Chronic kidney disease (CKD) is a long-term condition in which the kidneys become damaged or lose some of their ability to filter blood effectively. CKD can develop gradually, and many people have few or no symptoms during the early stages. Diabetes and high blood pressure are among the most common causes of CKD in adults.
Blood pressure management is one of the most important parts of CKD treatment.
High blood pressure can damage the kidneys, while worsening kidney function can make blood pressure more difficult to control. Keeping blood pressure within the target established by a healthcare professional can help reduce the strain on the kidneys.
Treatment may include:
The ideal blood pressure target varies according to kidney function, age, cardiovascular risk, medications, and other factors.
Certain blood pressure medications can provide kidney-protective benefits, particularly for people with CKD and increased urine albumin.
Two important medication groups are:
These medications affect the renin-angiotensin system and can reduce pressure within the kidney's filtering units.
KDIGO recommends ACE inhibitor or ARB therapy for appropriate patients with CKD and albuminuria and emphasizes using the highest tolerated approved dose when indicated. Kidney function and potassium levels should be monitored after starting or increasing these medicines.
These medications are not appropriate for everyone, so treatment should be individualized.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors have become an important part of kidney-protective treatment for many people with CKD.
Examples include:
Although these medicines were initially developed to treat type 2 diabetes, research has shown kidney and cardiovascular benefits in appropriate patients with CKD.
The KDIGO 2024 guideline recommends an SGLT2 inhibitor for adults with type 2 diabetes and CKD when eGFR is at least 20 mL/min/1.73 m² and provides broader recommendations for selected adults with CKD.
Eligibility depends on kidney function, urine albumin, diabetes status, cardiovascular conditions, and other factors.
Diabetes is a major cause of CKD.
Keeping blood glucose within an individualized target can help reduce further kidney damage. Diabetes management may involve:
NIDDK recommends working with a healthcare team to establish an appropriate blood glucose goal rather than using the same target for everyone.
Some diabetes medications can also provide kidney or cardiovascular benefits, making medication selection an important part of modern CKD management.
CKD treatment requires ongoing monitoring.
Two particularly important measurements are:
eGFR: Estimates how well the kidneys filter blood.
Urine albumin-to-creatinine ratio (UACR): Measures albumin leaking into the urine and helps assess kidney damage.
NIDDK identifies eGFR and urine albumin as key markers used to monitor CKD and its progression.
Regular testing helps determine whether kidney function is stable or changing and whether treatment needs to be adjusted.
Dietary needs change as CKD progresses.
A kidney-focused eating plan may involve adjustments to:
However, not everyone with CKD needs the same restrictions.
For example, potassium restriction may be unnecessary in some people but essential for others with elevated blood potassium. Similarly, protein needs can vary depending on kidney function, nutritional status, age, and whether dialysis is being used.
NIDDK recommends working with a registered dietitian who understands kidney disease to develop an individualized meal plan.
Too much sodium can contribute to fluid retention and high blood pressure.
Reducing highly processed and heavily salted foods may help with blood pressure and fluid management.
Common sources of sodium include:
A kidney dietitian can help determine an appropriate sodium intake.
Some commonly used over-the-counter pain medications can be harmful to the kidneys.
NSAIDs, including ibuprofen and naproxen, can increase the risk of kidney injury, particularly in people who already have kidney disease or other risk factors.
This does not mean every person with CKD must avoid every pain medication. Instead, medication choices should be reviewed with a healthcare professional or pharmacist.
Prescription drugs, vitamins, herbal products, and supplements should also be reviewed because declining kidney function can change how medications are processed.
CKD is associated with an increased risk of cardiovascular disease.
Managing cardiovascular risk may include:
Protecting cardiovascular health is an important part of protecting overall health in people with CKD.
Regular physical activity can support cardiovascular health, weight management, blood pressure control, and overall well-being.
The appropriate type and intensity of exercise depend on age, kidney function, cardiovascular health, fitness level, and other medical conditions.
People who have been inactive or have advanced CKD should discuss an appropriate exercise plan with a healthcare professional.
Smoking can worsen cardiovascular risk and may contribute to progression of kidney disease.
Stopping smoking can provide benefits beyond kidney health, including reducing the risk of heart attack and stroke.
NIDDK includes smoking cessation among important lifestyle measures for people managing CKD.
As kidney function declines, complications can develop.
Possible complications include:
NIDDK identifies anemia, mineral and bone disorders, metabolic acidosis, malnutrition, and electrolyte abnormalities among possible complications of CKD.
Treatment depends on the specific complication.
For example, anemia may require investigation of iron status and other causes, while high potassium may require dietary changes, medication adjustments, or other treatments.
CKD is not a single disease.
It can result from conditions such as:
Identifying the cause can change treatment.
NIDDK emphasizes establishing the cause of CKD because specific treatments may exist for particular kidney diseases.
A nephrologist is a physician specializing in kidney disease.
A primary care professional may manage early or stable CKD, while nephrology involvement can become particularly useful when:
NIDDK notes that nephrology referral can be particularly beneficial for complicated disease, rapidly declining kidney function, and advanced CKD.
When CKD becomes advanced, treatment focuses not only on slowing progression but also on managing symptoms and preparing for possible kidney replacement therapy.
Kidney failure occurs when the kidneys can no longer adequately perform their functions.
Treatment options can include:
NIDDK identifies dialysis and kidney transplantation as treatments that can replace lost kidney function when kidney failure occurs.
Dialysis removes waste products and excess fluid from the blood when the kidneys can no longer do enough of this work.
Two major forms are:
Blood passes through a dialysis machine and filter before returning to the body.
The lining of the abdomen, called the peritoneum, is used as a natural filtering membrane with the help of dialysis solution.
The choice depends on medical circumstances, lifestyle considerations, access to treatment, and personal preferences.