Chronic Kidney Disease (CKD)
Kidney damage or reduced filtering that lasts 3 months or more. It’s common and usually silent, and much easier to slow than it used to be, thanks to blood pressure control and a few medicines.
Quick answer: Chronic kidney disease means an eGFR under 60, or signs of kidney damage such as albumin in the urine, for at least 3 months. About 1 in 10 adults has it, and most don’t know. Diabetes and high blood pressure cause most cases. Blood pressure control, SGLT2 inhibitors and ACE inhibitors or ARBs can slow it down.
How common. About 1 in 10 adults worldwide. In Australia, around 2 million adults have signs of CKD and about 9 in 10 of them don’t know it, according to Kidney Health Australia. It’s more common in older people and in Aboriginal and Torres Strait Islander people.
Causes. Diabetes and high blood pressure cause most cases. Others include inflammation of the kidney filters (glomerulonephritis), polycystic kidney disease, blockages (for example from an enlarged prostate or kidney stones), long-term use of anti-inflammatory painkillers, heart disease, smoking and obesity.
Symptoms. Usually none until kidney function is very low. Later: tiredness, itching, swollen ankles, foamy urine, getting up at night to pass urine, poor appetite, nausea, breathlessness and muscle cramps.
Testing and stages
A kidney health check is a blood test for eGFR, a urine test for albumin (the albumin-to-creatinine ratio, ACR) and a blood pressure check. It’s worth doing every 1 to 2 years if you have diabetes, high blood pressure, heart disease, obesity, a smoking history, a family history of kidney failure, or are an Aboriginal or Torres Strait Islander person. A single low eGFR is often a temporary dip: see low eGFR, or try our eGFR calculator.
eGFR stages (KDIGO), in mL/min/1.73 m²:
- G1, 90 or more: normal filtering; CKD only if there are other signs of damage
- G2, 60 to 89: mildly reduced
- G3a, 45 to 59: mildly to moderately reduced
- G3b, 30 to 44: moderately to severely reduced
- G4, 15 to 29: severely reduced
- G5, under 15: kidney failure
Albumin stages (urine ACR): A1 under 3 mg/mmol (under 30 mg/g), normal to mildly raised; A2 3 to 30 mg/mmol (30 to 300 mg/g), moderately raised; A3 over 30 mg/mmol (over 300 mg/g), severely raised. Your risk depends on both numbers together: more albumin means faster decline and more heart risk at any eGFR.
Slowing it down
Most people with early CKD never need dialysis. Slowing it down also protects the heart, which is the bigger risk for most people with CKD.
- Everyone · LifestyleBlood pressure, salt and smokingKeep blood pressure on target, eat less salt, stop smoking, stay active and keep a healthy weight.
- Works
- Blood pressure control is the foundation. KDIGO suggests a systolic target under 120 if tolerated; many people aim for under 130/80
- Salt
- Under 2 g of sodium a day (about 5 g, or a teaspoon, of salt)
- Watch for
- Avoid regular anti-inflammatory painkillers such as ibuprofen. Paracetamol is usually safer.
- Albumin in urine · PrescriptionACE inhibitor or ARBBlood pressure medicines that also lower pressure inside the kidney filters. See ACE inhibitors.
- Who
- Recommended for CKD with raised albumin, especially with diabetes or high blood pressure
- Works
- Slows decline and reduces albumin
- Watch for
- A small, expected rise in creatinine when starting; potassium and kidney blood tests after starting or changing the dose.
- Most people with CKD · PrescriptionSGLT2 inhibitorDapagliflozin or empagliflozin, once a day. See SGLT2 inhibitors.
- Who
- KDIGO 2024 recommends them for CKD with type 2 diabetes, CKD with raised albumin, or heart failure, if eGFR is 20 or more, and suggests them for others with lower eGFR
- Works
- In the DAPA-CKD trial, dapagliflozin cut the risk of major kidney decline, kidney failure or death by about 39%, with or without diabetes
- Watch for
- Genital thrush; pause on sick days; rarely, ketoacidosis.
