11 Things to Know About Chronic Kidney Disease

Most people with CKD aren’t aware that they have it because symptoms such as nausea and fatigue are nonspecific. That’s why screening is key to preventing the progression of kidney disease to kidney failure. Feeling off? “Ask your doctor to order a ‘kidney profile,’ which includes two simple tests,” says Gail Torres, senior clinical communications director at the National Kidney Foundation in New York City. ACR is a test that measures the amount of albumin (a kind of protein) in urine (more info on next slide); GFR (glomerular filtration rate) is a blood test that measures overall kidney function.

If you notice that you’re peeing more (or less) than you once did or if the color of urine has changed to dark orange or brown, you may be experiencing kidney issues. An ACR urine test can detect protein in your urine and confirm suspicions. “The more protein there is in your urine, the more scarring there is of the kidney,” says Robert Greenwill, M.D., chief of the division of nephrology at Mercy Medical Center in Baltimore. Scarring disturbs the kidneys' filtering process, allowing protein to leak from the blood into the urine.

The estimated glomerular filtration rate (eGFR) blood test (which measures kidney function) and UACR urine test (which detects kidney damage by measuring your albumin-to-creatinine ratio) are simple, but you have to take them a few times. “You'll need repeated lab tests to be certain you have CKD,” says Sharon Moe, M.D., director of the division of nephrology at the Indiana University School of Medicine. In addition, an ultrasound or CT scan will show if your kidneys are too large or too small or if there are problems in the structure of your kidneys or urinary tract.

People at highest risk of developing CKD also have diabetes, hypertension (high blood pressure), and/or a family history of kidney failure, likely due to compromised immune systems. “We also consider anyone else who has a chronic illness to be at high risk,” says Priya Singh, M.D., assistant professor of medicine and a transplant nephrologist at Ohio State University in Columbus. “This includes HIV, hepatitis C, or those undergoing chemotherapy to treat cancer.”

Living with uncontrolled blood pressure raises your risk of CKD because elevated blood pressure can damage the blood vessels within the kidney as well as throughout the body, says Dr. Greenwill. While hypertension may cause CKD, CKD can also cause hypertension and heart disease as the kidneys stop removing waste and extra fluid from your blood. In fact, “CKD increases your risk of hospitalization for a heart issue by two to three times, making this the biggest impact CKD has on your health,” says Dr. Greenwill.

“You can slow the progression of CKD by controlling your blood pressure,” Dr. Greenwill says. “We want patients to get their BP to less than 130 over 80.” If your blood pressure remains high, a class of drugs known as ACE inhibitors may be prescribed to keep your numbers in check. “These are the best weapon we have because they control blood pressure and lower protein levels in the urine which can slow the progression of CKD,” says Dr. Greenwill.

Diabetes accounts for 44% of new kidney failure cases, according to the National Kidney Foundation. What gives? Left untreated, diabetes can damage small blood vessels, including those in the kidneys. (High blood pressure is a strong predictor of diabetics getting CKD.) Controlling blood sugar—we know, it's hard—is key to keeping chronic kidney disease at bay. Also, hypertension meds (ACE inhibitors and angiotensin-2 receptor blockers) can effectively treat diabetic kidney disease.

According to the CDC, African Americans are four times more likely than Caucasians to develop kidney failure. In addition, a growing number of Hispanics are being diagnosed with kidney disease; since 2000, the number of Hispanics with kidney failure has increased more than 70%. Other groups at high risk of CKD include American Indians and Alaska Natives. Researchers still aren’t sure why, but some believe it may be related to higher rates of diabetes in these ethnicities.

In 2010, researchers zeroed in on a gene that raises CKD risk. Known as APOL1, this gene is highly prevalent in certain groups. Among others, “African Americans of Western African descent—such as those from Ghana—tend to have these mutations,” Dr. Singh says. “These same patients also tend to have a strong history of hypertension, kidney disease, and a family member on dialysis.” If you fall into this category, ask your doctor for the APOL1 test, an inexpensive genetic test that will reveal your risk for kidney disease.

On the list of ways to keep your kidneys healthy: Quit smoking, limit alcohol, maintain a healthy weight, and follow a plant-based diet. “This diet decreases dietary acid, sodium, and phosphate, all of which helps alleviate stress on the kidneys,” says Torres. Also, avoid taking nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil) or naproxen (Aleve). “These OTC meds can damage your kidneys if you’re taking them, say, three times a day for months,” says Dr. Singh. For pain relief, try acetaminophen (Tylenol).

The most exciting development in CKD treatment right now is the use of co-transporter 2 (SGLT2) inhibitors—originally used to treat type 2 diabetes, says Neil Powe, M.D, chief of medicine at the Priscilla Chan and Mark Zuckerberg San Francisco General Hospital. “This relatively new class of diabetes drugs has profound effects on reducing the progression of kidney disease as well as cardiovascular disease,” he says. “There are studies in progress also looking at whether these drugs can help patients with high blood pressure who are at risk for developing kidney disease.”