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Chronic kidney disease

(CKD)
Chronic kidney disease (CKD) is a long-term condition where the
kidneys work less well than they should. This page gives information
about CKD, its treatments and what to expect.

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What is CKD?

Chronic kidney disease means that your kidneys do not work as well as they
should. They can’t remove waste products from your body. Damage to the
kidney’s !lter system can also allow blood and protein to leak into the urine. This
is not always visible but can be found with a urine test.
Accessibility & Language Support
The term ‘chronic’ means that it is a long-term condition. It does not necessarily
mean your kidney damage is severe as many cases of CKD are mild and can be
managed with help from your GP and without hospital involvement.
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 Think Kidneys - www.thinkkidneys.nhs.uk

How is CKD diagnosed?

Most people are diagnosed by a blood and urine test. You may have these tests
as part of a routine check-up or because you are at risk of developing CKD

Once you are diagnosed your doctor will work out what stage of CKD you have.
This is done by measuring the amount of creatinine, a waste product which
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 builds up in kidney disease. Your doctors can use this to estimate how well your
kidneys are working. You may hear this referred to as your estimated glomerular
!ltration rate (e-GFR). It is based on how quickly your kidneys are cleaning your
blood and is measured in milliliters per minute

Most people with CKD stages one to three can manage the condition
themselves with their GP and do not need any specialist input from kidney
doctors.

CKD can slowly get worse over time, although for the majority of people it
remains stable and only a very small number of people will need renal
replacement therapy such as dialysis. It is unusual for kidney function to
improve dramatically once your kidneys have been damaged but it does depend
on the cause of the problem.

Is it common?

Yes. Around 10% of people in the UK have CKD. In people over the age of 80 this
increases to 20%. Usually this is mild and it may not become severe. The vast
majority of patients with CKD do not have any symptoms and do not need
specialist input.
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 Around 10% of people in the UK
have CKD

Who gets CKD?

Anyone can get CKD. It can a"ect children and adults of any age. Some people
are born with it and some develop it as they get older. It can run in some
families and is more common in people from Asian or African backgrounds.

What can increase the risk of developing CKD?

There are lots of causes of CKD. The most common causes include:

Diabetes
Heart disease
High blood pressure (hypertension)
In#ammation within the kidneys (glomerulonephritis)
Blockages to the #ow of urine such as prostate problems or cancers in the
bladder
Certain medications such as non-steroidal anti-in#ammatory drugs
(NSAIDs) which include ibuprofen (Brufen or Nurofen) or diclofenac
(Voltarol) among others
Family history of kidney disease which may include inherited diseases.

Your doctor will try to !nd out what has caused CKD in your case. For the
majority of people, your GP will look after you but some people will need to see
a kidney specialist and have further tests. It is not always possible to !nd out
what has caused the damage.
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 The vast majority of patients with CKD do not have any symptoms and do not need
specialist input.

What are the symptoms of CKD?

Most people do not have symptoms related to CKD. Even when your kidneys are
damaged, they can still work well enough to prevent you having any symptoms.
You can be born with just the one kidney and remain healthy.

You may still produce normal amounts of urine, even if you have CKD, but your
kidneys are unable to remove the toxins from your body that they need to in
order to keep you healthy. It is the quality rather than quantity of urine that you
produce that matters!

Symptoms may only be noticeable with more advanced kidney disease.

These include:

Generally feeling ill, lack of interest in everyday activities and loss of

concentration
Tiredness, low energy levels
Muscle weakness
Finding it di$cult to breathe (due to a build-up of #uid in the lungs)
Di$culty sleeping at night (insomnia)
Passing urine more often at night
Feeling sick
Headaches
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 Itching
Aching bones
Muscle cramps

Why does it matter if I have CKD if I don't have any symptoms?

Although you may not have any symptoms from CKD, kidney damage can still
a"ect your health. CKD can increase your chance of having high blood pressure,
heart disease or a stroke. It is therefore important that you are reviewed
regularly by either your GP or your kidney doctor.

Having CKD gives you have a higher risk of developing acute kidney injury (AKI).
This is a sudden drop in kidney function, often due to an illness or infection. AKI
can usually be treated very e"ectively but it can cause a permanent reduction in
your kidney function.

What will my kidney doctor do if I am found to have CKD?

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 At the !rst visit, your specialist kidney doctor will try and !nd out the cause of
your CKD. After that visit, each time you go you will have your weight and blood
pressure measured and a sample of your urine will be checked for signs of
blood, protein or infection. You will have a blood test to measure your kidney
function and check for signs of anaemia, bone health and blood acidity levels.
You will then speak to the doctor about your symptoms and discuss which
treatments are available.

What will the doctors do then?

1. Find out the cause of your CKD and treat it if possible

2. Work with you to make important choices on how to manage your
condition
3. Discuss possible lifestyle changes and medication that may relieve
symptoms and slow the CKD progression
4. Assess and reduce your risk of heart disease and strokes
5. Try to relieve any symptoms
6. Treat any complications such as anaemia and mineral changes

What treatment is available?

If your kidney function is stable and mild you will normally be referred back to
your GP. You should have yearly check-ups to make sure everything is okay but
may not need any speci!c treatment.

