Table of ContentsView AllTable of ContentsDietOTC SupplementsPrescriptionsDialysisKidney TransplantFrequently Asked QuestionsNext in Kidney Disease GuideWhat Is Kidney Disease?
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Table of Contents
Diet
OTC Supplements
Prescriptions
Dialysis
Kidney Transplant
Frequently Asked Questions
Next in Kidney Disease Guide
Chronic kidney disease (CKD)is defined as the progressive and irreversible damage to the kidneys that, over the course of months or years, can lead tokidney (renal) failure. While there is no cure for CKD, there are treatments that can significantly slow the progression of the disease if started early.
The treatment can vary based on your stage of disease and the underlyingcause, such as diabetes or high blood pressure. Treatment options may include a low-protein diet, antihypertensive and statin medications, diuretics, vitamin supplements, bone marrow stimulants, and phosphorus-reducing drugs.
Chronic Kidney Disease
If the disease progresses and the kidneys are no longer functioning—a condition known asend-stage renal disease (ESRD)—eitherdialysisor a kidney transplant would be needed for you to survive.
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CKD differs from anacute kidney injury (AKI)in that the latter is often reversible. With CKD, any damage done to the kidneys will be permanent. When damaged, fluids and waste normally excreted from the body in urine will “back up” and accumulate to increasingly harmful levels. Much of the waste is the result of the normal metabolism of protein.
Because CKD is progressive, immediatedietary changeswould be needed to restrict your intake of protein and substances even if have no symptoms. If the disease progresses and kidney function is further impaired, there may be additional restrictions to your diet.
The dietary guidelines would be based on the stage of disease, which ranges from stage 1 for minimal impairment to stage 5 for ESRD. In addition, you would need to achieve your ideal weight while maintaining the recommended daily nutritional goals outlined in the2020-2025 Dietary Guidelines for Americans.
It is usually best, particularly in the early stages, to work with a certified dietician to tailor a diet appropriate to your kidneys. Future consultations may also be recommended if and when your disease progresses.
Recommendations for All Stages of CKD
The goals of a CKD diet are to slow the progression of the disease and minimize any harm the accumulation of waste and fluids can do to other organs, most predominately the heart and cardiovascular system.
To this end, you would need to immediatelyadjust your dietin three key ways:
The 2020 guidelines from NKF and partner organizations call for about 0.6 grams of protein per kilogram (kg) of weight per day in people in CKD stages 3 through 5 who are stable, not on dialysis, and are not diagnosed with co-occurring diabetes.
For people with diabetes, it’s 0.6 to 0.8 grams per kg per day. The International Society of Renal Nutrition and Metabolism recommends the lower end of this range as a target for anyone with CKD. At 0.6 grams per kg, the estimated daily intakes for various weights are presented below.
Recommendations for Stages 4 and 5 CKD
As the disease progresses and your renal function drops below 70 percent of what it should be, your nephrologist will recommend a restriction of phosphorus and potassium, two electrolytes that can harm the body if they accumulate excessively.
Among the considerations:
A number of over-the-counter (OTC) supplements are commonly used to correct nutritional deficits that can occur in later stages of CKD. Among the recommended supplements:
Prescription medications are commonly used to manage thesymptoms of CKDor prevent later-stagecomplications. Some aid in reducing anemia and hypertension, while others are used to normalize the balance of fluids and electrolytes in the blood.
ACE Inhibitors
Angiotensin-converting enzyme (ACE) inhibitorsare used to relax blood vessels and reduce high blood pressure. They can be prescribed at any stage of the disease and are used on an ongoing (chronic) basis to reduce cardiovascular risk.
Commonly prescribed ACE inhibitors include:
Side effects include dizziness, cough, itchiness, rash, abnormal taste, and sore throat.
Angiotensin II Receptor Blockers
Angiotensin II receptor blockers (ARBs)function similarly to ACE inhibitor but target the receptor rather than the enzyme to reduce blood pressure. ARBs are typically used in people who cannot tolerate ACE inhibitors.
