Chronic Kidney Disease (CKD)

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What Is Chronic Kidney Disease?

Chronic kidney disease (CKD) means your kidneys are damaged and can’t filter blood the way they should. The disease is called “chronic” because the damage to your kidneys happens slowly over a long period of time. This damage can cause wastes to build up in your body. CKD can also cause other health problems.

Illustration of the location of the kidneys in the body.
Your kidneys are located in the middle of your back, just below your ribcage.

The kidneys’ main job is to filter extra water and wastes out of your blood to make urine. To keep your body working properly, the kidneys balance the salts and minerals—such as calcium, phosphorus, sodium, and potassium—that circulate in the blood. Your kidneys also make hormones that help control blood pressure, make red blood cells, and keep your bones strong.

Kidney disease often can get worse over time and may lead to kidney failure. If your kidneys fail, you will need dialysis or a kidney transplant to maintain your health.

The sooner you know you have kidney disease, the sooner you can make changes to protect your kidneys.

More information is provided in the NIDDK health topic, The Kidneys and How They Work.

Watch a video about what the kidneys do.

How common is CKD?

CKD is common among adults in the United States. More than 20 million American adults may have CKD.1

Who is more likely to develop CKD?

You are at risk for kidney disease if you have

  • Diabetes. Diabetes is the leading cause of CKD. High blood glucose, also called blood sugar, from diabetes can damage the blood vessels in your kidneys. Almost 1 in 3 people with diabetes has CKD.1
  • High blood pressure. High blood pressure is the second leading cause of CKD. Like high blood glucose, high blood pressure also can damage the blood vessels in your kidneys. Almost 1 in 5 adults with high blood pressure has CKD.1
  • Heart disease. Research shows a link between kidney disease and heart disease. People with heart disease are at higher risk for kidney disease, and people with kidney disease are at higher risk for heart disease. Researchers are working to better understand the relationship between kidney disease and heart disease.
  • Family history of kidney failure. If your mother, father, sister, or brother has kidney failure, you are at risk for CKD. Kidney disease tends to run in families. If you have kidney disease, encourage family members to get tested. Use tips from the family health reunion guide and speak with your family during special gatherings.

Your chances of having kidney disease increase with age.1 The longer you have had diabetes, high blood pressure, or heart disease, the more likely that you will have kidney disease.

African Americans, Hispanics, and American Indians tend to have a greater risk for CKD.2 The greater risk is due mostly to higher rates of diabetes and high blood pressure among these groups. Scientists are studying other possible reasons for this increased risk.

Watch a video about kidney disease risk.

If you are at risk for kidney disease, learn ways to prevent kidney disease.

What are the symptoms of CKD?

Early CKD may not have any symptoms

You may wonder how you can have CKD and feel fine. Our kidneys have a greater capacity to do their job than is needed to keep us healthy. For example, you can donate one kidney and remain healthy. You can also have kidney damage without any symptoms because, despite the damage, your kidneys are still doing enough work to keep you feeling well. For many people, the only way to know if you have kidney disease is to get your kidneys checked with blood and urine tests.

As kidney disease gets worse, a person may have swelling, called edema. Edema happens when the kidneys can’t get rid of extra fluid and salt. Edema can occur in the legs, feet, or ankles, and less often in the hands or face.

Symptoms of advanced CKD

  • chest pain
  • dry skin
  • itching or numbness
  • feeling tired
  • headaches
  • increased or decreased urination
  • loss of appetite
  • muscle cramps
  • nausea
  • shortness of breath
  • sleep problems
  • trouble concentrating
  • vomiting
  • weight loss

People with CKD can also develop anemia, bone disease, and malnutrition.

Does CKD cause other health problems?

Kidney disease can lead to other health problems, such as heart disease. If you have kidney disease, it increases your chances of having a stroke or heart attack.

High blood pressure can be both a cause and a result of kidney disease. High blood pressure damages your kidneys, and damaged kidneys don’t work as well to help control your blood pressure.

If you have CKD, you also have a higher chance of having a sudden change in kidney function caused by illness, injury, or certain medicines. This is called acute kidney injury (AKI).

How can CKD affect my day-to-day life?

Many people are afraid to learn that they have kidney disease because they think that all kidney disease leads to dialysis. However, most people with kidney disease will not need dialysis. If you have kidney disease, you can continue to live a productive life, work, spend time with friends and family, stay physically active, and do other things you enjoy. You may need to change what you eat and add healthy habits to your daily routine to help you protect your kidneys.

A photo of an older man and woman walking in a park.
People with kidney disease can continue to work, be active, and enjoy life.

Will my kidneys get better?

Kidney disease is often “progressive”, which means it gets worse over time. The damage to your kidneys causes scars and is permanent.

You can take steps to protect your kidneys, such as managing your blood pressure and your blood glucose, if you have diabetes.

What happens if my kidneys fail?

Kidney failure means that your kidneys have lost most of their ability to function—less than 15 percent of normal kidney function. If you have kidney failure, you will need treatment to maintain your health. Learn more about what happens if your kidneys fail.

References

Causes of CKD

Diabetes and high blood pressure are the most common causes of chronic kidney disease (CKD). Your health care provider will look at your health history and may do tests to find out why you have kidney disease. The cause of your kidney disease may affect the type of treatment you receive.

Diabetes

Too much glucose, also called sugar, in your blood damages your kidneys’ filters. Over time, your kidneys can become so damaged that they no longer do a good job filtering wastes and extra fluid from your blood.

Often, the first sign of kidney disease from diabetes is protein in your urine. When the filters are damaged, a protein called albumin, which you need to stay healthy, passes out of your blood and into your urine. A healthy kidney doesn’t let albumin pass from the blood into the urine.

Diabetic kidney disease is the medical term for kidney disease caused by diabetes.

High blood pressure

High blood pressure can damage blood vessels in the kidneys so they don’t work as well. If the blood vessels in your kidneys are damaged, your kidneys may not work as well to remove wastes and extra fluid from your body. Extra fluid in the blood vessels may then raise blood pressure even more, creating a dangerous cycle.

More information is provided in the NIDDK health topic, High Blood Pressure and Kidney Disease.

A photo of an older man checking his blood pressure at home.
High blood pressure can damage blood vessels in your kidneys.

Other causes of kidney disease

Other causes of kidney disease include

Tests & Diagnosis

How can I tell if I have kidney disease?

Early kidney disease usually doesn’t have any symptoms. Testing is the only way to know how well your kidneys are working. Get checked for kidney disease if you have

If you have diabetes, get checked every year. If you have high blood pressure, heart disease, or a family history of kidney failure, talk with your health care provider about how often you should get tested. The sooner you know you have kidney disease, the sooner you can get treatment to help protect your kidneys.

A photo of a nurse drawing blood from an older man at a doctor’s office.
Get tested to find out if you have kidney disease. Early treatment may help protect your kidneys.

What tests do doctors use to diagnose and monitor kidney disease?

To check for kidney disease, health care providers use

  • a blood test that checks how well your kidneys are filtering your blood, called GFR. GFR stands for glomerular filtration rate.
  • a urine test to check for albumin. Albumin is a protein that can pass into the urine when the kidneys are damaged.

If you have kidney disease, your health care provider will use the same two tests to help monitor your kidney disease and make sure your treatment plan is working.

Watch a video on how to check for kidney disease.

Blood test for GFR

Your health care provider will use a blood test to check your kidney function. The results of the test mean the following:

  • a GFR of 60 or more is in the normal range. Ask your health care provider when your GFR should be checked again.
  • a GFR of less than 60 may mean you have kidney disease. Talk with your health care provider about how to keep your kidney health at this level.
  • a GFR of 15 or less is called kidney failure. Most people below this level need dialysis or a kidney transplant. Talk with your health care provider about your treatment options.
A diagram of a GFR dial showing how a GFR that is 60 or higher is normal; a GFR below 60 may mean kidney disease; and a GFR of 15 or lower may mean kidney failure.
GFR results show whether your kidneys are filtering at a normal level.

You can’t raise your GFR, but you can try to keep it from going lower. Learn more about what you can do to keep your kidneys healthy.

Creatinine. Creatinine is a waste product from the normal breakdown of muscles in your body. Your kidneys remove creatinine from your blood. Providers use the amount of creatinine in your blood to estimate your GFR. As kidney disease gets worse, the level of creatinine goes up.

Urine Test for Albumin

If you are at risk for kidney disease, your provider may check your urine for albumin.

Albumin is a protein found in your blood. A healthy kidney doesn’t let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine. The less albumin in your urine, the better. Having albumin in the urine is called albuminuria.

A diagram showing a healthy kidney with albumin only found in blood, and a damaged kidney that has albumin in both blood and urine.
A healthy kidney doesn’t let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine.

A health care provider can check for albumin in your urine in two ways:

Dipstick test for albumin. A provider uses a urine sample to look for albumin in your urine. You collect the urine sample in a container in a health care provider’s office or lab. For the test, a provider places a strip of chemically treated paper, called a dipstick, into the urine. The dipstick changes color if albumin is present in the urine.

Urine albumin-to-creatinine ratio (UACR). This test measures and compares the amount of albumin with the amount of creatinine in your urine sample. Providers use your UACR to estimate how much albumin would pass into your urine over 24 hours. A urine albumin result of

  • 30 mg/g or less is normal
  • more than 30 mg/g may be a sign of kidney disease

If you have albumin in your urine, your provider may want you to repeat the urine test one or two more times to confirm the results. Talk with your provider about what your specific numbers mean for you.

If you have kidney disease, measuring the albumin in your urine helps your provider know which treatment is best for you. A urine albumin level that stays the same or goes down may mean that treatments are working.

How do I know if my kidney disease is getting worse?

You can keep track of your test results (262 KB)  over time. You can tell that your treatments are working if your

  • GFR stays the same
  • urine albumin stays the same or goes down

Your health care provider will work with you to manage your kidney disease.

