Topic Overview
Is this topic for you?
This topic provides
information about chronic kidney disease. If you are looking for information
about sudden kidney failure, see the topic
Acute Renal Failure.
What is chronic kidney disease?
Having chronic
kidney disease means that for some time your
kidneys have not been working the way they should.
Your kidneys have the important job of filtering your blood. They remove waste
products and extra fluid and flush them from your body as urine. When your
kidneys don't work right, wastes build up in your blood and make you
sick.
Chronic kidney disease may seem to have come on suddenly.
But it has been happening bit by bit for many years as a result of damage to
your kidneys.
Each of your kidneys has about a million tiny
filters, called nephrons. If nephrons are damaged, they stop working. For a
while, healthy nephrons can take on the extra work. But if the damage
continues, more and more nephrons shut down. After a certain point, the
nephrons that are left cannot filter your blood well enough to keep you
healthy.
One way to measure how well your kidneys are working is to figure out your glomerular filtration rate (GFR). The GFR is usually calculated using results from your blood creatinine (say "kree-AT-uh-neen") test. Then the stage of kidney disease is figured out using the GFR. There are five stages of kidney disease, from kidney damage with normal GFR to kidney failure.
There are things you can do to slow or stop the damage to
your kidneys. Taking medicines and making some lifestyle changes can help you
manage your disease and feel better.
Chronic kidney disease is
also called chronic renal failure or chronic renal insufficiency.
What causes chronic kidney disease?
Chronic
kidney disease is caused by damage to the kidneys. The most common causes of
this damage are:
- High blood pressure.
- High blood sugar (diabetes).
Other things that can lead to chronic kidney disease
include:
- Kidney diseases and infections, such as
polycystic kidney disease, pyelonephritis, and
glomerulonephritis, or a kidney problem you were born
with.
- A narrowed or blocked renal artery. The renal artery carries
blood to the kidneys.
- Long-term use of medicines that can damage the
kidneys. Examples include
non-steroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen (Advil) and celecoxib (Celebrex).
What are the symptoms?
You may start to have
symptoms only a few months after your kidneys begin to fail. But most people don't have symptoms early on. In fact, many don't have symptoms for as long as
30 years or more. This is called the "silent" phase of the disease.
How well your kidneys work is called kidney function. As your kidney
function gets worse, you may:
- Urinate less than normal.
- Have
swelling from fluid buildup in your tissues. This is called edema (say
"ih-DEE-muh").
- Feel very tired or sleepy.
- Not feel
hungry, or you may lose weight without trying.
- Often feel sick to
your stomach (nauseated) or vomit.
- Have trouble sleeping.
- Have headaches or trouble
thinking clearly.
How is chronic kidney disease diagnosed?
Your
doctor will do blood and urine tests to help find out how well your kidneys are
working. These tests can show signs of kidney disease and
anemia. (You can get anemia from having damaged
kidneys.) You may have other tests to help rule out other problems that could
cause your symptoms.
Your doctor will do tests that measure the amount of urea (BUN) and creatinine in your blood. These tests can help measure how well your kidneys are filtering your blood. As your kidney function gets worse, the amount of nitrogen (shown by the BUN test) and creatinine in your blood increases. The level of creatinine in your blood is used to find out the glomerular filtration rate (GFR). The GFR is used to show how much kidney function you still have. The GFR is also used to find out the stage of your kidney disease and to guide decisions about treatment.
Your doctor will ask questions about any
past kidney problems. He or she will also ask whether you have a family history of kidney disease and
what medicines you take, both prescription and over-the-counter drugs.
You may have a test that lets your doctor look at a picture of your
kidneys, such as an
ultrasound or
CT scan. These tests can help your doctor measure the
size of your kidneys, estimate blood flow to the kidneys, and see if urine flow
is blocked. In some cases, your doctor may take a tiny sample of kidney tissue
(biopsy) to help find out what caused your kidney
disease.
How is it treated?
Chronic kidney disease is
usually caused by another condition. So the first step is to treat the disease
that is causing kidney damage.
Diabetes and high blood pressure
cause most cases of chronic kidney disease. If you keep your blood pressure and
blood sugar in a target range, you may be able to slow or stop the damage to your
kidneys. Losing weight and getting more exercise can help. You may also need to
take medicines.
Kidney disease is a complex problem. You will
probably need to take a number of medicines and have many tests. To stay as
healthy as possible, work closely with your doctor. Go to all your
appointments. And take your medicines just the way your doctor says to.
Lifestyle changes are an important part of your treatment. Taking these
steps can help slow down kidney disease and reduce your symptoms. These steps may also
help with high blood pressure, diabetes, and other problems that make kidney
disease worse.
- Follow a diet that is easy on your kidneys.
