Chronic kidney disease

Chronic kidney disease - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Kidneys, bladder and prostate Chronic kidney disease Chronic kidney disease About chronic kidney disease Symptoms of chronic kidney disease Causes of chronic kidney disease Diagnosis of chronic kidney disease Treating chronic kidney disease Preventing chronic kidney disease Living with chronic kidney disease About chronic kidney disease Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work effectively. CKD does not usually cause symptoms until it reaches an advanced stage. Its usually detected at earlier stages by blood and urine tests. Symptoms of advanced kidney disease The main symptoms of advanced kidney disease include: tiredness swollen ankles, feet or hands (due to water retention) shortness of breath nausea blood in the urine Read more about the symptoms of chronic kidney disease Diagnosing chronic kidney disease Chronic kidney disease is most frequently diagnosed through blood and urine tests. If youre at a high risk of developing CKD, you may be screened annually. Screening may be recommended if you have: high blood pressure (hypertension) diabetes a family history of CKD Read more about diagnosing chronic kidney disease Why does it happen? The kidneys are 2 bean-shaped organs, the size of your fist. Theyre located on either side of the body, just beneath the ribcage. The main role of the kidneys is to filter waste products from the blood before converting them into urine. The kidneys also: help maintain blood pressure maintain the correct levels of chemicals in your body which, in turn, will helpheart and muscles function properly produce the active form of vitamin D that keeps bones healthy produce a substance called erythropoietin, which stimulates production of red blood cells Chronic kidney disease is the reduced ability of the kidney to carry out these functions in the long-term. This is most often caused by damage to the kidneys from other conditions, most commonly diabetes and high blood pressure. Read more about the causes of chronic kidney disease Who is affected? CKD is common andmainly associated with ageing. The older you get, the more likely you are to have some degree of kidney disease. Its estimated that about 1 in 5 men and 1 in 4 women between the ages of 65 and 74 has some degree of CKD. CKD is more common in people of south Asian origin (those from India, Bangladesh, Sri Lanka and Pakistan) and black people than the general population. The reasons for this include higher rates of diabetes in south Asianpeople and higher rates of high blood pressure in African or Caribbean people. Treating chronic kidney disease There is no cure for chronic kidney disease, although treatment can slow or halt the progression of the disease and can prevent other serious conditions developing. People with CKD are known to have an increased risk of a heart attack because of changes that occur to the circulation. Inaminority of people, CKD may cause kidney failure, also known as established renal failure (ERF) or end-stage kidney disease. In this situation, the usual functions of the kidney stop working. To survive, people with ERF may need to have artificial kidney treatment, called dialysis , or a kidney transplant. Read more about treating chronic kidney disease Living kidney donation A kidney transplant from a living donor can be planned to avoid or reduce the time someone is on dialysis. This can offer a better long term outcome for the person receiving the organ. There are 2 types of living kidney donation: directed donation  a person can donate a kidney to someone they know, like a family member or a friend altruistic kidney donation  a person can donate a kidney anonymously to someone they do not know Further information about living donation. Living with chronic kidney disease Being diagnosed with chronic kidney disease can be worrying, but support and advice are available to help you cope. Read more about living with chronic kidney disease Preventing chronic kidney disease The main way to reduce the chances of CKD developing is to ensure any existing conditions, such as diabetes and high blood pressure, are carefully managed. Some lifestyle changes can also reduce the risk of CKD developing, these include: having a healthy diet avoiding drinking excessive amounts of alcohol exercising regularly avoiding medicines that can damage the kidney Read more about preventing chronic kidney disease Symptoms of chronic kidney disease Most people with CKD have no symptoms because the body can tolerate even a large reduction in kidney function. In other words, we are born with a lot more kidney function than is necessary for survival. Kidney function is often sufficient if only 1 kidney is working. That is why people can give a kidney to someone needing a kidney transplant. A change in kidney function is usually discovered through a routine blood or urine test. If you are diagnosed with kidney disease, your kidney function will be monitored with regular blood and urinetests, and treatment aims to keep any symptoms to a minimum. If the kidneys continue to lose function and there is progression towards kidney