Options include:
Side effects include dizziness, diarrhea, muscle cramps, weakness, sinus infection, leg or back pain, insomnia, and irregular heartbeat.
Statin Drugs
Statin drugsare used to lower cholesterol and reduce the risk of cardiovascular disease. As with ARBs and ACE inhibitors, they are used on an ongoing basis.
The statin drugs commonly prescribed to treat high cholesterol (hypercholesterolemia) include:
Side effects include headache, constipation, diarrhea, rash, muscle aches, weakness, nausea, and vomiting.
Erythropoietin-Stimulating Agents
There are two ESAs currently approved for use in the U.S.:
Side effects include injection site pain, fever, dizziness, high blood pressure, and nausea.
Phosphorus Binders
Phosphorus binders, also known as phosphate binders, are often used in people with stage 5 CKD to reduce levels of phosphorus in the blood. They are taken orally before a meal and prevent the body from absorbing phosphorus from the foods you eat. There are different forms available, some of which use calcium, magnesium, iron, or aluminum as the binding agent.
Side effects include loss of appetite, upset stomach, gas, bloating, diarrhea, constipation, fatigue, itching, nausea, and vomiting.
Diuretics
When treating early-stage CKD, doctors will often use a thiazide diuretic which can be used safely on an ongoing basis. Options include:
Another more potent form of the drug, called a loop diuretic, may be prescribed in stage 4 and stage 5 CKD, especially if you are diagnosed with chronic heart failure (CHF). Options include:
Common side effects of diuretics include headache, dizziness, and muscle cramps.
Mineralocorticoid receptor antagonists (MRAs)
Mineralocorticoid receptor antagonists (MRAs) are generally only recommended for patients with chronic kidney disease (CKD) who have a certain level of kidney function, measured as an estimated glomerular filtration rate (eGFR) above 30 mL/min/1.73 m2.
They should not be used in patients with chronic kidney disease (CKD) stages 4 to 5. The risk of hyperkalemia, or high serum potassium levels, increases when starting MRAs if the patient’s serum potassium is already above 4.5 mEq/L while on an appropriate diuretic.
In 2021, the Food and Drug Administration approved Kerendia (finerenone), the first non-steroidal MRA, based on research suggesting it can reduce the risk of kidney complications in adults with CKD associated with type 2 diabetes. Side effects of Kerendia includehypotension(low blood pressure),hyponatremia(low sodium), and hyperkalemia (high potassium).
Phosphate Blockers
Sodium/hydrogen exchange 3 (NHE3) transporterblockers are used to lower phosphate levels in the blood. They are used in people with CKD on dialysis as an add-on therapy when phosphate binders do not work well or when phosphate binders are not tolerated.
The only current NHE3 inhibitor approved for CKD is Xphozah (tenapanor). Common side effects include diarrhea and increased bowel movements.
One such intervention is calleddialysis. This involves the mechanical or chemical filtering of waste and fluids from your blood when your kidneys are no longer able to do so. There are two methods commonly used for this, known as hemodialysis and peritoneal dialysis.
Hemodialysis
Hemodialysisuses a mechanical filtration machine to purify blood taken directly from a blood vessel and returned to your body in a clean and balanced state. It can be performed at a hospital or dialysis center. Newer portable models are available which allow you to undergo dialysis at home.
The process begins with a surgical procedure tocreate an access pointfrom which to draw and return blood from a vein or artery. There are three ways to do this:
Hemodialysis requires you to visit the hospital or clinic three times a week for four-hour sessions. While the home dialysis machine can offer you privacy and convenience, it requires six treatments per week at 2-1/2 hours each.
There is another home option, known as nocturnal daily hemodialysis, in which the cleansing of blood is done while you sleep. It is performed five to seven times per week, lasting six to eight hours, and may afford you the greater clearance of waste compared to the other versions.
Side effects of hemodialysis include low blood pressure, shortness of breath, abdominal cramps, muscle cramps, nausea, and vomiting.
Peritoneal Dialysis
Peritoneal dialysisuses chemicals rather than machinery to cleanse your blood. It involves the surgical implantation of a catheter into your abdomen through which a liquid solution, called dialysate, is fed to absorb waste and draw out accumulated fluids. The solution is then extracted and discarded.
