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Medical Information from the NKF - Chronic Kidney Disease


Key Points

  • CKD is very common, but less than 1 in 10 people with CKD ever require dialysis (artificial kidney treatment) or a kidney transplant
  • Someone with CKD is at increased risk of heart attack or stroke, especially if they smoke or are overweight
  • People with CKD should have regular checks of their kidney function, and have treatment if their blood pressure is 140/85 or more

What is chronic kidney disease (CKD)?


How common is CKD?


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How does someone know if they have CKD?

In most cases CKD does not cause any symptoms, and is detected because tests are abnormal. These may be urine tests for blood or protein; an X-ray or scan of the kidneys; or a blood test to measure kidney function.

What causes CKD?


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Measuring kidney function - eGFR

A test called the eGFR (estimated glomerular filtration rate) is used to measure kidney function. The eGFR is calculated by the laboratory from the level of a chemical called creatinine in the blood.

A normal eGFR is about 100 ml/min in young adults, so the eGFR is sometimes referred to as the percentage of normal kidney function, as the number is the same.

Some young adults with normal kidneys will have an eGFR as low as 75 ml/min, and this falls by about 1 ml/min per year as people get older, so many healthy people aged 75 will have an eGFR of 50-60 ml/min.

Most laboratories now report eGFR alongside their measurements of blood creatinine levels and this is the most reliable way to obtain an eGFR result. It is possible to use on-line calculator (e.g. at the Renal Association’s website - www.renal.org/eGFRcalc/GFR.pl) by putting in age, sex, blood level of creatinine and racial origin. However, different laboratories use different methods to measure serum creatinine, and each of these methods gives slightly different answers. The eGFR that the laboratory reports takes account of these differences, but the on-line calculators do not; so the results that they give are not quite as accurate.

What are the stages of CKD?

CKD is divided into 5 stages:-

  • CKD stage 1 is eGFR greater than 90 mls/min, with some sign of kidney damage on other tests (if all the other kidney tests are normal, there is no CKD).
  • CKD stage 2 is eGFR 60-89 with some sign of kidney damage (if all the kidney tests are normal, there is no CKD).
  • CKD stage 3a is eGFR 45-59 ml/min, a mild to moderate reduction in kidney function
  • CKD stage 3b is eGFR 30-44 ml/min, a moderate to severe reduction in kidney function
  • CKD stage 4 is eGFR 15-29 ml/min, a severe reduction in kidney function
  • CKD stage 5 is e GFR less than 15 ml/min, established kidney failure, when dialysis or a kidney transplant may be needed.

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What is the treatment for CKD?

There are some things that everyone with CKD should try to do. These are:-

  • Lose weight (if overweight), and take regular exercise
  • Stop smoking
  • Eat a healthy balanced diet

Treatment for CKD stages 1 and 2

The blood pressure should be treated carefully. If it is above 140/85, tablets are usually needed, and the aim is to get the blood pressure down to 130/80 or lower. The cholesterol should be checked, and some people will be advised to take a daily aspirin tablet. A blood test to check eGFR should be performed once a year. If the urine tests show a lot of protein in the urine, or the kidney function is declining over time, the case will be discussed with a kidney specialist, or a referral may be made to a kidney specialist.

Treatment for CKD stage 3

Treatment as in CKD stages 1 and 2, but with more careful monitoring for declining kidney function.

Treatment for CKD stages 4 and 5

Treatment as for CKD stages 1-3. Additionally, any medications should be reviewed, as the dose may need to be altered and some drugs may need to be avoided as they could damage the kidneys further. This should include prescribed drugs and any drugs bought at the chemist and complementary therapies. In CKD stages 4 and 5 it is usually necessary to get advice from a kidney specialist, especially in stage 5 because kidney failure may become life threatening.

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CKD and Diabetes

If someone with CKD also has diabetes, extra care to control the blood pressure, blood sugar levels and cholesterol levels is required. More intensive monitoring will be performed, including extra urine tests to look for protein in the urine. This is because CKD can be a complication of diabetes. However, CKD does not cause diabetes.

What if the kidney function keeps on getting worse and worse?

In people with declining kidney function, a treatment plan should be made with a kidney specialist team well before CKD stage 5 is reached. There are also several books and other aids that give information and help make a decision about the best treatment, some of which are available from the National Kidney Federation (for a FREE copy of Help I’ve got Kidney Failure by Dr Rob Higgins, phone the NKF Helpline on 0845 601 02 09 [Local charge within the UK]).

Leading a normal life with CKD

Most people with CKD should be able to lead normal lives. CKD does not normally run in families and routine family screening is not necessary if one person is affected. However, some specific types of kidney disease do run in families, and people should check with their health care team to see if testing of family members is needed.

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