What to know about chronic kidney disease (and how to prevent it)

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Rebecca Davis

WHAT TO KNOW ABOUT CHRONIC KIDNEY DISEASE, PLUS HOW TO PREVENT IT

Key takeaways

Chronic kidney disease (CKD) affects approximately 14% of Americans and often has few or no noticeable symptoms during its early stages. Because of this, early detection and proper management are important.
Several factors can increase the risk of developing CKD, including diabetes, high blood pressure, a family history of kidney disease, arterial vascular disease, and being of African American descent.
CKD progresses through five stages, with symptoms generally becoming more noticeable as kidney function declines. In advanced cases, CKD can lead to kidney failure, which may require dialysis or a kidney transplant.
Preventing or slowing CKD progression involves managing weight, blood sugar, and blood pressure, staying physically active, quitting smoking, following a kidney-friendly diet, using medications responsibly, and staying proactive with regular healthcare.

Changes in your urine, such as unusual color or increased foaminess, along with swelling around the ankles, may have several possible causes. Common factors such as stress, pregnancy, or infections can sometimes contribute to these symptoms, but they may also be signs of chronic kidney disease (CKD).

Because CKD can develop gradually and may not cause obvious symptoms in its early stages, persistent or unexplained changes should be discussed with a healthcare provider.

What is chronic kidney disease?

Chronic kidney disease (CKD) refers to kidney damage or reduced kidney function that persists for several months or longer. It occurs when the kidneys can no longer perform their normal filtration role effectively, which includes filtering blood and removing excess fluid and waste from the body.

Acute kidney injury, on the other hand, develops suddenly and may sometimes be reversed when identified and treated promptly. If kidney damage continues over time, it can progress to chronic kidney disease. Unlike some acute kidney problems, CKD can be difficult to reverse, and many people may not realize they have it until significant kidney damage has already occurred.

CKD is more common than many people realize. According to Kunal Malhotra, MD, a nephrologist with University of Missouri Health Care, national estimates indicate that approximately 14% of Americans have CKD. The condition affects about 1 in 3 people with diabetes and 1 in 5 people with high blood pressure.

Having diabetes or hypertension can increase the risk of CKD. Other risk factors include a family history of kidney disease, arterial vascular disease, and being of African American descent.

The stages of chronic kidney disease

Chronic kidney disease (CKD) progresses through five stages, based largely on kidney function and the estimated glomerular filtration rate (eGFR). Symptoms often become more noticeable as kidney function declines.

Stage 1: There may be signs of kidney damage, such as protein or blood in the urine, while overall kidney function remains relatively normal.
Stage 2: Kidney function begins to decline, although you may not notice any symptoms. Changes are often detected through testing, including an estimated GFR (eGFR). A healthy adult generally has an eGFR of 90 or higher, according to the National Kidney Foundation.
Stage 3: Kidney function has decreased further, and the kidneys may have more difficulty regulating fluids and electrolytes. Many people still have few noticeable symptoms at this stage, which can make CKD difficult to detect without regular testing.
Stage 4: Kidney function is significantly reduced, and symptoms may become more apparent. Fluid and electrolyte imbalances can contribute to swelling, fatigue, and weakness. At this stage, healthcare providers may begin preparing patients for advanced treatment options if kidney function continues to decline.
Stage 5: Kidney function is severely impaired and may progress to kidney failure. Possible symptoms include loss of appetite, fatigue, sleep problems, dry or itchy skin, swelling in the legs and feet, muscle cramps, frequent urination, and foamy or discolored urine. When kidney function becomes severely reduced, some people may need dialysis or a kidney transplant to replace lost kidney function. Learn more about dialysis.

One of the biggest challenges with CKD is that it can progress without obvious symptoms for years. According to Dr. Malhotra, the kidneys can compensate for declining function during the earlier stages, which means many people may not realize there is a problem until the disease becomes more advanced.

The good news is that CKD progression can often be slowed, and many risk factors can be managed. Early detection, regular kidney function testing, and proper management of conditions such as diabetes and high blood pressure can play an important role in protecting kidney health.

Diagnosing chronic kidney disease

When healthcare providers suspect chronic kidney disease (CKD), they typically use blood and urine tests to evaluate kidney function and look for signs of damage. Blood tests can measure the estimated glomerular filtration rate (eGFR), while a urinalysis can check for proteins such as albumin.

Providers may also measure creatinine levels. Creatinine is a waste product normally filtered out by the kidneys, so levels may increase when kidney function declines. However, creatinine levels can naturally vary based on factors such as age, sex, and muscle mass, so creatinine alone cannot confirm kidney disease. It is typically considered alongside eGFR and urine test results.

Depending on the situation, additional testing may include kidney ultrasounds or a kidney biopsy. Together, these tests can help healthcare providers identify kidney damage, determine its potential cause, and assess how well the kidneys are functioning.

Treating chronic kidney disease

Managing chronic kidney disease (CKD) often involves making healthy lifestyle changes and addressing the conditions that may be contributing to kidney damage. According to Dr. Malhotra, controlling underlying risk factors—particularly keeping diabetes well managed—and making appropriate dietary changes are important parts of protecting kidney function.