A dietitian can help you make an eating plan with the right amounts of salt
(sodium) and protein. You may also need to watch how much fluid you drink each
day.
- Make exercise a routine part of your life. Work with your
doctor to design an exercise program that is right for you.
- Do
not smoke or use tobacco.
- Do not drink alcohol.
Always talk to your doctor before you take
any new medicine, including over-the-counter remedies,
prescription drugs, vitamins, or herbs. Some of these can hurt your kidneys.
What happens if kidney disease gets worse?
When
kidney function falls below a certain point, it is called
kidney failure. Kidney failure affects your whole
body. It can cause serious heart, bone, and brain problems and make you feel
very ill. Untreated kidney failure can be life-threatening.
When you have kidney failure, you will probably have
two choices: start
dialysis or get a new kidney (transplant). Both of
these treatments have risks and benefits. Talk with your doctor to decide which
would be best for you.
- Dialysis is a process that filters your
blood when your kidneys no longer can. It is not a cure, but it can help you
feel better and live longer.
- Kidney transplant may be the best
choice if you are otherwise healthy. With a new kidney, you will feel much
better and will be able to live a more normal life. But you may have to wait
for a kidney that is a good match for your blood and tissue type. And you will
have to take medicine for the rest of your life to keep your body from
rejecting the new kidney.
Making treatment decisions when you are very ill is hard.
It is normal to be worried and afraid. Discuss your concerns with your loved
ones and your doctor. It may help to visit a dialysis centre or transplant
centre and talk to others who have made these choices.
Frequently Asked Questions
Learning about chronic kidney disease: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Living with chronic kidney disease: | |
Cause
The cause of
chronic kidney disease isn't always known. But any
condition or disease that damages blood vessels or other structures in the
kidneys can lead to kidney disease. The most common causes of chronic kidney
disease are:
- Diabetes.
It causes about 35% of all chronic kidney disease. High blood sugar
levels caused by diabetes damage blood vessels in the kidneys. If the blood
sugar level remains high, this damage gradually reduces the function of the
kidneys.
- High blood pressure (hypertension). It causes another 30% of all
kidney disease. Because blood pressure often rises with chronic kidney disease,
high blood pressure may further damage kidney function even when another
medical condition initially caused the disease.
Other conditions that can damage the kidneys and cause
chronic kidney disease include:
- Kidney diseases and infections, such as
polycystic kidney disease, pyelonephritis,
glomerulonephritis, or a kidney problem you were born
with.
- Having a narrowed or blocked renal artery. The renal
artery carries blood to the kidneys.
- Long-term use of
medicines that can damage the kidneys. Examples
include
non-steroidal anti-inflammatory drugs (NSAIDs), such as
ibuprofen (Advil) and celecoxib (Celebrex), and certain
antibiotics.
Diabetes and high blood pressure are the most common causes
of chronic kidney disease that leads to
kidney failure. Diabetes or high blood pressure may
also speed up the progression of chronic kidney disease in someone who already
has the disease.
Symptoms
Many people who develop
chronic kidney disease don't have symptoms at first.
This is known as the "silent" phase of the disease.
As your kidney
function gets worse, you may:
- Urinate less than normal.
- Have
swelling from fluid buildup in your tissues (edema).
- Feel very
tired.
- Lose your appetite or have an unexpected weight loss.
- Feel nauseated or vomit.
- Be either very sleepy or unable to sleep.
- Have
headaches or trouble thinking straight.
What Happens
At first with chronic kidney disease, your kidneys are still able to regulate the balance of fluids, salts, and
waste products in your body. But as kidney function decreases, you will start to have other problems, or complications. The worse your kidney function gets, the more complications you'll have and the more severe they will be.
When kidney function falls below a certain point, it is called
kidney failure. Kidney failure has harmful effects
throughout your body. It can cause serious heart, bone, and brain problems and
make you feel very ill.
After you have kidney failure, either
you will need to have dialysis or you will need a new kidney. Both choices have
risks and benefits.
Complications of chronic kidney disease
- Anemia. You may feel weak, have pale skin, and feel tired, because the kidneys can't produce enough of the hormone (erythropoietin) needed to make new red blood cells.
- Electrolyte imbalance. When the kidneys can't filter out certain chemicals, such as potassium, phosphate, and acids, you may have an irregular heartbeat, muscle weakness, and other problems.
- Uremic syndrome. You may be tired, have nausea
and vomiting, not have an appetite, or not be able to sleep when substances build up in your blood. The substances can be
poisonous (toxic) if they reach high levels. This syndrome can
affect many parts of your body, including the intestines, nerves, and heart.
