Chronic kidney disease

Question 1

How does someone develop kidney disease without noticing early symptoms?

Accepted Answer

Kidney disease often develops over many years with no warning signs. Most people feel fine until the damage is already advanced. Inside each kidney are about a million tiny structures called nephrons. These filter your blood. Kidney disease damages these nephrons slowly, over several years. The damage is gradual. Symptoms often don't appear until the disease is very advanced. Diabetes and high blood pressure are the most common causes of kidney disease. Having a close family member with kidney disease also raises your risk. Blood and urine tests are the only way to detect kidney disease early. Talk to your care team about whether you should be tested. This matters especially if you have diabetes, high blood pressure, or a family history.

Question 2

Why might doctors prescribe certain diabetes medications for people with kidney disease?

Accepted Answer

Diabetes is one of the most common causes of chronic kidney disease (CKD — when damaged kidneys can no longer filter blood the way they should). High blood sugar over many years can worsen kidney damage. Medicines to control blood sugar are among the treatments that may help slow CKD. These treatments can also include medicines to lower blood pressure and cholesterol. None of these treatments can cure kidney disease, but they may slow its progression. Your care team can monitor your kidney health with blood and urine tests and guide your treatment plan.

Question 3

What do eGFR and creatinine numbers mean, and why might they change over time?

Accepted Answer

GFR (glomerular filtration rate — a measure of how well your kidneys filter) and creatinine are blood tests your care team uses to check kidney health. A GFR of 60 or more is in the normal range. A GFR below 60 may mean kidney disease. A GFR of 15 or less is called kidney failure, when dialysis or a transplant is often needed. Creatinine is a waste product from the normal breakdown of your muscles. Healthy kidneys remove creatinine from your blood. Providers use creatinine levels to estimate your GFR. As kidneys become more damaged, creatinine builds up and GFR falls. Kidney disease tends to get worse over time, so these numbers can shift between visits. You cannot raise your GFR, but working with your care team may help keep it from going lower. At each visit your provider will compare your current numbers to past results. Ask what your numbers mean and how they compare to last time.

Question 4

Can weight loss help protect kidney function?

Accepted Answer

Yes, losing weight if you are overweight may help keep your kidneys healthier longer. Diabetes and high blood pressure are the most common causes of chronic kidney disease (long-term kidney damage). A heart-healthy diet—fruits, vegetables, whole grains, and low-fat dairy—is also recommended. Physical activity and eating less salt are helpful steps too. Talk to your care team about which of these steps fit your health situation.

Question 5

How is CKD different from kidney failure, and does everyone with CKD eventually need dialysis?

Accepted Answer

CKD and kidney failure are related, but they are not the same condition. Understanding this difference can ease some worry. CKD stands for chronic kidney disease. It means your kidneys are damaged. They can no longer filter blood as well as they should. This damage builds up slowly — over many years. Most people have no symptoms until the disease is very advanced. Blood and urine tests are the only way to check your kidney health. Kidney failure happens when kidneys stop working properly. Harmful wastes build up in your body. Blood pressure may rise. Your body may hold extra fluid. Your body may also not make enough red blood cells. CKD does not always lead to kidney failure. It sometimes progresses to that point — but not always. Treatments can't cure CKD, but they may slow it down. Eating less salt can help. Controlling your blood pressure helps too. Staying active is another good step. If your kidneys do fail, dialysis or a kidney transplant can replace their work. Each has benefits and drawbacks. Your care team can walk you through the options. They can help you decide what makes sense for you.

Question 6

What do CKD stages mean, and what should I expect at each stage?

Accepted Answer

CKD — chronic kidney disease — usually develops slowly, and your kidneys' health is tracked mainly through a blood test called GFR (glomerular filtration rate), which measures how well your kidneys filter your blood. A GFR of 60 or more is in the normal range. A GFR below 60 may mean kidney disease is present. A GFR of 15 or less is called kidney failure. Most people in the early stages of CKD have no symptoms. Testing is the only reliable way to know where you stand. As CKD advances, your nutritional needs can change, and a dietitian may help. Controlling blood pressure and blood sugar may help slow the progression. If the kidneys fail, treatment options include dialysis or a kidney transplant. Ask your care team to explain your GFR results and what they mean for your care plan.

Question 7

What steps can actually slow down kidney disease progression?

Accepted Answer

Kidney disease cannot be cured, but the right steps may slow it down. Controlling blood pressure is the single most important action you can take. If you have diabetes, meeting your blood sugar goals also helps protect your kidneys. What you eat matters too — choose foods with less salt, and limit foods high in potassium and phosphorus. Staying physically active, keeping a healthy weight, and not smoking are all part of protecting your kidneys. Take medicines as your care team prescribes. Avoiding medicines that can injure the kidneys is also important. Your care team can track your kidney health with a blood test called GFR (a measure of how well your kidneys filter blood) and a urine test that checks for albumin (a protein that leaks out when kidneys are damaged). A registered dietitian who specializes in kidney disease can help you build an eating plan. Talk with your care team about which steps apply to your situation.

Question 8

Why do high blood pressure and diabetes damage kidneys, and can managing them help prevent that damage?

Accepted Answer

Your kidneys filter waste and extra fluid from your blood. High blood pressure and diabetes are the most common causes of chronic kidney disease, or CKD. The damage they cause builds up slowly over many years. Many people have no symptoms until the disease is advanced. High blood pressure can directly harm your kidneys. Managing blood pressure and blood glucose — the sugar level in your blood — may help prevent CKD or slow it down. Treatments may include medicines to lower blood pressure and control blood sugar, though they cannot cure CKD. Talk with your care team about your kidney test results and goals.

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