failure (established renal failure or ERF), this will usually be tracked by blood tests and monitoring. If kidney failure does occur, the symptoms may include: weight loss and poor appetite swollen ankles, feet or hands (due to water retention) shortness of breath blood or protein in your urine (protein in your urine is not something you will notice as it can only be detected during a urine test) an increased need to urinate, particularly at night insomnia itchy skin muscle cramps high blood pressure (hypertension) nausea erectile dysfunction in men(an inability to get or maintain an erection) These are general symptoms and can be caused by many less serious conditions. Many of the symptomsabove can be avoided if treatment begins at an early stage, before any symptoms appear. If you are worried by any of these symptoms, arrange to see your GP. Causes of chronic kidney disease Kidney disease is most often caused by other conditions that put a strain on the kidneys. High blood pressure (hypertension) and diabetes are the most common causes of kidney disease. High blood pressure Blood pressure is a measure of the pressure your heart generates in your arteries with each pulse. Too much pressure can damage your bodys organs, leading to heart disease, stroke and worsening of kidney function. The cause of around 90% of cases of high blood pressure is unknown. There appears to be a link between the condition and a persons general health, diet, and lifestyle. Known risk factors for high blood pressure include: age (the risk of developing high blood pressure increases as you get older) family history of high blood pressure (the condition seems to run in families) being of African-Caribbean or south Asian origin obesity lack of exercise smoking excessive alcohol consumption high amount of salt in your diet high-fat diet stress Hypertension causes damage by putting strain on the small blood vessels in the kidneys. This prevents the filtering process from working properly. Diabetes Diabetes is a condition in which the body produces no  or too little  insulin ( type 1 diabetes ) or has become unable to make effective use of insulin ( type 2 diabetes ). Insulin is needed to regulatelevels of glucose (sugar) in your blood, preventing the levels going too high after a meal and too low between meals. If diabetes is poorly controlled, too much glucose can build up in your blood. The glucose can damage the tiny filters in the kidneys, which affects the ability of your kidneys to filter out waste products and fluids. It is estimated that 20% to 40% of people with type 1 diabetes will develop kidney disease before they reach 50 years of age. Around 30% of people with type 2 diabetes also show signs of developing kidney damage. The first sign of diabetic kidney disease is the appearance of low levels of protein in the urine. Therefore, your GP will ask for an annual urine test so any kidney disease can be detected as early as possible. All people with diabetes should have a kidney check every year. Early detection of kidney dysfunction in diabetes is important because it identifies people at risk or complications, such as eye problems and impotence. Other causes There are many other conditions that less commonly cause CKD, including: glomerulonephritis (inflammation of the kidney) pyelonephritis (infection in the kidney) polycystic kidney disease (an inherited condition where both kidneys are larger than normal due to the gradual growth of masses of cysts) failure of normal kidney development in an unborn baby while developing in the womb systemic lupus erythematosus (a condition of the immune system where the body attacks the kidney as if it were foreign tissue) long-term, regular use of medicines, such as lithium and non-steroidal anti-inflammatory drugs (NSAIDs) , including aspirin and ibuprofen blockages, for example due to kidney stones or prostate disease Diagnosis of chronic kidney disease Chronic kidney disease (CKD) is most frequently diagnosed through blood and urine tests. Screening If you are in a high-risk group for developing CKD, it is importantto be regularly screened for the condition. People who are not in a high-risk group are not normally screened for CKD. Annual screening is recommended for the following groups: people with high blood pressure (hypertension) people with diabetes people withacute kidney injury caused by medications such as lithium or NSAIDs such as ibuprofen, kidney stones or an enlarged prostate people with cardiovascular disease (conditions that affect the heart, arteries and veins, such as coronary heart disease or heart failure ) people with a family history of stage 5 CKD (see below for more information about staging) or an inherited kidney disease people with diseases that affect several parts of the body and may affect the kidneys, such as systemic lupus erythematosus people with blood in the urine (haematuria) or protein in the urine (proteinuria) where there is no known cause Your GP can advise you about whether or not you should be screened for CKD. Most often, the diagnosis of kidney disease is made because a routine blood or urine test indicates the kidneys may not be functioning normally. If