The dialysate solution is typically composed of salt and an osmotic agent like glucose which inhibits the reabsorption of water and sodium. The membrane that lines the abdominal cavity, called the peritoneum, serves as the filter through which fluids, electrolytes, and other dissolved substances can be extracted from the blood.
Once the catheter is implanted, the dialysis can be performed at home several times per day. For each treatment, two to three liters of solution would be fed into your belly through the catheter and kept there for four to six hours. Once the waste solution is drained, the process is started all over again with fresh dialysate solution.
Automated cycling machines can perform this task this overnight, providing you greater independence and time to pursue everyday interests.
Complications of peritoneal dialysis include infection, low blood pressure (if too much fluid is extracted), and abdominal bleeding.The procedure itself can cause abdominal discomfort and impaired breathing (due to the increased pressure placed on the diaphragm).
Akidney transplantis a procedure in which a healthy kidney is taken from a live or deceased donor and surgically implanted into your body. While it is a major surgery fraught with short- and long-term challenges, a successful transplant can not onlyextend your lifebut restore you to a near-normal state of function.
With that being said, the results can vary from person. While you will no longer require dialysis or the same dietary restrictions, you will need to take immune-suppressive drugs for the rest of your life to avoidorgan rejection. This can increase the risk of infection, requiring you to take extra steps to avoid illness and treat infections aggressively.
People with stage 5 CKD can get a transplant at any age, whether they are a child or senior. However, you would need to be healthy enough to withstand the operation and must be free from cancer and certain infections.
What to Expect
Toassess your eligibility, you would have to undergo physical and psychological evaluation. If a problem is found, it would need to be treated or corrected before the transplant is approved.
Once a donor kidney is found, you will be scheduled and prepped for surgery. In most cases, only one kidney would be transplanted without removing the old ones. You would generally be well enough to return home after a few days.
Once transplanted, it can take up to three weeks for the new organ to be fully functional. During this time would need to continue dialysis.
Thanks to advances in transplant surgery and management, kidney transplants from a deceased donor last 10 to 15 years on average and transplants from a living donor last 15 to 20 years on average.
Antihypertensive drugslike ACE inhibitors, ARBs, anddiureticscan help control blood pressure and reduce stress on the kidneys. Statin drugs help lower cholesterol and preventatherosclerosisthat contributes to high blood pressure. People with later-stage CKD may be given erythropoietin-stimulating agents (ESAs) to preventanemiaand phosphorus binders to preventhyperphosphatemia, both of which can be severe.
Diet is the main intervention for all stages of CKD. This involves reducing protein and sodium intake, and following aheart-healthy dietto better manage blood pressure. With later-stage CKD, restricting potassium- and phosphorus-containing foods is essential. Exercise, smoking cessation, and weight loss (if needed) are also crucial to the treatment plan.
Chronic kidney disease is staged with a test called theestimated glomerular filtration rate (eGFR), which measures kidney function based on acreatinine blood testalong with your age, sex, and race. When the eGFR drops below 15, this means that your kidneys are severely damaged and your condition is stage 5. Stage 5 CKD is the point where dialysis is started to keep you alive.
Peritoneal dialysis, which uses chemicals and the lining of the stomach to filter waste, may have an advantage over traditional hemodialysis in the early days—in part because it can be done at home on a more frequent basis. Even so, the benefits are limited to the first year or two of treatment; after that, the survival benefit for both are essentially equal.
Stage 5 CKD, also known as end-stage renal disease (ESRD), is the point where a kidney transplant would be considered. It may also be considered with stage 4 CKD, either when the eGFR drops below 20 or another organ transplant is needed. A full evaluation is needed to determine if the benefits of a transplant outweigh the risks.
What Is the Life Expectancy With Chronic Kidney Disease?