You may receive treatment for some of the symptoms of kidney disease,
including anaemia, #uid retention and treatment to keep your bones healthy.

If you are approaching the later stages of CKD you should start to be given
information about the possible treatments available.

These include kidney transplantation, dialysis and conservative

management. There are big decisions to be made, and support and advice will
be given to you by all the professionals in the kidney unit to help you decide
what you want to do.

What can I do to help myself?

If you smoke, stop. Ask for help in stopping if you need to. There are lots of
treatments to help.
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 Try to control your blood pressure. Take any blood pressure medications
regularly and as directed by your doctor. Reduce the amount of salt in your diet
to less than 6g (one teaspoon) per day.

You can !nd advice on how to reduce your salt intake on the food switch
website.

Take regular exercise - see our exercise section

Maintain a healthy weight. If you are overweight, have diabetes or advanced

kidney disease, and need advice on your diet, ask your GP about the services
available in your area. They may refer you to a dietitian for specialist advice.

Eat a healthy and balanced diet, with support from your GP and dietician where
this is available.

You can !nd out a lot more about following a kidney-friendly diet on our Kidney
Kitchen site.

Avoid anti-in#ammatory medicine such as ibuprofen as they can make kidney

disease worse. Ask your pharmacist each time you are given a new medicine to
check that it is okay for you to take with your reduced kidney function

If you are unwell you may need to temporarily stop taking certain medications.
This is particularly important if you take blood pressure medications. Please
discuss this with your GP, pharmacist or kidney specialist.

Do not stop your medication without taking medical advice.

Understanding our kidneys

Most people have two kidneys (although 1 in 10,000 of us is born with only one
kidney) and, if we are healthy our two kidneys work by !ltering out waste
products from the bloodstream which are passed out of the body as urine. Our
kidneys help to control our blood pressure and they make a hormone which
helps create red blood cells and stops anaemia. They also play a very important
role in maintaining healthy bones. In addition, they keep a number of salts and
chemicals at the right level in the body, such as sodium, potassium, phosphate
and calcium. Any chemical imbalances can cause problems in other parts of the
body and as kidney disease can interfere with medications it is important that
patients seek advice from their GP or consultant.
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 Getting support
We know how di$cult being diagnosed with a long term condition like kidney
disease can be. We’re here to give our total support to help improve the quality
of life for everyone a"ected by kidney disease and have a number of ways we
can help support you:

Financial support - If you’re a kidney patient struggling to make ends meet

we may be able to help you.
Advice and support - our national advocacy service provides personal help
and support to anyone a"ected by kidney disease.
Counselling and support service - our counselling and support service
o"ers support, information, and guidance.
If you haven't already signed up to hear the latest news and information
from us you can do so on our sign-up page.

Living with kidney disease

Kidney disease a"ects di"erent people in di"erent ways, both physically and
emotionally. It can impact on many aspects of life, including personal
relationships, jobs and social life.

Get help with the many aspects of living with kidney disease, including mental
health, diet, #uid restrictions, questions to ask you doctor, and bene!ts, on our
Living with kidney disease section

We also have information on the following:

Lifestyle - diet, #uids and exercise

Exercise and keeping !t
Mental health
Bene!ts
Employment
Itching and chronic kidney disease
Fatigue (tiredness)
Restless legs syndrome
Pregnancy and chronic kidney disease
Sexual health and contraception
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 Kidney failure
For most people with chronic kidney disease there is only a mild or moderate
reduction in kidney function with few symptoms. However it can develop to a
more serious stage where the kidneys no longer work - this is called kidney
failure.

Around 10% of people with CKD may reach a stage that is known as established
renal failure when the kidneys can no longer work well enough to keep us
healthy and alive, and support from dialysis treatment or a kidney transplant is
considered. Remember It’s never too late to review your choice of care and you
can even change your treatment. Always talk to your kidney care team for good
advice.

Find out more about kidney failure

Treatment choices
Kidney transplant: Transplantation is the best treatment for the majority of
patients with established renal failure. Transplantation extends life expectancy,
improves quality of life and o"ers freedom from dialysis.

Dialysis: Dialysis is an arti!cial way of removing waste products and unwanted

water from your blood. You can choose between:

Haemodialysis where blood is washed through a machine either at home

or in hospital.
Peritoneal dialysis where #uid is passed into your abdomen up to four
times a day, or overnight at home

No dialysis: Some patients choose a path called conservative treatment rather

than treatment with dialysis. This may suit people with other medical conditions
who feel dialysis is not for them.

Find out more about treatments

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 Kidney
transplant
This is the most successful treatment
for kidney failure. Donated kidneys
come from two sources: the
national deceased (cadaveric) donor
pool, or from a living donor. Kidneys
from living donors o"er the best
chance of success overall and
prevent the need to join the national
transplant waiting list. One in three
kidney transplants in the UK is
now performed from a living donor,
either between close family members
(blood relatives) or between non-
blood relatives, including partners
and friends.

