Kidney disease, chronic

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Overview

Kidney disease, chronic
Kidney disease, chronic

Chronic kidney disease (CKD) is a long-term condition where the kidneys don't work as well as they should.

It's a common condition often associated with getting older. It can affect anyone, but it's more common in people who are black or of south Asian origin.

CKD can get worse over time and eventually the kidneys may stop working altogether, but this is uncommon. Many people with CKD are able to live long lives with the condition.

Symptoms of CKD

There are usually no symptoms of kidney disease in the early stages. It may only be diagnosed if you have a blood or urine test for another reason and the results show a possible problem with your kidneys.

At a more advanced stage, symptoms can include:

See a GP if you have persistent or worrying symptoms that you think could be caused by kidney disease.

Causes of CKD

Chronic kidney disease is usually caused by other conditions that put a strain on the kidneys. Often it's the result of a combination of different problems.

CKD can be caused by:

You can help prevent CKD by making healthy lifestyle changes and ensuring any underlying conditions you have are well controlled.

Tests for CKD

CKD can be diagnosed using blood and urine tests. These tests look for high levels of certain substances in your blood and urine that are signs your kidneys aren't working properly.

If you're at a high risk of developing kidney disease (for example, you have a known risk factor such as high blood pressure or diabetes), you may be advised to have regular tests to check for CKD so it's found at an early stage.

The results of your blood and urine tests can be used to tell the stage of your kidney disease. This is a number that reflects how severe the damage to your kidneys is, with a higher number indicating more serious CKD.

Treatments for CKD

There's no cure for CKD, but treatment can help relieve the symptoms and stop it getting worse.

Your treatment will depend on how severe your condition is.

The main treatments are:

  • lifestyle changes to help you remain as healthy as possible
  • medicine to control associated problems such as high blood pressure and high cholesterol
  • dialysis – treatment to replicate some of the kidney's functions; this may be necessary in advanced CKD
  • kidney transplant – this may also be necessary in advanced CKD

You'll also be advised to have regular check-ups to monitor your condition.

Outlook for CKD

CKD can range from a mild condition with no or few symptoms, to a very serious condition where the kidneys stop working, sometimes called kidney failure.

Most people with CKD will be able to control their condition with medicine and regular check-ups. CKD only progresses to kidney failure in around 1 in 50 people with the condition.

If you have CKD, even if it's mild, you're at an increased risk of developing other serious problems, such as cardiovascular disease. This is a group of conditions affecting the heart and blood vessels, which includes heart attack and stroke.

Cardiovascular disease is one of the main causes of death in people with kidney disease, although healthy lifestyle changes and medicine can help reduce your risk of developing it.

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Symptoms

Many people with chronic kidney disease (CKD) will not have symptoms because it does not usually cause problems until it reaches an advanced stage.

Early stages of CKD

Kidney disease does not tend to cause symptoms when it's at an early stage.

This is because the body is usually able to cope with a significant reduction in kidney function.

Kidney disease is often only diagnosed at this stage if a routine test for another condition, such as a blood or urine test, detects a possible problem.

If it's found at an early stage, medicine and regular tests to monitor it may help stop it becoming more advanced.

Later stages of CKD

A number of symptoms can develop if kidney disease is not found early or it gets worse despite treatment.

Symptoms can include:

This stage of CKD is known as kidney failure, end-stage renal disease or established renal failure. It may eventually require treatment with dialysis or a kidney transplant.

When to get medical advice

See your GP if you have persistent or worrying symptoms that you think could be caused by kidney disease.

The symptoms of kidney disease can be caused by many less serious conditions, so it's important to get a proper diagnosis.

If you do have CKD, it's best to get it diagnosed as soon as possible. Kidney disease can be diagnosed by having blood and urine tests.

Diagnosis

Chronic kidney disease (CKD) can be diagnosed with blood and urine tests.

In many cases, CKD is only found when a routine blood or urine test you have for another problem shows that your kidneys may not be working normally.

Who should be tested for CKD?

See your GP if you have persistent symptoms of CKD, such as:

Your GP can look for other possible causes and arrange tests if necessary.

Because CKD often has no symptoms in the early stages, some people at a higher risk should be tested regularly.