this happens, the test is usually repeated toconfirm the diagnosis. Glomerular filtration rate (GFR) An effective way of assessing how well your kidneys are working is to calculate your glomerular filtration rate (GFR). GFR is a measurement of how many millilitres (ml) of waste fluid your kidneys can filter from the blood in a minute (measured in ml/min). A healthy pair of kidneys should be able to filter more than 90ml/min. It is difficult to measure the GFR directly, so it is estimated using a formula. The result is called the estimated GFR or eGFR. Calculating your eGFR involves taking a blood sample and measuring the levels of a waste product called creatinine and taking into account your age, gender and ethnic group. The result is similar to the percentage of normal kidney function. For example, an eGFR of 50ml/min equates to 50% kidney function. The following tests are used to detect proteinuria (protein in the urine) urine tests  used to see whether there is blood or protein in your urine albumin and creatinine testing  this is another urine test which compares the amounts of albumin (a protein) and creatinine in your urine, and the ratio of the 2 (the albumin:creatinine ratio or ACR) can be used with eGFR to give doctors a more accurate idea of how the kidneys are functioning Staging A 6-stage system, based on eGFR levels, is used to describe the progression of CKD. The higher the stage, the more severe the CKD. Stage 1 (sometimes called G1): the eGFR is normal (above 90 or more), but other testing shows evidence of kidney damage. Stage 2 (G2): the eGFR has decreased slightly (60 to 89), but is still considered to be in the normal range for a young adult. If you have stage 1 or 2 CKD, it is recommended you have annual eGFR tests so the progression of the condition can be carefully monitored. Stage 3 is divided into 2: stage 3a (G3a) and 3b (G3b). In stage 3a, the eGFR has decreased mildly (45 to 59) and this is termed a mild to moderate decrease in kidney function and should be checked annually. In stage 3b (G3b) it has decreased moderately (30 to 44) and is termed a moderate to severe reduction in kidney function and should be checked every 6 months. Stage 4 (G4): the eGFR has reduced severely (15 to 29). By this time, it is possible you will be experiencing symptoms of CKD. Further testing should be carried out every 6 months. Stage 5 (G5): the kidneys have lost almost all of their function (an eGFR of below 15), which is known as establishedrenal failure. Further testing should be carried out every 3 months. However, over time, GFR can fluctuate, so one abnormal test result does not automatically mean you have CKD. A diagnosis of CKD is usually only confirmed if repeated eGFR tests show your eGFR is consistently lower than normal over 3 months. Other tests Other tests are also used to assess the levels of damage to your kidneys: kidney scans, such as an ultrasound scan, a magnetic resonance imaging (MRI) scan or a computerised tomography (CT) scan, are used to find out whether there are any unusual blockages in your urine flow  in cases of advanced kidney disease, the kidneys are shrunken and have an uneven shape kidney biopsy  a small sample of kidney tissue is taken so that the cells can be examined under a microscope for damage Treating chronic kidney disease Lifestyle changes The following lifestyle changes are known to help reduce your blood pressure and help control CKD: stopping smoking eating a healthy, low-fat, balanced diet restricting your salt intake to less than 6g (0.2oz) a day notusing over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen, except when advised to by a medical professional moderating your alcohol intakeso it is within recommended limits losing weight if you are overweight or obese doing regular exercisefor at least 30 minutes a day, 5 times a week Readmore about preventing high blood pressure through lifestyle changes. Medications for high blood pressure One of the main ways to reduce the progression of kidney damage is to manage high blood pressure . Good control of blood pressure isvital to protect the kidneys. People with CKD should aim to get their blood pressure down to below 140/90mmHg but if you also have diabetes you should aim to get it down to below 130/80mmHg. There are many types of blood pressure drugs.Medicines called angiotensin converting enzyme (ACE) inhibitors are used to control high blood pressure in people with CKD. As well as reducing blood pressure around the body and reducing the strain on blood vessels,ACE inhibitorsgive additional protection to the kidney. ACE inhibitors include: ramipril enalapril lisinopril perindopril Side effects of ACE inhibitors include: a persistent, dry cough dizziness tiredness or weakness headaches Most of these side effects should pass within a few days, although some people continue to have a dry cough. If the side effects of ACE inhibitors are particularly troublesome, you can be given an alternative medication called an angiotensin-II receptor blocker (ARB).This group of medicines includes: candesartan eprosartan irbesartan azilsartan olmesartan temisartan valsartan losartan The side effects of ARBs are uncommon, but