Chronic kidney disease (CKD) is

the permanent loss of kidney function. CKD may be the result of

physical injury or a disease that

damages the kidneys, such as

diabetes or high blood pressure.

When the kidneys are damaged,

they do not remove wastes and

extra water from the blood as well

as they should.

CKD is a family affair because you

may be at risk if you have a blood

relative with kidney failure.

CKD is a silent condition. In the

early stages, you will not notice any

symptoms. CKD often develops

so slowly that many people don’t

realize they’re sick until the disease is advanced and they are

rushed to the hospital for lifesaving dialysis.

National Kidney and Urologic Diseases Information Clearinghouse

National

Institute of

Diabetes and

Digestive 

and Kidney

Diseases

NATIONAL 

INSTITUTES

OF HEALTH

Chronic Kidney Disease:

A Family Affair

U.S. Department

of Health and

Human Services

A Growing Problem

CKD is a growing problem in the United States.

Between 1990 and 2000, the number of people

with kidney failure requiring dialysis or transplantation virtually doubled to 380,000. If this trend

continues, the number of people with kidney failure will approach 700,000 by 2010. The annual

cost of treating kidney failure in the United States

has already topped $20 billion.

Kidney failure is only a part of the picture.

Experts estimate that 20 million Americans have

significantly reduced kidney function, and even a

small loss of kidney function can double a person’s risk of developing cardiovascular disease.

Many of these people will experience heart

attacks or strokes before they become aware of

their kidney disease. So identifying and treating

CKD early can help prevent heart problems as

well as postpone kidney failure.

1990

180,000 people with kidney failure

2000

380,000 people with kidney failure

Between 1990 and 2000, the number of people with kidney failure requiring dialysis or transplantation

more than doubled.
Who is at risk? 

Risk factors are conditions that make you 

more likely to develop a disease. The leading risk factors for CKD are 

•	 diabetes 

•	 high blood pressure 

•	 family history of kidney failure 

Having diabetes increases your risk of 

developing CKD. In fact, diabetes is the 

leading cause of kidney failure. High blood 

pressure is the second leading cause. 

CKD runs in families, so you may have an 

increased risk if your mother, father, sister, 

or brother has kidney failure. 

Some racial groups are also at increased 

risk for CKD. 

•	 African Americans are nearly four


times as likely to develop kidney


failure as white Americans.


•	 American Indians have nearly three 

times the risk compared to whites. 

•	 Hispanic Americans have nearly twice 

the risk of non-Hispanic whites. 

Screening for kidney disease includes simple blood and 

urine tests. 

If you have diabetes or high blood pressure, 

or a close family member with kidney failure, you should get checked for kidney disease, especially if you’re a member of one 

of the racial or ethnic groups at higher risk 

for CKD. 

How can I find out if 

I have CKD? 

Since early CKD has no symptoms, the only 

way to find out if you have it is through 

simple medical tests. 

•	 Blood pressure. High blood pressure 

can lead to kidney damage, and it can 

also be a sign that kidney damage has 

already occurred. If your blood pressure is high, you’ll want to get it under 

control to make sure your kidneys 

remain healthy. 

•	 Blood. The glomerular filtration rate 

(GFR) measures how efficiently the 

kidneys are filtering waste from the 

blood. The new method of calculating 

GFR requires only a measurement of 

the creatinine (kree-AT-ih-nin) in a 

blood sample. Creatinine is a waste 

product in the blood created by the 

normal breakdown of muscle cells 

during activity. When kidneys are not 

working well, creatinine builds up in 

the blood. 

•	 Urine. Measuring the amount of a 

protein called albumin in the urine 

can show a kidney problem. A large 

amount of protein in the urine is 

known as proteinuria and is a sign 

of kidney damage. Your doctor may 

test for protein using a dipstick in a 

sample of your urine taken in the doctor’s office. The color of the dipstick 

indicates the level of protein. 

A test that can show smaller amounts 

of protein or albumin in the urine is 

2	 Chronic Kidney Disease: A Family Affair 
called a microalbumin test and also 

uses a dipstick in the urine. 

Your doctor may also do a calculation 

of the protein-to-creatinine or albumin-to-creatinine ratio. Healthy kidneys move creatinine from the blood 

into the urine. A ratio greater than 30 

milligrams of albumin per 1 gram of 

creatinine indicates that the kidneys 

are leaking helpful substances from 

the blood and failing to filter out 

harmful substances. This test should 

be used in people at high risk, especially those with diabetes. 

