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Written by: Emmanuel Dubure, MPhil & Kristen DiFilippo, PhD, RDN

Chronic Kidney Disease (CKD) occurs when the kidneys lose their ability to function properly over time (Pan American Health Organization, 2022). The kidneys, a pair of organs that remove waste substances from the body, also perform other functions including controlling blood pressure and helping to make red blood cells (Raghavendra et al., 2013). When the kidneys fail to work properly, waste can build up in the body and cause harm including cardiovascular disease and kidney failure as well as anemia, weak bones, fluid retention, and the accumulation of unwanted substances in the blood (Bello et al., 2017). CKD impacts many people with over 800 million people suffering  CKD globally (Kovesdy, 2022), and nearly 36 million in the United States (Centers for Disease Control and Prevention[CDC], 2023).

Diagnosis of CKD

CKD is diagnosed when the glomerular filtration rate (GFR), a marker of kidney function declines to less than 60 mL/min, or when GFR is above 60 mL/min with other signs of kidney abnormality for at least three months. The signs used with GFR to diagnose CKD include high protein levels in the urine and structural changes in the kidneys which can be assessed by viewing the kidneys in a medical scan.

Stages of CKD

There are five stages of CKD. These are classified based on the extent of decline of kidney function.

  • Stage 1: A normal GFR of ≥ 90 mL/min, but with other signs of kidney abnormality such as high protein in the urine
  • Stage 2: A mild decrease in kidney function and a GFR of 60–89 mL/min with other signs of kidney abnormality
  • Stage 3a: A moderate decline in kidney function with a GFR of 45–59 mL/min
  • Stage 3b: A moderate decline in kidney function with a GFR of 30–44 mL/min
  • Stage 4: A severe decline in kidney function with a GFR of 15–29 mL/min
  • Stage 5: Also known as end-stage kidney disease and characterized by a GFR of <15 mL/min

(Kidney Disease: Improving Global Outcomes [KDIGO], 2014)

Signs and symptoms of CKD

The initial stages of CKD may show no visible signs (Chen et al., 2019). However, some later signs may include tiredness, itchy skin, puffiness, swollen limbs, muscle cramps, and changes in urine output and appearance (National Kidney Foundation, 2024).

Risk factors for CKD

Risk factors for CKD include uncontrolled diabetes, hypertension and advancing age. Other factors include smoking, obesity, a family history of CKD and being Black/African American. Excessive use of certain medications, autoimmune conditions and some infections may also affect the kidneys (Evans & Taal, 2015).

Prevention of CKD

CKD can be prevented by managing pre-existing medical conditions and risk factors for the disease. It is recommended to maintain a healthy weight, avoid smoking and eat a diet low in sodium, saturated fats and trans fats (National Institute of Diabetes and Digestive and Kidney Diseases, 2024).

Management of CKD

CKD is managed using dietary modification, medication and dialysis.

  • Dietary changes: People with CKD will need a special diet to reduce the buildup of waste in the body. Protein, sodium, potassium and phosphorus intake is often controlled with the help of a dietitian (Kalantar-Zadeh & Fouque, 2017). Fluids may also be restricted depending on the patient’s condition (Lambert et al., 2022).
  • Medication: Medication may be used to treat comorbidities such as diabetes and heart disease (Li et al., 2023).
  • Dialysis: End-stage kidney disease is managed with dialysis, a procedure to artificially remove waste from the blood (Himmelfarb et al., 2020). Patients may also need a kidney transplant to survive (Hariharan et al., 2021).

CKD is a progressive disease with many adverse outcomes. Prevention, early diagnosis, and treatment are crucial to reduce the burden of this disease. 


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