- Heart disease. Chronic
kidney disease speeds up hardening of the arteries (atherosclerosis) and increases the risk of
stroke, heart attack,
and heart failure. Heart disease is the most common cause
of death in people with kidney failure.
- Bone disease (osteodystrophy). Abnormal levels of substances, such as calcium, phosphate, and vitamin D, can lead to bone
disease.
- Fluid buildup (edema). As kidney function gets worse, fluids and salt build up in the body. When fluid builds up in the lungs
(pulmonary edema), it can cause
heart failure.
What Increases Your Risk
Some of the things that lead
to
chronic kidney disease are related to your age and
your genetic makeup. You may be able to control other things that increase your
risk, such as dietary habits and exercise.
Things you cannot control
The main risk factors
for chronic kidney disease are:
- Age. The kidneys begin
to get smaller as people get older. By age 80, most people have lost about 30% of
their kidney mass.
- Race. People of African descent
and First Nations are more likely to get chronic kidney disease.
- Being male. Men have a
higher risk for chronic kidney disease than women do.
- Family history. Family history is a factor in the development
of both
diabetes and
high blood pressure, the major causes of chronic
kidney disease.
Polycystic kidney disease is one of several inherited
diseases that cause kidney failure.
Things you may be able to control
You may be able
to slow the progression of chronic kidney disease and prevent or delay kidney failure by controlling things that increase
your risk of kidney damage, such as:
- High blood pressure,
which gradually damages the tiny blood vessels in the kidneys.
- Diabetes. A persistently high
blood sugar level can damage blood vessels in the kidneys. Over time, kidney
damage can progress, and the kidneys may stop working altogether.
- Eating protein and fats. Eating a diet
low in protein and fat may reduce your risk for kidney
disease.
- Certain medicines. Avoid long-term
use of
medicines that can damage the kidneys, such as pain
relievers called
NSAIDs and certain
antibiotics.
When To Call a Doctor
Call 911 or other emergency services if you have
chronic kidney disease and you develop:
- A very slow heart rate (less than 50 beats a
minute).
- A very rapid heart rate (more than 120 beats a
minute).
- Chest pain or severe shortness of
breath.
- Severe muscle weakness.
To check your heart rate, see the
instructions for
taking a pulse.
Call your doctor immediately
if you:
- Have symptoms of
uremic syndrome, such as increasing fatigue, nausea
and vomiting, loss of appetite, or inability to sleep.
- Vomit blood
or have blood in your stools.
Call your doctor if you:
- Are feeling more tired or
weak.
- Have swelling of the arms or
feet.
- Bruise often or
easily or have unusual bleeding.
- Are being treated with
dialysis and you:
- Have belly pain while you are being treated with peritoneal
dialysis.
- Have
signs of infection at your catheter or
dialysis access site, such as pus draining from the
area.
- Have any other problem that your dialysis instruction manual
or nurse's instructions say you should call about.
If you have uncontrolled weight loss, discuss this with
your doctor during your next visit.
Watchful waiting
A wait-and-see approach is not a good idea if
you could have chronic kidney disease. See your doctor. If you have been
diagnosed with chronic kidney disease, follow your treatment plan. And call
your doctor if you notice any new symptoms.
Who to see
Your family doctor, general practitioner, or nurse practitioner can diagnose and treat
chronic kidney disease. You may be referred to a specialist, such as:
If you are diagnosed with chronic kidney
disease, you will likely be referred to a nephrologist for treatment.
You may also be referred to
a:
- Surgeon, if you need a
dialysis access site or if you are being
considered for a kidney transplant.
- Dietitian, who can help you with meal
planning and choosing foods that are best for people with this disease.
- Psychologist or
social worker, who can help you and your family with
emotional stress or financial issues.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Examinations and Tests
Tests for
chronic kidney disease are vital to help find out:
- Whether kidney disease happened suddenly
or has been happening over a long time.
- What
is causing the kidney damage.
- Which treatment is best to help
slow kidney damage.
- How well treatment is
working.
- When to begin
dialysis or have a
kidney transplant.
After you are diagnosed with chronic kidney disease, blood
and urine tests can help you and your doctor monitor the disease.
Tests to check kidney function
When kidney
function is decreased, substances such as
urea,
creatinine, and certain
electrolytes begin to build up in the blood. The
following tests measure levels of these substances to show how well your kidneys are working.
- A blood creatinine test helps to estimate the glomerular filtration rate (GFR) by measuring the level of creatinine in your blood. The doctor can use the GFR to regularly check how well the kidneys are working and to stage your kidney disease.
- A blood urea nitrogen (BUN) test measures how much nitrogen from the waste product urea is in your blood.
BUN level rises when the kidneys aren't working well enough to remove urea from the blood.