If your first laboratory test shows high 

levels of protein, another test should 

be done 1 to 2 weeks later. If the 

second test also shows high levels of 

protein, you have persistent protein 

in the urine (proteinuria) and should 

have additional tests to test your 

kidney function. 

A 24-hour urine collection is no longer necessary. Small samples of urine and blood, 

which can easily be taken in the doctor’s 

office, are all the new methods require. 

Several organizations offer free screenings 

for kidney disease. You may be able to 

have your kidney function measured at a 

local health fair. The National Kidney 

Foundation’s KEEP (Kidney Early Evaluation Program) initiative offers blood and 

urine testing, onsite consultation with a 

physician, and referral and followup services for people whose test results are 

outside the normal range. The American 

Kidney Fund’s MIKE (Minority Intervention and Kidney Education) Program offers 

educational sessions and medical screenings. The American Association of Kidney 

Patients’ Finding Your Strength program 

offers education about your kidneys, tests 

to expect, and ways to stay healthy with 

CKD. Contact information for these and 

3	 Chronic Kidney Disease: A Family Affair 

other organizations appears in the For 

More Information section at the end of 

this fact sheet. 

What can I do to slow down 

or avoid kidney failure? 

Learning about reduced kidney function 

allows you to take steps to keep your kidneys healthy as long as possible. You can 

control many of the things that can make 

CKD worse and may lead to kidney failure. 

•	 If you have diabetes, control your 

blood glucose, also called blood sugar. 

Studies show that keeping tight control 

of blood glucose can delay or prevent 

kidney failure. 

•	 If you have high blood pressure,


keep your blood pressure below 


140/90 mm Hg.


•	 If you have high blood pressure 

with CKD, keep your blood pressure 

below 130/80 mm Hg. Blood pressure 

medicines called ACE (angiotensinconverting enzyme) inhibitors and 

ARBs (angiotensin receptor blockers) 

protect the kidneys better than other 

medicines. You may need a combination of two or more drugs to keep your 

blood pressure below 130/80. In many 

cases, a medicine that lowers blood 

pressure by increasing urination, 

called a diuretic, should also be part 

of the plan. 

•	 If you have CKD, don’t eat too much 

protein. Protein breaks down into 

the waste products the kidneys must 

excrete. Reducing those waste products by eating less protein means the 

kidneys don’t have to work so hard. 

But eating too little protein can lead to 

poor nutrition. Work with a dietitian 

to make sure you get the right amounts 

of protein and other nutrients. 
What can I do to avoid the 

complications of CKD? 

CKD can lead to many other health problems well before kidney failure occurs. 

•	 Anemia. Anemia develops when 

the kidneys fail to produce enough 

erythropoietin, or EPO, the hormone 

that directs the bones to make red 

blood cells. Anemia can cause heart 

problems. 

•	 Bone problems. Healthy kidneys help 

keep your bones strong by balancing 

the levels of calcium and phosphorus 

in the blood. CKD can lead to bone 

problems by throwing those minerals 

out of balance. 

•	 Acidosis. The kidneys also maintain 

the acid/base balance in the blood. 

Kidney problems may lead to acidosis, 

a condition in which the blood is too 

acidic. Acidosis can disrupt body 

functions. 

•	 Cardiovascular disease (CVD). 

Patients with CKD are more likely to 

die from a heart attack or stroke than 

from kidney failure. Even a small loss 

of kidney function can double a person’s risk of developing CVD. 

If you have CKD, you will need to have 

regular checkups to monitor blood levels 

of creatinine, urea nitrogen, potassium, 

phosphorus, parathyroid hormone, hemoglobin, and cholesterol. If your blood 

tests show abnormal levels of any of these 

substances several times, your doctor will 

prescribe medicines. For example, if you 

have anemia indicated by low levels of 

hemoglobin on repeated tests, your doctor 

can prescribe a synthetic form of EPO 

(erythropoietin) to help your body make 

more red blood cells. 

You have the power to prevent kidney failure. 

Work with your doctor to manage the 

health problems that CKD can cause. 

Taking charge of your health can make 

your kidneys last longer. You have the 

power to prevent kidney failure. 

Points to Remember 

•	 Chronic kidney disease (CKD) is a 

growing problem in the United States. 

Some 20 million Americans with 

reduced kidney function are at 

increased risk for kidney failure 

and cardiovascular disease. 

•	 The leading causes of CKD are diabetes and high blood pressure. If you 

have either one of these conditions, 

you should have your kidney function 

checked regularly. 