can include dizziness. Both ACE inhibitors and ARBs can cause a reduction in kidney function in some peopleand increased levels of potassium in the blood, so blood tests will need to be performed after you start treatment and whenever the dose changes. If you are on an ACE inhibitor or ARB and you develop a fever/infection or need medicines for other conditions, its important to ask your doctor if the ACE inhibitor or ARB needs to be temporarily stopped. Medication to reduce cholesterol Studies have shown that people with CKD have a higher risk of cardiovascular disease, including heart attacks and strokes. This is because some of the risk factors for CKD are the same as those for heart attacks and strokes, including high blood pressure and high levels of cholesterol in the blood (atherosclerosis). Statins are a type of medication used to lower cholesterol levels. Cholesterol causes narrowing of the arteries that can lead to a blockage of the blood supply to the heart (causing a heart attack) or the brain (causing a stroke). Statins work by blocking the effects of an enzyme in your liver (called HMG-CoA reductase), which is used to make cholesterol. Statins sometimes have mild side effects, including: constipation diarrhoea headaches abdominal pain Occasionally, statins can cause muscle pain, weakness and tenderness. If you experience any of these symptoms, contact your GP. Youmay need to have a blood test or change your treatment. If you have kidney disease, you may be asked to reduce your daily fluid and salt intake. You may develop a build-up of fluid as your kidneys will not be able to get rid of fluid as well as they did before. If you are asked to reduce the amount of fluid you drink, you must also take into account fluid in foods, such as soup and yoghurt. Your GP or dietitian can advise you about this. The excess fluid that occurs as a result of kidney disease often builds up in your ankles or around your lungs. You may also be given diuretics (water tablets), such as furosemide, which will help get rid of the excess fluid from your body. If you do not have any fluid retention and youhave notbeen toldto reduce your fluid intake, there is no need to do so.In fact, it could be harmful in some circumstances. Anaemia Many people with stage three, four and five CKD develop anaemia . Anaemia is a condition in which you do not have enough red blood cells. Symptoms of anaemia include: tiredness lethargy shortness of breath (dyspnoea) palpitations (awareness of heartbeat) Anaemia can occur because of many other conditions and your doctor will investigate to rule outother possible causes. Most people with kidney disease will be given iron supplements because iron is needed for the production of red blood cells. To boost iron levels, iron may be given as tablets, such as daily ferrous sulphate tablets, or as occasional intravenous infusions. If this is not enough to treat anaemia, you may be started on injections of erythropoietin, a hormone which helps your body produce more red blood cells. These injections are often administered into a vein (intravenously)or under the skin (subcutaneously). Examples of these injections include epoetin alfa, beta and zeta, darbepoetin and methoxy polyethylene glycol-epoetin beta. Correction of phosphate balance If you have stage 4 or 5 kidney disease, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it. Phosphate is a mineral that, with calcium, makes up most of your bones. Phosphate is obtained through diet, mainly dairy foods. The kidneys usually filter outexcess phosphate. If phosphate levels rise too much, it can upset the normal calcium balance of the body. This can lead to thinning of the bones and furring of the arteries. You may be asked to limit the amount of phosphate in your diet. Foodshigh in phosphate include red meat, dairy produce, eggs and fish. Your GP or dietitian should be able to advise you about how much phosphate you can eat. However, there is no advantage in reducing your intake of these foods unless you have a raised phosphate level.Always aska healthcare professional before changing your diet. If reducing the amount of phosphate in your diet does not lower your phosphate level enough, you may be given medicines called phosphate binders. These medicines bind to the phosphate in the food inside your stomach and stop it from being absorbed into your body. To work properly, phosphate binders must be taken just before meals. The most commonly used phosphate binderis calcium carbonate, but thereare also alternatives that may be more suitable foryou. The side effects of phosphate binders are uncommon but include: nausea stomach ache constipation diarrhoea flatulence (wind) skin rash itchy skin Vitamin D supplements People with kidney disease can have low levels of vitamin D, necessary for healthy bones. This is because the kidneys need to activate the vitamin D from food andthe sun before it can be used by the body. Treatment for kidney failure  transplant or dialysis Many people with kidney failure can continue with treatment using medicines and will have good-functioning kidneys for the rest of their lives. In a few people, kidney disease will progress to the