Regular testing is recommended if you have:

You're also more likely to develop kidney disease if you're black or of south Asian origin.

People taking long-term medicines that can affect the kidneys, such as lithium, omeprazole or non-steroidal anti-inflammatory drugs (NSAIDs), should also be tested regularly.

Talk to your GP if you think you may need regular testing for kidney disease.

Tests for CKD

Blood test

The main test for kidney disease is a blood test. The test measures the levels of a waste product called creatinine in your blood.

Your doctor uses your blood test results, plus your age, size, gender and ethnic group to calculate how many millilitres of waste your kidneys should be able to filter in a minute.

This calculation is known as your estimated glomerular filtration rate (eGFR).

Healthy kidneys should be able to filter more than 90ml/min. You may have CKD if your rate is lower than this.

Urine tests

A urine test is also done to:

  • check the levels of substances called albumin and creatinine in your urine – known as the albumin:creatinine ratio, or ACR
  • check for blood or protein in your urine

Alongside your eGFR, urine tests can help give a more accurate picture of how well your kidneys are working.

Other tests

Sometimes other tests are also used to assess the level of damage to your kidneys.

These may include:

  • an ultrasound scan, MRI scan or CT scan – to see what the kidneys look like and check whether there are any blockages
  • a kidney biopsy – a small sample of kidney tissue is removed using a needle and the cells are examined under a microscope for signs of damage

Test results and stages of CKD

Your test results can be used to determine how damaged your kidneys are, known as the stage of CKD.

This can help your doctor decide the best treatment for you and how often you should have tests to monitor your condition.

Your eGFR results is given as a stage from 1 of 5:

  • stage 1 (G1) – a normal eGFR above 90ml/min, but other tests have detected signs of kidney damage
  • stage 2  (G2) – a slightly reduced eGFR of 60 to 89ml/min, with other signs of kidney damage
  • stage 3a (G3a) – an eGFR of 45 to 59ml/min
  • stage 3b (G3b) – an eGFR of 30 to 44ml/min
  • stage 4 (G4) – an eGFR of 15 to 29ml/min
  • stage 5 (G5) – an eGFR below 15ml/min, meaning the kidneys have lost almost all of their function

Your ACR result is given as a stage from 1 to 3:

  • A1 – an ACR of less than 3mg/mmol
  • A2 – an ACR of 3 to 30mg/mmol
  • A3 – an ACR of more than 30mg/mmol

For both eGFR and ACR, a higher stage indicates more severe kidney disease.

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Treatment

There's no cure for chronic kidney disease (CKD), but treatment can help relieve the symptoms and stop it getting worse.

Your treatment will depend on the stage of your CKD.

The main treatments are:

  • lifestyle changes – to help you stay as healthy as possible
  • medicine – to control associated problems, such as high blood pressure and high cholesterol
  • dialysis – treatment to replicate some of the kidney's functions, which may be necessary in advanced (stage 5) CKD
  • kidney transplant – this may also be necessary in advanced (stage 5) CKD

Lifestyle changes

The following lifestyle measures are usually recommended for people with kidney disease:

  • stop smoking if you smoke
  • eat a healthy, balanced diet
  • restrict your salt intake to less than 6g a day - that's around 1 teaspoon
  • do regular exercise – aim to do at least 150 minutes a week
  • manage your alcohol intake so you drink no more than the recommended limit of 14 units of alcohol a week
  • lose weight if you're overweight or obese
  • avoid over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, except when advised to by a medical professional – these medicines can harm your kidneys if you have kidney disease

Medicine

There's no medicine specifically for CKD, but medicine can help control many of the problems that cause the condition and the complications that can happen as a result of it.

You may need to take medicine to treat or prevent the different problems caused by CKD.

High blood pressure

Good control of blood pressure is vital to protect the kidneys.

People with kidney disease should usually aim to get their blood pressure down to below 140/90mmHg, but you should aim to get it down to below 130/80mmHg if you also have diabetes.

There are many types of blood pressure medicines, but medicines called angiotensin converting enzyme (ACE) inhibitors are often used. Examples include ramipril, enalapril and lisinopril.