Managing CKD

If you have chronic kidney disease (CKD), you can take steps to protect your kidneys from more damage.

The sooner you know you have kidney disease, the better. The steps you take to protect your kidneys from damage also may help prevent heart disease—and improve your health overall. Making these changes when you have no symptoms may be hard, but it’s worthwhile.

Ten ways to manage kidney disease

  1. Control your blood pressure
  2. Meet your blood glucose goal if you have diabetes
  3. Work with your health care team to monitor your kidney health
  4. Take medicines as prescribed
  5. Work with a dietitian to develop a meal plan
  6. Make physical activity part of your routine
  7. Aim for a healthy weight
  8. Get enough sleep
  9. Stop smoking
  10. Find healthy ways to cope with stress and depression

Control your blood pressure

The most important step you can take to treat kidney disease is to control your blood pressure. High blood pressure can damage your kidneys. You can protect your kidneys by keeping your blood pressure at or less than the goal set by your health care provider. For most people, the blood pressure goal is less than 140/90 mm Hg.

Work with your health care provider to develop a plan to meet your blood pressure goals. Steps you can take to meet your blood pressure goals may include eating heart-healthy and low-sodium meals, quitting smoking, being active, getting enough sleep, and taking your medicines as prescribed.

A photo showing a close-up of a health care provider checking a patient’s blood pressure.
The most important step you can take to treat kidney disease is to control your blood pressure.

Meet your blood glucose goal if you have diabetes

To reach your blood glucose goal, check your blood glucose level regularly. Use the results to guide decisions about food, physical activity, and medicines. Ask your health care provider how often you should check your blood glucose level.

Your health care provider will also test your A1C. The A1C is a blood test that measures your average blood glucose level over the past 3 months. This test is different from the blood glucose checks you do regularly. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months. Stay close to your daily blood glucose numbers to help you meet your A1C goal.

The A1C goal for many people with diabetes is below 7 percent. Ask your health care provider what your goal should be. Reaching your goal numbers will help you protect your kidneys. Learn more about how to manage diabetes.

Work with your health care team to monitor your kidney health

The tests that health care providers use to test for kidney disease can also be used to track changes to kidney function and damage. Kidney disease tends to get worse over time. Each time you get checked, ask your provider how the test results compare to the last results. Your goals will be to

Your health care provider will also check your blood pressure and, if you have diabetes, your A1C level, to make sure you are meeting your blood pressure and blood glucose goals.

Bring this document to your appointment to help keep track of your kidney test results (262 KB) .

How can I prepare for visits with my health care provider?

The more you plan for your visits, the more you will be able to learn about your health and treatment options.

Make a list of questions
It’s normal to have a lot of questions. Write down your questions as you think of them so that you can remember everything you want to ask when you see your health care provider. You may want to ask about what tests are being done, what test results mean, or the changes you need to make to your diet and medicines.

Sample questions to ask your provider for people with kidney disease

About your tests

  • What is my GFR? What does that mean?
  • Has my GFR changed since last time?
  • What is my urine albumin? What does it mean?
  • Has my urine albumin changed since the last time it was checked?
  • Is my kidney disease getting worse?
  • Is my blood pressure where it needs to be?

About treatment and self-care

  • What can I do to keep my disease from getting worse?
  • Do any of my medicines or doses need to be changed?
  • What time of day should I take each of my medicines?
  • Do I need to change what I eat?
  • Will you refer me to a dietitian for diet counseling?
  • When will I need to see a nephrologist (kidney specialist)?
  • Do I need to worry about dialysis or a kidney transplant?
  • What do I need to do to protect my veins?

About complications

  • What other health problems may I face because of my kidney disease?
  • Should I be looking for any symptoms? If so, what are they?

Bring a friend or relative with you for support
A trusted friend or family member can take notes, ask questions you may not have thought of, offer support, and help remember what the provider said during the visit. Talk ahead of time about what you want to get out of the visit and the role you would like your friend or relative to play.

Who is part of my health care team?

The following health care providers may be part of the health care team involved in your treatment:

A photo of a health care provider listening to an older patient and companion.

Primary care provider. Your primary care provider (PCP)—doctor, nurse practitioner, or physician assistant—is the person you see for routine medical visits. Your PCP may monitor your kidney health and help you manage your diabetes and high blood pressure. A PCP also prescribes medicines and may refer you to specialists.

Nurse. A nurse may help with your treatment and teach you about monitoring and treating kidney disease, as well as managing your health conditions. Some nurses specialize in kidney disease.

Registered dietitian. A registered dietitian is a food and nutrition expert who helps people create a healthy eating plan when they have a health condition such as kidney disease. Dietitians can help you by creating an eating plan based on how your kidneys are doing. “Renal dietitians” often work in dialysis centers and are specially trained to work with people with kidney failure.

Diabetes educator. A diabetes educator teaches people with diabetes how to manage their disease and handle diabetes-related problems.

Pharmacist. A pharmacist educates you about your medicines and fills your prescriptions. An important job for the pharmacist is to review all of your medicines, including over-the-counter (OTC) medicines, and supplements, to avoid unsafe combinations and side effects.

Social worker. When you are close to needing dialysis, you may have a chance to meet with a social worker. A dialysis social worker helps people and their families deal with the life changes and costs that come with having kidney disease and kidney failure. A dialysis social worker also can help people with kidney failure apply for help to cover treatment costs.

Nephrologist. A nephrologist is a doctor who is a kidney specialist. Your PCP may refer you to a nephrologist if you have a complicated case of kidney disease, your kidney disease is quickly getting worse, or your kidney disease is advanced.

Take medicines as prescribed

Many people with CKD take medicines prescribed to lower blood pressure, control blood glucose, and lower cholesterol.

Two types of blood pressure medicines, ACE inhibitors and ARBs, may slow kidney disease and delay kidney failure, even in people who don’t have high blood pressure. The names of these medicines end in –pril or –sartan.

Many people need to take two or more medicines for their blood pressure. You may also need to take a diuretic, sometimes called a water pill. The aim is to meet your blood pressure goal. These medicines may work better if you limit your salt intake.

Know that your medicines may change over time

Your health care provider may change your medicines as your kidney disease gets worse. Your kidneys don’t filter as well as they did in the past, and this can cause an unsafe buildup of medicines in your blood. Some medicines can also harm your kidneys. As a result, your provider may tell you to

  • take a medicine less often or take a smaller dose
  • stop taking a medicine or switch to a different one

Your pharmacist and health care provider need to know about all the medicines you take, including OTC medicines, vitamins, and supplements.

A photo of a health care provider talking about medicine to an older patient.
Talk with your provider about all the medicines you take, including OTC medicines, vitamins, and supplements.

Be careful about the over-the-counter medicines you take

If you take OTC or prescription medicines for headaches, pain, fever, or colds, you may be taking nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include commonly used pain relievers and cold medicines that can damage your kidneys and lead to acute kidney injury, especially in those with kidney disease, diabetes, and high blood pressure.

Ibuprofen and naproxen are NSAIDs. NSAIDs are sold under many different brand names, so ask your pharmacist or health care provider if the medicines you take are safe to use.

You also can look for NSAIDs on Drug Facts labels like the one below:

An example of a Drug Facts label for a nonsteroidal anti-inflammatory drug (NSAID) that shows the active ingredient of ibuprofen and its purpose as a pain reliever.

If you have been taking NSAIDs regularly to control chronic pain, you may want to ask your health care provider about other ways to treat pain, such as meditation or other relaxation techniques. You can read more about pain management at the NIH National Center for Complementary and Integrative Health website.

Tips for managing your medicines

The next time you pick up a prescription or buy an OTC medicine or supplement, ask your pharmacist how the product may

  • affect your kidneys
  • affect other medicines you take

Fill your prescriptions at only one pharmacy or pharmacy chain so your pharmacist can

  • keep track of your medicines and supplements
  • check for harmful interactions

Keep track of your medicines and supplements:

  • Keep an up-to-date list of your medicines and supplements in your wallet. Take your list with you, or bring all of your medicine bottles, to all health care visits.
A photo of a patient showing all his medicine bottles to a health care provider.
You may want to bring all of your medicine bottles with you to your health care visits.

Work with a dietitian to develop a meal plan

What you eat and drink can help you

  • protect your kidneys
  • reach your blood pressure and blood glucose goals
  • prevent or delay health problems caused by kidney disease

As your kidney disease gets worse, you may need to make more changes to what you eat and drink.

A dietitian who knows about kidney disease can work with you to create a meal plan that includes foods that are healthy for you and that you enjoy eating. Cooking and preparing your food from scratch can help you eat healthier.

Nutrition counseling from a registered dietitian to help meet your medical or health goals is called medical nutrition therapy (MNT). If you have diabetes or kidney disease and a referral from your primary care provider, your health insurance may cover MNT. If you qualify for Medicare, MNT is covered.

Your health care provider may be able to refer you to a dietitian. You can also find a registered dietitian online through the Academy of Nutrition and Dietetics. Work closely with your dietitian to learn to eat right for CKD.

Make physical activity part of your routine

Be active for 30 minutes or more on most days. Physical activity can help you reduce stress, manage your weight, and achieve your blood pressure and blood glucose goals. If you are not active now, ask your health care provider about the types and amounts of physical activity that are right for you.

View physical activity and weight-management resources to help you get and stay motivated.

Aim for a healthy weight

Being overweight makes your kidneys work harder and may damage your kidneys. The NIH Body Weight Planner is an online tool to help you tailor your plans to achieve and stay at a healthy weight. The Body Weight Planner is part of the SuperTracker, a free food-, physical activity-, and weight-tracking tool from ChooseMyPlate.gov that will help you build a healthier diet, manage your weight, and reduce your risk of chronic disease, including kidney disease.