- A fasting blood glucose test is done to measure your
blood sugar. High blood sugar levels damage blood vessels in the
kidneys.
-
Blood tests measure levels of waste products and
electrolytes in your blood that should be removed by your kidneys.
- A blood test for
parathyroid hormone (PTH) checks the level of PTH, which helps control calcium and phosphorus levels.
-
Urinalysis (UA) and a urine test for
microalbumin, or other urine tests, can measure protein in your
urine. Normally there is little or no protein in urine.
Tests for anemia
If the kidneys don't produce
enough of the hormone
erythropoietin needed to make red blood cells,
anemia can develop. The following tests help monitor anemia:
Other tests
Your doctor may use other tests to
monitor kidney function or to find out whether another kidney disease
or condition is contributing to reduced kidney function.
- An
ultrasound of the kidney (renal ultrasound) helps estimate how long you may have had chronic
kidney disease. It also checks whether urine flow from the
kidneys is blocked. An ultrasound also may help find causes
of kidney disease, such as obstruction or
polycystic kidney disease.
- A
duplex Doppler study or
angiogram of the kidney may be done to check for
problems caused by restricted blood flow (renal artery stenosis).
- A
kidney biopsy may help find out the cause of chronic
kidney disease. After a kidney transplant, a doctor may use this test if he or she suspects the organ is being rejected by your body.
Early screening for chronic kidney disease
Experts
recommend screening tests for chronic kidney disease in high-risk groups, such
as people with
diabetes or
high blood pressure. Kidney disease runs in families, so close
family members may also want to have their kidney function tested. Being diagnosed with kidney
disease before it has progressed gives you the best chance to control the
disease.
To learn more about screening if you already have diabetes or high blood pressure, see:
Treatment Overview
The goal of treatment for
chronic kidney disease is to prevent or slow
further damage to your kidneys. Another condition such as
diabetes or
high blood pressure usually causes kidney disease, so
it is important to identify and manage the condition that is causing your
kidney disease. It is also important to prevent diseases and avoid situations
that can cause kidney damage or make it worse.
Treatment to control kidney disease
Control the disease that's causing the kidney damage
One of the most important parts of treatment is to control the disease that
is causing kidney damage. You and your doctor
will create a plan to aggressively treat and manage your condition to help
slow any more damage to your kidneys.
If you have
diabetes, it is important to control your blood sugar
levels with diet, exercise, and medicines. A persistently high blood sugar
level can damage the blood vessels in the kidneys. For more information about kidney disease caused by diabetes, see the topic
Diabetic Nephropathy.
If you have high blood pressure, it is also important to control your blood pressure with diet, exercise, and any medicines your doctor prescribes. The goal is to keep your blood
pressure less than 130/80.1 To learn ways to help control your blood pressure, see the topic High Blood Pressure.
If other conditions or diseases are causing kidney damage,
such as a blockage (obstruction) in the urinary tract or long-term use of
medicines that can damage the kidneys, you and your doctor will work out a treatment plan.
Take medicines if prescribed
You may be prescribed a blood pressure
medicine, such as an
ACE inhibitor or an
angiotensin II receptor blocker (ARB). These medicines
are used to reduce protein in the
urine and help manage high blood pressure.
Have a healthy lifestyle
You can take steps at home to
help control your kidney disease. For example:
- Follow a diet that is healthy for your kidneys.
A dietitian can help you make an eating plan with the right amounts of salt
(sodium), fluids, and protein.
Kidney Disease: Changing Your Diet
- Make exercise a routine part of your life. Work with your
doctor to make an exercise program that's right for you.
- Don't use substances that can harm your kidneys, such as alcohol, any kind of tobacco, or illegal drugs. Also, be sure
that your doctor knows about all prescription medicines, over-the-counter medicines,
and herbs that you are taking.
Go to all follow-up visits
Your doctor
will use blood and urine tests to regularly check how well your kidneys are
functioning and whether changes to your treatment plan are needed. These tests are critical to help monitor your disease. The tests
include:
Treat any complications
As the disease gets worse, your symptoms—such as fatigue, nausea, and loss of appetite—may occur more often or
become more severe. Work with your doctor to create a treatment plan to help
control these symptoms.
If you develop anemia, you may need to take medicine called
human recombinant erythropoietin (rhEPO). It helps your body make new red
blood cells and may help improve your appetite and
general sense of well-being.
You may also need an iron supplement if you have an
iron deficiency.
If you develop uremic syndrome (uremia), you will need to have wastes and fluids removed through dialysis or
your kidney replaced through a kidney transplant.
Treatment for kidney failure
When your
kidney function has fallen below a certain point, it is called
kidney failure. Kidney failure has harmful effects
throughout your body. It can cause serious heart, bone, and brain problems and
can make you feel very ill.
