This topic provides
information about chronic kidney disease. If you are looking for information
about sudden kidney failure, see the topic
Acute Renal Failure.
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 do not 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.
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:
You may start to have
symptoms only a few months after your kidneys begin to fail. But most people do
not have symptoms early on. In fact, many do not 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 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 ask questions about any
past kidney problems, 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 near normal, 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. They 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 my 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.
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.
The cause of
chronic kidney disease is not 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.
Diabetes causes about 35% of all chronic kidney disease. High blood sugar
levels caused by diabetes damage blood vessels in the kidneys. If the blood
sugar level remains high, this damage gradually reduces the function of the
kidneys.
High blood pressure (hypertension). High blood pressure causes another 30% of all
kidney disease. Because blood pressure often rises with chronic kidney disease,
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:
Studies have shown frequent
use of aspirin and acetaminophen (Tylenol) may also harm your kidneys.1 Be sure your doctor knows about all prescription medicines,
over-the-counter medicines, and herbs that you are taking.
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 do not 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 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 trouble thinking straight.
What Happens
Chronic kidney disease can greatly impact your life as it gets worse (progresses). At
first, the kidneys are still able to regulate the balance of fluids, salts, and
waste products in your body. But as kidney function decreases, complications
begin to develop. The number and severity of complications caused by chronic
kidney disease increase as kidney function gets worse.
If you
are not able to control the disease, your kidney function will continue to get
worse. 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 develop kidney failure, either
you will need to have dialysis or you will need a new kidney. Both choices have
risks and benefits. Talk with your doctor to decide which would be best for
you.
Regardless
of what causes chronic kidney disease, serious problems occur when the kidneys
cannot adequately filter and remove all of the waste products from the body. As
these waste products build up, symptoms and serious complications start to
occur. Complications of severe chronic kidney disease may include:
Uremic syndrome. In
uremic syndrome,
urea and
creatinine levels in the bloodstream rise. Fatigue and
weight loss are common symptoms. Uremic syndrome can affect many body systems,
such as the intestines, nerves, and heart.
Anemia.
Anemia occurs when the kidneys do not produce enough
of a protein called
erythropoietin for the body to make new red blood
cells. The more damage that has occurred in the kidneys, the more severe the
anemia may be.
Electrolyte imbalance.
Electrolyte imbalance occurs when the kidneys cannot
adequately filter out certain chemicals from the blood , such as potassium,
phosphate, and acids.
Heart disease. Chronic
kidney disease speeds up hardening of the arteries (atherosclerosis) and increases the risk of
heart attack and
heart failure. Heart disease is the most common cause
of death in people with kidney failure.
Bone disease (osteodystrophy). The kidneys must be able to maintain a healthy
balance of substances such as calcium, phosphate, and vitamin D to help keep
bones strong. Kidney disease causes abnormal levels of these substances. This
leads to renal bone disease.
Fluid imbalances. As kidney function continues to decline, the kidneys are
increasingly unable to filter fluids and maintain salt balance. When the
kidneys are no longer able to properly remove salt and water from the body,
fluid builds up in the tissues of the body (edema). Fluid buildup in the lungs
(pulmonary edema) can cause
heart failure.
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 the development of chronic kidney disease are:
Age. The kidney begins
to get smaller at about age 35. By age 80, most people have lost about 30% of
their kidney mass.
Race. African-Americans
and Native Americans are more likely to develop chronic kidney disease.
Being male. Men have a
higher risk of developing chronic kidney disease than women.
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 the
development of
kidney failure by controlling things that increase
your risk of kidney damage, such as:2
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 of developing kidney
disease.
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.
Soon after you have been diagnosed with chronic kidney
disease, your doctor may refer you to a nephrologist. A nephrologist can treat
kidney disease and other conditions that may be contributing to it and help you
make other decisions about treatment. Nephrologists also often take over the
care of people who have
kidney failure when they need
dialysis or after they receive a
kidney transplant.
