Chronic Kidney Failure
What is it?
- Chronic kidney failure describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood which are then excreted in your urine. When chronic kidney failure damages your kidneys, dangerous levels of fluid and waste can accumulate in your body.
- In the early stages of chronic kidney failure, you may have few signs or symptoms. Chronic kidney failure may not become apparent until your kidney function is significantly impaired.
- Treatment for chronic kidney failure, also called chronic kidney disease, focuses on slowing the progression of the kidney damage, usually by controlling the underlying cause. Chronic kidney failure can progress to end-stage kidney disease, which is fatal without artificial filtering (dialysis) or a kidney transplant.
Signs and symptoms of kidney failure develop slowly over time if kidney damage progresses slowly. Signs and symptoms of kidney failure may include:
- Decreased urine output or no urine output
- Loss of appetite
- Fatigue and weakness
- Sleep problems
- Decreased mental sharpness
- Muscle twitches and cramps
- Swelling of the feet and ankles
- Persistent itching
Signs and symptoms of kidney failure are often nonspecific, meaning they can also be attributed to other illnesses. In addition, because your kidneys are highly adaptable and able to compensate for lost function, signs and symptoms of kidney failure may not appear until irreversible damage has occurred.
Chronic kidney failure occurs when a disease or condition impairs kidney function. Over several months or years, this can cause worsening kidney damage.
Diseases and conditions that commonly cause chronic kidney failure include:
- Type I diabetes
- Type II diabetes
- High blood pressure
- Enlarged prostate
- Kidney stones
- Bladder cancer
- Kidney cancer
- A condition that causes urine to back up into your kidneys (vesicoureteral reflux)
- Polycystic kidney disease
- Kidney infection (pyelonephritis)
- Damage to the artery that carries blood to your kidneys (renal artery stenosis)
Factors that may increase your risk of chronic kidney failure include:
- High blood pressure (hypertension)
- Heart disease
- High cholesterol
- African-American, American Indian or Asian-American race
- A family history of kidney disease
- Age 65 or older
Chronic kidney failure can affect almost every part of your body. Potential complications may include:
- Fluid retention, which could lead to swelling in your arms and legs, high blood pressure or fluid in your lungs (pulmonary edema)
- A sudden rise in potassium levels in your blood (hyperkalemia), which could impair your heart's ability to function and may be life-threatening
- Cardiovascular disease
- Weak bones and an increased risk of bone fractures
- Decreased sex drive or impotence
- Damage to your central nervous system, which can cause difficulty concentrating, personality changes or seizures
- Decreased immune response, which makes you more vulnerable to infection
- Pericarditis, an inflammation of the sac-like membrane that envelops your heart (pericardium)
- Pregnancy complications that carry risks for the mother and the developing fetus
- Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring either dialysis or a kidney transplant for survival
To determine whether you have chronic kidney failure, you may undergo tests and procedures including:
- Blood tests. Kidney function tests look for the level of waste products, such as creatinine and urea, in your blood.
- Urine tests. Analyzing a sample of your urine may reveal abnormalities that point to chronic kidney failure.
- Imaging tests. Your doctor may use ultrasound to assess your kidneys. Other imaging tests may be used in some cases.
- Removing a sample of kidney tissue for testing. Your doctor may recommend a kidney biopsy to remove a sample of kidney tissue. The biopsy sample is sent to a laboratory for testing to help determine what's causing your kidney problems. Kidney biopsy is often done using a long, thin needle that's inserted through your skin and into your kidney.
Treatments and drugs
Chronic kidney failure has no cure, but treatment can help control signs and symptoms, reduce complications, and slow the progress of the disease. If your kidneys become severely damaged, you may need treatments for end-stage kidney disease.
Treating the cause of kidney failure
Your doctor will work to slow or reverse the disease or condition that's causing your kidney failure. Treatment options vary depending on the cause of your kidney failure.
Stopping the underlying condition may slow kidney damage, but sometimes kidney failure worsens despite treatment. Damage to the kidneys can cause stress on the kidneys that continues to worsen even when an underlying condition, such as high blood pressure, has been controlled.
Treating complications of kidney failure
Kidney failure complications can be controlled to make you more comfortable. Treatments may include:
- Treatment to control high blood pressure. People with chronic kidney failure may experience worsening high blood pressure. Your doctor may recommend medications to lower your blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers — and to preserve kidney function. High blood pressure medications can initially decrease kidney function, so you may have frequent blood tests to monitor your condition. Your doctor will likely also recommend a low-salt diet.
- Medications to lower cholesterol levels. Your doctor may recommend medications, called statins, to lower your cholesterol. People with chronic kidney failure often experience high levels of bad cholesterol, which can increase the risk of heart disease.
- Medications to relieve anemia. In certain situations, your doctor may recommend supplements of the hormone erythropoietin to induce production of more red blood cells. This may help relieve the fatigue and weakness that's associated with anemia.
- Medications to relieve swelling. People with chronic kidney failure may retain fluids. This can lead to swelling in your arms and legs, as well as high blood pressure. Medications called diuretics can help maintain the balance of fluids in your body.