•	 CKD can run in families. If you have 

a parent, brother, or sister with kidney 

failure, you should have your kidney 

function checked. 

•	 African Americans, American Indians, 

and Hispanic Americans have higher 

rates of CKD than white Americans. 

If you belong to one of these high-risk 

groups and have any of the other risk 

4 Chronic Kidney Disease: A Family Affair 
factors for CKD, you should have your 

kidney function checked. 

•	 Medical tests for kidney function 

should include a check for protein 

in the urine and a calculation of 

glomerular filtration rate (GFR) based 

on a measurement of creatinine in the 

blood. 

•	 If CKD is found early, you can manage 

it to prevent or delay kidney failure 

and avoid cardiovascular disease. 

Hope Through Research 

The National Institute of Diabetes and 

Digestive and Kidney Diseases (NIDDK) 

has many research programs aimed at 

slowing the progression of chronic kidney 

disease. The NIDDK is sponsoring the 

Chronic Renal Insufficiency Cohort 

(CRIC) Study to determine the risk factors 

for rapid decline in kidney function and 

development of cardiovascular disease. 

This study of about 3,000 patients with 

chronic renal insufficiency, which is another 

way of describing CKD, will reflect the 

racial, ethnic, and gender composition of 

the ESRD population in the United States. 

The data collected and specimens obtained 

from people in this study will serve as a 

national resource for investigating chronic 

kidney as well as cardiovascular disease. 

Establishing this group of patients and 

following them into the future will also 

provide an opportunity to examine genetic, 

environmental, behavioral, nutritional, 

quality-of-life, and health resource utilization factors in this population. The main 

part of the study will consist of monitoring 

patients and following up at regular clinic 

visits with kidney function measurements, 

cardiovascular studies, and laboratory tests. 

In addition, participants will answer questionnaires to assess various demographic, 

nutritional, and quality-of-life factors. 

5	 Chronic Kidney Disease: A Family Affair 
For More Information 

American Association of Kidney Patients 

3505 East Frontage Road 

Suite 315 

Tampa, FL 33607 

Phone: 1–800–749–2257 or 813–636–8100 

Email: info@aakp.org 

Internet: www.aakp.org 

American Kidney Fund 

6110 Executive Boulevard 

Suite 1010 

Rockville, MD 20852 

Phone: 1–800–638–8299 or 301–881–3052 

Email: helpline@akfinc.org 

Internet: www.kidneyfund.org 

Life Options Rehabilitation 

Resource Center 

c/o Medical Education Institute, Inc. 

414 D’Onofrio Drive 

Suite 200 

Madison, WI 53719 

Phone: 1–800–468–7777 

Email: lifeoptions@MEIresearch.org 

Internet: www.lifeoptions.org 

National Kidney Disease 

Education Program 

3 Kidney Information Way 

Bethesda, MD 20892 

Phone: 1–866–4–KIDNEY (454–3639) 

Email: nkdep@info.niddk.gov 

Internet: www.nkdep.nih.gov 

National Kidney Foundation 

30 East 33rd Street 

New York, NY 10016 

Phone: 1–800–622–9010 or 212–889–2210 

Email: info@kidney.org 

Internet: www.kidney.org 

National Kidney and 

Urologic Diseases 

Information Clearinghouse 

3 Information Way


Bethesda, MD 20892–3580


Phone: 1–800–891–5390


Fax: 703–738–4929


Email: nkudic@info.niddk.nih.gov


Internet: www.kidney.niddk.nih.gov


The National Kidney and Urologic Diseases 

Information Clearinghouse (NKUDIC) is a 

service of the National Institute of Diabetes 

and Digestive and Kidney Diseases (NIDDK). 

The NIDDK is part of the National Institutes 

of Health under the U.S. Department of Health 

and Human Services. Established in 1987, the 

clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to 

their families, health care professionals, and the 

public. NKUDIC answers inquiries, develops 

and distributes publications, and works closely 

with professional and patient organizations and 

Government agencies to coordinate resources 

about kidney and urologic diseases. 

Publications produced by the clearinghouse 

are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet was 

reviewed by Phylis Ermann, L.C.S.W., American Kidney Fund; and Kris Robinson, Executive 

Director, American Association of Kidney 

Patients. 

This publication is not copyrighted. The 

clearinghouse encourages users of this fact 

sheet to duplicate and distribute as many 

copies as desired. 

This fact sheet is also available at 

www.kidney.niddk.nih.gov and 

www.nkdep.nih.gov. 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 05–5391 

December 2004