What to know about chronic kidney disease (and how to prevent it)

You’ve noticed changes in your urine—like discoloration and foaminess—and you’ve been swelling up lately, especially around your ankles. Some of your symptoms may be easily explained by common conditions, such as stress, pregnancy, and infection, but this constellation of symptoms could also be blamed on chronic kidney disease (CKD).

What is chronic kidney disease?

Classified as damage to your kidneys that has gone on for many months, chronic kidney disease occurs when your kidneys stop working like the fine-tuned filtration system they are (moving blood, fluid, and waste through your body 24/7).

Acute kidney disease, or damage that is mild and has occurred recently, may be reversed if doctors catch it in time. Acute kidney disease then becomes chronic kidney disease. But chronic kidney disease is harder to cure—and damage to the kidneys is often something you might not know you have until it’s too late to intervene.  

Chronic kidney disease is actually more common than you think. According to University of Missouri Health Care nephrologist Kunal Malhotra, MD, national statistics show that 14% of Americans have it, including 1 in 3 people with diabetes, and 1 in 5 patients with high blood pressure. Having either—or both—of those conditions makes you more likely to have chronic kidney disease, as does having a family history of kidney problems, having arterial vascular disease, or being of African American descent.

The stages of chronic kidney disease

There are five stages of chronic kidney disease. Here’s how they break down:

• Stage 1: You may have signs of kidney damage, like protein or blood in your urine, but it’s not yet affecting your kidneys’ overall functioning.
• Stage 2: You begin experiencing some loss of function, but it’s likely not detectable yet unless your doctor tests your GFR, or glomerular filtration rate, which is part of a common electrolytes laboratory i.e., basic metabolic panel (BMP). In healthy adults, GFR should be at least 90.
• Stage 3: Your kidney function drops to 40% or 50%. You’re beginning to accumulate electrolytes and fluid, but your kidneys are still working to overcompensate for the loss of function—so you still might not be aware yet of the damage.
• Stage 4: As your kidney function continues to plummet, it can no longer mask its efforts to work effectively. You begin noticing symptoms like swelling as your body accumulates salt and potassium. At this point, you may feel fatigued and tired. 
• Stage 5: Later on in the disease, once functioning has dropped below 30%, you may experience loss of appetite, fatigue or insomnia, dry and itchy skin, eye puffiness, swelling of the legs, ankles, and feet, muscle cramps, frequent urination, and discolored or foamy urine (signs of increased protein or blood in the urine). When your kidneys are operating at 15% (or less) of normal function, you may require a kidney transplant or dialysis to prevent kidney failure.

The trickiest thing about chronic kidney disease, says Dr. Malhotra, is its silent progression. 

“You start to have a loss of function in stage two, but the kidneys have a mechanism to overcome those barriers,” says Dr. Malhotra. “It creeps up on people…for the most part, it’s not until stage four that you actually notice symptoms.” In other words, it’s often unnoticeable until it’s too late to stop or reverse the damage. There are very few warning signs in the early stages that you’re experiencing reduced functioning.

It’s not all bad news, though: There are things you can do to slow down the progression of chronic kidney disease if you have it and, thankfully, ways to prevent it from happening in the first place.

Diagnosing chronic kidney disease 

Physicians who suspect chronic kidney disease in their patients will typically run bloodwork to check GFR and perform a urinalysis to measure a specific kind of protein called albumin. They may also measure creatinine levels; creatinine, a waste product filtered by the kidneys, often accumulates when kidney function is lowered. Since a normal level of creatinine varies with sex, age, and muscle mass, creatinine levels alone can’t diagnose kidney disease, though it may be used in conjunction with urinalysis and GFR testing.

These lab tests, in addition to ultrasounds and biopsies of the kidney, can help doctors diagnose the presence of damage. 

Treating chronic kidney disease 

As for treatment, much of it relies on healthy lifestyle changes. “It’s important to correct underlying risk factors, like making sure your diabetes is well-controlled, as well as making dietary changes,” says Dr. Malhotra.

He adds that limiting your use of unnecessary supplements and medications (especially over-the-counter anti-inflammatory drugs like ibuprofen, which can cause kidney injury and exacerbate chronic kidney disease symptoms), along with smoking cessation and regular exercise can also prevent further kidney damage from occurring. 

According to Dr. Robert Greenwell, chief of nephrology at Mercy Medical Center in Baltimore, treating high blood pressure is another way to protect your kidneys from further damage. Controlling your blood pressure with an ACE inhibitor or drugs like losartan or lisinopril can help you maintain kidney function and lower the amount of protein in your urine.

