Chronic Kidney Disease (CKD)
Chronic kidney disease (CKD) is a degenerative disease of the kidneys. In addition to medication, CKD is managed nutritionally with diets that modify the intake of specific nutrients affected by impaired kidney function.
Chronic kidney disease (CKD) occurs when the kidneys' ability to filter and detoxify the blood is impaired, leading to the build up of waste products in the body. The condition generally gets worse over time, but progression can be stabilized and markers of the disease can be reversed in some instances. CKD affects 11–13% of the global population, and 14.0% of the United States population.
CKD does not usually present with any symptoms until kidney function is impaired by 50% or more. Symptoms include fatigue, confusion, brain fog, headaches, poor appetite, nausea, vomiting, poor sleep, nighttime muscle cramping, swelling in the feet and around the eyes, dry and itchy skin, and more frequent urination or lack of any urination.
Common signs of CKD include markers used for diagnosis — decreased GFR, decreased albumin, protein in the urine, elevated creatinine or cystatin — and markers of the underlying conditions — dyslipidemia, high blood pressure, glycemic dysregulation, and elevated uric acid levels.
In its early stages, CKD is a silent disease — there are usually no symptoms to warn that something may be going awry with the kidneys. Some experts recommend that people with risk factors for CKD (e.g., those with diabetes, hypertension, heart disease) receive yearly kidney function screenings.
CKD is diagnosed when kidney function tests show markers of serious kidney damage, e.g., decreased glomerular-filtration-rate (GFR) or creatinine, elevated ualbumin, or electrolyte abnormalities. Markers of kidney damage must persist over time to be labeled "chronic". CKD is classified based on GFR into 1 of 5 stages, where stage 1 is the least progressed disease state, and stage 5 represents kidney failure.  End-stage renal disease (ESRD) is defined as CKD stage 5 treated with dialysis.
CKD treatment includes strategies to manage impaired kidney function, to address the underlying cause, and to prevent any further kidney damage. For the majority of people with CKD, that means addressing heart disease, hypertension, and diabetes with medications, diet, and lifestyle changes. Treatment for CKD includes medications that lower blood pressure and block the renin-angiotensin-aldosterone system (RAAS). Other medications are used to manage uric acid levels, sodium levels, metabolic acidosis, blood lipids, blood glucose, and bone mineralization, and dialysis is used to externally purify the blood when the kidneys no longer function.
CKD compromises the kidneys’ ability to balance electrolytes and nutrients in the blood, so managing CKD involves limiting foods higher in sodium, phosphorus, and protein; supplementing or emphasizing foods high in calcium and vitamin-d to reach normal levels, and increasing total calories when a person is at risk for unintentional weight loss. potassium may be restricted or emphasized on an individual basis in order to maintain normal serum-potassium levels.
Studies on the effects of specific diets are sparse and short term, but show benefits to some markers of the disease. Studied diets include low-protein and very-low-protein diets, low-salt diets, low-fat diets, low-carbohydrate diets, high fruit-and-vegetable diets, plant-based diets, vegan , vegetarian diets, the Dietary Approaches to Stop Hypertension (DASH) diet, mediterranean-diet, American Heart Association diet, and American Diabetes Association diet.
The most common supplements studied for CKD are amino acid supplements used in conjunction with very-low-protein diets. Others include alkalizing therapy with potassium citrate salts, vitamin-d supplements, and omega-3 fatty acids supplements. Many other supplements have been investigated, including vitamin-e, antioxidant therapy, coenzyme-q10, n-acetylcysteine, bardoxolone methyl, and human recombinant superoxide dismutase, potassium, calcium fortification, nitrate, turmeric and boswellia, curcumin, vitamin-k, B vitamins, astragalus, cordyceps, and Rheum officinale.
No alternative modalities have been well studied for their use in managing CKD outcomes or symptoms. However, complementary modalities that promote general well-being by increasing physical activity and promoting stress reduction (acupuncture, mindfulness, tai chi, etc.) can be used to enhance well-being in people with CKD. A foundation of CKD treatment is managing conditions that cause CKD. Therefore, complementary approaches that benefit type-2-diabetes, hypertension, or heart disease may in turn benefit persons with CKD. Additionally, some modalities may help with feelings of depression and anxiety in people with CKD.
Diabetes, heart disease, and hypertension are the three most common diseases that lead to CKD. Some medications when used in excess or for prolonged periods (like chemotherapies and nonsteroidal anti-inflammatories) can cause CKD as well. Other causes of kidney damage that can lead to and/or worsen CKD include systemic infections, trauma or injury to the kidneys, congenital abnormalities, and autoimmune conditions.