If you are to receive
dialysis, you will be referred to a
surgeon who will prepare a
dialysis access. A dialysis access is a site on your
body where blood or other fluids can be removed, filtered, and returned to the
body during dialysis. You will be referred to a surgeon if you are being
considered for a kidney transplant.
You may also be referred to
a:
Dietitian, to help you with meal
planning. Because of the many restrictions in your diet, you may find it hard
to get enough calories to maintain your weight. A dietitian can help you make
wise food choices.
Psychologist or
social worker, to help you and your family with
emotional stress or financial issues.
People who have
chronic kidney disease may not have symptoms of the
disease until
kidney function has decreased to a very low level.
Tests are vital to help determine:
Whether kidney disease has developed suddenly
or as a long-term process (acute renal failure versus chronic kidney disease). Some of the tests used to evaluate
acute renal failure may also be used if a person with
chronic kidney disease has a sudden drop in kidney function.
What
is causing the kidney damage.
The best type of treatment to help
slow the progression of kidney damage.
After you are diagnosed with chronic kidney disease, blood
and urine tests can help 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 bloodstream. The
following blood and urine tests measure changing levels of these substances in
the bloodstream and can help estimate how well your kidneys are working.
A
fasting blood glucose test is done to measure your
blood sugar. High blood sugar levels damage blood vessels in the
kidneys.
A blood test measures your levels of
electrolytes, which are filtered out of the body by
the kidneys. Altered levels of electrolytes, such as sodium and potassium, may
mean the kidneys are not functioning adequately.
A blood test for
parathyroid hormone (PTH) checks the level of PTH in
the blood. PTH helps control calcium and phosphorus levels in the blood. A high
parathyroid hormone level can be caused by conditions that lead to low blood
calcium levels, such as chronic kidney disease.
Urine tests, such
as
urinalysis (UA) and random urine test for
microalbumin, measure the amount of protein in the
urine. Normally there is little or no protein in urine. Kidney disease can
cause increased protein in the urine.
Kidney disease runs in families, so encourage close
family members to have their kidney function tested. If kidney disease is found
early, treatment can be started to slow or stop the damage.
Tests for anemia
If the kidneys do not produce
enough of the protein
erythropoietin needed to make red blood cells,
anemia can develop. This type of anemia is treated
with a medicine called
human recombinant erythropoietin (rhEPO) that helps your body make new red
blood cells.
Reticulocyte count. A low reticulocyte count often means decreased production of red
blood cells by the bone marrow. Iron deficiency or low levels of erythropoietin
can cause decreased production of red blood cells by the bone
marrow.
Iron studies. Your body needs iron for
the proper function of hemoglobin, the protein in red blood cells that carries
oxygen. Decreased production of red blood cells or the inability to store iron
in the body can cause a low iron level.
Serum ferritin test, to measure the protein that binds to iron in the body.
Decreased production of red blood cells, low iron in the body, or the inability
to store iron in the body can cause a low level of serum ferritin.
Other tests
Your doctor may use other tests to
monitor reduced kidney function or to determine whether another kidney disease
or condition is contributing to reduced kidney function.
An
ultrasound of the kidney (renal ultrasound) accurately
measures the size of the kidneys, which may help estimate how long chronic
kidney disease has been present and to check whether urine flow from the
kidneys is blocked. An ultrasound also may help identify other possible causes
of kidney disease, such as obstruction or
polycystic kidney disease.
A
kidney biopsy may help determine the cause of chronic
kidney disease. It may also be used after kidney transplant when organ
rejection is suspected.
The
dye used during
CT scan and
intravenous pyelogram (IVP) may damage the kidneys
further, so these tests typically are not used to evaluate kidney
disease.
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. Being diagnosed with kidney
disease before it has progressed gives you the best chance to control the
disease.