Get enough sleep

Aim for 7 to 8 hours of sleep each night. Getting enough sleep is important to your overall physical and mental health and can help you meet your blood pressure and blood glucose goals. You can take steps to improve your sleep habits.

Stop smoking

Cigarette smoking can make kidney damage worse. Quitting smoking may help you meet your blood pressure goals, which is good for your kidneys, and can lower your chances of having a heart attack or stroke. For tips on quitting, go to Smokefree.gov.

Find healthy ways to cope with stress and depression

Long-term stress can raise your blood pressure and your blood glucose and lead to depression. Some of the steps that you are taking to manage your kidney disease are also healthy ways to cope with stress. For example, physical activity and sleep help reduce stress. Listening to your favorite music, focusing on something calm or peaceful, or meditating may also help you. Learn more about healthy ways to cope with stress.

Depression is common among people with a chronic, or long-term, illness. Depression can make it harder to manage your kidney disease. Ask for help if you feel down. Seek help from a mental health professional. Talking with a support group, clergy member, friend, or family member who will listen to your feelings may help.

Eating Right

You may need to change what you eat to manage your chronic kidney disease (CKD). Work with a registered dietitian to develop a meal plan that includes foods that you enjoy eating while maintaining your kidney health.

The steps below will help you eat right as you manage your kidney disease. The first three steps (1-3) are important for all people with kidney disease. The last two steps (4-5) may become important as your kidney function goes down.

The first steps to eating right

Step 1: Choose and prepare foods with less salt and sodium

Why? To help control your blood pressure. Your diet should contain less than 2,300 milligrams of sodium each day.

  • Buy fresh food often. Sodium (a part of salt) is added to many prepared or packaged foods you buy at the supermarket or at restaurants.
  • Cook foods from scratch instead of eating prepared foods, “fast” foods, frozen dinners, and canned foods that are higher in sodium. When you prepare your own food, you control what goes into it.
  • Use spices, herbs, and sodium-free seasonings in place of salt.
  • Check for sodium on the Nutrition Facts label of food packages. A Daily Value of 20 percent or more means the food is high in sodium.
  • Try lower-sodium versions of frozen dinners and other convenience foods.
  • Rinse canned vegetables, beans, meats, and fish with water before eating.

Look for food labels with words like sodium free or salt free; or low, reduced, or no salt or sodium; or unsalted or lightly salted.

An example of a Nutrition Facts food label that shows a Percent Daily Value of 5 percent of sodium per serving.
Look for sodium on the food label. A food label showing a Percent Daily Value of 5% or less is low sodium. Also look for the amount of saturated and trans fats listed on the label.

Step 2: Eat the right amount and the right types of protein

Why? To help protect your kidneys. When your body uses protein, it produces waste. Your kidneys remove this waste. Eating more protein than you need may make your kidneys work harder.

  • Eat small portions of protein foods.
  • Protein is found in foods from plants and animals. Most people eat both types of protein. Talk to your dietitian about how to choose the right combination of protein foods for you.

Animal-protein foods:

  • Chicken
  • Fish
  • Meat
  • Eggs
  • Dairy

A cooked portion of chicken, fish, or meat is about 2 to 3 ounces or about the size of a deck of cards. A portion of dairy foods is ½ cup of milk or yogurt, or one slice of cheese.

Plant-protein foods:

  • Beans
  • Nuts
  • Grains

A portion of cooked beans is about ½ cup, and a portion of nuts is ¼ cup. A portion of bread is a single slice, and a portion of cooked rice or cooked noodles is ½ cup.

Step 3: Choose foods that are healthy for your heart

Why? To help keep fat from building up in your blood vessels, heart, and kidneys. To help keep fat from building up in your blood vessels, heart, and kidneys.

  • Grill, broil, bake, roast, or stir-fry foods, instead of deep frying.
  • Cook with nonstick cooking spray or a small amount of olive oil instead of butter.
  • Trim fat from meat and remove skin from poultry before eating.
  • Try to limit saturated and trans fats. Read the food label.

Heart-healthy foods:

  • Lean cuts of meat, such as loin or round
  • Poultry without the skin
  • Fish
  • Beans
  • Vegetables
  • Fruits
  • Low-fat or fat-free milk, yogurt, and cheese

Learn more about heart-healthy eating.

A photo of an older couple making a heart-healthy meal.
Choose heart-healthy foods to help protect your blood vessels, heart, and kidneys.

Limit alcohol
Drink alcohol only in moderation: no more than one drink per day if you are a woman, and no more than two if you are a man. Drinking too much alcohol can damage the liver, heart, and brain and cause serious health problems. Ask your health care provider how much alcohol you can drink safely.

The next steps to eating right

As your kidney function goes down, you may need to eat foods with less phosphorus and potassium. Your health care provider will use lab tests to check phosphorus and potassium levels in your blood, and you can work with your dietitian to adjust your meal plan. More information is provided in the NIDDK health topic, Nutrition for Advanced Chronic Kidney Disease.

Step 4: Choose foods and drinks with less phosphorus

Why? To help protect your bones and blood vessels. When you have CKD, phosphorus can build up in your blood. Too much phosphorus in your blood pulls calcium from your bones, making your bones thin, weak, and more likely to break. High levels of phosphorus in your blood can also cause itchy skin, and bone and joint pain.

  • Many packaged foods have added phosphorus. Look for phosphorus—or for words with “PHOS”—on ingredient labels.
  • Deli meats and some fresh meat and poultry can have added phosphorus. Ask the butcher to help you pick fresh meats without added phosphorus.

Your health care provider may talk to you about taking a phosphate binder with meals to lower the amount of phosphorus in your blood. A phosphate binder is a medicine that acts like a sponge to soak up, or bind, phosphorus while it is in the stomach. Because it is bound, the phosphorus does not get into your blood. Instead, your body removes the phosphorus through your stool.

Step 5: Choose foods with the right amount of potassium

Why? To help your nerves and muscles work the right way. Problems can occur when blood potassium levels are too high or too low. Damaged kidneys allow potassium to build up in your blood, which can cause serious heart problems. Your food and drink choices can help you lower your potassium level, if needed.

  • Salt substitutes can be very high in potassium. Read the ingredient label. Check with your provider about using salt substitutes.
  • Drain canned fruits and vegetables before eating.
Foods Lower in Potassium
  • Apples, peaches
  • Carrots, green beans
  • White bread and pasta
  • White rice
  • Rice milk (not enriched)
  • Cooked rice and wheat cereals, grits
  • Apple, grape, or cranberry juice
Foods Higher in Potassium
  • Oranges, bananas, and orange juice
  • Potatoes, tomatoes
  • Brown and wild rice
  • Bran cereals
  • Dairy foods
  • Whole-wheat bread and pasta
  • Beans and nuts
Foods Lower in Phosphorus
  • Fresh fruits and vegetables
  • Breads, pasta, rice
  • Rice milk (not enriched)
  • Corn and rice cereals
  • Light-colored sodas/pop, such as lemon-lime or homemade iced tea
Foods Higher in Phosphorus
  • Meat, poultry, fish
  • Bran cereals and oatmeal
  • Dairy foods
  • Beans, lentils, nuts
  • Dark-colored sodas/pop, fruit punch, some bottled or canned iced teas that have added phosphorus

Some medicines also can raise your potassium level. Your health care provider may adjust the medicines you take.

View tips for people with chronic kidney disease:

Preventing CKD

You are more likely to develop kidney disease if you have

  • diabetes
  • high blood pressure
  • heart disease
  • a family history of kidney failure

What can I do to keep my kidneys healthy?

You can protect your kidneys by preventing or managing health conditions that cause kidney damage, such as diabetes and high blood pressure. The steps described below may help keep your whole body healthy, including your kidneys.

During your next medical visit, you may want to ask your health care provider about your kidney health. Early kidney disease may not have any symptoms, so getting tested may be the only way to know your kidneys are healthy. Your health care provider will help decide how often you should be tested.

See a provider right away if you develop a urinary tract infection (UTI), which can cause kidney damage if left untreated.

Make healthy food choices

Choose foods that are healthy for your heart and your entire body: fresh fruits, fresh or frozen vegetables, whole grains, and low-fat or fat-free dairy products. Eat healthy meals, and cut back on salt and added sugars. Aim for less than 2,300 milligrams of sodium each day. Try to have less than 10 percent of your daily calories come from added sugars.

Photo of a healthy food choice: a grilled chicken breast with salad.
Choose foods that are healthy for your body.

Tips for making healthy food choices

  • Cook with a mix of spices instead of salt.
  • Choose veggie toppings such as spinach, broccoli, and peppers for your pizza.
  • Try baking or broiling meat, chicken, and fish instead of frying.
  • Serve foods without gravy or added fats.
  • Try to choose foods with little or no added sugar.
  • Gradually work your way down from whole milk to 2 percent milk until you’re drinking and cooking with fat-free (skim) or low-fat milk and milk products.
  • Eat foods made from whole grains—such as whole wheat, brown rice, oats, and whole-grain corn—every day. Use whole-grain bread for toast and sandwiches; substitute brown rice for white rice for home-cooked meals and when dining out.
  • Read food labels. Choose foods low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
  • Slow down at snack time. Eating a bag of low-fat popcorn takes longer than eating a slice of cake. Peel and eat an orange instead of drinking orange juice.
  • Try keeping a written record of what you eat for a week. It can help you see when you tend to overeat or eat foods high in fat or calories.

Research has shown that the DASH eating plan may help you lower your blood pressure. If you have diabetes, high blood pressure, or heart disease, you may want to locate and work with a dietitian to create a meal plan that meets your needs.

Make physical activity part of your routine

Be active for 30 minutes or more on most days. If you are not active now, ask your health care provider about the types and amounts of physical activity that are right for you. Add more activity to your life with these tips to help you get active.