23 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. Department of Agriculture and U.S. Department of Health and Human Services.Dietary Guidelines for Americans, 2020-2025.National Kidney Foundation.How much sodium is safe for kidney patients?National Kidney Foundation.CKD diet: How much protein is the right amount?Rhee CM, Wang AY, Biruete A, Kistler B, Kovesdy CP, Zarantonello D, et al.Nutritional and dietary management of chronic kidney disease under conservative and preservative kidney care without dialysis.J Ren Nutr. 2023 Nov;33(6S):S56-S66. doi: 10.1053/j.jrn.2023.06.010.St-Jules DE, Goldfarb DS, Pompeii ML, Sevick MA.Phosphate additive avoidance in chronic kidney disease.Diabetes Spectr. 2017;30(2):101-106. doi:10.2337/ds16-0048National Kidney Foundation.Potassium in your CKD diet.MedlinePlus.ACE inhibitors.Barreras A, Gurk-Turner C.Angiotensin II receptor blockers.Proc (Bayl Univ Med Cent). 2003;16(1):123-6.Ward NC, Watts GF, Eckel RH.Statin toxicity: mechanistic insights and clinical implications.Circ Res. 2019;124(2):328-350. doi:10.1161/CIRCRESAHA.118.312782Cleveland Clinic.Erythropoietin.Harvard Health Publishing.Tips for taking diuretic medications.Xanthakis V, Vasan RS.Aldosterone and the risk of hypertension.Curr Hypertens Rep. 2013;15(2):102-107. doi:10.1007/s11906-013-0330-yBauersachs J, Jaisser F, Toto R.Mineralocorticoid receptor activation and mineralocorticoid receptor antagonist treatment in cardiac and renal diseases.Hypertension. 2015;65(2):257-263. doi:10.1161/HYPERTENSIONAHA.114.04488U.S Food and Drug Administration.FDA approves drug to reduce risk of serious kidney and heart complications in adults with chronic kidney disease associated with type 2 diabetes.U.S. Food and Drug Administration.Xphozah label.Vassalotti J, Centor R, Turner B, et al.Practical approach to detection and management of chronic kidney disease for the primary care clinician.Am J Med.2016;129(2):153-62. doi:10.1016/j.amjmed.2015.08.025.Stuart S, Booth TC, Cash CJ, et al.Complications of continuous ambulatory peritoneal dialysis.RadioGraphics. 2009;29(2):441-60. doi:10.1148/rg.292085136United Network for Organ Sharing.Organ transplant.American Kidney Fund (AKF).Kidney donation and transplant.American Kidney Fund.Stages of chronic kidney disease (CKD).Gaitonde DY, Cook DL, Rivera IM.Chronic kidney disease: detection and evaluation.Amer Fam Phys.2017;96(12):776-83.Sinnakirouchenan R, Holley JL.Peritoneal dialysis versus hemodialysis: risks, benefits, and access issues.Adv Chron Kidney Dis.2011;18(6):428-32. doi:10.1053/j.ackd.2011.09.001Cleveland Clinic.Am I a candidate for a kidney transplant?
