Chronic kidney disease

What is it?

Your kidneys clean the blood: they remove waste and extra water as urine, keep the body's chemicals in balance and help control blood pressure.² In chronic kidney disease (CKD) the kidneys are damaged and filter less well, so waste can build up.² The damage usually comes slowly, over many years.²

It is common, and more common as people get older and in people of Black or South Asian origin.¹ The most common causes are high blood pressure and diabetes.² High cholesterol, kidney infections, inflammation of the kidneys, blockages such as kidney stones, and long-term use of some medicines can also cause it.¹ One cause, polycystic kidney disease, runs in families.¹

The first signs

In the early stages there are usually no signs.¹ Many people have none until the disease is far advanced.² Later signs can be:¹

• tiredness;¹
• swollen ankles, feet or hands;^1,3
• shortness of breath;¹
• feeling sick;¹
• blood in your pee.¹

How doctors find out

Blood and urine tests are the only way to know.² Your family doctor arranges a blood test (eGFR) that shows how well your kidneys filter, and a urine test (ACR) that shows whether protein is leaking into your pee.⁴ Scans can show the shape of the kidneys and any blockage, and sometimes a tiny piece of kidney is checked under a microscope (a biopsy).⁴ The results give the stage of the disease.⁴ Regular tests are advised if you have high blood pressure, diabetes, heart disease, or serious or inherited kidney disease in your family.⁴

Current treatment

Healthy lifestyle with medicines for blood pressure and cholesterol, sometimes an SGLT2 inhibitor such as dapagliflozin to protect the kidneys, and dialysis or a transplant if the kidneys fail.Source: NHS

Will it get worse?

It can get worse over time, but it does not always, and many people live long lives with it.^1,5 Kidney damage cannot be repaired.⁵ Only about 2 in 100 people with CKD reach kidney failure, when the kidneys stop working.¹ Even mild CKD raises the risk of heart and blood vessel disease, such as heart attack and stroke, which is one of the main causes of death in people with kidney disease; healthy lifestyle changes and medicines can help lower this risk.¹

Medicines: what helps, and what to watch for

Medicines control blood pressure (often ACE inhibitors such as ramipril) and cholesterol (statins), which protects the kidneys and the heart.³ SGLT2 inhibitors such as dapagliflozin may help protect the kidneys, often in people with diabetes.³ Other medicines treat problems that CKD can cause, such as swelling, anaemia (too few red blood cells) or too much phosphate.³

Good to know:

• ACE inhibitors can cause a dry cough, dizziness, tiredness or headaches; if so, other blood pressure medicines can be used;³
• statins can cause feeling sick, constipation or diarrhoea, or muscle and joint pain;³
• water tablets (diuretics) can dry you out and lower your salt or potassium levels.³

Exercise and food help too

• if your potassium or phosphate is high, a dietitian helps you plan what to eat;^5,3
• have the flu vaccine every year and the one-off pneumococcal vaccine.⁵

Dialysis or a transplant, for some people

If the kidneys fail, dialysis takes over some of their work.^3,2 In haemodialysis a machine cleans your blood, usually about three times a week, in hospital or at home.³ In peritoneal dialysis fluid is put into your tummy to draw out waste, normally at home, several times a day or overnight.³ A kidney transplant is often the most effective treatment for advanced kidney disease, but it is major surgery, you need medicines (immunosuppressants) for the rest of your life to stop your body attacking the new kidney, and the wait can be months or years.³ About 90 in 100 transplanted kidneys still work after five years.³

Is there a cure?

No.^1,3 Treatment can ease the symptoms and slow the disease down.³ Clinical studies of kidney disease are listed on ClinicalTrials.gov, from the US National Institutes of Health.²

See the 937 trials you can join

Sources

Written in plain words by Frontlight from these pages:

1. NHS: Chronic kidney disease – Overview
2. MedlinePlus: Chronic Kidney Disease
3. NHS: Chronic kidney disease – Treatment
4. NHS: Chronic kidney disease – Diagnosis
5. NHS: Chronic kidney disease – Living with