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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

What chronic kidney disease is

In short

Chronic kidney disease (CKD) means your kidneys have been damaged, or have filtered less than they should, for at least 3 months (KDIGO 2024, Table 1). More than 1 in 7 US adults have it, and most people in the early stages have no symptoms (NIDDK). Diabetes and high blood pressure are the most common causes in adults (NIDDK). Damage that is already done usually cannot be undone, but good care can slow it down, and most people with diabetes and kidney disease never reach kidney failure (NIDDK). The one thing to do: get two tests every year, a blood test (eGFR) and a urine test (UACR), and know your results.

What healthy kidneys do

Healthy kidneys filter about half a cup of blood every minute (NIDDK). Each job below explains a part of CKD care.

Job When kidney disease gets worse Read more
Remove waste and extra water as urine Waste builds up; swelling and breathlessness eGFR and creatinine, Fluid
Keep potassium, sodium, phosphorus and calcium in balance Potassium or phosphate can rise Blood potassium, Phosphate, calcium and PTH
Remove acid made by the body Bicarbonate in the blood falls Bicarbonate
Make hormones for blood pressure, red blood cells and strong bones High blood pressure, anemia (tiredness), bone problems Hemoglobin and iron
Clear insulin from the blood Insulin lasts longer, so lows can become more common Insulin and dialysis

Sources for the table: NIDDK (the jobs); KDIGO 2026 anemia (anemia); KDIGO 2017 (minerals and bone); ADA–KDIGO consensus (insulin clearance and lows in advanced CKD).

How CKD is defined

You have CKD if either of these lasts at least 3 months (KDIGO 2024, Table 1, in our words):

  1. Signs of kidney damage. The most common one is albumin in the urine. Others are blood in the urine that does not go away, changes seen on a kidney scan or biopsy, or having had a kidney transplant.
  2. Low filtering: an eGFR under 60 mL/min/1.73 m².
Test Sign of CKD (lasting 3 months or more)
eGFR (blood test) under 60 mL/min/1.73 m²
UACR (urine test) 30 mg/g or more
Test Sign of CKD (lasting 3 months or more)
eGFR (blood test) under 60 mL/min/1.73 m²
UACR (urine test) 3 mg/mmol or more

Why 3 months? One result can be off after a stomach bug, a hard workout, a high-protein meal or a new medicine. KDIGO asks for a repeat test to confirm a high UACR or a low eGFR before calling it CKD (KDIGO 2024, practice point 1.1.1.2). KDIGO also says to use both tests, because each one catches problems the other misses (KDIGO 2024, practice point 1.1.1.1).

Your eGFR is worked out from a creatinine blood test plus your age and sex (NKF; CKD-EPI 2021 equation). Your results then give you a G category (filtering) and an A category (albumin). See CKD stages.

Why it is usually silent

KDIGO says a low eGFR and albumin in the urine "are often silent" and are found only by lab tests (KDIGO 2024, chapter 1). Many people have no symptoms until the disease is advanced (NIDDK). Late symptoms include poor appetite, nausea and tiredness (KDIGO 2024, practice point 5.2.2.1). Feeling well is not proof that your kidneys are fine.

What happens over time

  • It can often be slowed. Advanced, long-lasting CKD usually cannot be reversed, but the sooner you know, the sooner you can protect your kidneys (NIDDK). With diabetes, the main tools are glucose, blood pressure and kidney-protecting medicines (Type 1 diabetes and your kidneys).
  • The heart is the biggest risk. People with CKD are more likely to have heart disease. For most people with CKD, the risk of dying from heart disease is higher than the risk of reaching kidney failure (KDIGO 2024, section 3.15). That is why blood pressure, cholesterol and not smoking matter at every stage.
  • Kidney failure is an eGFR under 15 (category G5) (KDIGO 2024, Table 2). Treatment choices are a transplant, dialysis, or care focused on symptoms without dialysis (NIDDK; Choosing a treatment).

Words we use

Kidney doctors agreed on clear, patient-centered words in 2020 (KDIGO nomenclature).

You may hear This handbook says Why
renal kidney plainer word
end-stage renal disease kidney failure says what is happening; Medicare still uses the old name in its rules
renal replacement therapy kidney replacement therapy (dialysis or a transplant) same meaning, plainer word
"reduced kidney function" your eGFR and UACR numbers numbers say more than "reduced"
diabetic nephropathy kidney disease with diabetes plainer words
dialysis patient person on dialysis people first

More words are in the Glossary.

What to do

  • Get both tests at least once a year: eGFR (blood) and UACR (urine) (KDIGO 2024, practice points 1.1.1.1 and 2.1.1).
  • Write down your latest eGFR and UACR with the date. Your lab report is the source; your lab's range wins (Lab results).
  • Find your category on CKD stages, then read your stage page (Your stage, day to day).
  • Ask what caused your CKD. With type 1 diabetes it is usually diabetes, but not always (Type 1 diabetes and your kidneys).
  • Bring a family member or friend to visits. KDIGO says education that involves care partners helps (KDIGO 2024, practice point 5.3.2).
  • Check every new medicine, supplement or herbal remedy with your pharmacist (KDIGO 2024, practice point 4.1.3; Medicines to avoid).
  • In the app, enter your stage and labs so "Suggest targets" can start from them (First setup).

Examples

  • Ana, 38, type 1 diabetes for 22 years. Her eGFR is 72 and her UACR is 64 mg/g (7 mg/mmol), on two tests four months apart. She has CKD: the albumin is a sign of damage, even though her filtering is above 60. Her categories are G2 A2.
  • Tom, 61. His eGFR was 54 a week after a stomach bug and 71 a month later. His UACR is 12 mg/g. One low result that recovers is not CKD. His team rechecks next year.
  • Lee, 55. His eGFR has been 52, 50 and 49 over a year, and his UACR is 15 mg/g. He has CKD (G3a A1): low filtering for more than 3 months counts, even with no albumin.

Ask your care team

  1. What do you think caused my kidney disease?
  2. What are my latest eGFR and UACR, and which G and A categories are they?
  3. How often should we check them?
  4. What is my risk of kidney failure in the next 5 years?
  5. Which of my medicines protect my kidneys and my heart?

More are on Questions to ask.

Get help now if…

  • You pass much less urine than usual, or have new swelling or breathlessness.
  • A lab or your team tells you your potassium is very high.
  • See Get help now for the full list and when to call 911.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.