chronic kidney disease

Overview
Chronic Kidney Disease (CKD) is a long-term condition where the kidneys gradually lose their ability to filter waste and excess fluids from the blood. Over time, this decline can lead to waste buildup, fluid imbalances, and complicationsacross multiple body systems. CKD often develops silently and worsens over months or years.

Why It’s Important
CKD can progress to kidney failure, requiring dialysis or a transplant to sustain life. Even in earlier stages, it significantly increases the risk of heart disease, stroke, and early death. Early detection and management can slow or prevent progression and reduce complications.

Quick Facts

  • Affects 1 in 7 adults in the U.S. (CDC); many are unaware they have it

  • Higher risk in people with diabetes, high blood pressure, and heart disease

  • CKD is a chronic condition and progresses through five stages

  • More common in Black, Hispanic, Indigenous, and older populations

  • CKD can occur at any age, but risk rises with age

  • Most people don’t have symptoms until later stages

What Happens in the Body
Healthy kidneys filter blood, regulate electrolytes, balance fluids, and help control blood pressure. In CKD, the kidneys gradually lose these abilities due to damage to nephrons (the filtering units). As function declines, waste and fluid accumulate, leading to fatigue, swelling, high blood pressure, and more serious complications if untreated.

Common Signs and Symptoms
Symptoms often appear in later stages and may include:

  • Fatigue or weakness

  • Swelling in ankles, feet, or face (fluid retention)

  • Urinating more or less frequently

  • Foamy urine (from protein loss)

  • Shortness of breath

  • Nausea or poor appetite

  • Difficulty concentrating

  • High blood pressure that’s hard to control

Diagnosis
CKD is diagnosed through routine lab tests:

  • eGFR (estimated glomerular filtration rate) — measures how well kidneys filter (normal is 90+ mL/min)

  • Urine albumin-to-creatinine ratio (ACR) — detects protein in urine

  • Blood creatinine levels

  • Imaging (ultrasound, CT) or kidney biopsy may be used to assess structural damage
    See a doctor if you have diabetes, hypertension, or a family history of kidney problems—even without symptoms.

Stages of CKD (Based on eGFR)

  • Stage 1: Kidney damage with normal function (eGFR ≥ 90)

  • Stage 2: Mild decrease in function (eGFR 60–89)

  • Stage 3a/b: Moderate decline (eGFR 45–59 / 30–44)

  • Stage 4: Severe decrease (eGFR 15–29)

  • Stage 5: Kidney failure (eGFR < 15 or on dialysis)

Progression is not always linear; early treatment can slow or halt worsening.

Treatment and Management
There is no cure, but CKD can often be managed or slowed:

  • Control blood pressure (target <130/80 mmHg) using ACE inhibitors or ARBs

  • Manage diabetes with medication and glucose monitoring

  • Dietary changes: low sodium, limited protein, potassium, and phosphorus intake

  • Regular monitoring of labs and kidney function

  • Avoid NSAIDs and nephrotoxic drugs

  • Dialysis or kidney transplant for end-stage kidney disease (Stage 5)

Risks and Complications
Without treatment, CKD can lead to:

  • End-stage kidney failure

  • Heart disease, heart failure, or stroke

  • Anemia (low red blood cell count)

  • Bone disease from calcium and phosphorus imbalance

  • Electrolyte disturbances (especially high potassium)

  • Early death from cardiovascular causes

Who Is at Risk

  • People with diabetes (leading cause) or hypertension

  • Family history of kidney disease

  • People over age 60

  • African American, Hispanic, Native American populations

  • Obesity, heart disease, or frequent use of certain pain medications

  • Autoimmune diseases like lupus

Related Conditions

  • Diabetic kidney disease

  • Hypertensive nephropathy

  • Polycystic kidney disease (PKD)

  • Heart disease and anemia, which often coexist with CKD

When to See a Doctor

  • If you have risk factors such as diabetes, high blood pressure, or family history

  • If you notice symptoms like swelling, changes in urination, or unexplained fatigue

  • If you’re taking medications that may affect kidney function

  • Even without symptoms, regular kidney function screening is recommended for at-risk individuals

Last Updated: June 19, 2025