Screening tests for people who have diabetes
Kidney damage caused by diabetes is called
diabetic nephropathy. Doctors diagnose diabetic
nephropathy with a urine test for
microalbumin that detects protein in the urine.
Normally there is little or no protein in urine. Kidney disease can cause
increased protein in the urine, or proteinuria. The results of two tests done
within a 3- to 6-month period are needed to diagnose diabetic nephropathy.
When to begin testing for protein in the urine depends on the
type of diabetes you have. After testing begins, you should have it every
year.
Type 1 diabetes:
Because it takes a few years before people with type 1 diabetes start showing
signs of kidney damage, testing for protein in the urine is often done yearly
after you have had the disease for 5 years. For children, testing usually
begins at the time of puberty and continues yearly throughout
life.
Type 2 diabetes: Because people with
type 2 diabetes have usually had the disease for several years before it is
diagnosed, diabetes may have already caused some kidney damage. Testing for
protein in the urine is often done yearly after type 2 diabetes is
diagnosed.
Screening tests for people who have high blood pressure
When you are first diagnosed with
high blood pressure, you should have an estimate of
glomular filtration rate (GFR) to check your kidney
function. If your kidney function is normal and your blood pressure is normal
with treatment, you will need to see your doctor yearly to have your overall
health and kidney function evaluated.
Experts recommend that
people with kidney disease keep their blood pressure below 130/80.3
During your yearly visit,
your doctor may order a
chemistry screen, which includes a
urine test to measure the amount of protein in the
urine. If your test results are normal and your blood pressure is under
control, no further testing is needed. If initial tests are abnormal, more
tests may be needed to evaluate your kidney function.
The goal of treatment for
chronic kidney disease is to prevent or slow
additional 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 or avoid situations
that can cause kidney damage or make it worse.
Initial treatment
One of the most important parts
of treatment for
chronic kidney disease is to control the disease that
is causing it. If you have diabetes or high blood pressure, you and your doctor
will develop a plan to aggressively treat and manage your condition to help
slow additional damage to your kidneys.
Your doctor will also
check you for other conditions or diseases that may cause kidney damage,
including a blockage (obstruction) in the urinary tract or long-term use of
medicines that can damage the kidneys, such as some
antibiotics or pain relievers (such as
NSAIDs).
You can take steps at home to
help control your kidney disease:
Follow an eating plan that is good for your
kidneys. A dietitian can help you make an eating plan with the right amounts of
sodium, fluids, and
protein. For more information, see:
Make exercise a routine part of your life. Try
to do at least 2½ hours a week of
moderate exercise.4 One way
to do this is to be active 30 minutes a day, at least 5 days a week. It's fine
to be active in blocks of 10 minutes or more throughout your day and week. Work
with your doctor or other health professional to design an exercise program
that is right for you. Exercise may help you control diabetes and high blood
pressure, which can lead to kidney disease.
Avoid taking
medicines that can damage your kidneys, like ibuprofen
(such as Advil), naproxen sodium (Aleve), and celecoxib (Celebrex). Be sure
your doctor knows about all prescription medicines, over-the-counter medicines,
and herbs that you are taking.
Avoid
dehydration. Get treatment right away for illnesses,
such as diarrhea, vomiting, or fever, that can cause you to lose fluids. Be
especially careful when you exercise or during hot weather. For more
information, see the topic
Dehydration.
Do not 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.
Do not drink alcohol or
use illegal drugs.
Ongoing treatment
As part of your ongoing
treatment for chronic kidney disease, 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 increase the blood supply to the kidneys, reduce protein in the
urine, and help manage high blood pressure. The recommended target blood
pressure for people with kidney disease is less than 130/80.3
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.
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
include:
Tests to measure the amount of protein in your
urine, to find out whether your medicines need to be
adjusted.
