The nuts and bolts

What is chronic kidney disease?

Chronic Kidney Disease (CKD) involves an increasing loss of kidney function over a period of months or years. The kidneys filter toxins and excess fluids from the blood, which are then removed in the urine. Advanced chronic kidney disease can cause dangerous levels of fluid, electrolytes and wastes to build up in the body, potentially resulting in kidney failure and deterioration of overall health. Untreated kidney failure is fatal.

How many people have chronic kidney disease?

Chronic Kidney Disease is a worldwide public health crisis impacting 850 million1 individuals worldwide. It’s estimated to impact close to 40 million2 adults in the United States.

1 Accessed 03.2024.

2 Accessed 03.2024.

What are the criteria for chronic kidney disease?

CKD is defined as abnormalities of kidney structure or function, present for > 3 months, with implications for health.

Criteria for CKD:
Either of the following present for › 3 months
Markers of kidney damage
(one or more)
  • Albuminuria (ACR ≥ 30 mg/g)
  • Urine sediment abnormalities
  • Electrolyte and other abnormalities due to tubular disorders
  • Abnormalities detected by histology
  • Structural abnormalities detected by imaging
  • History of kidney transplantation
Decreased GFR GFR <60 ml/min/1.73 m2
Abbreviations CKD, chronic kidney disease; GFR, glomerular filtration rate.

What are the stages of chronic kidney disease?

There are five stages of chronic kidney disease, marked by the percent of kidney function a patient has left.

For example, in stage 1, the damage to the kidneys is mild and the patient will likely have no symptoms.

In contrast, in stage 5, the patient will be in renal failure or end stage kidney disease, requiring dialysis or a kidney transplant.

What are the symptoms or signs of chronic kidney disease?

Chronic kidney disease is largely asymptomatic in its early stages. In advanced CKD, patients may experience some of these symptoms, but not attribute them to their kidneys:

  • Severe fatigue
  • Itching
  • Muscle cramps
  • Nausea
  • Loss of appetite
  • Swelling in the hands, feet, face, or belly
  • Urinating a lot, or not much at all
  • Shortness of breath
  • Trouble sleeping

The only way to know how well a patient’s kidneys are/are not working is to have them tested.1

  1. An eGFR (estimated Glomerular Filtration Rate) blood test will indicate how well the kidneys are working. It is a measure of current kidney function.
  2. UACR (Urine Albumin-to-Creatinine Ratio) or UPCR (Urine Protein-to-Creatine Ratio) tests will check for protein in the urine. They are a measure of kidney damage.
  3. Imaging tests (e.g., ultrasound, scan, X-ray, or MRI) can also uncover issues with the kidneys.

What are the causes of chronic kidney disease?

Diabetes (high blood sugar) is the leading cause of chronic kidney disease, making up nearly 40%1 of its cases. Hypertension (high blood pressure) is its second leading cause.

Both diabetes and high blood pressure can cause damage to the blood vessels and tiny filters within the kidneys. When these are damaged, the kidneys do not work as well, nor do they heal, which may lead to kidney failure.

Chronic kidney disease can also be caused by2:

  • Infections, like COVID-19
  • Repeated urinary tract infections (UTI)
  • Inherited diseases (also called genetic disease)
  • Autoimmune disease
  • Recurring kidney stones
  • Kidney cancer

What are the chronic kidney disease risk factors?

According to the CDC, the risk factors of chronic kidney disease in order of significance are:

  • Diabetes
  • High blood pressure
  • Heart disease
  • Family history of diabetes or CKD
  • Family member who has needed dialysis or a kidney transplant
  • Obesity
  • Smoking
  • Being Black, Native American, or Asian American
  • Frequent use of medications that can damage the kidneys

Can chronic kidney disease be prevented?

The best way to prevent chronic kidney disease is to control blood sugar and blood pressure, as diabetes and high blood pressure are the two most common causes of CKD.

Other ways to reduce patient risk for developing chronic kidney disease include:

  • Instructing patients to follow the instructions for over-the-counter medications and explain that taking too many pain relievers for a long period of time could lead to kidney damage.
  • Recommending that patients maintain a healthy lifestyle, including diet and exercise most days of the week.
  • Strongly encouraging patients not to smoke; explaining that smoking can damage the kidneys and make existing kidney damage worse.

How can clinicians treat their patient’s chronic kidney disease?

  1. Medical management.

    In the last decade, new medications, shown to help protect the kidneys, have been introduced. For example, SGLT2 inhibitors are medications that may reduce the risk of kidney failure in adults with chronic kidney disease. Medications, combined with appropriate referral to a specialist and patient engagement, are all important for reducing the burden of CKD worldwide.

  2. Diet and exercise.

    There are some kidney-friendly diet options that may decrease the symptoms and/or progression of chronic kidney disease in your patients. These options include decreasing the intake of sugar, salt, and carbohydrates. In addition, you may recommend that your patient consume less alcohol (no more than two drinks per day for men, and one for women). Quitting smoking is also recommended.

    An exercise regimen of 30 minutes or more on most days of the week may also help with your patient’s symptoms.

  3. Dialysis.

    Dialysis removes waste and extra fluids from the blood when the patient’s kidneys have failed and are not able to do so on their own. Dialysis is only 10-15% as effective as normal kidney function.

  4. Kidney transplant.

    Your patient’s unhealthy kidney may need to be replaced by a healthy kidney from someone else’s body, either through a living or deceased donor.

Once a patient is diagnosed with chronic kidney disease, can his/her progression be mitigated?

After the age of 40, on average, adults lose approximately 1% of their kidney function per year.1

If a patient has chronic kidney disease and diabetes, the rate of decline can be even greater. That’s where the kidneyintelX.dkd test can provide useful information.

Learn more about our FDA approved test here.

How does kidneyintelX.dkd work?

To find out how it works and performs, please go to the Test page here.

How can clinicians implement kidneyintelX.dkd in their offices?

The kidneyintelX.dkd test is appropriate for use when adult patients with type 2 diabetes are also diagnosed with chronic kidney disease, stages 1-3b. It is a simple blood test that can be added to a regularly scheduled blood order.

For more details about our test, please go to the Test page here.