Aim for a healthy weight

The NIH Body Weight Planner is an online tool to help you tailor your plans to achieve and stay at a healthy weight. The Body Weight Planner is a part of the SuperTracker, a free food-, physical activity-, and weight-tracking tool from ChooseMyPlate.gov that will help you build a healthier diet, manage your weight, and reduce your risk of chronic disease, including kidney disease.

If you are overweight or obese, work with your health care provider or dietitian to create a realistic weight-loss plan. View more weight control and physical activity resources to help you get and stay motivated.

Get enough sleep

Aim for 7 to 8 hours of sleep each night. If you have trouble sleeping, take steps to improve your sleep habits.

Stop smoking

If you smoke or use other tobacco products, stop. Ask for help so you don’t have to do it alone. You can start by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips on quitting, go to Smokefree.gov.

Limit alcohol intake

Drinking too much alcohol can increase your blood pressure and add extra calories, which can lead to weight gain. If you drink alcohol, limit yourself to one drink per day if you are a woman and two drinks per day if you are a man. One drink is:

  • 12 ounces of beer
  • 5 ounces of wine
  • 1.5 ounces of liquor

Explore stress-reducing activities

Learning how to manage stress, relax, and cope with problems can improve emotional and physical health. Physical activity can help reduce stress, as can mind and body practices such as meditation, yoga, or tai chi.

Manage diabetes, high blood pressure, and heart disease

If you have diabetes, high blood pressure, or heart disease, the best way to protect your kidneys from damage is to

Keep blood glucose numbers close to your goal. Checking your blood glucose, or blood sugar, level is an important way to manage your diabetes. Your health care team may want you to test your blood glucose one or more times a day.

Keep your blood pressure numbers close to your goal. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Read more about high blood pressure.

Take all your medicines as prescribed. Talk with your health care provider about certain blood pressure medicines, called ACE inhibitors and ARBs, which may protect your kidneys. The names of these medicines end in –pril or –sartan.

Be careful about the daily use of over-the-counter pain medications. Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can damage your kidneys. Learn more about over-the-counter medicines and your kidneys.

To help prevent heart attacks and stroke, keep your cholesterol levels in the target range. There are two kinds of cholesterol in your blood: LDL and HDL. LDL or “bad” cholesterol can build up and clog your blood vessels, which can cause a heart attack or stroke. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels. A cholesterol test also may measure another type of blood fat called triglycerides.

Ask your health care provider questions

Ask your health care provider the following key questions about your kidney health during your next medical visit. The sooner you know you have kidney disease, the sooner you can get treatment to help protect your kidneys.

Key questions for your health care provider:

  • What is my glomerular filtration rate (GFR)?
  • What is my urine albumin result?
  • What is my blood pressure?
  • What is my blood glucose (for people with diabetes)?
  • How often should I get my kidneys checked?

Other important questions:

  • What should I do to keep my kidneys healthy?
  • Do I need to be taking different medicines?
  • Should I be more physically active?
  • What kind of physical activity can I do?
  • What can I eat?
  • Am I at a healthy weight?
  • Do I need to talk with a dietitian to get help with meal planning?
  • Should I be taking ACE inhibitors or ARBs for my kidneys?
  • What happens if I have kidney disease?

What If My Kidneys Fail?

Some people live with kidney disease for years and are able to maintain kidney function. Others progress quickly to kidney failure.

Kidney failure means that your kidneys have lost most of their ability to function—less than 15 percent of normal kidney function. If your kidney function drops to this level, you may have symptoms from the buildup of waste products and extra water in your body.

To replace your lost kidney function, you may have one of three treatment options:

End-stage renal disease (ESRD) is kidney failure that is treated by dialysis or kidney transplant.

Some people with kidney failure choose not to have dialysis or a transplant but continue to receive care from their health care team, take medicines, and monitor their diet and lifestyle choices.

Work with your health care team and family to consider your options and choose a treatment that is right for you.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many diseases and conditions.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Anemia

What is anemia?

Anemia is a condition in which the body has fewer red blood cells than normal. Red blood cells carry oxygen to tissues and organs throughout the body and enable them to use energy from food. With anemia, red blood cells carry less oxygen to tissues and organs—particularly the heart and brain—and those tissues and organs may not function as well as they should.

How is anemia related to chronic kidney disease?

Anemia commonly occurs in people with chronic kidney disease (CKD)—the permanent, partial loss of kidney function. Anemia might begin to develop in the early stages of CKD, when someone has 20 to 50 percent of normal kidney function. Anemia tends to worsen as CKD progresses. Most people who have total loss of kidney function, or kidney failure, have anemia.1 A person has kidney failure when he or she needs a kidney transplant or dialysis in order to live. The two forms of dialysis include hemodialysis and peritoneal dialysis. Hemodialysis uses a machine to circulate a person’s blood through a filter outside the body. Peritoneal dialysis uses the lining of the abdomen to filter blood inside the body.

What are the kidneys and what do they do?

The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine.

Healthy kidneys produce a hormone called erythropoietin (EPO). A hormone is a chemical produced by the body and released into the blood to help trigger or regulate particular body functions. EPO prompts the bone marrow to make red blood cells, which then carry oxygen throughout the body.

What causes anemia in chronic kidney disease?

When kidneys are diseased or damaged, they do not make enough EPO. As a result, the bone marrow makes fewer red blood cells, causing anemia. When blood has fewer red blood cells, it deprives the body of the oxygen it needs.

Other common causes of anemia in people with kidney disease include blood loss from hemodialysis and low levels of the following nutrients found in food:

  • iron
  • vitamin B12
  • folic acid

These nutrients are necessary for red blood cells to make hemoglobin, the main oxygen-carrying protein in the red blood cells.

If treatments for kidney-related anemia do not help, the health care provider will look for other causes of anemia, including

  • other problems with bone marrow
  • inflammatory problems—such as arthritis, lupus, or inflammatory bowel disease—in which the body’s immune system attacks the body’s own cells and organs
  • chronic infections such as diabetic ulcers
  • malnutrition
Top: process of normal red blood cell production with a healthy kidney. Bottom: process of reduced red blood cell production with a damaged kidney.
Healthy kidneys produce a hormone called EPO. EPO prompts the bone marrow to make red blood cells, which then carry oxygen throughout the body. When the kidneys are diseased or damaged, they do not make enough EPO. As a result, the bone marrow makes fewer red blood cells, causing anemia.

What are the signs and symptoms of anemia in someone with chronic kidney disease?

The signs and symptoms of anemia in someone with CKD may include

  • weakness
  • fatigue, or feeling tired
  • headaches
  • problems with concentration
  • paleness
  • dizziness
  • difficulty breathing or shortness of breath
  • chest pain

Anyone having difficulty breathing or with shortness of breath should seek immediate medical care. Anyone who has chest pain should call 911.

What are the complications of anemia in someone with chronic kidney disease?

Heart problems are a complication of anemia and may include

  • an irregular heartbeat or an unusually fast heartbeat, especially when exercising.
  • the harmful enlargement of muscles in the heart.
  • heart failure, which does not mean the heart suddenly stops working. Instead, heart failure is a long-lasting condition in which the heart can’t pump enough blood to meet the body’s needs.

How is anemia in chronic kidney disease diagnosed?

A health care provider diagnoses anemia based on

  • a medical history
  • a physical exam
  • blood tests

Medical History

Taking a medical history is one of the first things a health care provider may do to diagnose anemia. He or she will usually ask about the patient’s symptoms.

Physical Exam

A physical exam may help diagnose anemia. During a physical exam, a health care provider usually examines a patient’s body, including checking for changes in skin color.

Blood Tests

To diagnose anemia, a health care provider may order a complete blood count, which measures the type and number of blood cells in the body. A blood test involves drawing a patient’s blood at a health care provider’s office or a commercial facility. A health care provider will carefully monitor the amount of hemoglobin in the patient’s blood, one of the measurements in a complete blood count.

The Kidney Disease: Improving Global Outcomes Anemia Work Group recommends that health care providers diagnose anemia in males older than age 15 when their hemoglobin falls below 13 grams per deciliter (g/dL) and in females older than 15 when it falls below 12 g/dL.2 If someone has lost at least half of normal kidney function and has low hemoglobin, the cause of anemia may be decreased EPO production.

Two other blood tests help measure iron levels:

  • The ferritin level helps assess the amount of iron stored in the body. A ferritin score below 200 nanograms (ng) per milliliter may mean a person has iron deficiency that requires treatment.2
  • The transferrin saturation score indicates how much iron is available to make red blood cells. A transferrin saturation score below 30 percent can also mean low iron levels that require treatment.2

In addition to blood tests, the health care provider may order other tests, such as tests for blood loss in stool, to look for other causes of anemia.

How is anemia in chronic kidney disease treated?

Depending on the cause, a health care provider treats anemia with one or more of the following treatments:

Iron

The first step in treating anemia is raising low iron levels. Iron pills may help improve iron and hemoglobin levels. However, for patients on hemodialysis, many studies show pills do not work as well as iron given intravenously.2

Erythropoietin

If blood tests indicate kidney disease as the most likely cause of anemia, treatment can include injections of a genetically engineered form of EPO. A health care provider, often a nurse, injects the patient with EPO subcutaneously, or under the skin, as needed. Some patients learn how to inject the EPO themselves. Patients on hemodialysis may receive EPO intravenously during hemodialysis.

Studies have shown the use of EPO increases the chance of cardiovascular events, such as heart attack and stroke, in people with CKD. The health care provider will carefully review the medical history of the patient and determine if EPO is the best treatment for the patient’s anemia. Experts recommend using the lowest dose of EPO that will reduce the need for red blood cell transfusions. Additionally, health care providers should consider the use of EPO only when a patient’s hemoglobin level is below 10 g/dL. Health care providers should not use EPO to maintain a patient’s hemoglobin level above 11.5 g/dL.2 Patients who receive EPO should have regular blood tests to monitor their hemoglobin so the health care provider can adjust the EPO dose when the level is too high or too low.2 Health care providers should discuss the benefits and risks of EPO with their patients.

