If you or someone you care for has chronic kidney disease (CKD), this web site may help you learn more about the illness. It has been designed to provide some basic information on the disease and tips on managing your condition. In addition to the information here, we have included a number of other web sites and resources that will give you more detailed information and guidance in managing chronic kidney disease. We hope you find these additional resources useful.

What do the kidneys do?
Different names - renal vs. kidney
What is chronic kidney disease?
What causes chronic kidney disease?
Who is at risk?
What are the symptoms of chronic kidney disease?
How is chronic kidney disease diagnosed?
What are the complications of chronic kidney disease?
When kidneys fail: end stage kidney disease

What do the kidneys do?

Kidneys are as important to your health as your heart or lungs. Shaped like kidney beans and about the size of your fist, your kidneys are located on either side of your spine under the lower ribs. Their main task is to remove waste products and excess fluids from the body through the urine. The kidneys also ensure that the blood supply to your body's tissues has the proper balance of water, minerals (sodium, potassium, phosphate, calcium, and magnesium) and other substances that the body needs to work properly. They produce important hormones that help control blood pressure and stimulate the bone marrow to produce red blood cells. Your kidneys help keep your bones strong and muscles functioning properly by producing the Vitamin D that you need in order absorb calcium from the foods you eat.

Different names - renal vs. kidney

You may be confused by the many different names used to describe kidney disease. Until recently, kidney disease was referred to as "renal" disease. These days, the term "kidney" is preferred. However, you may still hear terms such as "chronic renal insufficiency", "renal disease" and "end stage renal disease". Most people now use the term "chronic kidney disease" rather than "chronic renal insufficiency". However, you may still hear both "end stage renal disease" and "end stage kidney disease". Just remember that "renal" means kidney.

What is chronic kidney disease?

Chronic kidney disease (CKD) refers to the condition where the kidney's filtering ability is damaged over the course of many years due to a disease or other medical conditions. CKD is often called a "silent disease" because you may experience few symptoms until the disease has seriously progressed. To be diagnosed with CKD, you must have some type of kidney abnormality or "marker" such as protein in the urine and have decreased kidney function for three months or longer.

If diagnosed and treated early, kidney disease may be slowed down or stopped. However, if it keeps getting worse, wastes can build up in your blood and make you feel sick. CKD can lead to complications such as high blood pressure, anemia, weak bones, poor nutrition and nerve damage. It also increases your risk of developing heart and blood vessel disease. CKD may eventually lead to kidney failure (see End Stage Kidney Disease) - this is the point at which life-saving measures such as dialysis or kidney transplant are needed.

There is no cure for CKD - the goal of treatment is to keep the kidneys functioning as long as possible.

What causes chronic kidney disease?

The two leading causes of chronic kidney disease (CKD) are diabetes and hypertension.

Diabetes
Diabetes is the leading cause of CKD. Insulin is a hormone that helps the body use the sugar (glucose) found in the foods we eat. Diabetes is a chronic medical condition where the body does not make enough insulin or does not use insulin properly. As a result, the amount of glucose in the blood stays high. High glucose acts like a poison, damaging the kidney's blood vessels and filters. If you have diabetes, talk with your doctor about how to keep your blood glucose as close to normal as possible to ensure your diabetes is under control. See Diabetes: Information for Patients.

Hypertension
Hypertension, or high blood pressure, is the second leading cause of CKD. High blood pressure damages the kidney's small blood vessels and filters, causing kidney function to deteriorate more quickly. Blood pressure greater than 130/80 mm/Hg is considered high and poses many risks to your health, including kidney disease, heart attack and stroke. If you have been diagnosed with CKD, it is important that you work with your doctor to keep your blood pressure under control. For information on how to manage high blood pressure, see Hypertension: Information for Patients.

Other causes of CKD include:

• glomerulonephritis, a group of diseases that cause inflammation and damage to the kidney's filtering units
• trauma or injury to the kidneys
• infection in the kidney and/or repeated urinary infections
• inherited kidney disease (e.g. polycystic kidney disease)
• lupus and other diseases that affect the body's immune system
• certain drugs (both prescription and "street" drugs) and poisons
• prolonged use of certain non-prescription pain killers - see A Note on Over-the-Counter (OTC) Pain Relieving Medications

Who is at risk?

While anyone at any age can develop chronic kidney disease (CKD), a number of risk factors have been identified that may lead to possible problems with your kidneys. These include:

• Diabetes. Diabetes is the leading cause of CKD. If you have diabetes, talk with your doctor about how to keep your blood glucose as close to normal as possible to ensure your diabetes is under control.
• Hypertension. Hypertension, also called high blood pressure, is the second highest cause of CKD. Keep your blood pressure under control. A number of effective medications are available to help you with this task. Your doctor will help you to determine which medication is right for you.
• Cardiovascular disease. In addition to hypertension, other diseases of the heart and blood vessels may increase your risk for kidney disease. People who have had heart attacks or strokes, congestive heart failure, coronary artery disease or peripheral vascular disease need to be monitored carefully for kidney problems.
• Family history of kidney disease. Some kidney diseases are genetic. People with a mother, father, brother or sister who has had a kidney disease are more likely to develop problems with their kidneys.
• Age. People 60 years and older are at a higher risk for developing CKD.
• Race. People belonging to certain ethnic groups, such as First Nations and Pacific Islanders, are at a higher risk for developing this disease.

What are the symptoms of chronic kidney disease?

Chronic kidney disease is usually a silent disease. Most people do not have any symptoms in the early stages. Symptoms that may show up as your kidney function deteriorates include:

• frequent headaches
• fatigue
• itching all over your body

• frequent urination or passing less urine
• swelling in legs, ankles, feet, face and/or hands
• metallic or bad taste in mouth
• nausea and vomiting
• loss of appetite
• shortness of breath
• feeling cold
• trouble concentrating, dizziness
• leg pain or muscle cramps

How is chronic kidney disease diagnosed?