Side effects of ACE inhibitors can include:

If the side effects of ACE inhibitors are particularly troublesome, you can be given a medicine called an angiotensin-II receptor blocker (ARB) instead.

Find out more about how high blood pressure is treated.

Diabetes or high ACR

If you also have type 2 diabetes or a high albumin to creatinine ratio (ACR) you may be offered a medicine called dapagliflozin, as well as medicines for high blood pressure. Dapagliflozin helps to lower your blood sugar and can reduce damage to your kidneys.

High cholesterol

People with CKD have a higher risk of cardiovascular disease, including heart attack and stroke.

This is because some of the causes of kidney disease are the same as those for cardiovascular disease, including high blood pressure and high cholesterol.

You may be prescribed medicines called statins to reduce your risk of developing cardiovascular disease. Examples include atorvastatin and simvastatin.

Side effects of statins can include:

  • headaches
  • feeling sick
  • constipation or diarrhoea
  • muscle and joint pain

Read more about how high cholesterol is treated.

High potassium levels

People with CKD can develop high potassium levels in their blood, called hyperkalaemia, because their kidneys do not work properly.

Hyperkalaemia can cause muscle weakness, stiffness and tiredness. If it becomes severe, it can cause an irregular heartbeat (arrhythmia) which can lead to a heart attack.

If you have CKD, it's important to avoid taking potassium supplements and some medicines used to treat high blood pressure and heart failure because they can make your potassium levels too high. Talk to a GP about the medicines you take if you're worried.

A medicine called sodium zirconium cyclosilicate can be used to treat hyperkalaemia in adults, but only if it's used:

  • in emergency care for acute life-threatening hyperkalaemia alongside standard care
  • in people with hyperkalaemia that does not get better, CKD stage 3b to 5, or heart failure

People with hyperkalaemia that does not get better (called persistent CKD) who also have CKD stage 3b to 5, or heart failure, should only take sodium zirconium cyclosilicate if they:

  • have a serum potassium level of at least 6.0 mmol/litre and
  • are not also taking a certain amount of renin-angiotensin-aldosterone system (RAAS) inhibitor because of hyperkalaemia and
  • are not on dialysis

You should stop taking sodium zirconium cyclosilicate if RAAS inhibitors are no longer suitable for you.

Water retention

You may get swelling in your ankles, feet and hands if you have kidney disease.

This is because your kidneys are not as effective at removing fluid from your blood, causing it to build up in body tissues (oedema).

You may be advised to reduce your daily salt and fluid intake, including fluids in food such as soups and yoghurts, to help reduce the swelling.

In some cases you may also be given diuretics (tablets to help you pee more), such as furosemide.

Side effects of diuretics can include dehydration and reduced levels of sodium and potassium in the blood.

Anaemia

Many people with advanced-stage CKD develop anaemia, which is a lack of red blood cells.

Symptoms of anaemia include:

  • tiredness 
  • lack of energy
  • shortness of breath
  • a pounding, fluttering or irregular heartbeat (palpitations) 

If you have anaemia, you may be given injections of a medicine called erythropoietin. This is a hormone that helps your body produce more red blood cells.

If you have an iron deficiency as well, iron supplements may also be recommended.

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Bone problems

If your kidneys are severely damaged, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it.

Along with calcium, phosphate is important for maintaining healthy bones. But if your phosphate level rises too much, it can upset the balance of calcium in your body and lead to thinning of the bones.

You may be advised to limit the amount food you eat which are high in phosphate, such as red meat, dairy products, eggs and fish.

If this does not lower your phosphate level enough, you may be given medicines called phosphate binders. Commonly used medicines include calcium acetate and calcium carbonate.

Some people with CKD also have low levels of vitamin D, which is necessary for healthy bones.

If you're low in vitamin D, you may be given a supplement called colecalciferol or ergocalciferol to boost your vitamin D level. 

Glomerulonephritis

Kidney disease can be caused by inflammation of the filters inside the kidneys, known as glomerulonephritis.

In some cases this happens as a result of the immune system mistakenly attacking the kidneys.

If a kidney biopsy finds this is the cause of your kidney problems, you may be prescribed medicine to reduce the activity of your immune system, such as a steroid or a medicine called cyclophosphamide.