After you have kidney failure, either
you will need to have dialysis or you will need a new kidney. Both choices have
risks and benefits.
Dialysis
Dialysis is a process that does the work of healthy
kidneys by clearing wastes and extra fluid from the body and restoring the
proper balance of chemicals (electrolytes) in the blood. You may use
dialysis for many years, or it may be a short-term measure while you are
waiting for a kidney transplant.
To learn more about dialysis, see Other Treatment.
Kidney transplant
Kidney transplant is often a better treatment option than dialysis for kidney failure,
because it may allow you to live a fairly normal life. But there are some
drawbacks. For example, you will probably need to have dialysis
while you wait for a kidney.
To learn more about kidney transplants, see Surgery.
Making treatment
decisions when you are very ill is difficult. It is normal to be fearful and
worried about the risks involved. Discuss your concerns with your family and
your doctor. It may be helpful to visit the dialysis centre or transplant
centre and talk to others who have chosen these options.
Hospice palliative care
As
your disease gets worse, you may want to think about
hospice palliative care. Hospice palliative care is a kind of care for
people who have diseases that don't go away and that often get worse over time. It
is different from care to cure your illness, called curative treatment.
Hospice palliative care focuses on improving your quality of life—not just in your
body but also in your mind and spirit. Some people combine hospice palliative care
with curative care, but usually this means they don't want dialysis treatments
in order to sustain their lives.
Hospice palliative care may help you
manage symptoms or side effects from treatment. It could also help you cope
with your feelings about living with a long-term disease, make future plans
around your medical care, or help your family better understand your disease
and how to support you.
If you are interested in hospice palliative care,
talk to your doctor. He or she may be able to manage your care or refer you to
a doctor who specializes in this type of care.
For more
information, see the topic
Hospice Palliative Care.
End-of-life issues
Chronic kidney disease progresses to
kidney failure when damage to the kidneys is so severe
that
dialysis or a kidney transplant is needed to control
symptoms and prevent complications and death. Many people have successful
kidney transplants or live for years using dialysis. But at this point you may
wish to talk with your family and doctor about health care and other legal
issues that arise near the end of life.
A time may come when your
goals or the goals of your loved ones may change from treating or curing your
disease to maintaining comfort and dignity. You may find it helpful and
comforting to state your health care choices in writing (with an
advance care plan) while you are
still able to make and communicate these decisions. Think about your treatment
options and which kind of treatment will be best for you.
You may wish to choose a
substitute decision maker, usually a family member or loved
one, to make and carry out decisions about your care if you become unable to
speak for yourself. You also have the option to refuse or stop treatment. For
more information, see the topic
Care at the End of Life.
Prevention
Chronic kidney disease may sometimes be prevented by controlling the other diseases or
factors that can contribute to kidney disease. People who have
already developed
kidney failure also need to focus on these things to
prevent the complications of kidney failure.
- Keep your blood pressure below 130/80. Learn to
check your blood pressure at home.
- High Blood Pressure: Checking Your Blood Pressure at Home
- If you have diabetes, keep your blood sugar within a target range. Talk with your doctor how often to check your
blood sugar.
- Diabetes: Checking Your Blood Sugar
- Stay at a healthy weight. This can help you
prevent other diseases, such as diabetes, high blood pressure, and heart
disease. For more information, see the topic
Weight Management.
- Control your cholesterol levels. For more information, see the topic
High Cholesterol.
- Don't smoke or use
other tobacco products. Smoking can lead to
atherosclerosis, which reduces blood flow to the
kidneys and increases blood pressure. For more information on how to quit, see
the topic
Quitting Smoking.
Home Treatment
There are many things you can do at
home to slow the progression of chronic kidney disease.
Lifestyle changes
- Keep your blood pressure below 130/80. Learn
to check your blood pressure at home.
- High Blood Pressure: Checking Your Blood Pressure at Home
- If you have
diabetes, keep your blood sugar within a target range.
- Diabetes: Checking Your Blood Sugar
- Stay at a healthy weight. This can also reduce
your risk for
coronary artery disease, diabetes,
high blood pressure, and
stroke. For more information, see the topic
Weight Management.
- Follow the eating plan your dietitian created for you. Your
eating plan will balance your need for calories with your need to limit certain
foods, such as sodium, fluids, and
protein.
- Kidney Disease: Changing Your Diet
- Make exercise a routine part of your life. Work
with your doctor to design an exercise program that is right for you. Exercise
may lower your risk for diabetes and high blood pressure.
- Don't smoke or use other
tobacco products. Smoking can lead to
atherosclerosis, which reduces blood flow to the
kidneys and increases blood pressure. For more information on how to quit, see
the topic
Quitting Smoking.
