Kidney failure (chronic renal failure)

About kidney disease

The urinary (renal) system

Your kidneys are the main part of your urinary system and are found towards the back of your abdomen (tummy). Most people have two kidneys, although it’s possible to be born with just one. Your kidneys filter water and waste products from your blood to make urine, which is passed out of your body via your bladder. These waste products are toxic if not removed.

Types of kidney disease

  • Chronic kidney disease. This is diagnosed if your kidneys aren't functioning as well as they should be over three or more months. It can lead kidney failure.
  • Acute kidney injury. This is when your kidney function drops quickly over a few hours or days. It's more common if you’re over 75 or are being treated in hospital.

Kidney disease is common, affecting around 10 in 100 women and five in 100 men in the UK. The risk of getting kidney disease increases with age.

This factsheet focuses on chronic kidney disease.

Symptoms of chronic kidney disease

Often there are no symptoms, especially in the early stages of the condition. But if you do have symptoms, they may include:

  • feeling sick or vomiting
  • poor appetite
  • weight loss
  • swollen feet or ankles
  • feeling tired and weak

Advanced kidney disease can have the following symptoms:

  • restless legs and leg cramping at night
  • itchy skin
  • skin bruises
  • anaemia

If you have these symptoms, see your GP.

Complications of chronic kidney disease

As your kidney disease gets worse, you can develop:

  • high blood pressure (hypertension)
  • diseases of your heart or blood vessels called cardiovascular disease
  • nerve damage
  • malnutrition
  • weak bones
  • anaemia

Causes of chronic kidney disease

There are many possible causes of kidney disease. Some of the factors that increase your risk of kidney disease include:

  • high blood pressure
  • diabetes
  • inflammation of your kidney
  • disease or inflammation of the blood vessels to and from your kidneys
  • cysts in your kidneys
  • an enlarged prostate restricting urine flow
  • kidney stones
  • frequent urinary infections
  • taking certain medicines, such as lithium or non-steroidal anti-inflammatory drugs (NSAIDs)

Diagnosis of chronic kidney disease

You will often be diagnosed with kidney disease after you visit your GP about something else and have a blood test. Or your GP may test for kidney disease if you're at high risk of developing it.

Your GP will ask about your symptoms and examine you. You may need to give a blood or urine sample for testing.

Your GP may refer you to a urologist or a nephrologist. A urologist is a doctor who specialises in identifying and treating conditions that affect the urinary system. A nephrologist is a doctor specialising in conditions affecting the kidneys.

Your doctor will measure your glomerular filtration rate (GFR), which is the rate at which your kidneys remove waste products, to see how well your kidneys are working. You may need to have an ultrasound scan. If the cause isn't clear from these tests, your doctor may take a kidney biopsy. A biopsy is a small sample of tissue that is sent to a laboratory for testing.

Kidney failure is diagnosed if your kidneys are no longer working as they should be and you need dialysis or a transplant.

Treatment of chronic kidney disease

Self-help

Your doctor may advise you to reduce your salt intake, only drink alcohol within the recommended limits, take regular exercise, keep to a healthy weight and stop smoking. This will help you stay as healthy as possible.

Try not to take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac unless your doctor prescribes them.

Medicines

If there is a direct cause for your condition, you may need medicines to treat this. Your doctor may stop any medicines you’re taking that may be affecting how your kidneys are working.

You may need medicines to reduce high blood pressure. These might include angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).

Your doctor may also recommend medicines to reduce your risk of cardiovascular disease. These include statins to reduce cholesterol and antiplatelets to reduce the risk of blood clots.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

You may need to take other medicines as your condition progresses. For example, your doctor may suggest iron or erythropoietin if you have anaemia.

Hospital treatment

If your GP refers you to a specialist, you may be treated in hospital. For some treatments, especially for the later stages of kidney disease, you will need to be in the renal unit of a hospital.

Dialysis

If your kidneys aren’t working, you may need to have dialysis. Dialysis is an artificial way of getting rid of waste and unwanted water from your blood. Dialysis may be temporary or permanent.

There are two types of dialysis: haemodialysis and peritoneal dialysis. If you have haemodialysis, your blood passes through a machine to filter and clean it.

Peritoneal dialysis uses your peritoneum as a filter. The peritoneum is a thin membrane that lines the inside of your abdomen, and surrounds and supports your abdominal organs. In a similar way to your kidneys, your peritoneum contains tiny blood vessels, making it a useful filter. During dialysis, fluid is passed into your peritoneum and the peritoneal membrane then acts as a filter for dialysis.

                                                                Dialysis

Special considerations

If you're planning to get pregnant

When you're pregnant, your kidneys work harder to remove the waste products you and your baby produce, and this may affect your kidney disease. If you have chronic kidney disease, you should discuss any plans to get pregnant with your doctor.

Living with chronic kidney disease

If you need dialysis, discussing options with your healthcare professional can help you manage your condition effectively. You will need to regulate your diet, your fluid intake and weight if you have dialysis.

