A Joint Commission-Accredited Program
UC San Diego Health is a national and international leader in the care of people aged 18 years and older with chronic kidney disease
stages 2-5. In 2010, our program received the nation’s first chronic kidney disease certificate of distinction from
The Joint Commission for helping patients achieve long-term success by delivering:
Our program has earned the Gold Seal of Approval from The Joint Commission, which signifies the highest level of quality care for patients.
treatment plans that include both holistic (e.g., diet therapy) and conventional therapies
- Self-management support
- Coordinated care from diagnosis to management based on evidence-based guidelines defined by the
National Kidney Foundation
Treating chronic kidney disease is a complex process, often requiring management of coinciding conditions (e.g., diabetes, hypertension) that can increase risk for cardiovascular disease and death.
Our multidisciplinary team has the expertise, support and tools that can help you effectively manage chronic kidney disease and its complications.
Chronic kidney disease (CKD) affects an estimated
26 million adults in the U.S. – and millions more are at risk. It is an irreversible condition that increases risk for heart and blood vessel disease. While there is no cure for chronic kidney disease, there are treatment and preventive strategies to slow disease progression and avoid end-stage renal disease.
About Chronic Kidney Disease
The kidneys have an important function of filtering waste and removing excess fluid out of the blood, balancing minerals, and helping to control blood pressure.
Chronic kidney disease is the gradual loss of kidney function over time. It can take months or years for the condition to develop. As the disease progresses, wastes accumulate to unhealthy levels in your blood, which can make you feel ill.
This buildup can lead to complications such as:
- Cardiovascular disease
- Poor bone health
- Nerve damage
- Low blood cell count (anemia)
- High blood pressure (hypertension)
- Vitamin D deficiency
- Kidney failure
Early Screening and Intervention
The goal of treatment is to keep chronic kidney disease from progressing to kidney failure. Early detection and intervention is essential. Note that routine screening is NOT advised for those who are under 50 and considered to be low risk.
We recommend early, routine screenings for those who:
- Have hypertension
- Have diabetes
- Have cardiovascular disease
- Have a personal history of cancer or use of nephrotoxic medications
- Have a family history of chronic kidney diseases
- Are African American, American Indian, Alaska Native, or Hispanic (these groups have a higher rate of diabetes and high blood pressure, and therefore an increased risk of developing kidney failure).
We use two simple tests to check kidney function:
Urine test -- to check for protein
Protein in the urine can be a sign of kidney disease. When the filters in the kidneys are damaged, protein may leak into the urine as a result. This test is known by several names, including proteinuria, urine albumin-to-creatinine ratio, microalbuminuria, and macroalbuminuria.
Blood test -- to check your glomerular filtration rate (GFR)
Your glomerular filtration rate (GFR) measures how well the blood is filtered by your kidneys. It is calculated based on your age, gender, ethnicity, height, weight, and blood creatinine measurement.
Stages of Chronic Kidney Disease
Your glomerular filtration rate (GFR) determines the stage of kidney disease.
GFR is expressed in mL/min/1.73m2.
Normal value is considered to be above 90 mL/min/1.73m2.
|Stage 1||GFR = 90 mL/min/1.73m2|
Blood protein albumin begins to leak into the urine.
|Stage 2||GFR = 60-89 mL/min/1.73m2|
More albumin leaks into the urine. The kidney’s filtering function begins to decrease. As filtration fails, the body begins to retain more waste. Blood pressure may also rise during this time as a result of developing kidney damage.
|Stage 3||GFR = 30-59 mL/min/1.73m2|
Mild to moderate loss of kidney function.
Stage 4||GFR = 15-29 mL/min/1.73m2|
Severe loss of kidney function.
|Stage 5||GFR = Less than 15 mL/min/1.73m2 (or on dialysis)|
Severe, end-stage kidney failure.
You may not have any symptoms until your kidney disease is advanced.
Symptoms can include:
- Dry, itchy skin
- Nausea and vomiting
- Loss of appetite
- Weight loss or weight gain
- Swelling in the legs (edema)
- Trouble sleeping
- Changes in urination
- Metallic taste in the mouth
- Joint problems
- Muscle cramps
- Shortness of breath
Causes and Risk Factors
The top two causes of chronic kidney disease are diabetes and high blood pressure. Together they account for nearly two-thirds of all cases of chronic kidney disease. The other one-third of cases may be a result of other conditions that can damage the kidney:
- Birth defects of the kidney (e.g., polycystic kidney disease)
- Diseases that affect the body’s immune system (e.g., lupus)
- Recurrent urinary tract infections or kidney stones
- Acute kidney injury
- Certain medications
Diabetes and Chronic Kidney Disease
Diabetes is the leading cause of chronic kidney disease and kidney failure in the U.S. And the number of people with diabetes is growing – it’s predicted that diabetes will soon account for half of all cases of kidney failure.
If you have diabetes and chronic kidney disease, getting blood glucose under control is critical.
Learn more about diabetes self-management at UC San Diego Health.
