Chronic Kidney Disease:
A Family Affair
                   National Kidney and Urologic Diseases Information Clearinghouse...
Who is at risk?                                          If you have diabetes or high blood pressure,
called a microalbumin test and also        other organizations appears in the For
    uses a dipstick in the urine.       ...
What can I do to avoid the
complications of CKD?
CKD can lead to many other health prob­
lems well before kidney failure o...
factors for CKD, you should have your    development of cardiovascular disease.
    kidney function checked.              ...
For More Information                      National Kidney and
American Association of Kidney Patients   Urologic Diseases
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Chronic Kidney Disease: A Family Affair

  1. 1. Chronic Kidney Disease: A Family Affair National Kidney and Urologic Diseases Information Clearinghouse Chronic kidney disease (CKD) is the permanent loss of kidney func- A Growing Problem tion. CKD may be the result of physical injury or a disease that CKD is a growing problem in the United States. National Between 1990 and 2000, the number of people Institute of damages the kidneys, such as Diabetes and diabetes or high blood pressure. with kidney failure requiring dialysis or transplan- Digestive When the kidneys are damaged, tation virtually doubled to 380,000. If this trend and Kidney Diseases they do not remove wastes and continues, the number of people with kidney fail- extra water from the blood as well ure will approach 700,000 by 2010. The annual NATIONAL INSTITUTES as they should. cost of treating kidney failure in the United States OF HEALTH has already topped $20 billion. CKD is a family affair because you may be at risk if you have a blood Kidney failure is only a part of the picture. relative with kidney failure. Experts estimate that 20 million Americans have significantly reduced kidney function, and even a CKD is a silent condition. In the small loss of kidney function can double a per- early stages, you will not notice any son’s risk of developing cardiovascular disease. symptoms. CKD often develops Many of these people will experience heart so slowly that many people don’t attacks or strokes before they become aware of realize they’re sick until the dis- their kidney disease. So identifying and treating ease is advanced and they are CKD early can help prevent heart problems as rushed to the hospital for life- well as postpone kidney failure. saving dialysis. 1990 2000 180,000 people with kidney failure 380,000 people with kidney failure U.S. Department of Health and Between 1990 and 2000, the number of people with kidney failure requiring dialysis or transplantation Human Services more than doubled.
  2. 2. Who is at risk? If you have diabetes or high blood pressure, or a close family member with kidney fail­ Risk factors are conditions that make you ure, you should get checked for kidney dis­ more likely to develop a disease. The lead­ ease, especially if you’re a member of one ing risk factors for CKD are of the racial or ethnic groups at higher risk • diabetes for CKD. • high blood pressure How can I find out if • family history of kidney failure I have CKD? Having diabetes increases your risk of Since early CKD has no symptoms, the only developing CKD. In fact, diabetes is the way to find out if you have it is through leading cause of kidney failure. High blood simple medical tests. pressure is the second leading cause. • Blood pressure. High blood pressure CKD runs in families, so you may have an can lead to kidney damage, and it can increased risk if your mother, father, sister, also be a sign that kidney damage has or brother has kidney failure. already occurred. If your blood pres­ Some racial groups are also at increased sure is high, you’ll want to get it under risk for CKD. control to make sure your kidneys remain healthy. • African Americans are nearly four times as likely to develop kidney • Blood. The glomerular filtration rate failure as white Americans. (GFR) measures how efficiently the kidneys are filtering waste from the • American Indians have nearly three blood. The new method of calculating times the risk compared to whites. GFR requires only a measurement of the creatinine (kree-AT-ih-nin) in a • Hispanic Americans have nearly twice blood sample. Creatinine is a waste the risk of non-Hispanic whites. product in the blood created by the normal breakdown of muscle cells during activity. When kidneys are not working well, creatinine builds up in the blood. • Urine. Measuring the amount of a protein called albumin in the urine can show a kidney problem. A large amount of protein in the urine is known as proteinuria and is a sign of kidney damage. Your doctor may test for protein using a dipstick in a sample of your urine taken in the doc- tor’s office. The color of the dipstick indicates the level of protein. Screening for kidney disease includes simple blood and A test that can show smaller amounts urine tests. of protein or albumin in the urine is 2 Chronic Kidney Disease: A Family Affair
