Chronic kidney disease

Chronic kidney disease is when your kidneys don’t work as well as they should. It’s a long-term condition which varies in how severe it is – from mild through to severe. Mild kidney disease is relatively common and can be managed successfully. Severe kidney disease is when your kidneys stop working (kidney failure) and this can be life-threatening.

About chronic kidney disease

Your kidneys filter out waste products from your body and get rid of them in the form of urine. They also play a part in making red blood cells, balancing the amount of fluid in your cells and controlling your blood pressure. So, if your kidneys aren’t working properly, it can sometimes lead to serious long-term health problems.

If you have chronic kidney disease it means the condition has lasted for three months or longer. It’s a common condition and around one in 10 people have it. The chances of developing it increase as you get older and it’s linked to other conditions such as high blood pressure and type 2 diabetes, and being overweight.

Treating chronic kidney disease early and regularly monitoring it can help to slow down the development of the condition and prevent complications.

Symptoms of chronic kidney disease

Chronic kidney disease is often diagnosed when you’ve already had it for some time, because there are usually no symptoms. It’s sometimes discovered when you have a routine blood or urine test for something else, or a check-up for another health condition, such as type 2 diabetes.

Symptoms usually only develop if you have severe kidney disease and kidney failure. Symptoms can be vague, but may include:

• feeling sick or being sick
• losing weight
• swollen feet or ankles
• cramp, which is often worse at night
• feeling tired and weak
• itchy skin
• disturbed sleep
• feeling out of breath

If you have any of these symptoms, speak to your doctor.

Diagnosis of chronic kidney disease

If you have a long-term health condition, such as high blood pressure, heart disease or diabetes, your doctor will do regular tests to check how well your kidneys are working. Your doctor will also test you for kidney problems if there is kidney disease in your family.

Your doctor will examine you and ask about any medicines you take and any other health problems. If your doctor thinks you may have kidney disease, you will have several tests. These can help to show how well your kidneys work, what the cause of any problem may be, and whether kidney disease has caused other health issues.

Your doctor will usually arrange for you to have these tests.

• Blood tests, including one for GFR (glomerular filtration rate). This shows how much blood is filtered by your kidneys over a set time. It also measures a chemical called creatinine. This is a waste product produced by your muscles, which is cleared out of your body by your kidneys. Eating meat can affect the result, so you’ll be asked not to have any for 12 hours before the test.
• Urine tests, including one to check for any blood or protein.
• An ultrasound scan of your kidneys. This can help to show what may be causing your kidney problems.

The results of these tests can help to show how severe the kidney disease is. See our FAQs about stages of kidney disease for more information. Depending on the results, your doctor may refer you to a nephrologist (a doctor who specialises in conditions that affect the kidneys).

You may also be asked to have an MRI or CT scan or a renal biopsy to find out the cause of your kidney disease. A biopsy is when a small sample of your kidney tissue is taken and sent to a laboratory for testing.

Self-help

Chronic kidney disease is a life-long condition so the health professionals treating you will help you to self-manage as much as you can. That includes doing things like finding out about your condition, understanding your test results and what they mean and making changes to your lifestyle.

:There are many things you can do to help your kidneys work at their best. These include:

• making some changes to the foods you eat, which may include eating less salt
• stopping smoking
• only drinking alcohol within the recommended limits
• being regularly active
• keeping to a healthy weight

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or diclofenac, can affect how well your kidneys work, so don’t take them unless your doctor prescribes them. It’s a good idea not to take herbal medicines or protein supplements too.

People with chronic kidney disease can and do lead active and full lives. But living with chronic kidney disease can be challenging and difficult, and you’ll need to make changes to your lifestyle. If you’re finding it hard to cope or need support, ask your doctor or specialist nurse for help. They can refer you for one-to-one support or counselling. There are support groups for people with kidney disease where you can find information and support.

Treatment of chronic kidney disease

Chronic kidney disease can get worse over time, so treatment focuses on preventing this and helping you stay well. Your doctor will do regular check-ups and help you keep your kidneys working as well as possible, for as long as possible. You will also be given treatment to help prevent complications and manage other conditions such as high blood pressure.

The treatment you need will depend on how severe your kidney disease is.

Medicines  Your doctor will ask you to take medicines to keep your kidneys working as well as possible and to prevent complications. You may be asked to take: one or more medicines to lower and control your blood pressure medicines that reduce your chance of developing heart disease or having a stroke, such as statins to control your cholesterol levels medicines that keep other conditions such as diabetes well controlled supplements such as vitamin D and calcium, to keep vitamins and minerals at the right levels in your body   Some medicines can affect how well your kidneys work. Your doctor and pharmacist can check any other medicines you’re taking and tell you if you need to change them.   If you have any questions, ask your pharmacist or doctor for advice.

Treatment for severe kidney disease (kidney failure)

If you have severe kidney disease and your kidneys aren’t working, you’re likely to need either dialysis or a kidney transplant. You can also choose not to have either of these treatments and instead have your symptoms controlled to help you stay as comfortable as possible. Dialysis and kidney transplant aren’t suitable for everyone. Your doctor will talk about all the choices available for you and the pros and cons of each.

Dialysis acts like an artificial kidney by getting rid of waste and excess water from your blood. There are two types of dialysis.

• Haemodialysis. This is when your blood passes through a machine to filter and clean it. 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 uses your peritoneum as a filter. This is the thin lining on the inside of your tummy (abdomen). Fluid is passed into the space that surrounds your peritoneum and as blood moves through it, waste products move into the dialysis fluid. This is then drained away. You can have peritoneal dialysis at home and you or a relative or carer can be trained to do it. Peritoneal dialysis must be done several times every day or night.

A kidney transplant is when a kidney from a donor is put into your body. This can come from someone who is living or from someone who has died. If you have a kidney transplant, you’ll need regular check-ups for the rest of your life. You’ll also need to take medicines to stop your body rejecting the kidney.

Kidney transplants can be life-saving and can also improve the quality of your life because you won’t need regular dialysis.

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Causes of chronic kidney disease

The main causes of chronic kidney disease are diabetes and high blood pressure. Other possible causes include:

• conditions that damage your kidneys, such as acute glomerulonephritis
• some medicines, such as lithium, ACE inhibitors and ciclosporin
• repeated kidney stones
• inherited kidney conditions, such as polycystic kidney disease
• a urinary tract blockage – this can slow or stop the flow of urine from your body and cause kidney damage (for example, in older men, an enlarged prostate can cause partial or complete blockage of the urinary tract)
• repeat infections

Complications of chronic kidney disease

As kidney disease gets worse, you can develop complications, including:

• severe kidney disease, which needs treatment with dialysis or a kidney transplant
• high blood pressure (hypertension) and high cholesterol levels
• heart disease, stroke and other conditions that affect your blood vessels
• damage to your nerves
• malnutrition – this is when your body isn’t getting the nutrients it needs
• weak bones
• anaemia

Prevention of chronic kidney disease

If you have health problems which could lead to chronic kidney disease, such as diabetes or high blood pressure, it’s important to manage them well. If you get treatment for conditions like these early and keep them well controlled, it can reduce the likelihood of developing chronic kidney disease. Keeping to a healthy weight and not smoking can also help to prevent chronic kidney disease.