stage where the kidneysstop working and it becomes life threatening. This is called kidney failure or established renal failure (ERF). This rarelyhappens suddenly, and there will be time to plan the next stage of your condition. The decision whether to have dialysis, a kidney transplant or supportive treatment should be discussed with your healthcare team. Read more about dialysis andkidney transplants. Supportive treatment If you decide not to have dialysis or a transplant for kidney failure, or they are not suitable for you,you will be offered supportive treatment. This is also called palliative care. The aim is to treat and control the symptoms of kidney failure without using dialysis or transplantation. Supportive treatment 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 or have 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 that will shorten their life, 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 physical illness, especially severe heart disease or stroke, that will shorten their life If you choose to have supportive treatment, your kidney unit will still look after you. Doctors and nurses will make sure you receive: medicines to protect your remaining kidney functionfor 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 helpto plan your home and money affairs bereavement support for your family after your death Read more information: Kidney Research UK: Information on choosing not to start dialysis Bereavement support from CRUSE What is good kidney disease care? Kidney disease services should: identify people at risk of kidney disease, especially people with high blood pressure or diabetes, and treat them as early as possible to maintain their kidney function give people access to investigative treatment and follow them up to reduce the risk of the disease getting worse give people good-quality information about managing their condition provide information about the development of the disease and treatment options provide access to a specialist renal (kidney) team give people access to transplant or dialysisservices if required provide supportive care Your treatment for kidney disease will need to be reviewed regularly. It may be helpful for you to make a care plan because this can help you manage your day-to-day health. Your kidney disease specialist nurse may be able to help with this. Preventing chronic kidney disease In most cases, chronic kidney disease (CKD) cannot be completely prevented, although you can take steps to reduce the chances of the condition developing. Managing your condition If you have a chronic (long-term) condition, such as diabetes, that could potentially cause chronic kidney disease, it is importantit is carefully managed. Follow the advice of your GP and keep all appointments relating to your condition. People with diabetes are advised to have their kidney function tested every year. Read more about Type 1 diabetes and Type 2 diabetes Smoking Smoking increases your risk of cardiovascular disease, includingheart attacks or strokes, and it can increase the likelihood that any existing kidney problems will get worse. If you stop smoking, you will improve your general health and reduce your risk of developing other serious conditions, such as lung cancer and heart disease. The NHS smoking helpline can offer you advice and encouragement to help you quit smoking.Phone Quit Your Way Scotland on0800 84 84 84. Read moreabout stopping smoking Diet A healthy diet is importantfor preventing chronic kidney disease. It will lower the amount of cholesterol in your blood and keep your blood pressure at a healthy level. Eat a balanced diet that includes plenty of fresh fruit and vegetables ( 5 a day ) and whole grains. Limit the amount of salt in your diet to no more than 6g (0.2oz) a day. Too much salt will increase your blood pressure. One teaspoonful of salt is equal to about 6g. Avoid eating foods high in saturated fat because this will increase your cholesterol level. Foods high in saturated fat include: meat pies sausages and fatty cuts of meat butter ghee (a type of butter often used in Indian cooking) lard cream hard cheese cakes and biscuits foods that contain coconut oil or palm oil Eating some foods that are high in unsaturated fat can help decrease your cholesterol level. Foodshigh in unsaturated fat include: oily fish avocados nuts and seeds sunfloweroil rapeseedoil olive oil Read more abouthealthy food and diet Alcohol Drinking excessive amounts of alcohol will cause your blood pressure to rise, as well as raising cholesterol levels in your blood. Therefore, sticking to the recommended alcohol consumption limits is the best way to reduce your risk of developing high blood pressure (hypertension) and CKD. Exercise Regular exercise should help lower your blood pressure and reduce your risk of developing CKD. At least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (such as cycling or fast walking) every week, is recommended. Read more about health and fitness Painkillers Kidney disease can be caused by the improper use (such as taking too many)of non-steroidal anti-inflammatories (NSAIDs) , such as aspirin and ibuprofen . If you need to take painkillers,make sure