  3. 3. called a microalbumin test and also other organizations appears in the For uses a dipstick in the urine. More Information section at the end of this fact sheet. Your doctor may also do a calculation of the protein-to-creatinine or albu- min-to-creatinine ratio. Healthy kid­ What can I do to slow down neys move creatinine from the blood or avoid kidney failure? into the urine. A ratio greater than 30 Learning about reduced kidney function milligrams of albumin per 1 gram of allows you to take steps to keep your kid­ creatinine indicates that the kidneys neys healthy as long as possible. You can are leaking helpful substances from control many of the things that can make the blood and failing to filter out CKD worse and may lead to kidney failure. harmful substances. This test should be used in people at high risk, espe­ • If you have diabetes, control your cially those with diabetes. blood glucose, also called blood sugar. Studies show that keeping tight control If your first laboratory test shows high of blood glucose can delay or prevent levels of protein, another test should kidney failure. be done 1 to 2 weeks later. If the second test also shows high levels of • If you have high blood pressure, protein, you have persistent protein keep your blood pressure below in the urine (proteinuria) and should 140/90 mm Hg. have additional tests to test your • If you have high blood pressure kidney function. with CKD, keep your blood pressure A 24-hour urine collection is no longer nec­ below 130/80 mm Hg. Blood pressure essary. Small samples of urine and blood, medicines called ACE (angiotensin­ which can easily be taken in the doctor’s converting enzyme) inhibitors and office, are all the new methods require. ARBs (angiotensin receptor blockers) protect the kidneys better than other Several organizations offer free screenings medicines. You may need a combina­ for kidney disease. You may be able to tion of two or more drugs to keep your have your kidney function measured at a blood pressure below 130/80. In many local health fair. The National Kidney cases, a medicine that lowers blood Foundation’s KEEP (Kidney Early Evalua­ pressure by increasing urination, tion Program) initiative offers blood and called a diuretic, should also be part urine testing, onsite consultation with a of the plan. physician, and referral and followup ser­ vices for people whose test results are • If you have CKD, don’t eat too much outside the normal range. The American protein. Protein breaks down into Kidney Fund’s MIKE (Minority Interven­ the waste products the kidneys must tion and Kidney Education) Program offers excrete. Reducing those waste prod­ educational sessions and medical screen­ ucts by eating less protein means the ings. The American Association of Kidney kidneys don’t have to work so hard. Patients’ Finding Your Strength program But eating too little protein can lead to offers education about your kidneys, tests poor nutrition. Work with a dietitian to expect, and ways to stay healthy with to make sure you get the right amounts CKD. Contact information for these and of protein and other nutrients. 3 Chronic Kidney Disease: A Family Affair
  4. 4. What can I do to avoid the complications of CKD? CKD can lead to many other health prob­ lems well before kidney failure occurs. • Anemia. Anemia develops when the kidneys fail to produce enough erythropoietin, or EPO, the hormone that directs the bones to make red blood cells. Anemia can cause heart problems. • Bone problems. Healthy kidneys help keep your bones strong by balancing the levels of calcium and phosphorus You have the power to prevent kidney failure. in the blood. CKD can lead to bone problems by throwing those minerals out of balance. Work with your doctor to manage the health problems that CKD can cause. • Acidosis. The kidneys also maintain Taking charge of your health can make the acid/base balance in the blood. your kidneys last longer. You have the Kidney problems may lead to acidosis, power to prevent kidney failure. a condition in which the blood is too acidic. Acidosis can disrupt body functions. Points to Remember • Chronic kidney disease (CKD) is a • Cardiovascular disease (CVD). growing problem in the United States. Patients with CKD are more likely to Some 20 million Americans with die from a heart attack or stroke than reduced kidney function are at from kidney failure. Even a small loss increased risk for kidney failure of kidney function can double a per- and cardiovascular disease. son’s risk of developing CVD. • The leading causes of CKD are