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Improving muscle strength

If you are having a bad flare-up and are unable to exercise, you may be offered electrical stimulation to make your muscles stronger.

This is where electrodes are placed on your skin and small electrical impulses are sent to weak muscles, usually in your arms or legs.

Dialysis

For a small proportion of people with CKD, the kidneys will eventually stop working.

This usually hapens gradually, so there should be time to plan the next stage of your treatment.

One of the options when CKD reaches this stage is dialysis. This is a method of removing waste products and excess fluid from the blood.

There are 2 main types of dialysis:

  • haemodialysis – this involves diverting blood into an external machine, where it's filtered before being returned to the body
  • peritoneal dialysis – this involves pumping dialysis fluid into a space inside your tummy to draw out waste products from the blood as they pass through vessels lining the inside of your tummy

Haemodialysis is usually done about 3 times a week, either at hospital or at home. Peritoneal dialysis is normally done at home several times a day, or overnight.

If you don't have a kidney transplant, treatment with dialysis will usually need to be lifelong.

Talk to your doctor about the pros and cons of each type of dialysis and which type you would prefer if your kidney function becomes severely reduced.

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Kidney transplant

An alternative to dialysis for people with severely reduced kidney function is a kidney transplant.

This is often the most effective treatment for advanced kidney disease, but it involves major surgery and taking medicines (immunosuppressants) for the rest of your life to stop your body attacking the donor organ.

You can live with one kidney, which means donor kidneys can come from living or recently deceased donors. 

But there's still a shortage of donors, and you could wait months or years for a transplant.

You may need to have dialysis while you wait for a transplant.

Survival rates for kidney transplants are very good. About 90% of transplants still function after 5 years and many work usefully after 10 years or more.

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Supportive treatment

You'll be offered supportive treatment if you decide not to have dialysis or a transplant for kidney failure, or they're not suitable for you. This is also called palliative or conservative care.

The aim is to treat and control the symptoms of kidney failure. It includes medical, psychological and practical care for both the person with kidney failure and their family, including discussion about how you feel and planning for the end of life.

Many people choose supportive treatment because they:

  • are unlikely to benefit from or have a good quality of life with treatment
  • do not want to go through the inconvenience of treatment with dialysis
  • are advised against dialysis because they have other serious illnesses, and the negative aspects of treatment outweigh any likely benefits 
  • have been on dialysis, but have decided to stop this treatment 
  • are being treated with dialysis, but have another serious illness, such as severe heart disease or stroke, that will shorten their life

Supportive care through the kidney unit can still help you to live for some time with a good quality of life.

Doctors and nurses will make sure you receive:

  • medicines to protect your remaining kidney function for as long as possible 
  • medicines to treat other symptoms of kidney failure, such as feeling out of breath, anaemia, loss of appetite or itchy skin 
  • help to plan your home and money affairs 
  • bereavement support for your family

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Living with

Many people with chronic kidney disease (CKD) are able to live long lives without being unduly affected by the condition.

Although it's not possible to repair damage that has already happened to your kidneys, CKD will not necessarily get worse. 

CKD only reaches an advanced stage in a small proportion of people.

But even if your condition is mild, it's important to take good care of yourself to help stop it getting worse and reduce your risk of other health problems, such as cardiovascular disease.

Looking after yourself

Take your medicine

It's very important that you take any prescribed medicine, even if you do not feel unwell. Some medicines are designed to prevent serious problems from happending in the future.

It's also useful to read the information leaflet that comes with the medicine about possible interactions with other medicines or supplements.

Check with your care team if you plan to take any painkillers or nutritional supplements. These can sometimes affect your kidneys or interfere with your medicine.

Also speak to your care team if you have any concerns about the medicine you are taking, or if you're experiencing any side effects.

Have a healthy diet

A healthy, balanced diet can help improve your general health and reduce your risk of developing further problems.

A balanced diet should include:

  • plenty of fruit and vegetables – aim for at least 5 portions a day 
  • meals that include starchy foods, such as potatoes, wholegrain bread, rice or pasta
  • some dairy or dairy alternatives
  • some beans or pulses, fish, eggs, or meat as a source of protein
  • low levels of saturated fat, salt and sugar

You may also be given advice about dietary changes that can specifically help with kidney disease, such as limiting the amount of potassium or phosphate in your diet.

