Chronic Kidney Disease

What is Chronic Kidney Disease (CKD)?

Chronic Kidney Disease (CKD) affects as many as one in nine Americans and may be caused by diabetes, hypertension, glomerulonephritis, hereditary or urological diseases.

CKD is defined as kidney damage or a decrease in kidney function that persists over three months. The GFR (glomerular filtration rate) is a formula that uses age, race, gender and serum creatinine level to measure kidney function. Patients who have a GFR less than 60 ml/min/1.73 m2 for three months or more are diagnosed as having CKD. Kidney disease progresses as the number of nephrons (filtering units) diminish. However, it is possible to slow the progression of kidney disease at its various stages – with the goal, as often as possible, being to prevent the development of kidney failure requiring dialysis or kidney transplantation.

The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative for Clinical Practice Guidelines on CKD outlines the following stages for evaluation, classification and treatment strategy:

  • Stage 1 – GFR = 90 ml/min/1.73m2 Kidney damage with normal or high GFR
  • Stage 2 – GFR = 60 to 89 ml/min/1.73m2 Kidney damage with mild decreased GFR
  • Stage 3 – GFR = 30 to 59 ml/min/1.73m2 Moderately decreased GFR
  • Stage 4 – GFR = 15 to 29 ml/min/1.73m2 Severely decreased GFR
  • Stage 5 – GFR = <15 ml/min/1.73m2 Kidney Failure

This universal classification system enables providers to develop an action plan tailored to the stage of the disease. Some key factors in managing CKD include nutrition, blood pressure monitoring, stress management and dialysis. Our goal is to identify and reduce the risk factors associated with loss of kidney function by creating an action plan and closely monitoring the GFR to determine the effectiveness of our efforts.


About Chronic Kidney Disease

Kidney Disease develops when healthy kidney function slows down resulting in waste and excess fluid staying in the body.  Chronic Kidney Disease (CKD) is defined as kidney damage or a decrease in kidney function below 60% of normal that persists over three months.


  • Diabetes
  • High blood pressure
  • Glomerulonephritis which causes inflammation and damage to the kidney’s filtering units.
  • Polycystic kidney disease in which large cysts form in the kidneys and damage surrounding tissue.
  • Malformations in babies during development in utero
  • Lupus and other immune system diseases
  • Kidney stones, tumors, enlarged prostate
  • Repeated urinary tract infections


There are often no early warning symptoms; however, as CKD progresses, symptoms may include:

  • Weakness
  • Lack of concentration
  • Loss of appetite
  • Metallic taste in the mouth or ammonia breath
  • Inability to sleep
  • Swelling in the feet and ankles
  • Dry, itchy skin
  • Muscle cramps at night
  • Puffiness around the eyes, particularly in the morning
  • Increasing frequency of urination, especially at night


There are some preventative measures you can take to decrease your risk of developing CKD.

  • Monitor your blood pressure – this should often be 130/80 or below, and often requires a good bit of effort from the patient and providers to get there
  • Physical activity most days of the week
  • Follow a balanced nutrition plan
  • Do not smoke
  • Follow your doctor prescribed treatment plan for high blood pressure or diabetes
  • Limit the amount of over-the-counter pain medications you take
  • Treat urinary tract infections immediately
  • Drink water instead of refined-sugar laden soft drinks and juices

Complications of CKD

  • High blood pressure leading to headaches, dizziness, confusion, double/blurred vision, seizures, heart disease, heart attack and stroke.
  • Anemia (low red blood cell counts) that can be associated with pale complexion, weakness, reduced ability to exercise, feeling of poor health, constantly feeling cold, heart disease and decreased alertness and thinking ability.
  • Cardiovascular Disease developing a higher risk of chest pain, heart attacks and congestive heart failure with symptoms including shortness of breath, swelling of feet/ankles, stroke, and narrowing of the arteries in the legs causing pain, inability to walk and tissue breakdown.
  • Cholesterol/triglyceride abnormalities
  • Nutrition imbalances, decrease in appetite, lower protein levels in blood, and loss of muscle.
  • Bone disorders including abnormal bone structure, decreased bone strength and bone pain.

Neuropathy resulting in fatigue, impaired memory, confusion, disorientation, hallucinations, coma, sleep disorders, decreased sensation in extremities, itching, burning and muscle irritability.