Many people with kidney disease need iron supplements and EPO to raise their red blood cell count to a level that will reduce the need for red blood cell transfusions. In some people, iron supplements and EPO will improve the symptoms of anemia.

Red Blood Cell Transfusions

If a patient’s hemoglobin falls too low, a health care provider may prescribe a red blood cell transfusion. Transfusing red blood cells into the patient’s vein raises the percentage of the patient’s blood that consists of red blood cells, increasing the amount of oxygen available to the body.

Vitamin B12 and Folic Acid Supplements

A health care provider may suggest vitamin B12 and folic acid supplements for some people with CKD and anemia. Using vitamin supplements can treat low levels of vitamin B12 or folic acid and help treat anemia. To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements, with their health care provider.

Read more about vitamin B12 and folic acid on the MedlinePlus website at www.nlm.nih.gov/medlineplus. Read more about complementary and alternative medicine at www.nccam.nih.gov.

Eating, Diet, and Nutrition

A health care provider may advise people with kidney disease who have anemia caused by iron, vitamin B12, or folic acid deficiencies to include sources of these nutrients in their diets. Some of these foods are high in sodium or phosphorus, which people with CKD should limit in their diet. Before making any dietary changes, people with CKD should talk with their health care provider or with a dietitian who specializes in helping people with kidney disease. A dietitian can help a person plan healthy meals.

Read more about nutrition for people with CKD on the National Kidney Disease Education Program page.

The following chart illustrates some good dietary sources of iron, vitamin B12, and folic acid.

Food Serving Size Iron Vitamin B12 Folic Acid
100 percent fortified breakfast cereal ¾ cup (1 oz) 18 mg 6 mcg 394 mcg
beans, baked 1 cup (8 oz) 8 mg 0 mcg 37 mcg
beef, ground 3 oz 2 mg 2 mcg 8 mcg
beef liver 3 oz 5 mg 67 mcg 211 mcg
clams, fried 4 oz 3 mg 1 mcg 66 mcg
spinach, boiled 1 cup (3 oz) 2 mg 0 mcg 115 mcg
spinach, fresh 1 cup (1 oz) 1 mg 0 mcg 58 mcg
trout 3 oz 0 mg 5 mcg 16 mcg
tuna, canned 3 oz 1 mg 1 mcg 2 mcg

Points to Remember

  • Anemia is a condition in which the body has fewer red blood cells than normal. Red blood cells carry oxygen to tissues and organs throughout the body and enable them to use energy from food.
  • Anemia commonly occurs in people with chronic kidney disease (CKD)—the permanent, partial loss of kidney function. Most people who have total loss of kidney function, or kidney failure, have anemia.
  • When kidneys are diseased or damaged, they do not make enough erythropoietin (EPO). As a result, the bone marrow makes fewer red blood cells, causing anemia.
  • Other common causes of anemia in people with kidney disease include blood loss from hemodialysis and low levels of the following nutrients found in food:
    • iron
    • vitamin B12
    • folic acid
  • The first step in treating anemia is raising low iron levels.
  • If blood tests indicate kidney disease as the most likely cause of anemia, treatment can include injections of a genetically engineered form of EPO.
  • Many people with kidney disease need iron supplements and EPO to raise their red blood cell count to a level that will reduce the need for red blood cell transfusions.
  • A health care provider may suggest vitamin B12 and folic acid supplements for some people with CKD and anemia.
  • A health care provider may advise people with kidney disease who have anemia caused by iron, vitamin B12, or folic acid deficiencies to include sources of these nutrients in their diets.

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

About the Kidney Failure Series

You and your doctor will work together to choose a treatment that's best for you. The publications of the NIDDK Kidney Failure Series can help you learn about the specific issues you will face.

Booklets

Fact Sheets

High Blood Pressure

What is high blood pressure?

Blood pressure is the force of blood pushing against blood vessel walls as the heart pumps out blood, and high blood pressure, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the body. Factors that can increase this force include higher blood volume due to extra fluid in the blood and blood vessels that are narrow, stiff, or clogged.

Picture of blood flowing through a normal blood vessel, blood flowing through a narrowed blood vessel, and too much blood flowing through a normal blood vessel.
Blood pressure is the force of blood pushing against blood vessel walls as the heart pumps out blood.

Blood pressure test results are written with two numbers separated by a slash. For example, a health care provider will write a blood pressure result as 120/80. A health care provider will say this blood pressure result as “120 over 80.” The top number is called the systolic pressure and represents the pressure as the heart beats and pushes blood through the blood vessels. The bottom number is called the diastolic pressure and represents the pressure as blood vessels relax between heartbeats.

Most people without chronic health conditions have a normal blood pressure if it stays below 120/80. Prehypertension is a systolic pressure of 120 to 139 or a diastolic pressure of 80 to 89. High blood pressure is a systolic pressure of 140 or above or a diastolic pressure of 90 or above.1

People should talk with their health care provider about their individual blood pressure goals and how often they should have their blood pressure checked.

What are the kidneys and what do they do?

The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. In men the urethra is long, while in women it is short.

Kidneys work at the microscopic level. The kidney is not one large filter. Each kidney is made up of about a million filtering units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a two-step process. The glomerulus lets fluid and waste products pass through it; however, it prevents blood cells and large molecules, mostly proteins, from passing. The filtered fluid then passes through the tubule, which sends needed minerals back to the bloodstream and removes wastes. The final product becomes urine.

Urinary tract inside the outline of the upper half of a human body and a drawing of a kidney with an inset of a nephron.
Each kidney is made up of about a million filtering units called nephrons.

How does high blood pressure affect the kidneys?

High blood pressure can damage blood vessels in the kidneys, reducing their ability to work properly. When the force of blood flow is high, blood vessels stretch so blood flows more easily. Eventually, this stretching scars and weakens blood vessels throughout the body, including those in the kidneys.

If the kidneys’ blood vessels are damaged, they may stop removing wastes and extra fluid from the body. Extra fluid in the blood vessels may then raise blood pressure even more, creating a dangerous cycle.

High blood pressure is the second leading cause of kidney failure in the United States after diabetes, as illustrated in Figure 1.2 In addition, the rate of kidney failure due to high blood pressure increased 7.7 percent from 2000 to 2010.3

Figure 1. Causes of kidney failure in the United States

A pie chart listing the causes of kidney failure in the United States.

What are the symptoms of high blood pressure and kidney disease?

Most people with high blood pressure do not have symptoms. In rare cases, high blood pressure can cause headaches.

Kidney disease also does not have symptoms in the early stages. A person may have swelling called edema, which happens when the kidneys cannot get rid of extra fluid and salt. Edema can occur in the legs, feet, or ankles and less often in the hands or face. Once kidney function decreases further, symptoms can include

  • appetite loss
  • nausea
  • vomiting
  • drowsiness or feeling tired
  • trouble concentrating
  • sleep problems
  • increased or decreased urination
  • generalized itching or numbness
  • dry skin
  • headaches
  • weight loss
  • darkened skin
  • muscle cramps
  • shortness of breath
  • chest pain

How are high blood pressure and kidney disease diagnosed?

A health care provider diagnoses high blood pressure when multiple blood pressure tests—often repeated over several visits to a health care provider’s office—show that a systolic blood pressure is consistently above 140 or a diastolic blood pressure is consistently above 90. Health care providers measure blood pressure with a blood pressure cuff. People can also buy blood pressure cuffs at discount chain stores and drugstores to monitor their blood pressure at home.

Kidney disease is diagnosed with urine and blood tests.

A male doctor taking the blood pressure of a female patient.
Health care providers measure blood pressure with a blood pressure cuff.

Urine Tests

Dipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine. Albumin is a protein in the blood that can pass into the urine when the kidneys are damaged. A patient collects the urine sample in a special container in a health care provider’s office or a commercial facility. The office or facility tests the sample onsite or sends it to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick change color when blood or protein is present in urine.

Urine albumin-to-creatinine ratio. A health care provider uses the albumin and creatinine measurement to determine the ratio between the albumin and creatinine in the urine. Creatinine is a waste product in the blood that is filtered in the kidneys and excreted in the urine. A urine albumin-to-creatinine ratio above 30 mg/g may be a sign of kidney disease.

Blood Test

A blood test involves having blood drawn at a health care provider’s office or a commercial facility and sending the sample to a lab for analysis. A health care provider may order a blood test to estimate how much blood the kidneys filter each minute, called the estimated glomerular filtration rate (eGFR). The results of the test indicate the following:

  • eGFR of 60 or above is in the normal range
  • eGFR below 60 may indicate kidney damage
  • eGFR of 15 or below may indicate kidney failure

Get Screened for Kidney Disease

Kidney disease, when found early, can be treated to prevent more serious disease and other complications. The National Kidney Foundation recommends people with high blood pressure receive the following regular screenings:

  • blood pressure tests
  • urine albumin
  • eGFR

Health care providers will help determine how often people with high blood pressure should be screened.

How can people prevent or slow the progression of kidney disease from high blood pressure?

The best way to slow or prevent kidney disease from high blood pressure is to take steps to lower blood pressure. These steps include a combination of medication and lifestyle changes, such as

  • healthy eating
  • physical activity
  • maintaining a healthy weight
  • quitting smoking
  • managing stress

No matter what the cause of the kidney disease, high blood pressure can increase damage to the kidneys. People with kidney disease should keep their blood pressure below 140/90.4

Medication

Medications that lower blood pressure can also significantly slow the progression of kidney disease. Two types of blood pressure-lowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have been shown effective in slowing the progression of kidney disease. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a health care provider may prescribe a diuretic—a medication that helps the kidneys remove fluid from the blood. A person may also need beta blockers, calcium channel blockers, and other blood pressure medications.