23 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. Department of Agriculture and U.S. Department of Health and Human Services.Dietary Guidelines for Americans, 2020-2025.National Kidney Foundation.How much sodium is safe for kidney patients?National Kidney Foundation.CKD diet: How much protein is the right amount?Rhee CM, Wang AY, Biruete A, Kistler B, Kovesdy CP, Zarantonello D, et al.Nutritional and dietary management of chronic kidney disease under conservative and preservative kidney care without dialysis.J Ren Nutr. 2023 Nov;33(6S):S56-S66. doi: 10.1053/j.jrn.2023.06.010.St-Jules DE, Goldfarb DS, Pompeii ML, Sevick MA.Phosphate additive avoidance in chronic kidney disease.Diabetes Spectr. 2017;30(2):101-106. doi:10.2337/ds16-0048National Kidney Foundation.Potassium in your CKD diet.MedlinePlus.ACE inhibitors.Barreras A, Gurk-Turner C.Angiotensin II receptor blockers.Proc (Bayl Univ Med Cent). 2003;16(1):123-6.Ward NC, Watts GF, Eckel RH.Statin toxicity: mechanistic insights and clinical implications.Circ Res. 2019;124(2):328-350. doi:10.1161/CIRCRESAHA.118.312782Cleveland Clinic.Erythropoietin.Harvard Health Publishing.Tips for taking diuretic medications.Xanthakis V, Vasan RS.Aldosterone and the risk of hypertension.Curr Hypertens Rep. 2013;15(2):102-107. doi:10.1007/s11906-013-0330-yBauersachs J, Jaisser F, Toto R.Mineralocorticoid receptor activation and mineralocorticoid receptor antagonist treatment in cardiac and renal diseases.Hypertension. 2015;65(2):257-263. doi:10.1161/HYPERTENSIONAHA.114.04488U.S Food and Drug Administration.FDA approves drug to reduce risk of serious kidney and heart complications in adults with chronic kidney disease associated with type 2 diabetes.U.S. Food and Drug Administration.Xphozah label.Vassalotti J, Centor R, Turner B, et al.Practical approach to detection and management of chronic kidney disease for the primary care clinician.Am J Med.2016;129(2):153-62. doi:10.1016/j.amjmed.2015.08.025.Stuart S, Booth TC, Cash CJ, et al.Complications of continuous ambulatory peritoneal dialysis.RadioGraphics. 2009;29(2):441-60. doi:10.1148/rg.292085136United Network for Organ Sharing.Organ transplant.American Kidney Fund (AKF).Kidney donation and transplant.American Kidney Fund.Stages of chronic kidney disease (CKD).Gaitonde DY, Cook DL, Rivera IM.Chronic kidney disease: detection and evaluation.Amer Fam Phys.2017;96(12):776-83.Sinnakirouchenan R, Holley JL.Peritoneal dialysis versus hemodialysis: risks, benefits, and access issues.Adv Chron Kidney Dis.2011;18(6):428-32. doi:10.1053/j.ackd.2011.09.001Cleveland Clinic.Am I a candidate for a kidney transplant?
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
U.S. Department of Agriculture and U.S. Department of Health and Human Services.Dietary Guidelines for Americans, 2020-2025.National Kidney Foundation.How much sodium is safe for kidney patients?National Kidney Foundation.CKD diet: How much protein is the right amount?Rhee CM, Wang AY, Biruete A, Kistler B, Kovesdy CP, Zarantonello D, et al.Nutritional and dietary management of chronic kidney disease under conservative and preservative kidney care without dialysis.J Ren Nutr. 2023 Nov;33(6S):S56-S66. doi: 10.1053/j.jrn.2023.06.010.St-Jules DE, Goldfarb DS, Pompeii ML, Sevick MA.Phosphate additive avoidance in chronic kidney disease.Diabetes Spectr. 2017;30(2):101-106. doi:10.2337/ds16-0048National Kidney Foundation.Potassium in your CKD diet.MedlinePlus.ACE inhibitors.Barreras A, Gurk-Turner C.Angiotensin II receptor blockers.Proc (Bayl Univ Med Cent). 2003;16(1):123-6.Ward NC, Watts GF, Eckel RH.Statin toxicity: mechanistic insights and clinical implications.Circ Res. 2019;124(2):328-350. doi:10.1161/CIRCRESAHA.118.312782Cleveland Clinic.Erythropoietin.Harvard Health Publishing.Tips for taking diuretic medications.Xanthakis V, Vasan RS.Aldosterone and the risk of hypertension.Curr Hypertens Rep. 2013;15(2):102-107. doi:10.1007/s11906-013-0330-yBauersachs J, Jaisser F, Toto R.Mineralocorticoid receptor activation and mineralocorticoid receptor antagonist treatment in cardiac and renal diseases.Hypertension. 2015;65(2):257-263. doi:10.1161/HYPERTENSIONAHA.114.04488U.S Food and Drug Administration.FDA approves drug to reduce risk of serious kidney and heart complications in adults with chronic kidney disease associated with type 2 diabetes.U.S. Food and Drug Administration.Xphozah label.Vassalotti J, Centor R, Turner B, et al.Practical approach to detection and management of chronic kidney disease for the primary care clinician.Am J Med.2016;129(2):153-62. doi:10.1016/j.amjmed.2015.08.025.Stuart S, Booth TC, Cash CJ, et al.Complications of continuous ambulatory peritoneal dialysis.RadioGraphics. 2009;29(2):441-60. doi:10.1148/rg.292085136United Network for Organ Sharing.Organ transplant.American Kidney Fund (AKF).Kidney donation and transplant.American Kidney Fund.Stages of chronic kidney disease (CKD).Gaitonde DY, Cook DL, Rivera IM.Chronic kidney disease: detection and evaluation.Amer Fam Phys.2017;96(12):776-83.Sinnakirouchenan R, Holley JL.Peritoneal dialysis versus hemodialysis: risks, benefits, and access issues.Adv Chron Kidney Dis.2011;18(6):428-32. doi:10.1053/j.ackd.2011.09.001Cleveland Clinic.Am I a candidate for a kidney transplant?
