Chronic Kidney Disease (CKD)

What is chronic kidney disease?

Your kidneys are two fist-sized organs below your rib cage that quietly do a great deal of work. Every day they filter waste and extra fluid from your blood, balance minerals like sodium and potassium, help control blood pressure, support healthy bones, and even signal your body to make red blood cells.

Chronic kidney disease means the kidneys have been damaged and don’t filter as well as they should — and that this has been true for at least three months. “Chronic” simply means long-lasting. As filtering drops, waste and fluid can slowly build up, and the kidneys’ other jobs can fall out of balance too.

Here’s the hopeful part, and it’s the most important sentence on this page: caught early, CKD can often be slowed dramatically. Many people who learn they have it early never go on to kidney failure. What you do next matters.

What causes chronic kidney disease?

Two conditions cause most cases:

• Diabetes. High blood sugar damages the kidneys’ tiny filters over time. It’s the leading cause of CKD.
• High blood pressure. Extra pressure wears down the small blood vessels that do the filtering. It’s the second leading cause.

Other causes include glomerular diseases (inflammation of the kidney’s filters, such as IgA nephropathy or lupus-related kidney disease), polycystic kidney disease (an inherited condition), repeated urinary infections or blockages, and long-term use of certain medications.

You may be at higher risk if you have diabetes or high blood pressure, heart disease, obesity, a family history of kidney disease, or you’re over 60. Risk is also higher in some communities, partly due to differences in access to care — one reason early testing matters so much.

What are the symptoms of CKD?

In the early stages, CKD usually causes no symptoms at all. People feel completely normal while their kidney function slowly declines. This is exactly why it’s so often missed, and why a simple test is the only reliable way to catch it early.

As CKD advances, symptoms can include:

• Tiredness and low energy
• Swelling in the feet, ankles, or hands
• Foamy urine, or changes in how often you go
• Trouble sleeping or concentrating
• Itchy or dry skin, nausea, or poor appetite
• Muscle cramps or shortness of breath

These symptoms have many possible causes, so having them doesn’t mean you have CKD. But if you live with diabetes or high blood pressure, or these symptoms persist, it’s worth getting your kidneys checked.

Understand your numbers: eGFR and uACR

CKD is one of the few conditions where you can — and should — know your own numbers. Two tests tell most of the story.

Knowing both numbers, and tracking how they change over time, tells you and your doctor more than either one alone. It’s worth writing them down and asking what they are at every visit.

The stages of CKD — the modern way

Most websites show CKD as five stages based on eGFR alone. That’s part of the picture, but current national guidelines use a more complete model — one that combines three things: the cause of the disease, your eGFR category, and your albuminuria (urine protein) category. Together they predict risk far better than eGFR alone.

The risk grid doctors actually use

Doctors combine these into a simple risk grid. Two people can both have an eGFR of 50 — but the one with high urine protein is at meaningfully higher risk. That’s why both numbers matter.

How is CKD diagnosed?

Diagnosing CKD is straightforward:

• A blood test for eGFR and creatinine, sometimes confirmed with cystatin C
• A urine test for the albumin-to-creatinine ratio (uACR)
• Blood pressure measurement

Because CKD is defined by damage lasting at least three months, tests are usually repeated to confirm it isn’t a temporary change. Sometimes an ultrasound looks at the kidneys’ structure, and in select cases — especially with glomerular disease — a kidney biopsy identifies the exact cause. Many of these tests can be done in our offices, several of which have an on-site lab.

Slowing CKD progression: what’s possible now

This is where kidney care has changed the most. Not long ago, the main tools for CKD were blood pressure control and managing diabetes. Today there are several medications proven to protect the kidneys directly and slow the disease — and used together, their effects add up. Under current national guidelines, treatment rests on a few “pillars”:

Alongside medication, the basics still matter enormously: controlling blood sugar and blood pressure, a kidney-friendly diet, staying active, not smoking, and avoiding medications that can harm the kidneys (your team can review which ones).

A CKD diagnosis today is not what it was a decade ago. Started early, the right combination of treatments holds many people’s kidney function steady for years.

For the specific program we offer around these newer therapies, see our advanced therapies for slowing CKD page.

The kidney–heart connection

One thing patients are rarely told: chronic kidney disease is also a heart condition. The kidneys and the cardiovascular system are deeply linked, and people with CKD are at higher risk of heart disease and stroke — often more than they are of reaching kidney failure. That’s why modern kidney care protects the heart at the same time as the kidneys, and why several of the medications above were chosen precisely because they do both. Caring for your kidneys is, in a real sense, caring for your heart.

Treatment across the stages, and planning ahead

In the earlier stages, the focus is protecting kidney function and slowing decline. As CKD advances, care shifts to managing its effects — anemia, bone and mineral changes, and electrolyte balance — and, if the kidneys near failure, preparing for what comes next.

If CKD reaches the later stages, your team will talk with you well in advance about options including dialysis and kidney transplant, so you have time to understand them and decide what fits your life. And because Georgia Nephrology physicians provide medical direction and care at more than 30 dialysis centers across metro Atlanta, your care can stay connected even if dialysis ever becomes part of it.

Living with chronic kidney disease

A diagnosis can feel heavy at first. Most people, though, manage CKD well — especially when it’s found early. A few things help:

• Know and track your numbers. Ask for your eGFR and uACR at each visit.
• Protect the basics. Blood pressure and blood sugar control do more than any single pill.
• Eat with your kidneys in mind. A dietitian can tailor attention to salt, and sometimes protein, potassium, and phosphorus.
• Keep moving, and don’t smoke. Both directly affect kidney and heart health.
• Mind your mental health, and bring someone with you — a second set of ears at appointments helps.

You’re not managing this alone. A kidney care team’s whole purpose is to guide you through it.

When should you see a nephrologist?

A nephrologist is a kidney specialist. Your primary care doctor handles a lot of early kidney care, but a referral makes sense when:

• Your eGFR is below 60 and staying there, or dropping
• You have protein or blood in your urine
• You have high blood pressure that’s hard to control
• You have diabetes that’s affecting your kidneys
• You have recurrent kidney stones or a family history of kidney disease
• The cause of your kidney problem isn’t clear

Seeing a specialist earlier — rather than waiting until kidney function is very low — consistently leads to better outcomes. If you’re not sure whether it’s time, it’s a reasonable thing to ask your primary care doctor directly.

Questions to ask your nephrologist

• What is my eGFR and my uACR, and what stage does that put me in?
• What is causing my kidney disease, and how fast is it changing?
• What can I do to slow it — and am I a candidate for the newer kidney-protecting medications?
• Which of my current medications affect my kidneys?
• What should my blood pressure and blood sugar targets be?
• How often will I be tested, and what symptoms should prompt me to call you?

Myths and facts