- Medications to protect your bones. Your doctor may prescribe calcium and vitamin D supplements to prevent weak bones. You may also take a phosphate-binding medication to lower the amount of phosphate in your blood. Lowering phosphate will increase the amount of calcium available for your bones so that they don't become weak and vulnerable to fracture.
- A low-protein diet to minimize waste products in your blood. As your body processes the proteins in the foods you eat, it creates waste products that your kidneys must filter from your blood. To reduce the amount of work your kidneys must do, your doctor may recommend a low-protein diet. Your doctor may ask you to meet with a dietitian who can help you assess how much protein you eat each day and suggest ways to lower your protein intake while still eating a healthy diet.
Treatment for end-stage kidney disease
If kidney damage continues to progress to the point where your kidneys are functioning at less than 15 percent of capacity, you have end-stage kidney disease. Your kidneys are no longer able to keep up with waste and fluid clearance on their own. Soon, dialysis or a kidney transplant becomes the only option to support life.
- Dialysis. Dialysis is an artificial means of removing waste products and extra fluid from your blood when your kidneys aren't able to perform these functions. There are two types of dialysis. In hemodialysis, blood is pumped out of your body to a machine that works like an artificial kidney, filtering waste out of your blood. The blood is then pumped back into your body. Another type of dialysis, called peritoneal dialysis, involves pumping a dialysis solution into your abdominal cavity. Peritoneal dialysis relies on your body's network of tiny blood vessels to carry waste products and excess fluids to your abdominal cavity where the dialysis solution absorbs them. The dialysis solution is then pumped out of your body, carrying the waste and excess fluids with it.
- Kidney transplant. If you have no life-threatening medical conditions other than kidney failure, a kidney transplant may be an option for you. Kidney transplant involves surgically placing a healthy kidney from a donor inside your body. Transplanted kidneys can come from deceased donors or from living donors.
Lifestyle and home remedies
As part of your treatment for chronic kidney disease, your doctor may recommend a special diet to help support your kidneys and limit the work they must do. Ask your doctor for a referral to a dietitian who can analyze your current diet and suggest ways to make your diet easier on your kidneys.
Depending on your situation, your kidney function and your overall health, your dietitian may recommend that you:
- Limit the amount of protein you eat. Your dietitian will determine the appropriate number of grams of protein you should eat each day. To lower the amount of protein you eat, limit high-protein foods such as meats, eggs, milk, cheese and beans. Instead, choose more low-protein foods, such as vegetables, fruits, breads and cereals.
- Choose lower potassium foods. Your dietitian may recommend that you choose lower potassium foods at each meal. High-potassium foods include bananas, oranges, potatoes, spinach and tomatoes. Low-potassium foods include apples, cabbage, carrots, green beans, grapes and strawberries.
- Avoid products with added salt. Lower the amount of sodium you eat each day by avoiding products with added salt, including many convenience foods, such as frozen dinners, canned soups and fast foods. Other foods with added salt include salty snack foods, canned vegetables, and processed meats and cheeses.
Coping and support
Receiving a diagnosis of chronic kidney failure can be worrisome. You may be concerned about what your diagnosis means for your future health. With time, you'll discover ways to help you cope with your feelings. Until you find what works for you, consider trying to:
- Connect with other people who have kidney disease. Other people with chronic kidney failure understand what you're feeling and can offer unique support. Ask your doctor about support groups in your area.
- Maintain your normal routine, when possible. Try to maintain a normal routine, doing the activities you enjoy and continuing to work, if your condition allows. This may help you cope with feelings of sadness or loss that you may experience after your diagnosis.
- Exercise most days of the week. With your doctor's permission, aim to exercise for at least 30 minutes most days of the week. This can help you cope with fatigue and stress.
- Find someone to talk with. Living with chronic kidney failure can be stressful, and it may help to talk about your feelings with someone you trust. You may have a friend or family member who is a good listener. Or you may find it helpful to talk with a clergy member. Ask your doctor for a referral to a social worker or counselor.
To reduce your risk of chronic kidney failure, try to:
- Drink alcohol in moderation, if at all. If you choose to drink alcohol, do so in moderation. Drink no more than one alcoholic drink a day if you're a woman. If you're a man, limit yourself to two alcoholic drinks a day.
- Follow instructions on over-the-counter medications. When using nonprescription pain relievers, such as aspirin, ibuprofen and paracetamol, follow the instructions on the packaging. Taking too many pain relievers could lead to kidney damage. If you have a history of kidney problems, ask your doctor whether these drugs are safe for you.
- Maintain a healthy weight. If your current weight is healthy, work to maintain it by exercising most days of the week. If you need to lose weight, talk to your doctor about strategies for healthy weight loss. Often this involves increasing the amount of exercise you get each day and decreasing the number of calories you eat.
- Don't smoke. If you don't smoke, don't start. If you're a smoker, talk to your doctor about quitting. Support groups, counseling and medications can all help you to stop.
- Manage your medical conditions with your doctor's help. If you have diseases or conditions that increase your risk of kidney failure, work with your doctor to control these. Ask your doctor about tests to look for signs of kidney damage.