Patient Information
Renal
Chronic Kidney Disease (CKD):
everything you need to know
What is CKD?
“Kidney disease” is a term used by doctors to describe when your kidneys
do not work as well as they should. “Chronic” means a long-term condition
that does not get completely better.
Some people think that “chronic” means severe. This is not always true.
Some patients with CKD have more severe disease, but most patients with
CKD have only a very slight kidney problem.
In the past, doctors have used the term “chronic kidney failure” (CRF) for
the same condition.
How common is CKD?
Mild to moderate CKD is very common. Recent research suggests that
1 in 10 people may have CKD. However, CKD is less common in young
adults, being present in 1 in 50 people.
In people aged over 75 years old, CKD is present in 1 in 2 people.
However, many of these people with CKD may not have diseased kidneys.
CKD may be due to normal ageing of their kidneys.
Severe kidney failure will not happen with normal ageing of your kidneys.
Kidney failure is when your kidneys stop working well enough to keep you
healthy. There is an increased risk of kidney failure if you have CKD and
high blood pressure, heart disease or a stroke. Regular medical checks
can monitor you for these issues.
Patient Information
What causes CKD?
There are many causes of CKD. The most common causes are ageing of
your kidneys and diabetes. Very few of the causes of CKD are curable but
they may be controlled.
Regular blood tests will be taken to check whether your kidney function is
stable. You will have a kidney scan, if we find reduced kidney function,
high blood pressure, protein leak in your urine or problems such as kidney
pain.
Some people will also have tests such as a cystoscopy (flexible tube to
look inside the bladder), or a kidney biopsy (a small piece of kidney is
removed with a needle and looked at under the microscope).
More information about causes of CKD
We have leaflets available for some of these conditions. Please ask our
team for more information.
• Diabetes mellitus: this directly damages the structure and function of your
kidneys and is the most common cause.
• Renovascular disease: or “renal artery stenosis” (narrowing of the blood
vessels of the kidney).
• Hypertension: or “high blood pressure” is both a cause and consequence
of kidney failure
• Glomerulonephritis: a chronic inflammation of the glomeruli (filters) of the
kidneys.
• Genetic disorders: these are usually inherited. An example is adult
Polycystic Kidney Disease (PKD)
• Urological disorders: urinary problems such as enlargement of the
prostate gland (in men), reflux nephropathy and urinary tract infections
Chronic Kidney Disease (CKD): everything you need to know www.uhcw.nhs.uk 2
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How do you know if you have CKD?
Usually, CKD does not cause any symptoms. It is only detected through
tests. These may be urine tests for blood or protein, an ultrasound scan of
your kidneys, or a blood test to measure kidney function.
Symptoms develop slowly and do not appear until most of your kidney
tissue has been damaged. The rate at which kidney failure worsens can
vary from person to person. Do not think that not having symptoms means
that CKD has not gotten worse. This is why regular tests by your doctor
are very important.
What are the symptoms of advanced CKD?
• fatigue and general weakness
• lack of concentration
• restless legs and muscle cramps
• itchy skin
• poor sleep
• nausea (feeling sick), vomiting
• unpleasant taste in the mouth
• loss of appetite and weight loss
• shortness of breath
• swollen ankles
How is advanced CKD diagnosed and monitored?
CKD is diagnosed and monitored by either your GP or nephrologist (kidney
specialist). This is informed by your medical history and the following tests.
In the early stages of CKD, people may be unaware that they have it and a
blood or urine test may be the only way it is found.
Urine tests
Your urine will be tested for certain substances, such as albumin (a type of
protein) and blood. Extra albumin in the urine is due to chronic damage to
your kidneys. It is measured using a urine dipstick or albumin creatinine
ratio (ACR). Blood picked up by the dipstick can be due to a urinary tract
infection (UTI), early inflammation (glomerulonephritis) and any urological
problems.
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Blood tests to measure kidney function eGFR
A test called the eGFR (estimated glomerular filtration rate) is used to
measure kidney function. The eGFR is calculated by measuring the level
of a substance called creatinine in your blood.
A normal eGFR is about 90 to120 ml/min in adults. The eGFR is
sometimes referred to as the percentage of normal kidney function as the
number is about the same.