Kidney damage rarely occurs in the first 10 years of diabetes. However, many people are not aware of having diabetes for years before diagnosis, and may already have kidney damage by the time they are diagnosed with diabetes.
People who have had diabetes for more than 25 years without signs of kidney disease have a lower risk of ever developing it.
Preventing and slowing kidney disease in those with diabetes may involve:
- Blood pressure medicines
- Thorough management of blood glucose
- A moderate- to low-protein diet (a high-protein diet can be harmful in a person with diabetes as it can increase protein in the urine and may accelerate loss of kidney function)
- Controlling of potential excessive acidity in the body (metabolic acidosis)
High Blood Pressure and Chronic Kidney Disease
Hypertension, or high blood pressure, can damage the blood vessels inside the kidneys, hindering their ability to function. This can lead to waste and fluid buildup, which can raise blood pressure even more. This dangerous cycle can progress kidney damage and increase your risk for cardiovascular disease and kidney failure. Cardiovascular disease is currently the leading cause of death in people with chronic kidney disease.
Blood pressure monitoring is an essential component of chronic kidney disease management.
Home Blood Pressure Monitoring
Frequent blood pressure monitoring allows more opportunities to spot blood pressure that is higher than desired. It can also help quickly determine the effectiveness of a new blood pressure medication.
We provide blood pressure monitors and cuffs to patients who cannot afford them, as well as training on how and when to use them. By making the management of hypertension easy and convenient, we are able to help you gain better control of your blood pressure and, consequently, better control of chronic kidney disease.
Since there is no cure for chronic kidney disease, the goal of treatment is to keep the disease from progressing to kidney failure, or end-stage renal disease (ESRD).
Our team promotes a holistic approach that embraces both conventional and alternative therapies.
Your individualized treatment plan may involve:
- Controlling conditions that can slow the progression of chronic kidney disease (e.g., diabetes, hypertension)
- Counseling on medication adherence and making adjustments
- Lifestyle and nutritional counseling
- Assistance with weight loss (if needed)
- Review of all your medications (prescription and over the counter) to make sure they are not harmful to your kidneys, as well as adjustment of the doses (to the level of your current kidney function)
- Patient education classes
- Referrals for vascular surgery, dialysis, and
- Psychosocial support in dealing with a chronic illness
We recognize the importance you play in your health. By providing continuing, hands-on information and self-management tools, we empower you to play an active role in the decision-making process.
You can help avoid complications by staying up to date on vaccinations, following the recommendations made by your doctor, and communicating any issues regarding your current treatment plan with your care team. How often you meet with the doctor depends on the rate of your chronic kidney disease progression.
Changing your diet can help prevent and treat common complications of chronic kidney disease.
Recommended modifications may include:
- Selecting foods that promote heart health
- Limiting your intake of salt
- Limiting intake of phosphorous and potassium (if your blood test shows levels that are too high)
- Lowering your protein intake
- Counting carbohydrates (if you have diabetes or pre-diabetes)
- Portion control
- Recommendations on vitamin supplementation
Our kidney health-focused dietician provides instruction on healthy eating and can help tailor your diet plan to suit your specific needs. Also available are dietician-led field trips to the grocery store where you can receive firsthand knowledge of what kinds of foods to buy.
Adopting certain lifestyle behaviors may help slow down chronic kidney disease progression.
Regular exercise: Aerobic and strength training can help control glucose (in those with diabetes) and prevent cardiovascular disease. It can help achieve ideal blood pressure control, weight loss (if desired) and emotional well-being.
Smoking cessation: Cigarette smoking is linked to abnormal urine albumin, elevated blood pressure and increased progression of chronic kidney disease.
See our Smoking Cessation program.
Losing weight: Kidneys have to work harder than normal in people who are overweight. UC San Diego Health’s
Bariatric and Metabolic program offers at-home weight-loss kits and surgical and non-surgical and weight management programs.
Most people with chronic kidney disease need to take medication to help slow disease progression.
Types of treatment include medicines that:
- Relieve swelling in the legs
- Protect your bones (e.g., vitamin D supplements, medicines to lower phosphorous level in the blood)
- Lower blood pressure (e.g., beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blocker, calcium channel blockers and diuretics)
- Lower cholesterol (i.e., statins)
- Treats anemia and iron deficiency
Ensuring that other medications you may be taking for conditions do not interfere with your chronic kidney disease medicines is critical. At each doctor visit you will meet with our team pharmacist who may review or update your medications.
The ultimate goal of chronic kidney disease treatment is to help you effectively manage your condition and keep you off dialysis. We try to bypass dialysis when possible by referring patients directly to
Determining if you need to begin dialysis is based on several factors including:
- How you feel
- If there is something life threatening on your labs
- The level of your kidney function
Low level of kidney function by itself (even if below 10 percent normal) does not automatically place you on dialysis. If the rate of decline in your GFR is slow, you may be able to stay off dialysis for quite some time, or even avoid it altogether.
Learn more about dialysis at UC San Diego Health.