- Don't drink alcohol or
use illegal drugs.
What to avoid
- Avoid taking
medicines that can harm your kidneys. Be sure that
your doctor knows about all prescription drugs, over-the-counter drugs, and herbs you are taking.
- Avoid
dehydration by promptly treating illnesses, such as
diarrhea, vomiting, or fever, that cause it. Be especially careful when you
exercise or during hot weather. For more information, see the topic
Dehydration.
- Avoid products containing magnesium, such as
antacids like milk of magnesia or some laxatives. These products increase your risk of
having abnormally high levels of magnesium (hypermagnesemia), which may
cause vomiting, diarrhea, or both.
- Avoid X-ray tests that require IV
dye (contrast material), such as an angiogram, an
intravenous pyelogram (IVP), and some CT scans. IV dye
can cause more kidney damage. Make sure that your doctor knows about any tests that you are scheduled to have.
Medications
Although medicine cannot reverse
chronic kidney disease, it is often used to help treat
symptoms and complications and to slow further kidney damage.
Medicines to treat high blood pressure
Most people who have chronic kidney disease have problems with high blood pressure at some time during their disease. Medicines that lower blood pressure help to keep it in a target range and stop any more kidney damage. Common blood pressure medicines include:
You may need to try several blood pressure medicines
before you find the medicine that controls your blood pressure well without
bothersome side effects. Most people need to take a combination of medicines to
get the best results. Your doctor may order blood tests 3 to 5 days after
you start or change your medicines. The tests help your doctor make sure that your medicines are working
correctly.
Medicines to treat symptoms and complications of chronic kidney disease
Medicines may be used to treat symptoms and complications of
chronic kidney disease. These medicines include:
Medicines used during dialysis
Both
erythropoietin (rhEPO) therapy and iron replacement therapy may also be used
during dialysis to treat anemia, which often develops in advanced chronic
kidney disease.
- Erythropoietin (rhEPO) stimulates the
production of new red blood cells and may decrease the need for blood
transfusions. This therapy may also be started before dialysis is needed, when
anemia is severe and causing symptoms.
- Iron therapy can help increase levels
of iron in the body when rhEPO therapy alone is not effective.
- Vitamin D helps keep bones strong and healthy.
What to think about
Talk with your doctor about what
types of
immunizations you should have if you have chronic
kidney disease. Also, be sure to discuss
medicine precautions. Make sure to tell your doctor
about all prescription drugs, over-the-counter drugs, and herbs you are
taking.
Surgery
Kidney transplant
If you have
chronic kidney disease that progresses, you may have
the option of a
kidney transplant. Most experts agree that it is the
best option for people with
kidney failure. In general, people who have kidney
transplants live longer than people treated with dialysis.
You will probably be considered a good candidate if
you don't have significant heart, lung, or liver disease or other diseases, such as
cancer, which might decrease your lifespan.
There are some drawbacks. You may have to wait for a kidney to be donated. If so, you will need to
have dialysis while you wait. Also, it may be hard to find a good
match for your blood and tissue types. Sometimes, even when the match is good,
the body rejects the new kidney.
After a kidney
transplant, you will have to take medicines called immunosuppressants.
These medicines, such as tacrolimus, help prevent your body
from
rejecting your new kidney.
- It is very important to take your medicines
exactly as prescribed. This will help keep your body from rejecting your new
kidney.
- You will need to take medicines for the rest of your
life.
- Because these medicines weaken the function of your
immune system, you will have an increased risk for serious infections or cancer.
Even if you take your medicines, there is a chance that
your body will reject your new kidney. If this happens, you will have to resume
dialysis or have another kidney transplant.
The success of the transplant also depends on what kind of donor kidney
you are receiving. The closer the donor kidney matches your genetic makeup, the
better the chances that your body will not reject it.
For more general information about transplant, see the
topic
Organ Transplant.
What to think about
A kidney transplant doesn't
guarantee that you will live longer than you would have without a new
kidney.
Kidney transplant surgery is
covered by provincial health plans. You may have to wait for a kidney to be donated. If so, you will need to have dialysis while you wait.
Other Treatment
Dialysis
Dialysis is a
mechanical process that performs the work that healthy kidneys would do. It
clears wastes and extra fluid from the body and restores the proper balance of
chemicals (electrolytes) in the blood. When
chronic kidney disease becomes so severe that your
kidneys are no longer working properly, you may need dialysis. You may use
dialysis to replace the work of the kidneys for many years. Or dialysis may be a
short-term measure while you are waiting for a kidney transplant.
The
two types of dialysis used to treat severe chronic kidney disease are
hemodialysis and
peritoneal dialysis.