Depending on the stage of your disease, you may be able
to take steps at home to help control your kidney disease:
Follow the eating plan your dietitian
developed for you. Your eating plan will balance your need for calories with
your need to limit certain foods, such as sodium, fluids, and
protein. For more information, see:
Make exercise a routine part of your life.
Exercise may help you control diabetes and high blood pressure.
Avoid taking
medicines that can damage your kidneys, like ibuprofen
(such as Advil), naproxen sodium (Aleve), and celecoxib (Celebrex). Be sure
your doctor knows about all prescription medicines, over-the-counter medicines,
and herbs that you are taking.
Avoid
dehydration. Get treatment right away for illnesses,
such as diarrhea, vomiting, or fever, that can cause you to become dehydrated.
Be especially careful when you exercise or during hot weather. For more
information, see the topic
Dehydration.
Do not smoke or use other
tobacco products, alcohol, or illegal drugs. 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.
Treatment if the condition gets worse
Chronic
kidney disease is often progressive. If the disease gets worse, your symptoms,
such as fatigue, nausea, and loss of appetite, may occur more frequently or
become more severe. Work with your doctor to develop a treatment plan to help
control these symptoms. An eating plan that limits the amount of protein,
fluids, and salt in your diet is usually needed to help slow the progression of
kidney failure. For more information, see:
Uremic syndrome (uremia) is a serious complication of
chronic kidney disease. It occurs when waste products build up in the body
because the kidneys are not able to eliminate them. These substances can become
poisonous (toxic) to the body if they reach high levels. Uremic syndrome can
affect many body systems, including the intestines, nerves, and heart. If it
develops, the mechanical removal of wastes and fluids (dialysis) or
replacement with a donor kidney (kidney transplant) will be
needed.
When the kidneys do not produce enough of the protein
that the body needs to produce new red blood cells (erythropoietin),
anemia develops. This type of anemia is treated with a
medicine called
human recombinant erythropoietin (rhEPO) that helps your body make new red
blood cells. Treatment with rhEPO may also help improve your appetite and
general sense of well-being.
You may also need to be checked for
iron deficiency and treated with an iron
supplement.
Treatment for kidney failure
If you are not
able to control
chronic kidney disease, your
kidney function will continue to get worse. 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 develop kidney failure, either
you will need to have dialysis or you will need a new kidney. Both choices have
risks and benefits. Talk with your doctor to decide which would be best for
you.
Dialysis is a process that performs 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.
Hemodialysis requires a machine that 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 surgeon 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 be the dialysis access.
Kidney transplant is often a better treatment option for kidney failure,
because it may allow you to live a fairly normal life. But there are some
drawbacks:
If no one you know can donate a kidney, the
wait for a transplant may be long. You will probably need to have dialysis
while you wait for a kidney.
It may be difficult to find a good
match for your blood and tissue types. Sometimes, even when the match is good,
the body rejects the new kidney.
You will have to take medicine to
suppress your
immune system (immunosuppressants) for the rest of
your life. These medicines help prevent your body from attacking your new
kidney (rejection). Not taking the medicines properly is a common cause of
rejection.
Immunosuppressant medicines work by lowering your
body's disease-fighting ability, so they increase your risk of getting
infections or cancer.
In some cases, kidney transplant is not
successful. If this is the case, transplant can be tried again.
For more general information about transplant, see the
topic
Organ Transplant.
Palliative care
As
your disease gets worse, you may want to think about
palliative care. Palliative care is a kind of care for
people who have diseases that do not go away and often get worse over time. It
is different than care to cure your illness, called curative treatment.
Palliative care focuses on improving your quality of life-not just in your
body, but also in your mind and spirit. Some people combine palliative care
with curative care, but usually this means they do not want dialysis treatments
in order to sustain their lives.
Palliative care may help you
manage symptoms or side effects from treatment. It could also help you cope
with your feelings about living with a long-term disease, make future plans
around your medical care, or help your family better understand your disease
and how to support you.