Exercise regularly

Regular physical activity can also help improve your general health.

Do not be scared to exercise. Exercise is good for anyone with kidney disease, however severe. 

Not only will it boost your energy, help you sleep, strengthen your bones, ward off depression and keep you fit, it may also reduce your risk of problems such as heart disease.

If you have mild to moderate CKD, your ability to exercise should not be reduced. You should be able to exercise as often and as vigorously as someone the same age as you with healthy kidneys.

If your condition is more advanced or you're already on dialysis, your ability to exercise is likely to be reduced and you may become breathless and tired more quickly.

But exercise is still beneficial. Start slowly and build up gradually. Check with your doctor before beginning a new exercise programme.

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Stop smoking

If you smoke, stopping smoking can improve your overall health and reduce your risk of many other health problems.

If you want to give up smoking a good first step is to contact Help Me Quit on 0808 250 4024  or visit the Help Me Quit website.

Limit your alcohol consumption

You may still be able to drink alcohol if you have kidney disease, but it's advisable not to exceed the recommended limits of more than 14 alcohol units a week.

Speak to your GP or care team if you find it difficult to cut down the amount of alcohol you drink.

Read some tips on cutting down on alcohol.

Get vaccinated

Kidney disease can put a significant strain on your body and make you more vulnerable to infections.

Everyone with the condition is encouraged to have the annual flu jab and the one-off pneumococcal vaccination.

You can get these vaccinations at your GP surgery or a local pharmacy that offers a vaccination service.

Regular reviews and monitoring

You'll have regular contact with your care team to monitor your condition.

These appointments may involve:

  • talking about your symptoms – such as whether they're affecting your normal activities or are getting worse
  • a discussion about your medicine – including whether you are experiencing any side effects
  • tests to monitor your kidney function and general health

It's also a good opportunity to ask any questions you have or raise any other issues you'd like to discuss with your care team.

You may also want to help monitor your condition at home – for example, by using a home blood pressure monitor.

Contact your GP or healthcare team if your symptoms are getting worse or you develop new symptoms.

Relationships and support

Coming to terms with a condition such as CKD can put a strain on you, your family and your friends. It can be difficult to talk to people about your condition, even if they're close to you.

Learning about CKD may help you and your family understand what to expect and to feel more in control of the illness, instead of feeling that your lives are now dominated by CKD and its treatment.

Be open about how you feel, and let your family and friends know what they can do to help. However, do not feel shy about telling them that you need some time to yourself, if that is what you need.

Get support

Your GP or healthcare team can reassure you if you have questions about your CKD, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP surgery will have information on these.

Some people find it helpful to talk to other people with CKD at a local support group or through an internet chat room.

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Sex and pregnancy

Sex

Having CKD can affect a sexual relationship. Some couples become closer after a diagnosis of CKD, while others find their loved ones are affected by worries about how they'll cope with the illness.

Both men and women may have issues about body image and self-esteem, and this can affect a relationship.

Problems such as erectile dysfunction and reduced sex drive are also fairly common in people with CKD.

Try to share your feelings with your partner. If you have problems with sex that do not get better with time, speak to your care team. Treatment and support is available.

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Pregnancy

If you have mild to moderate kidney disease, it's unlikely your condition or its treatment will affect your chances of having children.

More advanced kidney disease may affect a woman's periods and reduce a man's sperm count, which can make it more difficult to get pregnant, although this does not mean you will not be able to have a child.

It's important to use contraception if you do not want to get pregnant.

If you do want to try for a baby, it's a good idea to speak to your healthcare team for advice first. There may be risks to mother and baby, and changes to your treatment or check-ups may be necessary.

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Work, finances and benefits

Can I continue working?

If you're well enough, you can keep working for as long as you feel able.

Talk to your employer as soon as you feel your condition is affecting your ability to do your job so you can find a solution that suits both of you. For example, it may be possible for you to work part-time.

The Disability Discrimination Act 1995 requires employers to make reasonable adjustments to help a person with a disability.

