Chronic Kidney Disease
Key Points
- More than 1 in 7 American adults has chronic kidney disease (CKD).
- As many as 9 in 10 don't know they have it.
- Specific blood and urine tests are needed to check for CKD.
- CKD can be treated (the earlier treatment starts the better).
- Kidney diseases are a leading cause of death in the United States.
- About 360 people begin treatment for kidney failure (dialysis or kidney transplant) every day.
About your Kidneys and CKD
Your hard-working kidneys
Your kidneys, each just the size of a computer mouse, filter all the blood in your body every 30 minutes. They work hard to remove wastes, toxins, and excess fluid. They also:
- Help control blood pressure.
- Signal the body to make red blood cells.
- Help keep your bones healthy.
- Regulate blood chemicals that are essential to life.
Kidneys that function properly are critical for maintaining good health.
CKD
CKD is a condition in which the kidneys are damaged and can't filter blood as well as they should. Because of this, excess fluid and waste remain in the body and may cause health problems such as heart disease.
Other health problems related to CKD include:
- Anemia or low number of red blood cells.
- Increased occurrence of infections.
- Low calcium levels, high potassium levels, and high phosphorus levels in the blood.
- Loss of appetite or eating less.
- Depression or lower quality of life.
CKD has varying levels of seriousness. It usually gets worse over time, though treatment has been shown to slow progression. CKD can progress to kidney failure and early cardiovascular disease.
When the kidneys stop working, dialysis or kidney transplant is needed for survival. Kidney failure treated with dialysis or kidney transplant is called end-stage kidney disease. Not all people with kidney disease progress to kidney failure.
Symptoms
People with CKD may not feel ill or notice any symptoms. The only way to find out for sure if you have CKD is through blood and urine tests. These tests measure both the creatinine level in the blood and protein in the urine.
Reducing Risk
- Keep your blood pressure below 140/90 mm Hg (or the target your doctor sets for you).
- If you have diabetes, stay in your target blood sugar range as much as possible.
- Get active. Physical activity helps control blood pressure and blood sugar levels.
- Lose weight if needed.
- Get tested for CKD regularly if you're at risk.
- If you have CKD, meet with a dietician to create a kidney-healthy eating plan. The plan may need to change as you get older or if your health status changes.
- Take medicines as instructed and ask your doctor about blood pressure medicines called angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, which may protect your kidneys in addition to lowering blood pressure.
- If you smoke, make a plan to quit. Smoking can worsen kidney disease and interfere with medication that lowers blood pressure.
- Include a kidney doctor (nephrologist) on your health care team.
CKD by the numbers
- Kidney diseases are a leading cause of death in the United States.
- About 35.5 million US adults are estimated to have CKD, and most are undiagnosed.
- 40% of people with severely reduced kidney function (not on dialysis) are not aware of having CKD.
- Every 24 hours, 360 people begin dialysis treatment for kidney failure.
- In the United States, diabetes and high blood pressure are the leading causes of kidney failure, accounting for 2 out of 3 new cases.
- In 2019, treating Medicare beneficiaries with CKD cost $87.2 billion, and treating people with end-stage kidney disease cost an additional $37.3 billion.
CKD and Kidney Testing
CKD happens when your kidneys become damaged over time and can't filter your blood as well. Diabetes is a leading cause of CKD, and there are often no symptoms until your kidneys are badly damaged.
If you find and treat kidney disease early, you may be able to manage CKD and prevent other health complications. But the only way to know how well your kidneys are working is to get tested.
Urine Tests
One of the earliest signs of kidney disease is when protein leaks into your urine (proteinuria). Urine testing can check for this. There are two types of urine tests that can check your protein levels.
Dipstick urine test. A dipstick is a chemically treated paper placed in your urine sample. It changes color if your levels are above normal. This test is often done as part of overall urine testing. It can also be done as a quick test to look for albumin (a protein produced by your liver) in your urine.
A dipstick urine test doesn't provide an exact measurement of albumin but does let your doctor know if your levels are normal. If you have abnormal albumin levels, your doctor may want to run further tests.