dia­ If you have CKD, you will need to have betes and high blood pressure. If you regular checkups to monitor blood levels have either one of these conditions, of creatinine, urea nitrogen, potassium, you should have your kidney function phosphorus, parathyroid hormone, hemo­ checked regularly. globin, and cholesterol. If your blood tests show abnormal levels of any of these • CKD can run in families. If you have substances several times, your doctor will a parent, brother, or sister with kidney prescribe medicines. For example, if you failure, you should have your kidney have anemia indicated by low levels of function checked. hemoglobin on repeated tests, your doctor can prescribe a synthetic form of EPO • African Americans, American Indians, (erythropoietin) to help your body make and Hispanic Americans have higher more red blood cells. rates of CKD than white Americans. If you belong to one of these high-risk groups and have any of the other risk 4 Chronic Kidney Disease: A Family Affair
  5. 5. factors for CKD, you should have your development of cardiovascular disease. kidney function checked. This study of about 3,000 patients with chronic renal insufficiency, which is another • Medical tests for kidney function way of describing CKD, will reflect the should include a check for protein racial, ethnic, and gender composition of in the urine and a calculation of the ESRD population in the United States. glomerular filtration rate (GFR) based The data collected and specimens obtained on a measurement of creatinine in the from people in this study will serve as a blood. national resource for investigating chronic • If CKD is found early, you can manage kidney as well as cardiovascular disease. it to prevent or delay kidney failure Establishing this group of patients and and avoid cardiovascular disease. following them into the future will also provide an opportunity to examine genetic, Hope Through Research environmental, behavioral, nutritional, quality-of-life, and health resource utiliza­ The National Institute of Diabetes and tion factors in this population. The main Digestive and Kidney Diseases (NIDDK) part of the study will consist of monitoring has many research programs aimed at patients and following up at regular clinic slowing the progression of chronic kidney visits with kidney function measurements, disease. The NIDDK is sponsoring the cardiovascular studies, and laboratory tests. Chronic Renal Insufficiency Cohort In addition, participants will answer ques­ (CRIC) Study to determine the risk factors tionnaires to assess various demographic, for rapid decline in kidney function and nutritional, and quality-of-life factors. 5 Chronic Kidney Disease: A Family Affair
  6. 6. For More Information National Kidney and American Association of Kidney Patients Urologic Diseases 3505 East Frontage Road Information Clearinghouse Suite 315 3 Information Way Tampa, FL 33607 Bethesda, MD 20892–3580 Phone: 1–800–749–2257 or 813–636–8100 Phone: 1–800–891–5390 Email: Fax: 703–738–4929 Internet: Email: Internet: American Kidney Fund 6110 Executive Boulevard The National Kidney and Urologic Diseases Suite 1010 Information Clearinghouse (NKUDIC) is a Rockville, MD 20852 service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Phone: 1–800–638–8299 or 301–881–3052 The NIDDK is part of the National Institutes Email: of Health under the U.S. Department of Health Internet: and Human Services. Established in 1987, the clearinghouse provides information about dis­ Life Options Rehabilitation eases of the kidneys and urologic system to peo­ Resource Center ple with kidney and urologic disorders and to c/o Medical Education Institute, Inc. their families, health care professionals, and the 414 D’Onofrio Drive public. NKUDIC answers inquiries, develops Suite 200 and distributes publications, and works closely Madison, WI 53719 with professional and patient organizations and Phone: 1–800–468–7777 Government agencies to coordinate resources Email: about kidney and urologic diseases. Internet: Publications produced by the clearinghouse are carefully reviewed by both NIDDK scien­ National Kidney Disease tists and outside experts. This fact sheet was Education Program reviewed by Phylis Ermann, L.C.S.W., Ameri­ 3 Kidney Information Way can Kidney Fund; and Kris Robinson, Executive Bethesda, MD 20892 Director, American Association of Kidney Phone: 1–866–4–KIDNEY (454–3639) Patients. Email: Internet: National Kidney Foundation This publication is not copyrighted. The 30 East 33rd Street clearinghouse encourages users of this fact New York, NY 10016 sheet to duplicate and distribute as many Phone: 1–800–622–9010 or 212–889–2210 copies as desired. Email: This fact sheet is also available at Internet: and U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NIH Publication No. 05–5391 December 2004