This might, where possible, include changing or modifying tasks, altering work patterns, installing special equipment, allowing time off to attend appointments, or helping with travel to work.

What happens if I can no longer work?

If you have to stop work or work part-time because of CKD, you may find it hard to cope financially.

You may be entitled to one or more of the following types of financial support:

  • if you have a job but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer for up to 28 weeks
  • if you don't have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance
  • if you're aged 65 or over, you may be able to get Attendance Allowance
  • if you're caring for someone with kidney disease, you may be entitled to Carer's Allowance   
  • you may be eligible for other benefits if you have children living at home or a low household income

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Holidays and insurance

If you have mild CKD or you've had a transplant, going on holiday should not pose additional health problems, whether you're staying in the UK or going abroad.

Speak to your care team before you travel, and make sure you take enough medicine with you to cover your trip and some back-up medicine in case you end up needing to stay away from home for longer than planned.

If you're on dialysis, you can still enjoy holidays if you book your treatment before you go away.

If you want to travel to another part of the UK, discuss your plans with your renal unit as early as you can so they can arrange dialysis at a unit close to your destination.

In many parts of the country, the lack of facilities restricts the freedom of patients to travel, but Kidney Care UK's Dialysis Freedom service runs a holiday dialysis "swap" scheme to help with dialysis availability in other areas.

If you're going abroad, it may be easier to arrange dialysis at short notice as some overseas centres have more facilities, although holiday destinations may get booked up early.

It's a good idea to take out holiday health insurance in addition to carrying the EHIC. Anyone with kidney disease should declare it as a pre-existing medical condition on standard insurance application forms. It may exclude you from some policies. 

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Prevention

Chronic kidney disease (CKD) cannot always be prevented, but you can take steps to reduce the chances of getting the condition.

Following the advice below can reduce your risk.

Manage underlying conditions

If you have a long-term condition that could lead to CKD, such as diabetes or high blood pressure, it's important this is managed carefully.

Follow the advice of your GP, take any medicine you're prescribed and keep all appointments relating to your condition.

Stop smoking

Smoking increases your risk of cardiovascular disease, including heart attacks or strokes, which is associated with a higher risk of CKD.

Stopping smoking will improve your general health and reduce your risk of these serious conditions.

If you want to give up smoking a good first step is to contact Help Me Quit on 0808 250 4024. Visit the Help Me Quit website

Read more about stopping smoking.

Healthy diet

A healthy, balanced diet can reduce your risk of kidney disease by keeping your blood pressure and cholesterol at a healthy level.

A balanced diet should include:

  • plenty of fruit and vegetables – aim for at least 5 portions a day
  • meals based on starchy foods – such as potatoes, wholegrain bread, rice or pasta
  • some dairy or dairy alternatives
  • some beans or pulses, fish, eggs, or meat as a source of protein
  • low levels of saturated fat, salt and sugar

You may also be given advice about dietary changes that can specifically help with kidney disease, such as limiting the amount of potassium or phosphate in your diet.

Manage alcohol intake

Drinking excessive amounts of alcohol can cause your blood pressure and cholesterol levels to rise to unhealthy levels.

Sticking to the recommended alcohol limit is the best way to reduce your risk:

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over 3 days or more if you drink as much as 14 units a week

14 units is equivalent to 6 pints of average-strength beer or 10 small glasses of low-strength wine.

Find out more about alcohol units.

Exercise regularly

Regular exercise should help lower your blood pressure and reduce your risk of developing kidney disease.

At least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week is recommended, as well as strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms).

Find out more about health and fitness.

Be careful with painkillers

Kidney disease can be caused by taking too many non-steroidal anti-inflammatories (NSAIDs), such as aspirin and ibuprofen, or taking them for longer than recommended.

If you need to take painkillers, make sure you follow the instructions that come with the medicine.

Kidney risk calculator

There is a calculator you can use to work out your risk of developing moderate to severe kidney disease over the next 5 years. You just need to answer some simple questions.

The calculator is only valid if you do not already have a diagnosis of CKD stage 3b or worse. Ask your doctor if you're unsure.

You may wish to use the tool during your next GP or practice nurse consultation.

Use the QKidney Web Calculator.



The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 07/10/2022 16:04:18