Because there are few symptoms in the early stages of kidney disease, diagnosis depends on laboratory tests. A diagnosis of chronic kidney disease requires some type of kidney abnormality or "marker" such as protein in the urine and decreased kidney function for three months or longer. A number of diagnostic tests are used to determine how well your kidneys are functioning. Some tests that may be performed include:

• Creatinine. Creatinine (kree-At-uh-nin) is a waste product the body produces when it converts food into energy, and as a result of normal muscle activity. The kidneys filter creatinine from the blood and remove it from the body through urine. Higher levels of creatinine in the blood may be a sign that the kidneys are not working properly. As kidney disease progresses, the level of creatinine in the blood (serum creatinine) increases. Serum creatinine results alone, however, are not a reliable indicator of kidney problems, particularly in the early stages. Today, most laboratories use serum creatinine results to calculate estimated glomerular filtration rate (eGFR) - see below.
• Glomerular Filtration Rate. Glomerular filtration rate (GFR) measures the rate at which your kidneys filter your blood and is considered the best overall measure of kidney function. Glomerular filtration rate can be estimated by plugging serum creatinine values into an equation. Most laboratories in BC do this calculation automatically and report estimated glomerular filtration rate (eGFR) along with serum creatinine results. The lower the eGFR, the more serious the kidney damage.
• Urinalysis. Urinalysis can detect the presence of white or red blood cells in the urine - which may be a sign of kidney infection or other forms of kidney disease. Urinalysis can also detect large amounts of protein (albumin) - see below.
• Microalbumin. The "microalbumin" test or albumin/creatinine ratio (ACR) is used to detect small amounts of a protein called albumin in the urine. Healthy kidneys remove waste products from the blood, but keep protein in the blood supply. Urine, therefore, should contain little or no protein. But when your kidneys are damaged, the opposite occurs: waste products remain in your blood and protein leaks into your urine. When the damage is just beginning, only very small amounts of albumin escape into the urine, a condition known as microalbuminuria. In later stages of kidney disease, large amounts of protein leak into the urine, a condition called macroalbuminuria or proteinuria (pro-te-NU-re-uh).

What are the complications of chronic kidney disease?

As chronic kidney disease (CKD) progresses, the following complications may develop:

• Anemia. If your blood is low in red blood cells, you have anemia. Red bloods cells carry oxygen to the body's tissues and organs. The kidneys produce a hormone called erythropoietin (EPO) that stimulates red blood cell production. If your kidneys are not functioning well, fewer red blood cells are produced. Anemia may occur even in people with only moderate loss of kidney function. Symptoms may include lack of energy, headaches, irritability or difficulty concentrating. Muscle activity and cell building/repair may also be impaired.
• Electrolyte Imbalance. Electrolytes include such substances as sodium, potassium, phosphate, calcium, and magnesium. When the kidneys are unable to filter out these substances, they build-up and can impair muscle coordination, heart function, fluid absorption and excretion, nerve function and concentration.
• Fluid Imbalance. When kidney function decreases, fluid builds up in the body's tissues. Fluid build-up can cause congestive heart failure, and can also cause pulmonary edema, which results in dangerously low levels of oxygen in the blood and requires immediate treatment. See Congestive Heart Failure: Information for Patients.
• Uremia. When the kidneys are unable to properly remove waste products, these wastes build-up in the body and damage it. Some of the early signs of uremia are fatigue, loss of appetite, and edema (fluid build up in body tissue).

When kidneys fail: End Stage Kidney Disease

End Stage Kidney Disease, also known as end stage renal disease (ESRD), is a complete or near complete failure of the kidneys to function to excrete wastes, concentrate urine, and regulate electrolytes. When this happens, the body begins to fill up with waste products and excess water. This condition is called uremia and its symptoms include swelling of the hands and feet, fatigue and weakness. If uremia is not treated it usually leads to seizures or coma, and ultimately death. However, it is important to remember that End Stage Kidney Disease refers to the end of your kidney function, not the end of your life. End Stage Kidney Disease can be treated by dialysis or through a kidney transplant. However, preparing for these treatments takes time. It is important to discuss your treatment options with your doctor well before your kidneys fail.

Dialysis

Dialysis is a treatment that substitutes a machine for usual kidney function. Dialysis removes waste products from the blood, eliminate excess fluid from the body, and helps maintain the right balance of electrolytes. Dialysis does not cure End Stage Kidney Disease - it is a life-saving procedure that can extend life. Some people have lived from 10 to 20 years longer as a result of dialysis treatment.

There are two types of dialysis:

• Hemodialysis. The patient's blood vessels are connected to a dialysis machine by needles inserted through the arm or wrist. Blood is pumped from the body into the machine where a filter removes waste products and excess fluid from the blood. The clean blood is then sent back into the body. Hemodialysis is usually needed 3 times per week and can be performed in a hospital setting, in community settings, and even at home.
• Peritoneal Dialysis. A hollow flexible tube called a "catheter" is placed into a patient's abdomen. A special solution enters the abdomen through the catheter. This solution captures and removes wastes, and transfers excess fluid from the blood into the abdomen. After several hours the solution containing the waste and excess fluid is drained from the abdomen. Then a new solution enters the abdomen through the catheter. Peritoneal dialysis can be performed in your own home. There are various types of peritoneal dialysis. One form can be performed at night with the assistance of a special machine. Another requires that the solution be changed four times a day.

• a family member (often the most successful donor)
• a spouse or very close friend
• a person who has recently died