It is important to talk about living

donation with your friends and
family. If you have someone willing to donate a kidney, but they cannot be
matched to your blood group and tissue type, there is now a national scheme
called ‘paired donation’ which aims to match living kidneys across transplant
centres around the UK. Some units are also developing methods which
allow transplantation despite di"erences in blood groups. Some units can o"er
treatment to remove the antibodies from the blood in order to make an
incompatible transplant possible between a donor and recipient.

A kidney transplant before starting dialysis (known as a preemptive transplant) is

the gold standard of choice, as patients can avoid the need for dialysis
altogether and the kidney is likely to last longer.

If you are interested in !nding out more about living donation, it is best to talk to
a transplant coordinator who will explain the processes and options to you.
Donors can also talk in con!dence to members of the transplant team
before committing to donation.

Unfortunately not everyone is suitable for renal transplantation, particularly

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 those with multiple other medical
conditions, or people of advanced
age. All patients have to have tests to
ensure they are !t enough to receive
a transplant, and some may need
particular medical conditions to be
treated, or (in addition) they may
need to lose some weight, before
they are able to receive a kidney
transplant.

Find out more about transplants

Haemodialysis
During haemodialysis, blood #ows
out of your body, round a dialysis
machine, through a dialyser (arti!cial

kidney) which cleans it and it is then

returned to your body. This can be
done at home, in a ‘satellite’
haemodialysis unit near your home, or in a dialysis unit in a main hospital. You
will need a small operation to create a ‘!stula’, which is where an artery is
joined to a vein, so that the vein can be made bigger to allow dialysis needles to
reach your bloodstream. This is usually done six months before you start
dialysis, to give it time to enlarge although they can usually be used safely after
about six weeks if necessary. If you need dialysis before a !stula is made,
you may have a temporary dialysis line (a small plastic tube) put into a large vein
in your neck.

Standard haemodialysis is for four hours three times a week on alternate days. A
growing number of patients are now opting for self-care dialysis within the unit
as well as home haemodialysis which can o"er more independence, either with
daily nocturnal dialysis or conventional three times weekly home dialysis.

Patients are trained for home haemodialysis by the kidney care team to manage
their own treatment, and technical support is always available if it is needed.
Patients who do home haemodialysis insert the dialysis needles into their !stula
themselves, or have a spouse/relative/partner trained to do it for them.
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 Find out more about haemodialysis

Peritoneal
dialysis
This type of dialysis involves putting a
small, soft, plastic tube called a
catheter into your abdomen (tummy
area), which

allows dialysis #uid to be drained in

and out of what is called your
peritoneal cavity. Waste products are
passed from your blood and are
absorbed by the dialysis #uid. When
the #uid is drained out it takes the
waste and extra #uid out of your
body.

This can be done either by hand four times a day via a process called CAPD
(continuous ambulatory peritoneal dialysis), or by machine overnight and known
as APD (automated peritoneal dialysis). CAPD takes about 20–30 minutes to
drain the #uid in and out and needs to be done four times a day. APD
takes place for eight hours overnight and needs 30 minutes to set up and clean
the machine before and after each treatment.

The best way to make a choice about which dialysis treatment will suit you is to
talk to the sta" and to other patients about their decisions and what they like
and don’t like about their treatment choice. It is usually possible to change your
type of dialysis if you want to after some planning.

Find out more about peritoneal dialysis

No treatment
Some patients would rather not have any treatment for their kidney failure and
many units now have a dedicated team of nurses who are able to provide
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 support and care for these patients and their families. It is important to
remember that dialysis and transplantation is not for everyone and that people
have the right to choose not to be treated.

Patients who choose not to have dialysis are usually managed in the same way
as other patients with CKD until the point at which the kidney fails where the
priority of care changes to relieving the symptoms of kidney failure and
managing its complications.

Find out more about conservative care

Mineral bone disease

Your kidneys do many important jobs
such as removing waste and #uid
from the body. Once they are
damaged your kidneys can’t !lter
blood well. This leads to changes in
minerals and hormones which are
important to keep bones healthy.
This is known as mineral bone
disease or CKD-MBD.

Find out more

Information for
patients
There are lots of helpful materials
that provide information about
di"erent types of treatment and its
impact on

health and lifestyles and these are available from charities like Kidney Care UK,
as well as from your kidney unit. There are also useful DVDs, information lea#ets
and sources of NHS information on the internet such as NHS Choices. Some
units also have ‘peer support’ groups where you can speak to other patients
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 who have been through similar
experiences.

Order or download booklets

! Next in this section

Kidney Cancer

Related documents
Chronic kidney disease (CKD) lea!et 
Medicines for chronic kidney disease 
Understanding Acute Kidney Injury (AKI) 

Also read
:
 Living with kidney disease
Kidney disease a"ects di"erent people in di"erent ways, both physically and emotionally. It
can impact on …

Acute kidney injury (AKI)

A sudden loss of kidney function that develops within a few days

Lifestyle - diet, fluids and exercise

Find out more about managing your diet, #uid balance, and exercise when you have kidney
disease.

Kidney failure
For most people with chronic kidney disease there is only a mild or moderate reduction in
:
 Kidney failure
For most people with chronic kidney disease there is only a mild or moderate reduction in
kidney function wit…

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