If a 40 year old adult with normal kidneys has a GFR of 100 ml/min, and
this falls by about 1 ml/min per year from that age (as it is thought to),
many healthy people aged 75 will have an eGFR of 50 to 60 ml/min.
Other blood tests
Other substances in the blood like urea, potassium and phosphate are also
measured; high levels and can cause illness. Other blood tests, such as
haemoglobin and PTH, are carried out to detect anaemia and renal
(kidney) bone disease which may happen in advanced CKD.
Cardiovascular risk
People with CKD are at an increased risk of heart disease, stroke, and
poor circulation (peripheral vascular disease). Cardiovascular risk factors
like smoking, cholesterol and blood pressure will be monitored closely and
you will be given medicine where needed.
Patients who are having antihypertensive or lipid lowering therapy should
have their renal function assessed annually.
Ultrasound scan
You may have an ultrasound scan to check the size of your kidneys and
check for signs of any problems. This may provide information to help with
your diagnosis and can help us understand the likelihood of further kidney
function decline.
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What are the stages of CKD?
CKD is divided into 5 stages
• CKD stage 1: this is where eGFR is greater than 90 mls/min, with some
sign of kidney damage on other tests. If all the other kidney tests are
normal, there is no CKD.
• CKD stage 2: this is where eGFR is between 60 to 89 with some sign of
kidney damage. If all the other kidney tests are normal, there is no CKD.
• CKD stage 3: a mild-moderate degree of impairment in kidney function
occurs in this stage. This is subdivided in to 3a (eGFR 45 to 59) and 3b
(eGFR 30 to 44) because we now know that patients in 3b have increased
rate of cardiovascular diseases (heart attacks, strokes, narrowing of other
arteries). Despite the mild impairment, only a minority of patients progress
to end stage kidney failure. Most patients with stage 3a CKD can be
treated in a GP, but 3b patients need to be reviewed by a GP and then
referred to the hospital kidney specialist (nephrologist). This depends on
risk factors.
Some patients need further investigation where there are signs that
progression to end stage renal failure (stage 5) is likely.
• CKD stage 4: this is where eGFR is between15 to 29 ml/min, a severe
reduction in kidney function.
• CKD stage 5: this is where eGFR is less than 15 ml/min, when dialysis or
a kidney transplant may be needed.
How fast will kidneys get worse?
It depends on individual patients and their CKD causes. Remember that
people without kidney disease lose 1ml/min a year due to natural ageing.
The kidneys of many CKD patients over 75 years old will get worse a little
faster than normal ageing kidneys. They are unlikely to suffer severe
kidney failure.
For other patients, it is difficult to say. Your nephrologist may be able to
give an estimate if they can access your blood and urine tests from past
years.
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What is the treatment for CKD?
Although there is no cure for CKD, treatment is important to try and stop
what has caused CKD and to reduce the rate of decline in kidney function.
It will help to review your diet and lifestyle to reduce the risk of stroke and
heart attack.
There are some things that everyone with CKD should try to do.
• Lose weight (if overweight) and take regular exercise.
• Stop smoking
• Reduce the amount of salt in your diet to help control your blood
pressure
• Eat a healthy balanced diet
• Drink about 2 litres of fluid a day. 2 litres are about 10 cups or 6 mugs.
There is no benefit in drinking large amounts of fluid, except in people
who get lots of urine infections or in other special cases.
• You should not binge drink and be cautious in replacing extra fluid
losses in hot weather and during times of diarrhoea or vomiting.
• Buy an automatic blood pressure monitor to check your blood pressure
at home.
• Have an annual “flu jab” (influenza vaccination) and have the
pneumonia (pneumococcal) vaccine once. Talk to your GP about this.
• Avoid some types of painkillers: non-steroidal inflammatory medications
(NSAIDS) such as ibuprofen should be avoided. Ask your doctor if you
are unsure.
• Patients in whom initial urine dipstick reveals non-visible, or
“microscopic”, haematuria (blood in the urine) should have a urine
culture performed to exclude a urinary tract infection.
• Seek early treatment with antibiotics if you are prone to urine infection.
Symptoms of urine infections can include frequent need to urinate,
burning sensation on urinating, aches in the bladder or loin, smelly
urine.
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Treatment for early CKD stages 1, 2 and 3
Blood pressure should be treated carefully. If it is above 140/85, tablets are
usually needed. The aim is to get your blood pressure down to 130/80 or
lower.