you follow the instructions. This can help to avoid kidney damage. Living with chronic kidney disease Relationships and support Coming to terms with a condition such as kidney disease can put a strain on you, your family and your friends. It can be difficult to talkto people about your condition, even if they are close to you. Learning about kidney disease often helps because you and your family will understand more about what to expect and feel more in control of the illness, instead of feeling that your lives are now dominated by kidney disease 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 nurse can reassure you if you have questions about your kidney disease, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP practice will have information on these. Some people find it helpful to talk to other people with kidney disease at a local support group or online. Money and finances If you have to stop work or work part time because of your kidney disease, 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 if you do not have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance if you are aged 64 or under and need help with personal care or have walking difficulties, you may be eligible for Disability Living Allowance if you are aged 65 or over, you may be able to get Attendance Allowance if you are caring for someone with kidney disease, you may be entitled to Carers Allowance you may be eligible for other benefits if you have children living at home or if you have a low household income Sex and pregnancy The symptoms of kidney disease and the stress it causes in your life can affect your sexual relationships. Some couples become closer after a diagnosis of kidney disease, while others find that their loved ones are affected by worries about how they will cope with the effects of the illness. Both men and women may experience issues about body image and self-esteem, and this can affect the relationship. Try to share your feelings with your partner. If you have problems with sex that do not get better with time, speak to a counsellor or sex therapist. People on dialysis often experience specific sexual difficulties. Loss of sex drive in both men and women and impotence in men are commonly reported problems. Treatment is available, butit may take some time and requires commitment from both partners. The first step is to discuss it with your healthcare team. Pregnancy Both men and women with early stage kidney disease will findtheir fertility is unaffected. This means it is important to use contraception unless you want to have a baby. Later stage kidney disease may affectwomens periods, which can make pregnancy more difficult. For men, later stage kidney disease can cause a reduction in sperm count. However, having kidney disease does not mean you will not get pregnant or be able to father a child, soboth men and womenneed to use an effective method of contraception unless they want to have a baby. Women who want to have a baby should talk to their renal specialist or an obstetrician with an interest in kidney disease.Depending on the stage of kidney disease, there can be risks to both the mother and the baby. It is important to minimise any risk with a planned pregnancy. Your healthcare team can advise you about this. Holidays and insurance If you have mild kidney disease or youve had a transplant, going on holiday shouldnt pose additional health problems, whether youre staying in the UK or going abroad. If youre on dialysis, you can still enjoy holidays provided you book your treatment before you go away. If youre on dialysis and want to travel, discuss your plans with your renal unit as early as you can. It can sometimes be more difficult to arrange dialysis in the UK than it is abroad. The NHS will look after you if you get ill while on holiday in the UK. If youre in Europe, the European Health Insurance Card (EHIC) entitles you to free or reduced-cost hospital treatment. Its 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. Using over-the-counter medicines Some remedies are potentially harmful for people with kidney disease. Make sure you check with your doctor before taking a new over the counter medicine. Youre at higher risk of being harmed by certain over the counter remedies if: you have advanced kidney disease (stage 4 or 5, or a kidney function below 30% of normal) you have mild-to-moderate kidney disease (stage 3 with a kidney function between 30 and 60% of normal) and are elderly with another serious illness, such as coronary heart disease Whats safe and whats not Summarised below is a list of which over the counter remedies are safe for people with kidney disease to use and which should be avoided. This is just a guide. For more detailed information, consult your pharmacist, renal specialist or GP. Headaches Paracetamol is safe and the best choice of painkiller to treat a headache, but avoid soluble products as they are high in sodium. If your kidney function is less than about 50%, avoid painkillers containing aspirin, ibuprofen or similar drugs such as diclofenac. These products can deteriorate the function of damaged kidneys. Low-dose aspirin of 75mg to 150mg a day can be used if its