What is Chronic Kidney Disease (CKD)?

Chronic Kidney Disease, or CKD, means that your kidneys are damaged or are not working as well as they should for at least three months or longer. You might not feel sick at first, but tests can show signs of kidney damage, including extra protein in your urine or a lower kidney function number called eGFR (less than 60).

Doctors use stages to describe how serious CKD is. These stages help guide treatment.

Problems CKD Can Cause

When your kidneys don't work well, you can have problems such as:

• Too much fluid in your body (swelling)
• High levels of potassium
• Trouble keeping the right balance of minerals
• Bone problems
• Feeling tired
• Losing your appetite
• Feeling sick to your stomach
• High blood pressure
• Anemia (low blood count)
• Poor nutrition
• High cholesterol

How CKD is Treated

It’s important to slow down kidney damage. Controlling your blood pressure is a big part of this. If you have a lot of protein in your urine (over 300 mg/day), you may need extra treatment.

If you have CKD and excessive protein in your urine, your doctor will likely recommend a medicine called an SGLT2 inhibitor. Even if you only have a moderate amount of protein in your urine (between 30 and 299 mg/day), your doctor may suggest trying this medicine. These recommendations apply whether or not you have diabetes.

When to See a Kidney Specialist (Nephrologist)

Patients with more serious CKD (eGFR less than 30) should see a kidney doctor, also known as a nephrologist. Early on, your primary care provider and a nephrologist may collaborate to take care of you. Later, it may be better for you to be treated by a team of specialists at a CKD clinic, which is a special center focused on treating people with kidney problems.

Planning for Kidney Replacement Therapy

Some people with CKD may eventually need kidney replacement therapy. Planning early can help you stay healthier longer. Your doctor will talk with you about the different choices:

• Hemodialysis (cleaning the blood at a clinic or at home)
• Peritoneal dialysis (cleaning the blood using the lining of your belly)
• Kidney transplant (getting a kidney from a living or deceased donor)
• Conservative care (choosing not to have dialysis or a transplant)

If you decide on hemodialysis, you will need to see a surgeon early for a procedure that creates a special blood vessel, called an AV (arteriovenous) access, for future treatments.

When to Start Dialysis

Dialysis may be needed if you have:

• Serious inflammation around the heart or lungs
• Worsening confusion or nerve problems from kidney failure
• Serious bleeding problems from kidney disease
• Swelling that doesn’t get better with diuretics
• High blood pressure doesn’t get better with medicine
• Ongoing problems with your blood chemistry that medicine can't fix
• Constant nausea and vomiting
• Signs of poor nutrition
• Trouble thinking clearly
• Depression, constant itching, or restless leg syndrome