Managing chronic kidney disease

Learn about the stages of chronic kidney disease (CKD), steps you can take to slow CKD progression, and an introduction to kidney dialysis and transplant.

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Chronic kidney disease stages

There are 5 stages of CKD, from very mild damage in stage 1 to complete kidney failure in stage 5, which is end-stage kidney disease (ESKD). An eGFR kidney function test is used to determine the exact stage of CKD. In the early stages, your kidneys are still able to filter out waste from your blood. In the later stages, your kidneys must work harder to get rid of waste and may stop working altogether. 

 

CKD is a progressive disease, which means that kidney function declines over time. There are generally no symptoms of chronic kidney disease until you reach the later stages. Once you experience symptoms of CKD, the disease is usually in an advanced stage and in some cases you may be close to needing kidney dialysis or transplant.

The 5 stages of chronic kidney disease

The 5 stages of chronic kidney disease

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Steps you can take to slow progression of chronic kidney disease

There isn’t a cure for CKD in T2D. Once your kidneys are damaged, they can’t be repaired, so it’s important to do everything you can to keep your disease from progressing and causing further damage. By catching it early and managing your medical conditions, along with nutritional and lifestyle changes, you may be able to slow the progression of CKD.

Manage medical conditions

Manage medical conditions

Control your blood sugar. Achieving and maintaining optimal blood sugar control may help slow the progression of CKD.

Control your blood pressure. High blood pressure is both a cause and complication of CKD. Controlling blood pressure is one of the most effective things you can do to slow the progression of CKD.

Nutrition and lifestyle

Nutrition and lifestyle

Manage your diet by following a kidney-friendly meal plan.

Don’t smoke. Cigarette smoking is associated with progression of CKD. Smoking also contributes to death from stroke and heart attack in people with CKD. If you do smoke, talk to your doctor about how to quit.

Exercise at least 30 minutes a day, most days of the week. A combination of aerobic conditioning such as walking, biking, or jogging, along with strength training, is ideal. Physical activity may help prevent heart disease, improve glucose control in those with diabetes, and maintain muscle mass.

Maintain a healthy weight. Being overweight is linked to high blood pressure, heart disease, and CKD.

Medication and doctor support

Medication and doctor support

Avoid overuse of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, which can damage kidneys.

Take medication as prescribed by your healthcare provider.

Schedule regular checkups with your doctor to monitor your kidney function.

Consider seeing a nephrologist, a doctor who specializes in kidney diseases. Much like you see an ophthalmologist for your eyes, you may want to talk with a nephrologist about your kidney health.

 

Kidney-friendly meal plan

It may surprise you to learn that some of the foods you eat as part of a healthy diet for type 2 diabetes are not necessarily good for your kidneys if you have chronic kidney disease. A kidney-friendly meal plan helps protect your kidneys from further damage and limits the amount of potassium and phosphorus you consume, as well as fluids you drink. This can help keep waste and fluid from building up and causing problems. Be sure to talk with a dietitian about what is the best meal plan for you.

Limit potassium, phosphorus, and water

Potassium is a mineral found in foods such as bananas, potatoes, and spinach. When you have CKD in T2D, your potassium levels may be too high, so you may need to limit or avoid certain foods. Your doctor may have you take a medicine called a potassium binder to help your body get rid of extra potassium.


Phosphorus is a mineral found in foods such as oatmeal, whole grain bread, and nuts. When your kidneys aren’t working well, phosphorus can build up in your blood, leading to weak bones that easily break. Depending on your stage of CKD, your doctor may prescribe a medicine called a phosphate binder.

You may not need as much water because damaged kidneys do not get rid of extra fluid as well as they should. Too much fluid in your body can cause high blood pressure, swelling, and heart failure. Extra fluid can also build up around the lungs and make it hard to breathe. Based on your stage of CKD, your doctor may tell you to limit fluids.

Limit potassium, phosphorus, and water

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General dietary guidelines

Staying at a healthy weight and eating a balanced diet that is low in salt and fat can help you control your blood pressure, and keep you healthy and feeling well. Here are some helpful dietary considerations to keep in mind. Always talk to your doctor before making changes to your diet. 

Reduce sodium

Reduce sodium. Choose and prepare foods with less sodium to help control blood pressure. Aim for no more than 2300 mg of sodium daily.

Talk with a dietitian

Talk with a dietitian about what types of protein to include in your diet. Some doctors recommend that people with CKD limit protein or change their source of protein. A diet very high in protein can make the kidneys work harder and may cause more damage.

 

  • Lower-protein foods include bread, fruits, vegetables, pasta, and rice
  • Higher-protein foods include red meat, poultry, fish, and eggs
Medication and doctor support

Choose heart-healthy foods. Grill, broil, bake, roast, or stir-fry foods, instead of deep-frying them. Limit saturated and trans fats (found in margarine, microwave popcorn, fried foods, and some baked goods).

Limit alcohol

Limit alcohol to 1 drink a day for women and 2 for men. Excessive drinking can affect your health and worsen CKD.


Kidney dialysis

Kidney dialysis helps clean your blood when you reach end-stage kidney disease and your kidneys no longer function. There are 2 types, hemodialysis and peritoneal dialysis.

What is hemodialysis?

Hemodialysis is a treatment that uses a machine to filter waste and water from your blood. Hemodialysis also helps control blood pressure and balance important minerals in your blood, such as potassium, sodium, and calcium. The procedure is done at a dialysis center or at home. Each hemodialysis treatment lasts about 3 to 4 hours and is done 3 times a week.

Read more about hemodialysis


What is peritoneal dialysis?

Peritoneal dialysis cleans your blood by using the lining of your abdomen, called the peritoneum, and a cleaning solution called dialysate. The abdominal area is filled with a cleaning fluid called dialysate. The dialysate uses the lining that covers most of the organs in your belly to serve as a filter for the dialysis process. Peritoneal dialysis is done 7 days a week at home manually or with the help of a machine called a cycler.

Read more about peritoneal dialysis

Kidney dialysis

Kidney transplant

Kidney transplant is a surgery to give you a healthy kidney from someone else’s body. A kidney transplant may come from a live donor (usually someone you know) or from a deceased donor. The healthy kidney can do the job that your kidneys did when they were healthy.
 

The United Network for Organ Sharing (UNOS) keeps track of all the people in the United States who need kidney transplants and matches them with donors. The average wait time for a kidney from the national deceased donor waiting list in the United States is 5 years.