- ^The content of this page was partially adapted from MedlinePlus of the National Library of Medicine
- ^Nathan R Hill, Samuel T Fatoba, Jason L Oke, Jennifer A Hirst, Christopher A O'Callaghan, Daniel S Lasserson, F D Richard HobbsGlobal Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-AnalysisPLoS One.(2016 Jul 6)
- ^Daniel Murphy, Charles E McCulloch, Feng Lin, Tanushree Banerjee, Jennifer L Bragg-Gresham, Mark S Eberhardt, Hal Morgenstern, Meda E Pavkov, Rajiv Saran, Neil R Powe, Chi-Yuan Hsu, Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance TeamTrends in Prevalence of Chronic Kidney Disease in the United StatesAnn Intern Med.(2016 Oct 4)
- ^Kidney Disease: Improving Global Outcomes, and CKD Work GroupKDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease Chapter 1: Definition and classification of CKDKidney Int Supp.(2013 jan)
- ^David Y Gaitonde, David L Cook, Ian M RiveraChronic Kidney Disease: Detection and EvaluationAm Fam Physician.(2017 Dec 15)
- ^Chapter 3: Management of progression and complications of CKD.Kidney Int Suppl (2011).(2013-Jan)
- ^National Kidney FoundationKDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 updateAm J Kidney Dis.(2015 Nov)
- ^Ikizler TA, Burrowes JD, Byham-Gray LD, et al.KDOQI Clinical Practice Guidelines for Nutrition in CKD: 2020 UpdateAm J Kidney Dis.(2020 Sep)
- ^Kidney Disease: Improving Global Outcomes, and CKD Work GroupKDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease Chapter 3: Management of progression and complications of CKDKidney Int Supp.(2013 jan)
- ^Suetonia C Palmer, Jasjot K Maggo, Katrina L Campbell, Jonathan C Craig, David W Johnson, Bernadet Sutanto, Marinella Ruospo, Allison Tong, Giovanni Fm StrippoliDietary interventions for adults with chronic kidney diseaseCochrane Database Syst Rev.(2017 Apr 23)
- ^Kun Hyung Kim, Myeong Soo Lee, Tae-Hun Kim, Jung Won Kang, Tae-Young Choi, Jae Dong LeeAcupuncture and related interventions for symptoms of chronic kidney diseaseCochrane Database Syst Rev.(2016 Jun 28)
- ^Andrew S Levey, Lesley A Inker, Kunihiro Matsushita, Tom Greene, Kerry Willis, Edmund Lewis, Dick de Zeeuw, Alfred K Cheung, Josef CoreshGFR decline as an end point for clinical trials in CKD: a scientific workshop sponsored by the National Kidney Foundation and the US Food and Drug AdministrationAm J Kidney Dis.(2014 Dec)
- ^Inga Soveri, Ulla B Berg, Jonas Björk, Carl-Gustaf Elinder, Anders Grubb, Ingegerd Mejare, Gunnar Sterner, Sten-Erik Bäck, SBU GFR Review GroupMeasuring GFR: a systematic reviewAm J Kidney Dis.(2014 Sep)
- ^Paul E Stevens, Adeera Levin, Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group MembersEvaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guidelineAnn Intern Med.(2013 Jun 4)
- ^A S Levey, T Greene, G J Beck, A W Caggiula, J W Kusek, L G Hunsicker, S KlahrDietary protein restriction and the progression of chronic renal disease: what have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study groupJ Am Soc Nephrol.(1999 Nov)
- ^Vincenzo Bellizzi, Adamasco Cupisti, Francesco Locatelli, Piergiorgio Bolasco, Giuliano Brunori, Giovanni Cancarini, Stefania Caria, Luca De Nicola, Biagio R Di Iorio, Lucia Di Micco, Enrico Fiaccadori, Giacomo Garibotto, Marcora Mandreoli, Roberto Minutolo, Lamberto Oldrizzi, Giorgina B Piccoli, Giuseppe Quintaliani, Domenico Santoro, Serena Torraca, Battista F Viola, “Conservative Treatment of CKD” study group of the Italian Society of NephrologyLow-protein diets for chronic kidney disease patients: the Italian experienceBMC Nephrol.(2016 Jul 11)
- Kidney Oxygenation - Menno Pruijm, Lucie Hofmann, Julie Charollais-Thoenig, Valentina Forni, Marc Maillard, Andrew Coristine, Matthias Stuber, Michel Burnier, Bruno VogtEffect of dark chocolate on renal tissue oxygenation as measured by BOLD-MRI in healthy volunteersClin Nephrol.(2013 Sep)
- Itching - Se Kyoo Jeong, Hyun Jung Park, Byeong Deog Park, Il-Hwan KimEffectiveness of Topical Chia Seed Oil on Pruritus of End-stage Renal Disease (ESRD) Patients and Healthy VolunteersAnn Dermatol.(2010 May)
- Atherosclerotic Signs - Coombes JS, Sharman JE, Fassett RGAstaxanthin has no effect on arterial stiffness, oxidative stress, or inflammation in renal transplant recipients: a randomized controlled trial (the XANTHIN trial)Am J Clin Nutr.(2016 Jan)