U.S. Department of Agriculture and U.S. Department of Health and Human Services.Dietary Guidelines for Americans, 2020-2025.
National Kidney Foundation.How much sodium is safe for kidney patients?
National Kidney Foundation.CKD diet: How much protein is the right amount?
Rhee CM, Wang AY, Biruete A, Kistler B, Kovesdy CP, Zarantonello D, et al.Nutritional and dietary management of chronic kidney disease under conservative and preservative kidney care without dialysis.J Ren Nutr. 2023 Nov;33(6S):S56-S66. doi: 10.1053/j.jrn.2023.06.010.
St-Jules DE, Goldfarb DS, Pompeii ML, Sevick MA.Phosphate additive avoidance in chronic kidney disease.Diabetes Spectr. 2017;30(2):101-106. doi:10.2337/ds16-0048
National Kidney Foundation.Potassium in your CKD diet.
MedlinePlus.ACE inhibitors.
Barreras A, Gurk-Turner C.Angiotensin II receptor blockers.Proc (Bayl Univ Med Cent). 2003;16(1):123-6.
Ward NC, Watts GF, Eckel RH.Statin toxicity: mechanistic insights and clinical implications.Circ Res. 2019;124(2):328-350. doi:10.1161/CIRCRESAHA.118.312782
Cleveland Clinic.Erythropoietin.
Harvard Health Publishing.Tips for taking diuretic medications.
Xanthakis V, Vasan RS.Aldosterone and the risk of hypertension.Curr Hypertens Rep. 2013;15(2):102-107. doi:10.1007/s11906-013-0330-y
Bauersachs J, Jaisser F, Toto R.Mineralocorticoid receptor activation and mineralocorticoid receptor antagonist treatment in cardiac and renal diseases.Hypertension. 2015;65(2):257-263. doi:10.1161/HYPERTENSIONAHA.114.04488
U.S Food and Drug Administration.FDA approves drug to reduce risk of serious kidney and heart complications in adults with chronic kidney disease associated with type 2 diabetes.
U.S. Food and Drug Administration.Xphozah label.
Vassalotti J, Centor R, Turner B, et al.Practical approach to detection and management of chronic kidney disease for the primary care clinician.Am J Med.2016;129(2):153-62. doi:10.1016/j.amjmed.2015.08.025.
Stuart S, Booth TC, Cash CJ, et al.Complications of continuous ambulatory peritoneal dialysis.RadioGraphics. 2009;29(2):441-60. doi:10.1148/rg.292085136
United Network for Organ Sharing.Organ transplant.
American Kidney Fund (AKF).Kidney donation and transplant.
American Kidney Fund.Stages of chronic kidney disease (CKD).
Gaitonde DY, Cook DL, Rivera IM.Chronic kidney disease: detection and evaluation.Amer Fam Phys.2017;96(12):776-83.
Sinnakirouchenan R, Holley JL.Peritoneal dialysis versus hemodialysis: risks, benefits, and access issues.Adv Chron Kidney Dis.2011;18(6):428-32. doi:10.1053/j.ackd.2011.09.001
Cleveland Clinic.Am I a candidate for a kidney transplant?
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