- Extra protection · PrescriptionStatin, finerenone and GLP-1 medicinesA statin for most adults 50 and over with CKD. With type 2 diabetes and albumin, finerenone or a GLP-1 medicine such as semaglutide may be added.
- Works
- Statins cut heart attacks and strokes. In the FLOW trial, semaglutide lowered serious kidney events by about 24% in people with diabetes and CKD
- Watch for
- Potassium checks with finerenone; nausea with GLP-1 medicines.
- SpecialistKidney specialist careReferral to a nephrologist for an eGFR under 30, high albumin (ACR over 30 mg/mmol), a fast fall in eGFR, blood in the urine with protein, or hard-to-control blood pressure.
- Includes
- Planning for dialysis, a transplant or supportive care if kidney failure is approaching
- Watch for
- Anaemia, bone and potassium problems, which become more common at later stages.
Sick day rules. If you’re vomiting, have diarrhoea or a fever and can’t keep fluids down, some medicines (SGLT2 inhibitors, ACE inhibitors and ARBs, diuretics, metformin and anti-inflammatories) may need to be paused for a day or two. Ask your GP or pharmacist for a written sick day plan, and restart once you’re eating and drinking normally.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Kidney detox teas and cleansesYour kidneys are the detox. Some herbal products can damage kidneys, and many interact with medicines.
- Drinking extra waterA trial of extra water in CKD didn’t slow decline. Drink to thirst unless your doctor says otherwise.
See your GP if
- You have diabetes, high blood pressure or another risk factor and haven’t had a kidney health check in the past 1 to 2 years
- A blood test shows a low eGFR, or a urine test shows albumin or blood
- You notice foamy urine, swollen ankles or passing urine much more at night
- You have CKD and need a new medicine, including over-the-counter painkillers or supplements
Get urgent help for passing very little or no urine, severe breathlessness, chest pain, confusion or drowsiness, or a racing or irregular heartbeat with weakness (possible high potassium): call 000 (Australia) or your local emergency number.
Health days. World Kidney Day is the second Thursday in March, and Kidney Action Week (Australia) is in August: see our health days calendar.
Common questions
What are the stages of chronic kidney disease?
Five eGFR stages, from G1 (90 or more, with other signs of damage) to G5 (under 15, kidney failure), plus three albumin stages (A1 to A3). Both together set your risk.
Can chronic kidney disease be reversed?
Lost kidney function usually doesn’t come back, but CKD can often be slowed a lot. Many people with early CKD never reach kidney failure.
What eGFR is kidney failure?
An eGFR under 15 is stage 5, kidney failure. Planning for dialysis, transplant or supportive care usually starts well before then.
What should I eat with kidney disease?
Less salt, plenty of vegetables, and moderate protein. Only limit potassium or phosphate if your doctor or a dietitian tells you to, based on your blood tests.
Does drinking more water help kidney disease?
Not for most people. A trial of extra water in CKD didn’t slow decline. Drink to thirst unless you’ve been told otherwise.
Which painkillers are safe with kidney disease?
Paracetamol is usually the safest. Avoid regular anti-inflammatories such as ibuprofen, diclofenac and naproxen unless your doctor says they’re OK.
How fast does kidney disease progress?
It varies. Many people with stage 3 CKD stay stable for years. High albumin, diabetes and uncontrolled blood pressure speed it up.
Evidence and more information
- KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD
- Kidney Health Australia: CKD Management in Primary Care handbook
- Heerspink et al, NEJM 2020: Dapagliflozin in patients with CKD (DAPA-CKD)
- Perkovic et al, NEJM 2024: Semaglutide and kidney outcomes in type 2 diabetes (FLOW)
- Clark et al, JAMA 2018: Effect of coaching to increase water intake on kidney function decline
- NICE NG203: Chronic kidney disease, assessment and management
- Kidney Health Australia: Kidney Health Week 2023 media release
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