Some people decide that they don’t want to have treatment and choose to discuss end of life care with their doctor.

Prevention of chronic kidney disease

To stay as healthy as possible, try to maintain a healthy weight, eat a balanced diet, only drink alcohol within the recommended limits, keep active and quit smoking. Everyone over 40 should have their blood pressure checked. If you have diabetes, make sure you control your blood glucose as well as you can.

Talk to your GP about any medicines you are taking and be aware if they increase the risk of kidney disease so you get treatment early.

I have been told I have a stage of chronic kidney disease. What does this mean?

Answer

The stages of chronic kidney disease are a way of monitoring how well your kidneys are working.

Explanation

The stages of chronic kidney disease use glomerular filtration rate (GFR) to measure how well your kidneys are filtering waste products out of your body. GFR is measured as ml/min/1.73m. This stands for millilitres (ml) per minute (min) per overall kidney function (1.73m). These stages are used only as a guide and can differ between people.

  • Stage 1. The GFR may be normal or increased. A normal GFR is about 90ml/min/1.73m, so the GFR may be more than this.
  • Stage 2. The GFR is reduced but only mildly. This may be between 60 and 89ml/min/1.73m.
  • Stage 3. This is a moderate reduction in GFR and is usually between 30 and 59ml/min/1.73m. This stage is sometimes split into stages 3A (45 to 59) and 3B (30 to 44).
  • Stage 4. A severe reduction in GFR, which is usually between 15 and 29ml/min/1.73m.
  • Stage 5. This is kidney failure and the GFR is less than 15ml/min/1.73m. You may need dialysis at this stage. This is also sometimes termed end-stage kidney disease.

Symptoms often only occur at stages four and five of chronic kidney disease. Measuring these stages can help your doctor plan your treatment.

How quickly do you progress to end-stage kidney disease?

Answer

This differs between people and depends partly on the cause of your chronic kidney disease. It also partly depends on how well you take care of yourself and how soon you get treatment.

Explanation

It's difficult to predict how quickly chronic kidney disease can progress as different causes may mean it develops at different rates. Not everyone with chronic kidney disease will get worse.

If you have certain conditions, such as cardiovascular disease and diabetes, you should try to control these as well as possible because they can make kidney disease worse. Other factors that are linked to worsening of chronic kidney disease are smoking and being African-Caribbean.

Making sure you get treatment as soon as possible and that it meets your needs is crucial. Your doctor will be able to provide guidance to help you limit the progression of chronic kidney disease.

Eating a healthy, balanced diet, keeping physically active, only drinking alcohol within the recommended daily limits and stopping smoking will all help you stay as well as possible. Taking any medicines as prescribed is also essential.

Which form of dialysis is best: peritoneal dialysis or haemodialysis?

Answer

You generally only need dialysis if you have end-stage kidney disease. You can discuss which option is best for you with your doctor.

Explanation

If you have end-stage kidney disease you will most likely need dialysis. The machine which most people associate with dialysis is a haemodialysis machine.

During haemodialysis, a needle is inserted into your arm and attached by a tube to a haemodialysis machine. Your blood is drawn into the haemodialysis machine and then back into your body after it has been filtered through the machine to remove waste products.

Haemodialysis is usually done in a clinic or hospital, but it may be possible to have it at home. You can read or watch TV when you're having dialysis and a nurse will take care of you.

Peritoneal dialysis uses your peritoneum as a filter. The peritoneum is a thin membrane that lines the inside of your abdomen, and surrounds and supports your abdominal organs. In a similar way to your kidneys, your peritoneum contains tiny blood vessels making it a natural filter. A tube (catheter) is inserted into your abdomen, near your belly button. Two bags are connected to the catheter. One bag is placed high up and passes fresh fluid into your abdomen, while the other bag is placed near the floor to allow fluid containing waste products to collect after passing through the peritoneal membrane. This process is called continuous ambulatory peritoneal dialysis (CAPD).

CAPD may be used in tandem with a machine that fills and drains your abdomen, usually while you are sleeping. This is called continuous cycling peritoneal dialysis (CCPD) or automated peritoneal dialysis (APD).

You can manage peritoneal dialysis at home so you don't need to visit a clinic or hospital. This makes it more convenient than haemodialysis. You can also take the bags with you if you go away. You do need to be fully trained to make sure you can manage your dialysis well on your own. There is a risk of infection so strict hygiene methods are needed.

If you have had abdominal surgery, your doctor may recommend haemodialysis rather than peritoneal dialysis, but this will depend on other factors too.

What is end of life care?

Answer

This is the care you will receive if your end stage kidney disease can no longer be treated or you decide you no longer want treatment.

Explanation

You have the right to choose how you wish to be cared for if your kidney failure can no longer be treated with dialysis and you can't have a kidney transplant or you decide you no longer want treatment.

What palliative treatment you choose to receive if you need end of life care is your decision. If you would like information about end of life care, ask your doctor. He or she will be able to help guide you to ensure you make the choices that are right for you. You can agree a plan and discuss this together.