If you are interested in palliative care,
talk to your doctor. He or she may be able to manage your care or refer you to
a doctor who specializes in this type of care.
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.
What To Think About
If you have severe chronic
kidney disease but have not yet developed kidney failure, discuss with your
doctor which type of dialysis is best for you. The type of dialysis you have
may sometimes depend on how quickly you need to begin dialysis.
Learning about dialysis (predialysis education) is an important step in
preparing for dialysis. Most dialysis clinics offer predialysis services to
help you better understand your choices.
Dialysis can be expensive. But Medicare or
insurance may cover most or all of the costs. Check with your insurance or
Medicare about your coverage. The dialysis center or hospital can help you find
the best way to pay for your treatment.
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.
Prevention
Chronic kidney disease may sometimes be prevented by controlling the other diseases or
factors that can contribute to kidney disease. Because chronic kidney disease
is often caused by high blood pressure and diabetes, keeping your blood
pressure and blood sugar levels near normal can help prevent damage to your
kidneys.
The sooner you change factors that damage your kidneys,
the better. Controlling the following factors may slow the progression of
kidney damage in a person who has chronic 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. For more information, see:
If you have diabetes, keep your blood sugar as
close to normal as possible. Talk with your doctor how often to check your
blood sugar. For more information, see:
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
High Blood Pressure (Hypertension).
Maintain healthy levels of fats (lipids), such as cholesterol and
triglycerides. For more information, see the topic
High Cholesterol.
Do not 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.
If you already have chronic kidney disease, make sure that
you:
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.
Reduce your risk of heart
disease. Lifestyle changes such as eating a low-fat diet, quitting smoking, and
exercising regularly can help reduce your overall risk of developing heart
disease and stroke. For more information, see the topic
Coronary Artery Disease.
Treat other problems, such as
kidney stones, an
enlarged prostate, or bladder problems, that may block
the normal flow of urine out of the kidneys.
Follow an eating plan
for kidney disease. Talk with a dietitian to determine how much
protein you need each day. Studies have shown that a
low-protein diet may help lower the risk of kidney damage. For more
information, see:
Make exercise a routine part of your life. Try
to do at least 2½ hours a week of
moderate exercise.4 One way
to do this is to be active 30 minutes a day, at least 5 days a week. It's fine
to be active in blocks of 10 minutes or more throughout your day and week. 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, which can lead to
kidney disease.
What to avoid
Avoid taking
medications that can harm your kidneys. Be sure that
your doctor knows about all prescription, over-the-counter, and herbal
medicines 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.
Do not 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.
Do not drink alcohol or
use illegal drugs.
Avoid products containing magnesium, such as
antacids like Mylanta or Milk of Magnesia. These products increase your risk of
developing abnormally high levels of magnesium (hypermagnesemia), and they may
cause vomiting and/or diarrhea.
Medications
Although medicine cannot reverse
chronic kidney disease, it is often used to help treat
symptoms and complications and to slow further kidney damage.
Medication Choices
Medicines to treat high blood pressure
From 80%
to 90% of people with chronic kidney disease have problems with high blood
pressure at some time during their disease. Medicines to lower blood pressure
(antihypertensives) are used to keep blood pressure in a safe range and slow
the progression of kidney damage that is caused by high blood pressure. The
target is to keep your blood pressure below 130/80. The type of blood pressure
medicine used is thought to be less important than how well the medicine lowers
blood pressure.
Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors decrease blood pressure by opening (dilating)
blood vessels. ACE inhibitors slow damage to the kidneys caused by diabetes and
other kidney diseases.
Angiotensin II receptor blockers. These
medicines block the action of a hormone that causes blood vessels to narrow. As
a result, blood vessels relax and open, reducing blood pressure.
Diuretics. Diuretics
help remove extra sodium and fluid from the body, decreasing the volume of
circulating blood and lowering blood pressure.
Beta-blockers. Beta-blockers decrease blood pressure
by decreasing heart rate and cardiac output. They also relax blood
vessels.