Urine albumin-to-creatinine ratio (UACR). This test measures the amount of albumin and compares it to the amount of creatinine (a normal waste product from your muscles) in your urine. A UACR test lets the doctor know how much albumin passes into your urine over a 24-hour period. A urine albumin test result of 30 or above may mean kidney disease.
It's important to know that:
- The test may be repeated once or twice to confirm the results.
- If you have kidney disease, your albumin level in your urine helps your doctor determine the best treatment option.
- If your urine albumin level stays the same or goes down, it means your treatment is working.
Serum Creatinine
Because your kidneys remove waste, toxins, and extra fluid from the blood, blood tests can check your kidney function. They will show how well and how quickly your kidneys are doing their job to remove waste.
A serum creatinine blood test measures the amount of creatinine in your blood. If your kidneys aren't working well, your creatinine level goes up. Normal levels for you will depend on your sex, age, and muscle mass.
Usually a creatinine level more than 1.2 for women and 1.4 for men may mean the kidneys aren't working well.
Glomerular Filtration Rate (GFR)
The GFR is a blood test that measures how well your kidneys remove waste, toxins, and extra fluid from your blood. Your serum creatinine level, age, and sex are used to calculate your GFR number. Like other kidney tests, a normal GFR number for you will depend on your age and sex.
If your GFR is low, your kidneys are likely not working as they should. As kidney disease progresses, your GFR goes down. The results of your test can mean the following:
If your GFR is 60 or more together with a normal urine albumin test, you are in the normal range. But you'll still want to talk to your doctor about when you should be checked again.
If your GFR is less than 60, it may mean you have kidney disease. You'll want to talk to your doctor about treatment options that are best for you.
If your GFR is less than 15, it may mean your kidneys are failing. If your results show kidney failure, you'll likely need dialysis or a kidney transplant. If your GFR level is less than 20 over 6 to 12 months, your doctor may consider a kidney transplant.
Blood Urea Nitrogen (BUN)
A BUN is a blood test that measures the amount of urea nitrogen in your blood. Urea nitrogen is a waste product your body makes from the breakdown of protein in the foods you eat. Healthy kidneys filter urea nitrogen out of your blood, which leaves your body through your urine. This process helps keep your BUN level within a normal range.
A normal BUN level depends on your age and other health conditions, but usually ranges from 7 to 20. If your BUN level is higher than normal, this may be a sign that your kidneys aren't working well. As kidney disease progresses, your BUN level goes up.
Other Tests
Your doctor may also perform other tests to check your kidneys. These could include monitoring your blood pressure, running imaging tests, or performing a kidney biopsy. Kidney testing helps you and your doctor determine the best treatment plan for you.
Risk Factors
Diabetes
CKD is common in people with diabetes. Approximately 1 in 3 adults with diabetes has CKD.
Each kidney is made up of millions of tiny filters called nephrons. High blood sugar from diabetes can damage blood vessels in the kidneys and nephrons so they don't work well.
High blood pressure
Approximately 1 in 5 adults with high blood pressure has CKD. High blood pressure can make blood vessels narrower, reducing blood flow. Over time, blood vessels throughout the body weaken, including in the kidneys.
Damaged blood vessels in the kidneys may no longer work properly. When this happens, the kidneys can't remove all wastes and extra fluid from your body. Extra fluid can raise your blood pressure even more.
Heart disease
Adults with heart failure have a higher risk of CKD because of reduced blood flow to the kidneys. Having CKD is also a risk factor for heart disease.
Family history of CKD
CKD runs in families. You may be more likely to get kidney disease if you have a close relative with CKD.
Obesity
Having overweight or obesity raises your risk for high blood pressure and diabetes, the two biggest causes of CKD. This means that having overweight or obesity puts you at greater risk for CKD.
Medicare Costs
In 2019, treatment for Medicare beneficiaries with CKD cost $87.2 billion, and treatment for people with ESKD cost an additional $37.3 billion.
Costs can be reduced by preventing:
- CKD in people at risk.
- CKD progressing to ESKD.
- Other chronic conditions such as type 2 diabetes and heart disease, which can lead to CKD.
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