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-
When the kidneys are damaged, tation virtually doubled to 380,000. If this trend
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
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.
180,000 people with kidney failure 380,000 people with kidney failure
of Health and Between 1990 and 2000, the number of people with kidney failure requiring dialysis or transplantation
Human Services more than doubled.
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
• 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
• 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
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
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
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
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
• 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
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
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
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
For More Information National Kidney and
American Association of Kidney Patients Urologic Diseases
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Rockville, MD 20852 service of the National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK).
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Internet: www.kidneyfund.org and Human Services. Established in 1987, the
clearinghouse provides information about dis
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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.
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U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 05–5391