Calcium channel blockers. Calcium channel blockers
dilate blood vessels by relaxing the muscles in the vessel walls. This makes it
easier for blood to flow through the vessels and helps lower blood
pressure.
Vasodilators. Vasodilators relax the smooth muscle of
blood vessels, which opens (dilates) the blood vessels.
Direct renin inhibitors block the enzyme renin from
starting a process that helps regulate blood pressure. As a result, blood
vessels relax and widen, making it easier for blood to flow through the
vessels, which lowers blood pressure.
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
starting or changing your medicines, to make sure they are working
correctly.
Medicines to treat complications of chronic kidney disease
Other medicines may be used to treat complications of
chronic kidney disease, such as:
Medicines for
electrolyte imbalances. Specific medicines are
sometimes needed to treat imbalances of electrolytes, such as high potassium,
high phosphate, and low calcium levels.
Diuretics to
treat fluid buildup caused by chronic kidney disease.
ACE inhibitors for
heart failure. Regular blood tests are required to make sure that these
medicines do not raise potassium levels (hyperkalemia) or make kidney function
worse. For more information, see the topic
Heart Failure.
Medicines used during dialysis
Both
erythropoietin (rhEPO) therapy and iron replacement therapy may also be used
during dialysis to treat anemia, which often develops in advanced chronic
kidney disease.
Erythropoietin (rhEPO) 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.7
Iron therapy can help increase levels of iron in the
body when rhEPO therapy alone is not effective.
What To Think About
Talk with your doctor about what
types of
immunizations you should have if you have chronic
kidney disease. Also, be sure to discuss
medication precautions. Make sure you tell your doctor
about all prescription, over-the-counter, and herbal medicines you are
taking.
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.
If you
have kidney failure, your doctor may recommend a kidney transplant if you are a
good candidate for surgery. You will probably be considered a good candidate if
you do not have significant heart or lung disease or other diseases, such as
cancer, which might decrease your life span.
After a kidney
transplant, you will have to take medicines called immunosuppressants.
Immunosuppressants, 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 these medicines for the rest of your
life.
Because these medicines weaken the function of your
immune system, you will have an increased risk of
developing serious infections.
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.
What to think about
A kidney transplant does not
guarantee that you will live longer than you would have without a new
kidney.
Kidney transplant surgery is expensive but has been
covered by Medicare since the 1970s. Check with your insurance or Medicare
about your coverage.
You may have to wait for a kidney to be donated. If so, you will need to
have dialysis while you wait.
Other Treatment
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 it may be a
short-term measure while you are waiting for a kidney transplant.
Before starting dialysis, your doctor will arrange to have a surgeon place a
dialysis access in your body so that blood or body
fluids can be transferred between your body and the machine. The type of access
that you have depends on which type of dialysis you choose.
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.
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. Before starting dialysis, your doctor will
arrange to have a surgeon place a
dialysis access surgically in your body.
Both types of dialysis can be expensive. But
Medicare or insurance may cover most of the costs. Check with your insurance or
Medicare about your coverage. The dialysis center or hospital can help you find
the best way to pay for your treatment.
Other Places To Get Help
Organizations
Medicare (Department of Health and Human
Services)
7500 Security Boulevard
Baltimore, MD 21244-1850
Phone:
1-800-MEDICARE (1-800-633-4227) toll-free for the Medicare speech-automated system 1-877-267-2323 toll-free for the Centers for Medicare and Medicaid Services
TDD:
1-866-226-1819 toll-free
Web Address:
www.medicare.gov
This federal agency provides guides and other
information about Medicare. The Official U.S. Government Site for People With
Medicare (www.medicare.gov) provides useful information about Medicare
enrollment, coverage, billing, appeals, and drug discount cards, as well as the
latest Medicare policy changes impacting older Americans. Information on the
Medicare Hospice Benefit and how to choose a nursing home is also
included.