Eating, Diet, and Nutrition

Following a healthy eating plan can help lower blood pressure. A health care provider may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan. DASH focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and lower in sodium, which often comes from salt. The DASH eating plan

  • is low in fat and cholesterol
  • features fat-free or low-fat milk and dairy products, fish, poultry, and nuts
  • suggests less red meat, sweets, added sugars, and sugar-containing beverages
  • is rich in nutrients, protein, and fiber

Read more about DASH at www.nhlbi.nih.gov/health/resources/heart/hbp-dash-index.htm.

A dietitian may also recommend this type of diet for people who have already developed kidney disease. A diet low in sodium and liquid intake can help reduce edema and lower blood pressure. Reducing saturated fat and cholesterol can help control high levels of lipids, or fats, in the blood.

Health care providers may recommend that people with kidney disease eat moderate or reduced amounts of protein, though the benefits of reducing protein in a person’s diet is still being researched. Proteins break down into waste products that the kidneys filter from the blood. Eating more protein than the body needs may burden the kidneys and cause kidney function to decline faster. However, protein intake that is too low may lead to malnutrition, a condition that occurs when the body does not get enough nutrients. People with kidney disease who are on a restricted protein diet should be monitored with blood tests that can show low nutrient levels.

In addition, consuming too much alcohol raises blood pressure, so people should limit alcoholic drinks—two per day for men and one per day for women.

A health care provider can help people change their diet to meet their individual needs.

Physical Activity

Regular physical activity can lower blood pressure and reduce the chances of other health problems. A health care provider can provide information about how much and what kinds of activity are safe. Most people should try to get at least 30 to 60 minutes of activity most or all days of the week. A person can do all physical activity at once or break up activities into shorter periods of at least 10 minutes each. Moderate activities include brisk walking, dancing, bowling, riding a bike, working in a garden, and cleaning the house.

Body Weight

People who are overweight or obese should aim to reduce their weight by 7 to 10 percent during the first year of treatment for high blood pressure. This amount of weight loss can lower the chance of health problems related to high blood pressure. Overweight is defined as a body mass index (BMI)—a measurement of weight in relation to height—of 25 to 29. A BMI of 30 or higher is considered obese. A BMI lower than 25 is the goal for keeping blood pressure under control.5

Smoking

People who smoke should quit. Smoking can damage blood vessels, raise the chance of high blood pressure, and worsen health problems related to high blood pressure. People with high blood pressure should talk with their health care provider about programs and products they can use to quit smoking.

Stress

Learning how to manage stress, relax, and cope with problems can improve emotional and physical health. Some activities that may help reduce stress include

  • exercising
  • practicing yoga or tai chi
  • listening to music
  • focusing on something calm or peaceful
  • meditating

Points to Remember

  • Blood pressure is the force of blood pushing against blood vessel walls as the heart pumps out blood, and high blood pressure, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the body.
  • High blood pressure can damage blood vessels in the kidneys, reducing their ability to work properly. When the force of blood flow is high, blood vessels stretch so blood flows more easily. Eventually, this stretching scars and weakens blood vessels throughout the body, including those in the kidneys.
  • High blood pressure is the second leading cause of kidney failure in the United States after diabetes.
  • A health care provider diagnoses high blood pressure when multiple blood pressure tests—often repeated over several visits to a health care provider’s office—show that a systolic blood pressure is consistently above 140 or a diastolic blood pressure is consistently above 90.
  • Kidney disease is diagnosed with urine and blood tests.
  • The best way to slow or prevent kidney damage from high blood pressure is to take steps to lower blood pressure. These steps include a combination of medication and lifestyle changes, such as
    • healthy eating
    • physical activity
    • maintaining a healthy weight
    • quitting smoking
    • managing stress
  • No matter what the cause of the kidney disease, high blood pressure can increase damage to the kidneys. People with kidney disease should keep their blood pressure below 140/90.

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Heart Disease

If I have kidney disease, why should I learn about heart disease?

If you have kidney disease, you are more likely to get heart disease. Heart disease is the most common cause of death among people who have kidney disease. However, learning about kidney disease and heart disease can help you find ways to stay healthy.

Illustration of torso with bone structure, kidneys, heart, veins and arteries.
If you have kidney disease, you are more likely to get heart disease.

What is kidney disease?

Kidney disease means that the kidneys are damaged and can’t filter blood as they should. This damage can cause wastes to build up in the body. For most people, kidney damage occurs slowly over many years. This gradual loss of kidney function is called chronic kidney disease (CKD).

Most patients with CKD have no symptoms until kidney damage is advanced. After many years, you may start to feel sick or tired all of the time. Kidney failure is when you need a kidney transplant or a blood filtering treatment called dialysis to stay alive. Before you reach that stage, other health problems may develop. One of these problems is heart disease.

What is heart disease?

Heart disease includes any problem that keeps your heart from pumping blood as well as it should. The problem might start in your blood vessels or your heart. Heart and blood vessel problems include

  • the buildup of a substance called plaque in the walls of the blood vessels
  • a blood clot that blocks the flow of blood to the heart
  • heart attack—heart damage caused by a lack of blood and oxygen to the heart

The buildup of plaque is often the first step in making other problems. Plaque can block blood flow.

Illustration of a normal blood vessels
Normal blood vessel
Illustration of a blood vessel with plaque.
Blood vessel with plaque
Illustration of a blood vessel with plaque and blood clot.
Blood vessel with plaque and blood clot

The early symptoms of plaque in your blood vessels include

  • pain in your chest, called angina
  • pain in your legs when walking
  • sudden numbness or weakness in your arms or legs
  • temporary signs of a stroke—a blockage of blood to the brain—such as having a hard time speaking or drooping muscles in your face
  • feeling dizzy at times

A blood clot may form in a blood vessel that carries blood to the heart muscle. Then your heart muscle does not get the oxygen and nutrients it needs from the blood. The muscle becomes damaged. The damage to your heart caused by this blockage and lack of oxygen is called a heart attack.

Each person may have different heart attack symptoms. Symptoms can include

  • chest pains or discomfort, or often a sense of chest pressure
  • pain or discomfort in one or both arms—often the left arm—or in the back, jaw, neck, or stomach
  • shortness of breath
  • heavy sweating
  • nausea or vomiting
  • light-headedness

Women may not have chest pain. However, women may be more likely to have shortness of breath, nausea, or back and jaw pain.

If you have any of these symptoms, call 911 right away. You can start getting treatment in the ambulance on your way to the emergency room.

How are kidney disease and heart disease related?

Kidney disease and heart disease share two of the same main causes:

Diabetes

If you have diabetes, you have too much glucose, also called sugar, in your blood. Too much glucose in your blood for a long time can damage many parts of your body, including your heart and kidneys. More information is provided in the following NIDDK health topics:

High Blood Pressure

Blood pressure is the force of your blood pushing against the walls of your blood vessels. With high blood pressure, your heart works harder to pump blood, which can strain your heart. High blood pressure can damage your blood vessels. If high blood pressure damages the small blood vessels in your kidneys, your kidneys will not filter your blood as well as they should.

Blood pressure is written as two numbers separated by a slash. A doctor will say a blood pressure reading of 120/80 as “120 over 80.” The top number represents the force of blood pressing against the blood vessel walls when the heart is contracting. The bottom number represents the pressure when the heart is at rest between contractions. You should keep your blood pressure below 140/90 unless your doctor sets a different goal. Controlling your blood pressure can help protect your heart and kidneys.

High blood pressure is not only a cause of kidney disease; kidney disease is also a cause of high blood pressure. When you have damaged kidneys, they may be unable to filter extra water and salt from your body. The high blood pressure that results can then make kidney disease worse. Worsening kidney disease can raise blood pressure again. A dangerous cycle results as each disease makes the other worse. More information is provided in the NIDDK health topic, High Blood Pressure and Kidney Disease.

Who gets kidney disease?

You are more likely to develop kidney disease if you have

  • diabetes
  • high blood pressure
  • heart disease
  • lupus
  • a family member who has kidney failure

African Americans, Hispanics/Latinos, American Indians, and Alaska Natives are also more likely to develop kidney disease.

Who gets heart disease?

You are more likely to develop heart disease if you have

  • high blood pressure
  • high blood cholesterol, a blood fat
  • diabetes
  • kidney disease
  • a family history of early heart disease

You are also more likely to develop heart disease if you

  • smoke
  • eat a diet high in the wrong kinds of fats
  • have too much sodium—often from salt—in your diet
  • are overweight
  • don’t exercise
  • are a man age 45 or older
  • are a woman age 55 or older

What are the tests for kidney disease?

Tests for kidney disease include a blood test and a urine test. Both tests can be done in your doctor’s office or at a commercial facility.

  • The blood test checks your GFR, which tells how well your kidneys are filtering. GFR stands for glomerular filtration rate.
  • The urine test checks for albumin in your urine. Albumin is a protein that can pass into the urine when the kidneys are damaged.

If these tests show you have kidney disease, you may need to repeat these tests on a regular basis. More information is provided in the NIDDK health topic, Testing for Kidney Disease.

What are the tests for heart disease?

You can get several routine tests for heart disease in your doctor’s office or at an outpatient center, including

  • a blood pressure test
  • a blood test for cholesterol
  • an electrocardiogram—a test using sensors stuck to your skin to record the electrical signals that keep your heart beating

Another test, called a stress test, measures how your heart works during physical activity, such as walking, running on a treadmill, or riding a bike. This test usually takes place in a hospital or a specialized outpatient center.

If these tests show that you have heart disease, your doctor may want to do more tests.

How are kidney disease and heart disease treated?