- Hemodialysis uses a man-made membrane
called a dialyzer to clean your blood. You are connected to the dialyzer by
tubes attached to your blood vessels. Before hemodialysis treatments can begin,
a surgeon creates a site where blood can flow in and out of your body. This is
called the dialysis access. Usually the doctor creates the access by joining an
artery and a vein in the forearm or by using a small tube to connect an artery
and a vein. An access may be created on a short-term basis by putting a small
tube into a vein in your neck, upper chest, or groin.
- Peritoneal dialysis uses the lining of your belly, which is called the
peritoneal membrane, to filter your blood. Before you
can begin peritoneal dialysis, a surgeon needs to place a catheter in your
belly to create the dialysis access.
Kidney Failure: What Type of Dialysis Should I Have?
What to think about
If
you have severe chronic kidney disease but have not yet developed
kidney failure, talk to your doctor about which type
of dialysis would be best for you.
Learning about dialysis (predialysis education) is an important step in
preparing for dialysis. Most dialysis clinics offer predialysis services to
help you know about your choices.
Other Places To Get Help
Organizations
| Kidney Foundation of Canada |
| 300-5165 Sherbrooke Street West |
| Montreal, QC H4A 1T6 |
| Phone: | 1-800-361-7494
(514) 369-4806 |
| Fax: | (514) 369-2472 |
| Email: | info@kidney.ca |
| Web Address: | www.kidney.ca |
| |
The Kidney Foundation of Canada is a national volunteer
organization dedicated to improving the health and quality of life of people
living with kidney disease. The organization funds research, provides services
for the needs of individuals living with kidney disease, advocates for access
to health care, and promotes the awareness of organ donation. |
|
| Life Options |
| Life Options c/o Medical Education Institute |
| 414 D'Onofrio Drive |
| Suite 200 |
| Madison, WI 53719 |
| Phone: | 1-800-468-7777 |
| Fax: | (608) 833-8366 |
| Web Address: | www.lifeoptions.org |
| |
Life Options is a program supporting research,
education, and outreach for people living with kidney disease. They offer a
toll-free helpline for people who have questions about kidney function, dialysis,
keeping a job, Medicare, exercise, and more. The Web site has a link to Kidney
School, an interactive kidney learning center. They also have free
educational information, a message board, and links to other
resources. |
|
| National Kidney and Urologic Diseases Information
Clearinghouse |
| 3 Information Way |
| Bethesda, MD 20892-3580 |
| Phone: | 1-800-891-5390 |
| TDD: | 1-866-569-1162 |
| Fax: | (703) 738-4929 |
| Email: | nkudic@info.niddk.nih.gov |
| Web Address: | www.kidney.niddk.nih.gov |
| |
The National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC) provides information about diseases of the
kidneys and urologic system to people with these problems and to
their families, to health professionals, and to the public. NKUDIC answers
inquiries; develops, reviews, and distributes publications; and works closely
with professional and patient groups and government agencies to
coordinate resources about kidney and urologic diseases. NKUDIC, a federal agency, is a service of the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part
of the National Institutes of Health under the U.S. Department of Health and
Human Services. |
|
| National Kidney Foundation |
| 30 East 33rd Street |
| New York, NY 10016 |
| Phone: | 1-800-622-9010 |
| Phone: | (212) 889-2210 |
| Fax: | (212) 689-9261 |
| Web Address: | www.kidney.org |
| |
The National Kidney Foundation works to prevent kidney
and urinary tract diseases and help people affected by these conditions. Its
website has a lot of information about adult and child conditions. The site
has interactive tools, donor information, recipes for kidney disease patients,
and message boards for many kidney topics. Free materials, such as brochures
and newsletters, are available. |
|
| U.S. National Kidney Disease Education Program
(NKDEP) |
| 3 Kidney Information Way |
| Bethesda, MD 20892 |
| Phone: | 1-866-4-KIDNEY (1-866-454-3639) toll-free |
| Fax: | (301) 402-8182 |
| Email: | nkdep@info.niddk.nih.gov |
| Web Address: | nkdep.nih.gov |
| |
NKDEP is a program from the National
Institutes of Health (NIH) to help people who have kidney disease and to help their
doctors. The program helps people understand kidney disease. NKDEP wants to
help people who have diabetes, high blood pressure, or a family history of kidney
failure understand why it is important to know about kidney health. They offer
free educational materials and links to other resources. |
|
| United Network for Organ Sharing
(UNOS) |
| 700 North 4th Street |
| Richmond, VA 23219 |
| Phone: | 1-888-894-6361 |
| Web Address: | www.unos.org |
| |
The United Network for Organ Sharing (UNOS) is a nonprofit
scientific and educational organization that administers the nation's only
Organ Procurement and Transplantation Network (OPTN). It was established by the
U.S. Congress in 1984. UNOS collects and manages data about every transplant
event occurring in the United States, facilitates the organ matching and
placement process, and brings together health professionals, transplant
recipients, and donor families to develop organ transplantation policy.
