Kidney FAQs
Your Questions Answered
What is Chronic Kidney Disease (CKD)?
Your kidneys are vital organs in your body that play an essential role in keeping you healthy. They act like filters, cleaning your blood by removing waste and extra fluids, which are then turned into urine. When the kidneys have not been working well for a long time, it's called Chronic Kidney Disease (CKD).
How does CKD happen?
The most common things that cause CKD are:
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Diabetes: high blood sugar levels can damage the kidneys over time.
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High blood pressure: uncontrolled high blood pressure can harm the blood vessels in your kidneys and lead to kidney damage.
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Kidney infections: infections that happen again and again can harm the kidneys.
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Kidney stones: can damage the kidneys if they block the flow of urine.
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Family history: if anyone in your family has had kidney problems, you might have a higher risk.
How can you tell if you have CKD?
In the early stages, CKD usually shows no symptoms. But when CKD becomes more severe, some common signs include:
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Feeling tired
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Swollen ankles
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Trouble sleeping
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Reduced or loss of appetite
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Nausea and vomiting
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Loss of taste or abnormal taste sensations or dislike of meat
Taking care of your kidneys with CKD:
While there is no cure for CKD, you can still take steps to keep your kidneys as healthy as possible and slow how quickly the condition worsens.
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See your kidney doctor regularly and monitor kidney function using blood tests.
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Keep your blood pressure under control.
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Keep your blood sugar under control.
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Eat a balanced, heart healthy diet when possible.
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Stay active and exercise regularly.
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Stay hydrated (https://www.kidney.org/content/6-tips-be-water-wise-healthy-kidneys).
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Quit smoking.
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Sleep well (https://sleepeducation.org/healthy-sleep/healthy-sleep-habits/).
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Take medicines wisely. Only take medications prescribed by your doctor, and don't use any over-the-counter drugs without their approval. Avoid herbal supplements unless reviewed by or suggested by your kidney doctor.
For more details about healthy living habits that are not just good for your kidneys, but also for your overall health, check out this helpful resource - The Essential 8 (https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8)
Vitamins and herbal supplements:
When you find out you have CKD, you may feel the urge to do everything you can to control the disease or make it better, including taking vitamins, herbal or other nutritional supplements. In general, your kidney doctors do not endorse any vitamins or supplements specifically for helping to stabilize or improve CKD. However, there are some herbal supplements to avoid because they can make your CKD worse or cause other harm because of the CKD. More helpful information and a list of herbs can be found here - Herbal Supplements and Your Kidney https://www.kidney.org/atoz/content/herbalsupp
Foods and your kidneys:
You may read about many different diets that might be good for your kidney health. However, the most important dietary advice is the one that focuses on improving your overall health. Therefore, focusing on not eating too much, eating less salt and less red meat, avoiding sugary drinks and processed or packaged foods will help your kidneys more than any specialized diet. The one exception is the potential added benefit of restricting protein, especially animal protein (for example, red meat, like beef and pork). Please check with your kidney doctor to see if protein restriction is appropriate for you. If so, please see below for more information about low protein diet in CKD.
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Protein restriction in CKD:
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For more general information about protein in CKD and the different food sources of protein, check out the National Kidney Foundation site and fact sheet.
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To determine the protein content of various foods, use this helpful food counter booklet.
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AAKP Nutrition Counter (A reference booklet - Download) https://aakp.org/wp-content/uploads/2021/03/NutritionCounter_English_030321_Digital-2.pdf
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Salt (sodium) in CKD
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​Another important nutrient to pay attention to for good kidney health is your salt intake. Many people may consider themselves safe from eating too much salt because they don’t add any salt. However, what they don’t realize is that salt or sodium comes already added to many of the foods we eat. Particular foods that contain higher contents of sodium are any packaged foods, canned foods including soups, prepared or takeout foods. Salt is also contained in large quantities in many of the seasonings we use, like salad dressing or sauces.
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Our bodies do need some amount of salt to function properly. So the goal is not to eliminate salt entirely, rather take in the right amount of it. If you are eating foods that have labels, check for the sodium to see how much salt is in the food you are eating. We recommend restricting your daily sodium intake to less than 2000 mg.
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Practice reading food labels here
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If you are eating a lot of foods that don’t have labels, good for you! This is because most foods that don’t come with food labels are usually low in sodium. However, you can still find out how much sodium they contain by using the food counter booklet
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AAKP Nutrition Counter (A reference booklet - Download) https://aakp.org/wp-content/uploads/2021/03/NutritionCounter_English_030321_ Digital-2.pdf
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Potassium, phosphorus, and fluids
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You may also encounter information about limiting minerals such as potassium and phosphorus or advice about drinking either more fluid or less fluid. Generally, most patients with CKD do not need to limit potassium or phosphorus or even fluids until their condition is more severe. Therefore, do not start to limit foods with more potassium or phosphorus or modify your fluid intake until you discuss these recommendations with your kidney doctor.
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If you do need to limit your potassium intake, here are some helpful lists for identifying which foods are high in potassium (those you should eat less of) and which foods are low in potassium (those you can eat more regular amounts of). To understand why any particular food is considered high or low in potassium, you need to know the recommended amount of potassium in a low potassium diet is less than 2000 mg a day.
