. If you have advanced CKD, you may experience anxiety or depression. Advice from a therapist and/or a support group can provide the encouragement you need to care for yourself. Check out the National Kidney Foundation’s Online Communities page at to find resources near you.

Treating Late-Stage CKD

When kidney function is very low, you should start preparing for kidney failure treatment with dialysis or a kidney transplant.

Dialysis: There are three types of dialysis that most patients should be able to participate in. Each treatment has benefits and risks that should be discussed with your care team…

In-center hemodialysis. This is the traditional approach in which your blood is filtered through a dialysis machine. Minor surgery is needed first to create an access point in your arm where the tubing will be connected so that blood can flow into the dialysis machine and, after being filtered, be returned to your body. It is common to go to a dialysis center, usually three times a week for four hours at a time, but there also is home hemodialysis that usually requires a caregiver to assist you. People who do hemodialysis at home can do it more frequently, which can bring better results. New, more convenient approaches include doing daily but shorter home sessions and doing dialysis while you sleep.

Peritoneal dialysis involves filling the abdomen with a solution that filters your blood internally. Minor surgery is needed to create an access point near the belly button. There are two methods for peritoneal dialysis, both of which are done at home…

Continuous ambulatory peritoneal dialysis (CAPD). You place the solution into your abdomen through the access point, wait a certain period, then drain it. This is done three to five times a day.

Automated peritoneal dialysis (APD): You connect the tubing of a cycler machine to the access point, and it delivers and drains the solution for you. You usually can do this while you sleep.

For any type of home dialysis, you’ll receive training and be monitored regularly. Home treatments allow you to set your own schedule, and you won’t have to look for a dialysis clinic when you travel. But you must be willing to participate in your care rather than simply going to a dialysis clinic.

Kidney transplant. Age is not a barrier to a kidney transplant. If there is a kidney available from a living donor or a recently deceased kidney donor, it can be an alternative to dialysis. Care is needed afterward, and you will have to take anti-rejection medications for the rest of your life. Kidney transplant offers a better quality of life and longer survival for most patients.

Palliative care or symptom management. For those who are frail, have numerous medical conditions or have dementia, simply managing CKD symptoms might be appropriate. Symptom relief allows people to lead a meaningful life without the strain of dialysis.

On the horizon: The interactive web-based tool Decision Aid for Renal Therapy (DART), designed to communicate the choices available to older people with end-stage CKD. Developed by researchers from Tufts University and other institutions and tested at eight k­idney centers across the country, DART helped patients better assess treatment options. You can access it at

Should You Be Screened?

Until recently, CKD screening was only for people with diabetes, high blood pressure, cardiovascular disease or a family history of kidney disease. Because CKD is so common, the American College of Physicians recently analyzed the cost-effectiveness of screening all adults in the US. Published in Annals of Internal Medicine, the analysis found that testing for albumin starting at age 35 could extend quality of life.

The following symptoms may be caused by kidney disease, but it is best to get tested before symptoms start if you have any of the risk factors for kidney disease.

  • Changes in how often you urinate (more or less)
  • Itchy skin
  • Fatigue
  • Swelling in your limbs
  • Muscle cramps
  • Nausea and/or vomiting
  • Lack of appetite

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