Do You Have Chronic Kidney Disease?

Kidney trouble is part of aging, but it can be life-threatening if you neglect it. If you take proton pump inhibitors for heartburn, you’re at more risk.

Your kidneys — two bean-shaped organs that filter waste, including extra water — get less effective over time. This is a natural part of aging, but other conditions like high blood pressure, certain medications, smoking, and too much alcohol and red meat may speed up the decline.

Altogether, about one in three U.S. adults are at risk, and more than one in seven will get the disease, according to the National Kidney Foundation. But because it has no symptoms in the early stages, 90 percent of those with the problem don’t know they have it until they have reached a severe stage. Even the end stage, or  kidney failure,  can arrive without warning.

More people die of kidney disease than from breast or prostate cancer.

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What is chronic kidney disease?

You have chronic kidney disease if both kidneys are damaged. As your kidneys begin to fail, the waste they are designed to filter out builds up in your blood and causes symptoms like swollen feet. You may develop other problems, among them anemia, weak bones, poor nutrition, nerve damage, and even heart and blood vessel disease. Once you have kidney disease, your risk of stroke or heart attack rise.

Who is at risk for chronic kidney disease?

About half of all U.S. kidney failure patients have type 1 or type 2 diabetes, and another 29 percent have high blood pressure. Obesity is another risk factor. The risk among African Americans is about three times higher than for whites, and 1.3 times higher for Hispanics, compared to all non-Hispanics.

Children can be born with anomalies in their kidneys or urinary tract or kidney-related disorders. When urinary tract infections turn into kidney infections, children can get lasting kidney damage. In 2019, more than 1,000 children were waiting for a donated kidney for a kidney transplant.

What are the symptoms of chronic kidney disease?

When waste and extra water builds up, your feet and ankles may swell. You may be nauseated, vomit, lose your appetite, and develop shortness of breath.

How is chronic kidney disease diagnosed?

To diagnose chronic kidney disease, your doctors will look at the levels of creatine in your blood, combined with other factors that make up your glomerular filtration rate (GFR), a test that checks how well your kidneys filter blood. If that number is low, your doctor will check your urine for high protein levels (proteinuria), a sign of chronic kidney disease.

What are the stages of chronic kidney disease?

These stages are not inevitable, and the disease may progress slowly and not at all with proper care.

• Stage 1: Kidney damage with normal kidney function (estimated GFR greater than 90 mL/min per 1.73 m2) and persistent (more than 3 months) proteinuria.
• Stage 2: Kidney damage with mild loss of kidney function (estimated GFR 60-89 mL/min per 1.73 m2) and persistent (more than 3 months) proteinuria.
• Stage 3: Mild-to-severe loss of kidney function (estimated GFR 30-59 mL/min per 1.73 m2).
• Stage 4: Severe loss of kidney function (estimated GFR 15-29 mL/min per 1.73 m2).
• Stage 5: Kidney failure requiring dialysis or transplant for survival. Also known as ESRD (estimated GFR greater than 15 mL/min per 1.73 m2).

How fast does chronic kidney disease progress?

This varies dramatically, with diabetes a big factor. In a large 2018 study, researchers created a pool of all the adults within a large healthcare program in northern California who had reached stage 3 but had not had dialysis or a kidney transplant. Twenty-three percent of the patients who had diabetes lost more than 4mL/min per 1.73 m2 in two years vs. 15.3 percent of those without diabetes. High systolic blood pressure, heart failure, and anemia were also linked to fast progression.

How can you protect yourself from chronic kidney disease?

There’s much you can do early on, all consistent with the advice for general health.

Watch your medications. Common over-the-counter drugs can increase your risk. Do you regularly take ibuprofen (Advil) or naproxen (Aleve)? Acetaminophen (Tylenol) may be safer for your kidneys.

If you need acid-reducers for heart burn, the proton pump inhibitors Nexium (esomeprazole), Prevacid (lansoprazole) and Prilosec (omeprazole) raise your risk dramatically. Histamine-2 blockers such as Pepcid (famotidine) or Zantac (ranitidine) may be safer.

• Watch your drinks. Sugary drinks were linked to a higher risk, in a 2019 meta-analysis of diet and chronic kidney disease. Stay within standard recommendations for alcohol: a drink a day for women and two for men.
• Eat a healthful diet. Eating vegetables, fruit, legumes, nuts, whole grains, fish, and low-fat dairy are linked to lower risk of chronic kidney disease, the same overview found. Cut back on red and processed meat.
• Quit smoking. Smoking slows blood flow to the kidneys and other organs. It also interferes with medicines that treat high blood pressure, a leading cause of kidney disease.
• Stay fit. Exercise improves the risk factors linked to chronic kidney disease — diabetes, obesity, and high blood pressure.
• Get screened. If you don’t have symptoms, you don’t need screening. If you have diabetes, however, yearly screening is a good idea. High blood pressure is also a reason for regular screening. To diagnose chronic kidney disease, your doctors will look at the levels of creatine in your blood, combined with other factors that make up your glomerular filtration rate (eGFR). If that number is low, your doctor will check your urine for high protein levels, a sign of chronic kidney disease.

If you have chronic kidney disease, how can you avoid kidney failure and dialysis?

You’ll need to stay within healthy ranges for blood sugar and blood pressure. You may need to eat less protein, which stresses your kidneys, and less potassium, or take medicine to control phosphate absorption. Blood pressure drugs can lower urine protein as well.

People tend to become less active as chronic kidney disease progresses. But the more you exercise, the slower the decline in kidney function, research shows.

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