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A printable list of low, medium and high potassium foods;
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Another list with just high and low potassium foods;
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A short list of high potassium foods in pictures;
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A useful guide for reading food labels about potassium and other tips on reducing potassium intake;
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https://www.kidney.org/sites/default/files/02-10-0410_EBB_Potassium.pdf - A useful list that shows the potassium content of common foods;
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https://kitchen.kidneyfund.org/wp-content/uploads/2019/08/Beyond-Bananas-Potassium-Guide.pdf
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A list of high potassium foods (SPANISH)
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If you need to limit your phosphorus intake, here are some helpful lists of foods which are high in phosphorus to avoid. Your doctor could also prescribe you a medication, called a phosphorus binder, that could allow you to continue eating high phosphorus foods without causing high blood phosphorus levels. If you need to eat less phosphorus, the general goal is to have less than 1000 mg a day.
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A list of high phosphorus foods in pictures;
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An useful guide for reading food labels about phosphorus and other tips on reducing phosphorus intake;
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A printable list of high, medium and low phosphorus foods;
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A useful list that shows the phosphorus content of common foods;
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Water/Fluid intake
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What is the right amount of water to drink? This is one of the most common questions patients ask their kidney doctors. The answer is that “it depends.” One good discussion which is not too complicated is here;
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Sometimes, talking with a dietician can help you better understand your specific needs and develop a personalized plan for successfully managing your dietary needs. Please ask your kidney doctor for a referral.
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What happens if my kidneys fail?
There will be times when despite your best efforts, your CKD gets worse to the point that it causes you to not feel well. This happens when your kidney function becomes very low. You may hear your doctor mention your kidney function as the GFR (glomerular filtration rate) or eGFR (estimated glomerular filtration rate); GFR/eGFR is roughly equal to the percentage of normal function your kidneys have. When the percentage of your kidney function falls to 10% or less (in other words, a GFR less than 10), you might need more advanced treatments such as dialysis or kidney transplant. Some people decide dialysis or transplant is not for them because of their age, other medical conditions, or their personal situation and choose conservative management of their kidney disease with the support of their doctors. Without dialysis or kidney transplantation, the natural course of their kidney disease will be to progress, ultimately leading to death.
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Please see below for additional information about dialysis, transplant and conservative kidney disease management when kidney function is very low—between an eGFR of 5-10.
Dialysis:
Dialysis is an artificial way of cleaning your blood when your kidney function is very low, meaning your kidneys cannot remove toxins or fluid sufficiently to maintain your health. There are a few types of dialysis, hemodialysis in the dialysis clinic, peritoneal dialysis, and hemodialysis at home.
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In-center hemodialysis uses a machine to clean your blood and is done in a dialysis clinic. A dialysis technician connects you to a dialysis machine. Blood flows out of your body and runs through a hemodialysis machine that cleans your blood. The cleaned blood then flows back into your body. This treatment usually takes 3 to 4 hours and is usually done 3 times a week.
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In order to be able to connect to a hemodialysis machine, there are a few different types of ways of getting access to your blood. Dialysis personnel call these different ways into your blood vessels your dialysis vascular access. The different types of vascular accesses are a fistula, a graft, or a catheter. For a helpful video of these different types of accesses, check out here - https://unckidneycenter.org/kidneyhealthlibrary/dialysis-vascular-access-education/
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Peritoneal dialysis is done at home with no blood involved. A special soft tube is placed by surgery in your belly and remains there all the time. Special fluid is filled into the belly using this tube and stays in the belly to remove toxins from your blood. After a couple of hours, the fluid is drained and fresh fluid put in. This process is usually done while you are sleeping, and a small, simple machine does the filling and draining of the fluid for you automatically. This treatment is usually done every day, at home.
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Home hemodialysis is preferred by some patients. They need to undergo special training to learn how to do hemodialysis at home, usually with an assistant.
For more detailed information about any of the dialysis options above, check out these additional resources.
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AAKP.org dialysis information site https://aakp.org/center-for-patient-research-and-education/dialysis-education/
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Brochure about hemodialysis (English) https://www.kidney.org/sites/default/files/hemodialysis_0.pdf
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Brochure about hemodialysis (Spanish) https://www.kidney.org/sites/default/files/hemodialysis_-_spanish.pdf
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Brochure about peritoneal dialysis (English) https://www.kidney.org/sites/default/files/peritoneal_dialysis.pdf
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Brochure about peritoneal dialysis (Spanish) https://www.kidney.org/sites/default/files/peritoneal_dialysis_-_spanish.pdf
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Brochure about home hemodialysis (English) https://www.kidney.org/sites/default/files/home_hemo.pdf
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Brochure about home hemodialysis (Spanish) https://www.kidney.org/sites/default/files/home_hemo_-_spanish.pdf
*Brochure credit National Kidney Foundation, accessed via kidney.org.
Kidney transplant:
Some people may qualify for kidney transplant. You can discuss with your kidney doctor whether you are one of those people. If your kidney doctor feels you are eligible for kidney transplantation, they will refer you to a kidney transplant center for more testing. Once you have completed your kidney transplant evaluation at the kidney transplant center and found to be an acceptable candidate, you will be placed on a waiting list. The transplant center will also ask you about any possible friends or family who might be interested in donating a kidney to you. You can usually get a kidney transplant sooner from a living donor than from the waiting list.
Conservative management without dialysis or transplantation:
Some people do decide that neither dialysis or kidney transplant is right for them. Some people feel this way because they have gone through too many medical treatments or surgeries already and do not want yet another complicated treatment program. Other people feel this way because they decided that the type of life dialysis provides is not what they would be satisfied with. There are many more reasons why someone would decide not to undergo dialysis when they need it or when their doctors recommend it. If you find yourself contemplating not doing dialysis or kidney transplant, please discuss with your kidney doctor so they can help you manage the symptoms that develop from severe kidney failure and the transition to death.