UNOS: - Matches donors to recipients and coordinates
the organ-sharing process 24 hours a day, 365 days a
year.
- Maintains the databases that contain all clinical transplant
data for every transplant event that occurs in the United
States.
- Performs data analyses, fills data requests, produces the
Annual and other data reports, and authors authoritative
publications.
- Monitors every organ match to ensure adherence to
UNOS policy, and works with the Board of Directors to develop equitable
policies that maximize the limited supply of organs.
- Offers support
to members of the transplant community. These services include seminar
planning, providing educational programs and workshops, and much more.
- Provides assistance to patients, family members, and friends, and
sets professional standards for efficiency and quality patient
care.
- Raises public awareness about the importance of organ
donation.
- Works to keep patients informed about transplant issues
and policies.
- Offers comprehensive travel and event planning to
assist organizations within the transplant community.
|
|
References
Citations
- Stigant C, et al. (2003). Nephrology: 4. Strategies
for the care of adults with chronic kidney disease. Canadian Medical Association Journal, 168(12): 1553–1560.
Other Works Consulted
- Barry JM (2007). Renal transplantation. In PC Walsh et
al., eds., Campbell-Walsh Urology, 9th ed., vol. 2, pp.
1295–1324. Philadelphia: Saunders Elsevier.
- Curhan GC, Mitch WE (2008). Diet and kidney
disease. In BM Brenner, SA Levine, eds., Brenner and Rector's The Kidney, 8th ed., vol. 2,
pp. 1817–1847. Philadelphia: Saunders
Elsevier.
- Depner TA, et al. (2006). Clinical Practice Guidelines for Hemodialysis Adequacy, Peritoneal Dialysis Adequacy, and Vascular Access. New York: National Kidney Foundation. Available
online:
http://www.kidney.org/professionals/KDOQI/guideline_upHD_PD_VA/index.htm.
- Fouque D, Laville M (2009).
Low protein diets for chronic kidney disease in nondiabetic adults.
Cochrane Database of Systematic Reviews
(3).
- Himmelfarb J, et al. (2008).
Hemodialysis. In BM Brenner, SA Levine, eds., Brenner and Rector's The Kidney, 8th ed., vol. 2.,
pp. 1957–2006. Philadelphia: Saunders
Elsevier.
- Keith DS, et al. (2004). Longitudinal follow-up and
outcomes among a population with chronic kidney disease in a large managed care
organization. Archives of Internal Medicine, 164(6):
659–663.
- Klahr S, et al. (1994). The effects of dietary protein
restriction and blood pressure control on the progression of chronic renal
disease. New England Journal of Medicine, 330(13):
877–884.
- Kopple JD (2006). Nutrition, diet, and the kidney.
Modern Nutrition in Health and Disease, 10th ed., pp.
1475–1511. Baltimore: Lippincott Williams and Wilkins.
- Magee CC, Pascual M (2004). Update in renal
transplantation. Archives of Internal Medicine, 164(13):
1373–1388.
- Sarnak MJ, et al. (2005). The effect of lower target
blood pressure on the progression of kidney disease: Long-term follow-up on the
Modification of Diet in Renal Disease study. Annals of Internal Medicine, 142(5): 342–351.
- Sharma A, Blake PG (2008).
Peritoneal dialysis. In BM Brenner, SA Levine, eds.,
Brenner and Rector's The Kidney,
8th ed., vol. 2, pp. 2007–2036. Philadelphia: Saunders
Elsevier.
- U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/guidelines/default.aspx.
- Van Wyck DB, et al. (2006). Clinical Practice Guidelines for Anemia in Chronic Kidney Disease. New York:
National Kidney Foundation. Available online:
http://www.kidney.org/professionals/KDOQI/guidelines_anemia/pdf/AnemiaInCKD.pdf.
- Van Wyck DB, et al. (2007). KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease: 2007 Update of Hemoglobin Target. New York: National Kidney Foundation. Available online: http://www.kidney.org/professionals/kdoqi/guidelines_anemiaUP/guide1.htm.
- Wilkens KG, Juneja V (2008).
Medical nutrition therapy for renal disorders. In LK Mahan, S Escott-Stump,
eds., Krause’s Food and Nutrition Therapy,
12th ed., pp. 921–958. St. Louis, MO: Saunders
Elsevier.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Anne C. Poinier, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | Mitchell H. Rosner, MD - Nephrology |
|---|
| Last Revised | October 19, 2012 |
|---|