- C-Reactive Protein (CRP) - Chen Y, Abbate M, Tang L, Cai G, Gong Z, Wei R, Zhou J, Chen XL-Carnitine supplementation for adults with end-stage kidney disease requiring maintenance hemodialysis: a systematic review and meta-analysisAm J Clin Nutr.(2014 Feb)
- High-density lipoprotein (HDL) - Aneliya Parvanova, Matias Trillini, Manuel A Podestà, Ilian P Iliev, Carolina Aparicio, Annalisa Perna, Francesco Peraro, Nadia Rubis, Flavio Gaspari, Antonio Cannata, Silvia Ferrari, Antonio C Bossi, Roberto Trevisan, Sreejith Parameswaran, Jonathan S Chávez-Iñiguez, Fahrudin Masnic, Sidy Mohamed Seck, Teerayuth Jiamjariyaporn, Monica Cortinovis, Luca Perico, Kanishka Sharma, Giuseppe Remuzzi, Piero Ruggenenti, David G WarnockBlood Pressure and Metabolic Effects of Acetyl-l-Carnitine in Type 2 Diabetes: DIABASI Randomized Controlled TrialJ Endocr Soc.(2018 Mar 22)
- Exercise-Induced Oxidation - Fatouros IG, Douroudos I, Panagoutsos S, Pasadakis P, Nikolaidis MG, Chatzinikolaou A, Sovatzidis A, Michailidis Y, Jamurtas AZ, Mandalidis D, Taxildaris K, Vargemezis VEffects of L-carnitine on oxidative stress responses in patients with renal diseaseMed Sci Sports Exerc.(2010 Oct)
- C-Reactive Protein (CRP) - Castilla P, Echarri R, Dávalos A, Cerrato F, Ortega H, Teruel JL, Lucas MF, Gómez-Coronado D, Ortuño J, Lasunción MAConcentrated red grape juice exerts antioxidant, hypolipidemic, and antiinflammatory effects in both hemodialysis patients and healthy subjectsAm J Clin Nutr.(2006 Jul)
- C-Reactive Protein (CRP) - Du X, Wu J, Gao C, Tan Q, Xu YEffects of Resistant Starch on Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis.J Diabetes Res.(2022)
- C-Reactive Protein (CRP) - Guo G, Zhou J, Xu T, Sheng Z, Huang A, Sun L, Yao LEffect of Magnesium Supplementation on Chronic Kidney Disease-Mineral and Bone Disorder in Hemodialysis Patients: A Meta-Analysis of Randomized Controlled Trials.J Ren Nutr.(2022-Jan)
- High-density lipoprotein (HDL) - Fazelian S, Moradi F, Agah S, Hoseini A, Heydari H, Morvaridzadeh M, Omidi A, Pizarro AB, Ghafouri A, Heshmati JEffect of omega-3 fatty acids supplementation on cardio-metabolic and oxidative stress parameters in patients with chronic kidney disease: a systematic review and meta-analysis.BMC Nephrol.(2021-May-01)
- Inflammation - Deike E, Bowden RG, Moreillon JJ, Griggs JO, Wilson RL, Cooke M, Shelmadine BD, Beaujean AAThe Effects of Fish Oil Supplementation on Markers of Inflammation in Chronic Kidney Disease PatientsJ Ren Nutr.(2012 Jan 26)
- Inflammation - Knab AM, Shanely RA, Henson DA, Jin F, Heinz SA, Austin MD, Nieman DCInfluence of quercetin supplementation on disease risk factors in community-dwelling adultsJ Am Diet Assoc.(2011 Apr)
- Glomerular Filtration Rate - Nimrit Goraya, Jan Simoni, Chan-Hee Jo, Donald E WessonTreatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rateKidney Int.(2014 Nov)
- Glomerular Filtration Rate - Khedidja Mekki, Nassima Bouzidi-bekada, Abbou Kaddous, Malika BouchenakMediterranean diet improves dyslipidemia and biomarkers in chronic renal failure patientsFood Funct.(2010 Oct)
- Muscle Creatine Content - Jacques R Poortmans, Alain Kumps, Pierre Duez, Aline Fofonka, Alain Carpentier, Marc FrancauxEffect of oral creatine supplementation on urinary methylamine, formaldehyde, and formateMed Sci Sports Exerc.(2005 Oct)
- Kidney Function - Taes YE, Delanghe JR, De Bacquer D, Langlois M, Stevens L, Geerolf I, Lameire NH, De Vriese ASCreatine supplementation does not decrease total plasma homocysteine in chronic hemodialysis patientsKidney Int.(2004 Dec)
- Free Testosterone - Yeksan M, Polat M, Türk S, Kazanci H, Akhan G, Erdogan Y, Erkul IEffect of vitamin E therapy on sexual functions of uremic patients in hemodialysisInt J Artif Organs.(1992 Nov)
- Cerebral Blood Flow - Cook JS, Sauder CL, Ray CAMelatonin differentially affects vascular blood flow in humansAm J Physiol Heart Circ Physiol.(2011 Feb)
- Plasma Nitrate - Vahid S, Dashti-Khavidaki S, Ahmadi F, Amini M, Salehi Surmaghi MHEffect of herbal medicine achillea millefolium on plasma nitrite and nitrate levels in patients with chronic kidney disease: a preliminary study.Iran J Kidney Dis.(2012-Sep)
- Fat-free mass (FFM) - Lu Y, Wang YJ, Lu QThe effect of oral nutritional supplement on muscle fitness of patients undergoing dialysis: A systematic review and meta-analysis.J Adv Nurs.(2021-Apr)