How to prevent kidney disease 

Dr. Greenwell doubles down on the connection between chronic kidney disease and lifestyle choices—particularly as it relates to prevention. 

“When we find established, [long-term] damage to the kidneys, the likelihood of us reversing that is low,” he says. “But when we look at the big things that cause someone to need dialysis, those factors are usually lifestyle-related.” 

He also points to the high incidence of chronic kidney disease in patients with diabetes, hypertension, heart disease, HIV, over the counter NSAIDs and frequent drug use: “A lot of things that cause chronic kidney disease and result in permanent damage or needing dialysis can’t be fixed—but we could have prevented them 15 years ago with dietary and lifestyle choices.”

So what can you do now, before you experience chronic kidney disease, to maintain your healthy kidneys?

1. Manage your weight and blood sugar levels. Obesity, insulin-resistance, and high blood pressure often lead to diabetes, which is a leading cause of chronic kidney disease. If your diabetes is uncontrolled with long-standing Hemoglobin A1c above 8.0%, you should seek a diabetes specialist such as an endocrinologist to help with your diabetes as it is a leading cause of chronic kidney failure in the United States.
2. Exercise. Some studies suggest that exercise can slow the progression of stage three and stage four kidney disease.
3. Stop smoking. Smoking not only increases your risk of chronic kidney disease, it contributes to hypertension, hardening of the renal arteries, and proteinuria. It’s also a risk factor for end stage renal disease (ESRD).
4. Eat well. A kidney health-friendly diet rich in whole grains, lean animal protein and plant-based protein, monounsaturated fats, fruits, legumes, and vegetables can prevent kidney damage, as can cutting back on salt, alcohol, and saturated fat. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) also advises people with chronic kidney disease to monitor how much phosphorus and potassium is in their diet, since both can easily build up in your blood. That means: Avoid eating too much dairy, too many beans, legumes, dark-colored beverages, bananas, and oranges, among other foods. Opt for low-phosphorus and low-potassium foods like apples, carrots, rice milk, white pasta, and clear beverages when possible.
5. Manage existing health conditions. If you have diabetes, hypertension, or HIV, be sure that your doctor is regularly checking up on your kidney function since those diseases increase your risk of developing kidney disease.
6. Reduce medication use. “People take NSAIDs for aches and pains but don’t realize those medications are the most common cause of drug-induced kidney injury,” says Dr. Malhotra. “They can damage the kidney in multiple ways, causing an inflammatory condition that can be reversed—unless you’ve taken it for so long you’ve caused irreversible scarring.” He recommends only taking NSAID pain relievers, such as naproxen or ibuprofen, when absolutely necessary—and always under the supervision of a physician.
7. Be a strong advocate for yourself. “If you’ve got diabetes or high blood pressure, your doctor should be checking your kidney function already…and if they aren’t, you should be asking your doctor how your kidneys are doing,” says Dr. Greenwell. In other words, if you know you’re at a higher risk of kidney damage because of a prior condition, don’t be shy about making sure your doctor is keeping an eye on your kidney function.
8. Take a renal vitamin. According to the National Kidney Foundation, chronic kidney disease may cause you to limit certain foods or food groups, which means you could be lacking in some important vitamins and minerals. Taking a renal vitamin can ensure that you’re getting the correct nutrients—like iron, calcium, and B complex vitamins—every day. That said, people with chronic kidney disease should also avoid having an excess of certain nutrients, so you should always talk to your doctor before taking any supplements.

Can you reverse kidney damage? 

You typically can’t reverse chronic kidney disease because the damage and scarring is too extensive. Some forms of acute kidney disease, like the kind caused by medication overuse, can be reversed if caught early enough.

“Once [I see signs of damage], I think whether it could be from an acute and potentially-reversible cause first,” says Dr. Greenwell. “If the damage is recent—like your function was normal a month ago and now it’s not—I’ve got a better chance of helping you recover than if you have long-standing damage.”

At that point, Dr. Greenwell explains, less focus should be placed on trying to fix or cure the damage and more on how to slow it down. “It’s only when you’re down to about 10% functioning that you need dialysis or a transplant,” he says. “So you might have chronic kidney disease and an [abnormal] creatinine level of three, but you might be able to stay in that range for a long time. We can try to slow the damage down, so your creatinine levels worsen over 15 years instead of three.”

Talk to your healthcare provider about the best ways to slow the progression of your kidney problems.