Chronic Kidney Disease: What You Need to Know

Overview

Your kidneys are two bean-shaped organs that filter waste, excess fluid, and toxins from your blood to make urine. Chronic kidney disease (CKD) is a long-term condition where the kidneys are gradually damaged and lose this filtering ability over months or years. CKD is classified into 5 stages based on how well the kidneys are working, with stage 5 also called end-stage renal disease (ESRD) or kidney failure. Early stages of CKD often have no noticeable symptoms, which is why routine screening is critical for people at higher risk.

Signs & Symptoms

Most people with early-stage CKD (stages 1 and 2) have no symptoms at all, as the kidneys can still function well enough to meet the body's needs. Symptoms usually appear in later stages (3 and above) as kidney function declines. Common signs of advanced CKD include:

• Swelling in your legs, ankles, feet, or face from fluid buildup
• Persistent fatigue or weakness that does not improve with rest
• Changes in urination, such as needing to go more or less often, foamy urine, or urine that is darker or lighter than usual
• Nausea, vomiting, or loss of appetite
• Shortness of breath, even with light activity
• Confusion, difficulty concentrating, or memory problems
• Muscle cramps or twitches
• Itchy, dry skin that does not go away with moisturizer

Causes & Risk Factors

The two most common causes of CKD are diabetes and high blood pressure (hypertension). Over time, high blood sugar from diabetes damages the tiny blood vessels in the kidneys, while high blood pressure puts extra strain on the kidney's filtering units. Other causes include glomerulonephritis (inflammation of the kidney's filtering units), polycystic kidney disease (a genetic condition that causes fluid-filled cysts to grow in the kidneys), prolonged urinary tract obstruction, and repeated episodes of acute kidney injury (sudden, temporary kidney damage).

• Diabetes (type 1 or type 2)
• Uncontrolled high blood pressure
• Family history of kidney disease or kidney failure
• Heart disease or cardiovascular conditions
• Obesity (body mass index of 30 or higher)
• Smoking or long-term use of tobacco products
• Older age (65 and older)
• History of acute kidney injury or frequent use of nephrotoxic medications like NSAIDs (ibuprofen, naproxen)

Diagnosis

CKD is diagnosed through a combination of tests that measure kidney function and check for damage. Your provider will first calculate your estimated glomerular filtration rate (eGFR), a number that estimates how well your kidneys are filtering blood based on your blood creatinine level, age, sex, and race. They will also test your urine for albumin (a protein) or other signs of damage. Additional tests may include kidney ultrasounds to check for structural abnormalities, or in rare cases, a kidney biopsy to determine the cause of damage. CKD is confirmed if you have signs of kidney damage or an eGFR below 60 mL/min for 3 or more months in a row.

Treatment & Management

There is no cure for most types of CKD, but treatment focuses on slowing disease progression, managing symptoms, and preventing complications like heart disease, anemia, and bone disorders. Treatment plans are tailored to the stage of CKD and its underlying cause. Common treatments include: medications to control blood pressure (such as ACE inhibitors or ARBs, which also reduce protein in urine), medications to manage blood sugar if you have diabetes, treatments for anemia or bone disease related to CKD, and lifestyle changes. In stage 5 CKD, treatment options include dialysis (a machine that filters waste from your blood) or a kidney transplant.

Living With CKD

Many people with early to moderate CKD live full, active lives for decades with proper management. Regular follow-up appointments with a nephrologist (kidney specialist) are essential to monitor your kidney function and adjust your treatment plan as needed. You may also work with a renal dietitian to create a kidney-friendly meal plan, and a social worker to connect with resources and support groups. It is normal to feel anxious or overwhelmed after a CKD diagnosis—reach out to your care team for emotional support if you need it.