Your cholesterol should be checked, and some people will be advised to
take a daily aspirin tablet. A blood test to check eGFR should be
performed once a year. CKD stage 3 requires more careful monitoring for
declining kidney function. You should have a 6 month (then 12 monthly if
stable) monitoring check of blood creatinine, potassium, and haemoglobin
(Hb), urinary albumin (protein), blood pressure and assessment of
cardiovascular risk.
If your urine tests show a lot of protein in the urine, or your kidney function
is declining fast over time, this should be discussed with a kidney specialist
(nephrologist), or a referral may be made to a kidney specialist. It may then
be appropriate to use specific blood pressure tablets like Angiotensin-
Converting Enzyme (ACE) inhibitors or Angiotensin Receptor Blockers
(ARB) and aim for a lower blood pressure target. In a few cases, those
drugs can affect the kidneys and may need to be stopped. Your doctor
should check your blood creatinine and eGFR within 2 weeks of starting
you on these drugs.
If someone with CKD also has diabetes, extra care to control blood
pressure, blood sugar levels and cholesterol levels is required. This will
need intensive monitoring, including extra urine tests to look for albumin in
the urine. This is because CKD can be a complication of diabetes.
However, CKD does not cause diabetes.
Treatment for advanced CKD stages 4 and 5
Treatment should be as for CKD stages 1-3. All medicines should be
reviewed as their doses may need to be altered. Some medicines may
need to be avoided as they can damage the kidneys further. This review
should include prescribed medicines, any medicines bought at the chemist
and complementary therapies.
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Patient Information
In CKD stages 4 and 5, advice from a kidney specialist is usually
necessary, especially in stage 5. This is because kidney failure may
become life threatening. There are increasing symptoms (described
earlier) and complications such as anaemia and bone disease due to the
weakening kidneys. Diet changes and starting new medicines will often be
advised.
What if the kidney function continues getting worse?
In the few people with declining kidney function that are progressing to
CKD stage 5, a treatment plan should be made with the kidney specialist
team. This should happen well before CKD stage 5 is reached.
Patients need information, time, and counselling to help them decide on
the most appropriate option for them and to help prepare for any dialysis
and transplantation. Elderly or very frail patients may choose not to have
dialysis. This is a reasonable decision and is called supportive care.
Resources that can help with your decisions
Kidney Care UK www.kidneycareuk.org Phone: 01420 541 424
Chronic Kidney Disease Explained https://ckdexplained.co.uk/information-
for-patients-with-ckd/
National Kidney Federation www.kidney.org.uk Phone: 0800 169 0936
Who cares for patients with CKD?
Most patients in CKD stage 1, 2 and 3 will be checked yearly and
sometimes twice a year by their GP. On each visit, you should expect
blood pressure measurement, urine and blood tests and a review of your
medicines. Any point of concern may lead to a referral to a kidney
specialist (nephrologist) for a review.
Some patients with CKD stage 4 or 5 may still be reviewed by the GP
twice a year if they are well and their results are stable. Otherwise, they
are referred to the nephrology team of consultants, specialist nurses and
dieticians for regular follow-up.
Chronic Kidney Disease (CKD): everything you need to know www.uhcw.nhs.uk 8
Patient Information
Leading a normal life with CKD
Most people with CKD should be able to lead normal lives. CKD is not
usually hereditary (inherited from family members) and routine family
screening is not necessary if one person is affected. However, some
specific types of kidney disease are hereditary, and people should check
with their GP or hospital specialists to check family member testing is
needed.
Contact information
For more information, or if you have questions, please phone:
024 7696 7777 - Renal Unit, Monday to Saturday, 8am to 8pm)
024 7696 8256 / 024 7696 8258 - Ward 50 at night and on Sundays
024 7696 7786 - Clinical Nurse Specialists, voicemail call back service
024 7696 8315 - Renal Secretaries, Monday to Friday 8am to 5pm
The Trust has access to interpreting and translation services. If you need
this information in another language or format, please contact 024 7696
7777 and we will do our best to meet your needs.
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Document History
Department: Renal
Contact: 27777
Updated: November 2023
Review: November 2025
Version: 7.1
Reference: HIC/LFT/413/07
Chronic Kidney Disease (CKD): everything you need to know www.uhcw.nhs.uk 9