If you have kidney disease or heart disease, your health care provider will want you to control your blood glucose if you have diabetes and your blood pressure if you have high blood pressure. Your health care provider may prescribe medicines to keep your blood glucose and blood pressure under control. Medicines for blood glucose control can include insulin injections and pills. Certain medicines for blood pressure may also keep your kidney disease from getting worse.

Another important part of treating kidney disease and heart disease includes living a healthy lifestyle. Staying active can help protect your kidneys and your heart. Try to be active for 30 minutes or more most days of the week. Start with easy activities such as walking slowly or raking leaves. Later, try some activities that get your heart pumping, such as walking briskly or swimming. Always talk with your health care provider before starting any new exercise program. You can find more information about about weight control and physical activity at NIDDK's Weight Control Information Network. See the “Eating, Diet, and Nutrition” section below for tips on eating a healthy diet that will protect your heart and kidneys.

How can I prevent kidney disease and heart disease?

You cannot always prevent kidney disease and heart disease. However, you can lower your chance of having kidney disease and heart disease by taking the following steps:

  • See your health care provider as directed.
  • Keep your blood pressure below 140/90. Follow your provider’s advice on how to stay at or below your target.
  • Control your blood glucose if you have diabetes.
  • Have your blood and urine checked as your provider instructs.
  • Try to keep your cholesterol numbers in a healthy range. Talk with your provider about your cholesterol goals.
  • Control your weight. If you are overweight, talk with your provider about how you can lose weight.
  • Be physically active 30 minutes a day most days of the week.
  • Take all medicines as prescribed.
  • Eat healthy—see “Eating, Diet, and Nutrition.”

Eating, Diet, and Nutrition

A healthy diet can help protect you from heart disease and kidney disease. Keep your heart and kidneys healthy by eating plenty of the following foods:

  • fruits and vegetables
  • whole-grain breads and cereals
  • low-fat milk and milk products such as yogurt and cheese
  • lean meats or meat substitutes such as tofu
  • fish
  • unsaturated fats such as olive oil or corn oil
  • low-sodium foods

People with advanced chronic kidney disease may need to adjust their diet to avoid high potassium. If you have advanced kidney disease, you may need to limit foods such as bananas, oranges, potatoes, and tomatoes and eat apples, berries, grapes, and peaches instead. Check with your provider to find out if you should cut back on your potassium. Do not alter your diet without checking because you might eat less of these healthy fruits and vegetables unnecessarily.

More information is provided in the NIDDK health topic, Potassium: Tips for People with Chronic Kidney Disease.

You need protein. However, protein breaks down into wastes that your kidneys need to remove. Most people eat more protein than they need. Large amounts of protein make your kidneys work harder. High-quality proteins such as meat, fish, and eggs make fewer wastes than other sources of protein. Beans, whole grains, soy products, nuts and nut butters, and dairy products can also be good sources of protein.

More information is provided in the NIDDK health topic, Protein: Tips for People with Chronic Kidney Disease.

Phosphorus is a mineral that helps keep your bones healthy. Phosphorus also helps blood vessels and muscles work. Phosphorus is found naturally in foods rich in protein, such as meat, poultry, fish, nuts, beans, and dairy products. Phosphorus is also added to many processed foods. When you have kidney disease, phosphorus can build up in your blood, making your bones thin, weak, and more likely to break. Many people with kidney disease need to eat foods with less phosphorus than they are used to eating.

More information is provided in the NIDDK health topic, Phosphorous: Tips for People with Chronic Kidney Disease.

Sodium is a part of salt. Sodium is found in many canned, packaged, and “fast” foods. Sodium is also found in many seasonings and meats. You should limit the amount of sodium you get to 2,300 mg or less each day.

More information is provided in the NIDDK health topic, Sodium: Tips for People with Chronic Kidney Disease.

A dietitian is a health care provider who helps people with kidney disease choose the right foods and plan healthy meals. Talk with a dietitian about foods that might harm you and foods you should add to your diet.

More information is provided in the NIDDK health topic, Eating Right for Kidney Health: Tips for People with Chronic Kidney Disease.

What should I ask my doctor about kidney disease and heart disease?

Some questions to ask your doctor include

  • What is my blood pressure? What should it be?
  • How often should I have my blood pressure checked?
  • Should I be taking medicines to control my blood pressure?
  • Should I be on a special diet?
  • What are my cholesterol numbers? What should they be?
  • How much exercise should I be getting?
  • Where can I get help to quit smoking?

Points to Remember

  • If you have kidney disease, you are more likely to get heart disease. Heart disease is the most common cause of death among people who have kidney disease.
  • Kidney disease means that the kidneys are damaged and can’t filter blood as they should. This damage can cause wastes to build up in the body.
  • Heart disease includes any problem that keeps your heart from pumping blood as well as it should. The problem might start in your blood vessels or your heart.
  • Tests for kidney disease include a blood test and a urine test.
  • You can get several routine tests for heart disease in your doctor’s office or at an outpatient center, including
    • a blood pressure test
    • a blood test for cholesterol
    • an electrocardiogram
    • a stress test
  • If you have kidney disease or heart disease, you will want to control your blood glucose if you have diabetes, and your blood pressure if you have high blood pressure.
  • You can lower your chance of having kidney disease and heart disease by taking the following steps:
    • See your health care provider as directed.
    • Keep your blood pressure below 140/90. Follow your provider’s advice on how to stay at or below your target.
    • Control your blood glucose if you have diabetes.
    • Have your blood and urine checked as recommended.
    • Try to keep your cholesterol numbers in a healthy range.
    • Control your weight. If you are overweight, talk with your provider about how you can lose weight.
    • Be physically active 30 minutes a day most days of the week.
    • Take all medicines as prescribed.
    • Eat healthy.
  • You should limit the amount of sodium you get to 2,300 mg or less each day. Sodium is a part of salt.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Mineral & Bone Disorder

What is mineral and bone disorder in chronic kidney disease (CKD)?

Mineral and bone disorder in CKD occurs when damaged kidneys and abnormal hormone levels cause calcium and phosphorus levels in a person’s blood to be out of balance. Mineral and bone disorder commonly occurs in people with CKD and affects most people with kidney failure receiving dialysis.

In the past, health care providers used the term “renal osteodystrophy” to describe mineral and hormone disturbances caused by kidney disease. Today, renal osteodystrophy only describes bone problems that result from mineral and bone disorder in CKD. Health care providers might use the phrase “chronic kidney disease mineral and bone disorder,” or CKD-MBD, to describe the condition that affects the bones, heart, and blood vessels.

What is chronic kidney disease?

Chronic kidney disease is kidney damage that occurs slowly over many years, often due to diabetes or high blood pressure. Once damaged, the kidneys can’t filter blood as they should. This damage can cause wastes to build up in the body and other problems that can harm a person’s health, including mineral and bone disorder.

Why are hormones and minerals important?

Hormones and minerals are important because they help bones stay strong. If a person’s hormones and minerals are out of balance, his or her bones can become weak and malformed. Healthy bones continuously rebuild, sometimes taking a slightly altered shape or structure. To grow and rebuild, bones need

  • the hormone calcitriol—the active form of vitamin D
  • calcium
  • phosphorus
  • parathyroid hormone

The kidneys play an important role in maintaining healthy bone mass and structure by balancing phosphorus and calcium levels in the blood. Healthy kidneys activate a form of vitamin D that a person consumes in food, turning it into calcitriol, the active form of the vitamin. Calcitriol helps the kidneys maintain blood calcium levels and promotes the formation of bone.

The kidneys also remove extra phosphorus, helping balance phosphorus and calcium levels in the blood. Keeping the proper level of phosphorus in the blood helps maintain strong bones.

The parathyroid glands, four pea-sized glands in the neck, create parathyroid hormone, or PTH. Parathyroid hormone plays an important role in controlling calcium levels in the blood. When the kidneys do not function properly, extra parathyroid hormone is released into the blood to move calcium from inside the bones into the blood.

What causes mineral and bone disorder in chronic kidney disease?

Chronic kidney disease causes mineral and bone disorder because the kidneys do not properly balance the mineral levels in the body. The kidneys

  • stop activating calcitriol. The low levels of calcitriol in the body create an imbalance of calcium in the blood.
  • do not remove the phosphorus in the blood properly, so phosphorus levels rise in the blood. The extra phosphorus pulls calcium out of the bones, causing them to weaken.

Another factor contributes to the cause of mineral and bone disorder. When the kidneys are damaged, the parathyroid gland releases parathyroid hormone into the blood to pull calcium from the bones and raise blood calcium levels. This response restores the balance of phosphorus and calcium; however, it also starves the bones of much-needed calcium.

What are the signs and symptoms of mineral and bone disorder in chronic kidney disease?

In adults, symptoms of mineral and bone disorder in CKD may not appear until bone changes have taken place for many years. For this reason, people often refer to the disease as a “silent crippler.” Eventually, a person with the condition may begin to feel bone and joint pain.

Mineral and Bone Disorder in Children with Chronic Kidney Disease

Mineral and bone disorder in CKD is most serious when it occurs in children because their bones are still developing and growing. Growing children can show symptoms of mineral and bone disorder even in the early stages of CKD. Slowed bone growth leads to short stature, which may remain with a child into adulthood. One deformity caused by mineral and bone disorder in CKD occurs when the legs bend inward or outward, a condition often referred to as "renal rickets." More information is provided in the NIDDK health topic, Growth Failure in Children with Kidney Disease. Find more about children’s bone health on the Eunice Kennedy Shriver National Institute of Child Health and Human Development website at www.nichd.nih.gov.

What are the complications of mineral and bone disorder in chronic kidney disease?

The complications of mineral and bone disorder in CKD include slowed bone growth and deformities, and heart and blood vessel problems.