National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK)
Building 31, Room 9A06
31 Center Drive, MSC 2560
Bethesda, MD 20892-2560
Phone:
(301) 496-3583
Web Address:
www.niddk.nih.gov
The National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) provides information and conducts research on a wide
variety of diseases as well as issues such as weight control and
nutrition.
National Kidney and Urologic Diseases Information
Clearinghouse
3 Information Way
Bethesda, MD 20892-3580
Phone:
1-800-891-5390
Fax:
(703) 738-4929
E-mail:
nkudic@info.niddk.nih.gov
Web Address:
http://kidney.niddk.nih.gov
The National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC), a federal agency, is a service of the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part
of the National Institutes of Health under the U.S. Department of Health and
Human Services. The clearinghouse provides information about diseases of the
kidneys and urologic system to people with kidney and urologic disorders and to
their families, to health professionals, and to the public. NKUDIC answers
inquiries; develops, reviews, and distributes publications; and works closely
with professional and patient organizations and government agencies to
coordinate resources about kidney and urologic diseases.
National Kidney Foundation
30 East 33rd Street
New York, NY 10016
Phone:
1-800-622-9010 (212) 889-2210
Fax:
(212) 689-9261
Web Address:
www.kidney.org
The National Kidney Foundation works to prevent kidney
and urinary tract diseases and help people affected by these conditions. Its
Web site has a wealth of information about adult and child conditions. Free
materials, such as brochures and newsletters, are available.
United Network for Organ Sharing
(UNOS)
700 North 4th Street
Richmond, VA 23219
Phone:
1-888-894-6361
Web Address:
www.unos.org
The United Network for Organ Sharing (UNOS) is a nonprofit
scientific and educational organization that administers the nation's only
Organ Procurement and Transplantation Network (OPTN). It was established by the
U.S. Congress in 1984. UNOS collects and manages data about every transplant
event occurring in the United States, facilitates the organ matching and
placement process, and brings together health professionals, transplant
recipients, and donor families to develop organ transplantation policy.
UNOS:
Matches donors to recipients and coordinates
the organ-sharing process 24 hours a day, 365 days a
year.
Maintains the databases that contain all clinical transplant
data for every transplant event that occurs in the United
States.
Performs data analyses, fills data requests, produces the
Annual and other data reports, and authors authoritative
publications.
Monitors every organ match to ensure adherence to
UNOS policy, and works with the Board of Directors to develop equitable
policies that maximize the limited supply of organs.
Offers support
to members of the transplant community. These services include seminar
planning, providing educational programs and workshops, and much more.
Provides assistance to patients, family members, and friends, and
sets professional standards for efficiency and quality patient
care.
Raises public awareness about the importance of organ
donation.
Works to keep patients informed about transplant issues
and policies.
Offers comprehensive travel and event planning to
assist organizations within the transplant community.
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This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Fored CM, et al. (2001). Acetaminophen, aspirin, and
chronic renal failure. New England Journal of Medicine,
345(25): 1801-1808.
Mackenzie H, Brenner BM (1998). Current strategies
for retarding progression of renal disease. American Journal of Kidney Diseases, 31(1): 161-170.
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.
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/pdf/paguide.pdf.
Stigant C, et al. (2003). Nephrology: 4. Strategies
for the care of adults with chronic kidney disease. Canadian Medical Association Journal, 168(12): 1553-1560.
Toto RD (2004). Approach to the patient with kidney
disease. In BM Brenner, ed., Brenner and Rector's The Kidney, 7th ed., vol. 1, pp. 1079-1106. Philadelphia:
Saunders.
Remuzzi G, Minetti L (2000).
Hematologic consequences of renal failure. In BM Brenner et al., eds., Brenner and Rector's The Kidney, 6th ed., vol. 2, pp. 2079-2094. Philadelphia:
W.B. Saunders.
