Chronic Kidney Disease
Chronic kidney disease (CKD) is a long-term, largely silent condition in which the kidneys gradually lose their ability to filter waste and excess fluid from the blood. It affects 37 million Americans (1 in 7 adults), 90% of whom are undiagnosed. CKD is defined by kidney damage or reduced eGFR lasting 3+ months and is staged 1–5 by eGFR. It is a leading cause of cardiovascular disease and premature death. Once established, CKD is permanent — but progression can often be significantly slowed with proper management.
Symptoms
Early stages produce few or no symptoms. As CKD progresses: fatigue and weakness, changes in urination frequency or color, swelling in legs/ankles/feet (edema), difficulty concentrating or brain fog, nausea/vomiting/poor appetite, shortness of breath, persistent itching (pruritus), sleep problems and restless legs. Sudden swelling, extreme fatigue, difficulty breathing, or confusion require urgent evaluation.
Treatments
Blood pressure control with ACE inhibitors or ARBs (target <130/80 mmHg). Blood sugar management; SGLT2 inhibitors (e.g. empagliflozin) are kidney-protective independent of glucose effects. Kidney-friendly diet: limit sodium, potassium, phosphorus, and protein. Regular medication review to avoid nephrotoxic drugs. Anemia management with ESAs and iron. Bone/mineral health with phosphate binders and vitamin D. Stage 5 (kidney failure): hemodialysis, peritoneal dialysis, or kidney transplantation — transplant offers best long-term outcomes; planning should begin at Stage 4.
Risk Factors
Diabetes (leading cause — diabetic nephropathy), high blood pressure (second leading cause), polycystic kidney disease (inherited), glomerulonephritis (autoimmune), long-term NSAID/nephrotoxic medication use, obesity, smoking, age over 60, family history of kidney disease. Black, Hispanic, and Native American adults are disproportionately affected.
Prevalence
37 million Americans (1 in 7 adults) have CKD. 90% are undiagnosed. CKD is the 9th leading cause of death in the US and doubles the risk of heart disease. Diabetes and hypertension cause the majority of kidney failure cases. ~800,000 Americans are on dialysis or have received a kidney transplant.
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