Slowed Bone Growth and Deformities

Damaged kidneys must work harder to clear phosphorus from the body. High levels of phosphorus cause lower levels of calcium in the blood, resulting in the following series of events:

  • When a person’s blood calcium level becomes too low, the parathyroid glands release parathyroid hormone.
  • Parathyroid hormone removes calcium from bones and places it into the blood, raising a person’s blood calcium level at the risk of harming bones.
  • A low calcitriol level also leads to an increased level of parathyroid hormone.

If mineral and bone disorder in CKD remains untreated in adults, bones gradually become thin and weak, and a person with the condition may begin to feel bone and joint pain. Mineral and bone disorder in CKD also increases a person’s risk of bone fractures.

Heart and Blood Vessel Problems

In addition to harming bones, mineral and bone disorder in CKD can cause problems in the heart and blood vessels:

  • High levels of blood calcium can damage blood vessels and lead to heart problems.
  • High phosphorus levels also can cause blood vessels to become like bone, leading to hardening of the arteries.
  • High phosphorus levels also cause abnormal hormone regulation, even if the calcium level is acceptable.

Parathyroid hormone and another hormone made in the bones called FGF23 can also affect bone and heart health, leading to the following series of problems:

  • When parathyroid hormone or FGF23 levels are high, a person can have heart problems.
  • The complex hormone abnormalities that cause bone deformities can also harm a person’s heart and blood vessels.

How is mineral and bone disorder in chronic kidney disease diagnosed?

A health care provider diagnoses mineral and bone disorder in CKD with

  • a family and medical history
  • a physical exam
  • a blood test
  • a bone biopsy
  • an x-ray

Family and Medical History

Taking a medical and family history is one of the first things a health care provider may do to help diagnose mineral and bone disorder in CKD. He or she will ask the patient or caretaker questions about when the patient was first diagnosed with CKD and whether any family members have also had mineral and bone disorder with or without CKD.

Physical Exam

A physical exam may help diagnose mineral and bone disorder in CKD. During a physical exam, a health care provider usually examines a patient’s body for changes in bone structure.

Blood Test

A blood test involves drawing blood at a health care provider’s office or a commercial facility and sending the sample to a lab for analysis. The blood test shows levels of calcium, phosphorus, parathyroid hormone, and sometimes vitamin D.

Bone Biopsy

A bone biopsy is a procedure that removes a piece of bone tissue for examination with a microscope. A health care provider performs the biopsy in a hospital with light sedation and local anesthetic. The health care provider uses imaging techniques such as ultrasound or a computerized tomography scan to guide the biopsy needle into the hip bone. A pathologist—a doctor who specializes in diagnosing diseases—examines the bone tissue in a lab. The test can show whether a person’s bone cells are building normal bone.

X-ray

An x-ray is a picture created by using radiation and recorded on film or on a computer. The amount of radiation used is small. A radiographer performs the x-ray at a hospital or an outpatient center, and a radiologist—a doctor who specializes in medical imaging—interprets the images. Patients do not need anesthesia. The patient will lie on a table or stand during the x-ray. The technician will position the x-ray machine over the bone area. The patient will hold his or her breath as the x-ray machine takes the picture so that the picture will not be blurry. The radiographer may ask the patient to change position for additional pictures. An x-ray can show extra calcium in blood vessels.

Each of these tests can help the health care provider determine whether CKD or some other condition is causing the mineral and bone disorder and decide on a course of treatment.

How is mineral and bone disorder in chronic kidney disease treated?

Treating mineral and bone disorder in CKD includes preventing damage to bones by controlling parathyroid hormone levels through changes in eating, diet, and nutrition; medications and supplements; and dialysis. If these treatments do not bring parathyroid hormone levels under control, a health care provider may remove a person’s parathyroid glands surgically, a procedure called a parathyroidectomy.

Eating, Diet, and Nutrition

Changes in diet can treat mineral and bone disorder in CKD. Reducing dietary intake of phosphorus is one of the most important steps in preventing bone disease. Most foods contain phosphorus; however, processed and packaged foods contain especially high levels of phosphorus. Food producers use phosphorus as an additive to preserve the food on the shelf. People who have CKD or are on dialysis should avoid packaged foods containing ingredients that include the letters PHOS. A renal dietitian can help develop a dietary plan to control phosphorus levels in the blood. Some drinks and natural foods also contain high amounts of phosphorus, including

  • beer
  • cheese
  • cocoa
  • dark sodas
  • dried beans
  • milk
  • nuts
  • peanut butter
  • peas

More information is provided in the NIDDK health topics, How To Read a Food Label: Tips for People with Chronic Kidney Disease and Phosphorus: Tips for People with Chronic Kidney Disease.

Medications and Supplements

Medications protect the bones by restoring the proper balance of minerals and hormones. If the kidneys do not make adequate amounts of calcitriol, a health care provider may prescribe synthetic calcitriol as a pill (Rocaltrol) or, for dialysis patients, in an injectable form (Calcijex). Calcitriol helps reduce parathyroid hormone levels. Medications called doxercalciferol (Hectorol) and paricalcitol (Zemplar) act like calcitriol because they are also activated forms of vitamin D. A health care provider may prescribe a calcium supplement in addition to calcitriol or another activated form of vitamin D.

Certain forms of vitamin D—available by prescription or as over-the-counter vitamin supplements—require activation by a person’s kidneys before they can act as calcitriol does. However, the benefits of some of these not-yet-activated forms of vitamin D—for example, ergocalciferol (Calciferol, Drisdol) or cholecalciferol (Delta D3)—are unclear. To help ensure coordinated and safe care, people should discuss their use of alternative medications, including use of vitamin and mineral supplements, with their health care provider.

Cinacalcet hydrochloride (Sensipar) belongs to another class of prescription medications called calcimimetics. Cinacalcet lowers parathyroid hormone levels by imitating calcium’s effects on the parathyroid gland. Generally, this medication is used only in people on dialysis.

Often, health care providers will prescribe medications called phosphate binders—such as calcium carbonate (Tums), calcium acetate (PhosLo), sevelamer carbonate (Renvela), or lanthanum carbonate (Fosrenol)—to take with meals and snacks to bind phosphorus in the bowel. These medications decrease the absorption of phosphorus into the blood.

Dialysis

Dialysis is the process of filtering wastes and extra fluid from the body by means other than the kidneys. The two forms of dialysis are hemodialysis and peritoneal dialysis:

  • Hemodialysis uses a machine to circulate a person’s blood through a filter outside the body. The blood passes from a patient’s body through a needle, at nearly 1 pint per minute. The blood then travels through a tube that takes it to the filter, called a dialyzer. Inside the dialyzer, the blood flows through thin fibers that filter out wastes and extra fluid. After the machine filters the blood, it passes back to the body through another tube. More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Hemodialysis.
  • Peritoneal dialysis uses the lining of the abdomen to filter a person’s blood inside the body. A soft tube called a catheter is placed in the patient’s abdomen a few weeks before peritoneal dialysis begins. A person uses the catheter to fill the empty space inside the abdomen with dialysis solution—a kind of salty water—from a plastic bag. While inside the body, the dialysis solution absorbs wastes and extra fluid. After a few hours, the person drains the used dialysis solution into another bag for disposal. The person then restarts the process with a fresh bag of dialysis solution. More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Peritoneal Dialysis.

Increasing a person’s dialysis dose can help control the blood phosphorus level. In hemodialysis, the health care provider can adjust the dose by increasing how quickly the blood flows to and from the dialyzer. Another way to adjust the dose involves increasing the time of a person’s dialysis session or the number of sessions. In peritoneal dialysis, using more dialysis solution in each fill or increasing the number of fills each day increases the dose. More information is provided in the NIDDK health topics:

Parathyroidectomy

If diet, medications, and dialysis can’t control parathyroid hormone levels, a surgeon can remove one or more of the parathyroid glands. He or she performs the procedure using general anesthesia.

A good treatment program, including a low-phosphorus diet, appropriate medications, adequate dialysis, and, if necessary, surgery, can improve the body’s ability to repair bones damaged by mineral and bone disorder in CKD. Overall, people can improve their bone health by exercising and not smoking. People should consult a health care provider before beginning any exercise program.

Points to Remember

  • Mineral and bone disorder in chronic kidney disease (CKD) occurs when damaged kidneys and abnormal hormone levels cause calcium and phosphorus levels in a person’s blood to be out of balance. Mineral and bone disorder commonly occurs in people with CKD and affects most people with kidney failure receiving dialysis.
  • Chronic kidney disease is kidney damage that occurs slowly over many years, often due to diabetes or high blood pressure. Once damaged, the kidneys can’t filter blood as they should.
  • Hormones and minerals are important because they help bones stay strong. If a person’s hormones and minerals are out of balance, his or her bones can become weak and malformed.
  • Parathyroid hormone plays an important role in controlling calcium levels in the blood. When kidneys do not function properly, extra parathyroid hormone is released in the blood to move calcium from inside the bones into the blood.
  • Chronic kidney disease causes mineral and bone disorder because the kidneys do not properly balance the mineral levels in the body. The kidneys stop activating calcitriol and do not remove the phosphorus in the blood properly.
  • The complications of mineral and bone disorder in CKD include slowed bone growth and deformities, and heart and blood vessel problems.
  • Treating mineral and bone disorder in CKD includes preventing damage to bones by controlling parathyroid hormone levels through changes in eating, diet, and nutrition; medications and supplements; and dialysis.
  • Reducing dietary intake of phosphorus is one of the most important steps in preventing bone disease.
  • If diet, medications, and dialysis can’t control parathyroid hormone levels, a surgeon can remove one or more of the parathyroid glands.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

About the Kidney Failure Series

You and your doctor will work together to choose a treatment that's best for you. The publications of the NIDDK Kidney Failure Series can help you learn about the specific issues you will face.

Booklets

Fact Sheets

Learning as much as you can about your treatment will help make you an important member of your health care team.

October 2016
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.