Other steps that may help slow further kidney damage include:

Avoiding unnecessary supplements and medications: Some medications, particularly over-the-counter anti-inflammatory drugs such as ibuprofen, can potentially injure the kidneys or worsen existing kidney problems. Talk with a healthcare provider before regularly using these medications.
Quitting smoking: Avoiding tobacco can support overall cardiovascular and kidney health.
Staying physically active: Regular exercise can help manage factors such as weight, blood pressure, and blood sugar.
Controlling blood pressure: High blood pressure can contribute to ongoing kidney damage. Dr. Robert Greenwell, chief of nephrology at Mercy Medical Center in Baltimore, notes that managing blood pressure is an important part of protecting kidney function.

Medications such as ACE inhibitors and drugs such as losartan or lisinopril may be prescribed to help control blood pressure and reduce the amount of protein in the urine, which can help protect kidney function.

How to prevent kidney disease

Dr. Greenwell emphasizes the strong connection between chronic kidney disease (CKD) and lifestyle factors, particularly when it comes to prevention.

“When we find established, [long-term] damage to the kidneys, the likelihood of us reversing that is low,” he explains. “But when we look at the big things that cause someone to need dialysis, those factors are usually lifestyle-related.”

He also highlights the higher risk of CKD among people with diabetes, high blood pressure, heart disease, and HIV, as well as those who frequently use over-the-counter NSAIDs or other drugs. While some causes of CKD and permanent kidney damage cannot be reversed, many risk factors can potentially be addressed earlier through healthier dietary and lifestyle choices.

In other words, protecting kidney health often starts before kidney disease develops. So, what can you do now to help keep your kidneys healthy and reduce your risk of CKD?

Manage your weight and blood sugar.
Obesity, insulin resistance, and high blood pressure can increase the risk of developing diabetes, which is a major cause of chronic kidney disease. If your diabetes remains poorly controlled, particularly with a long-term A1C above 8.0%, consider working with a diabetes specialist, such as an endocrinologist, to improve blood sugar management.
Stay physically active.
Regular exercise supports overall health and may help slow the progression of kidney disease. Some studies suggest that physical activity may be particularly beneficial for people with Stage 3 or Stage 4 CKD. Kidney News research on exercise and CKD
Quit smoking.
Smoking can increase the risk of chronic kidney disease and may contribute to high blood pressure, narrowing of the kidney arteries, and protein in the urine. It is also associated with an increased risk of end-stage renal disease (ESRD).
Follow a kidney-friendly diet.
A balanced kidney-friendly diet can include whole grains, lean animal and plant proteins, healthy fats, fruits, legumes, and vegetables. Limiting sodium, alcohol, and saturated fat can also support kidney health.
For people who already have CKD, healthcare providers may recommend monitoring phosphorus and potassium intake, since these minerals can build up in the blood when kidney function is reduced. Dietary restrictions should be individualized, so discuss specific foods and nutrient limits with your healthcare provider or dietitian.
Manage existing health conditions.
Conditions such as diabetes, high blood pressure, and HIV can increase the risk of kidney disease. If you have any of these conditions, regular kidney function testing can help detect changes early.
Use medications carefully.
Frequent use of NSAID pain relievers, such as ibuprofen or naproxen, can potentially damage the kidneys. Dr. Malhotra notes that these medications can cause kidney injury in several ways and recommends using them only when necessary and under appropriate medical guidance.
Be proactive about your health.
If you have diabetes or high blood pressure, ask your healthcare provider about your kidney function and whether you need regular testing. Being aware of your risk factors can help ensure potential kidney problems are identified and managed early.
Ask about kidney-specific vitamins or supplements.
People with CKD may need to restrict certain foods, which can sometimes make it harder to get enough essential nutrients. The National Kidney Foundation notes that specialized renal vitamins may help provide nutrients such as iron, calcium, and B vitamins when appropriate. However, some vitamins and minerals can accumulate when kidney function is reduced, so always consult your healthcare provider before taking a renal vitamin or other supplement.

Can you reverse kidney damage?

Chronic kidney disease is generally not reversible because the damage and scarring to the kidneys can become permanent. However, some cases of acute kidney injury, including those caused by medication overuse, may be reversible when identified and treated early.

Dr. Greenwell explains that when kidney damage is first detected, healthcare providers should consider whether there is an acute and potentially reversible cause. If kidney function was normal recently and then declined suddenly, there may be a greater opportunity for recovery compared with damage that has developed over many years.

Once long-term kidney damage is established, the focus typically shifts from trying to reverse it to slowing its progression and preserving remaining kidney function. Some people with CKD can remain at a stable level of kidney function for many years with appropriate management, potentially delaying the need for dialysis or a transplant.

If you have kidney disease or abnormal kidney test results, talk with your healthcare provider about the best ways to protect your remaining kidney function and slow the progression of the condition.

Source: SingleCare

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