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Your Amazing Kidneys

The kidneys are complicated and amazing organs that do many essential tasks to keep us healthy.

The main job of your kidneys is to remove toxins and excess water from your blood.

Kidneys also help to control your blood pressure, to produce red blood cells and to keep your bones healthy.
Each roughly the size of your fist, kidneys are located deep in the abdomen, beneath the rib cage.

Your kidneys control blood stream levels of many minerals and molecules including sodium and potassium, and help to control blood acidity. Every day your kidneys carefully control the salt and water in your body so that your blood pressure remains the same.

Did you know?

Your Kidneys:

  • Make urine
  • Remove wastes and extra fluid from your blood
  • Control your body’s chemical balance
  • Help control your blood pressure
  • Help keep your bones healthy
  • Help you make red blood cells

What is

Chronic Kidney Disease

Chronic kidney disease (CKD) is a progressive loss in kidney function over a period of months or years. Each of your kidneys has about a million tiny filters, called nephrons. If nephrons are damaged, they stop working. For a while, healthy nephrons can take on the extra work. But if the damage continues, more and more nephrons shut down. After a certain point, the nephrons that are left cannot filter your blood well enough to keep you healthy.

When kidney function falls below a certain point, it is called kidney failure. Kidney failure affects your whole body, and can make you feel very ill. Untreated kidney failure can be life-threatening.

What you should not forget:

  • Early chronic kidney disease has no signs or symptoms.
  • Chronic kidney disease usually does not go away.
  • Kidney disease can be treated. The earlier you know you have it, the better your chances of receiving effective treatment.
  • Blood and urine tests are used to check for kidney disease.
  • Kidney disease can progress to kidney failure.

Kidney Diseases are Common, Harmful and often Treatable

Common: Between 8 and 10% of the adult population have some form of kidney damage, and every year millions die prematurely of complications related to Chronic Kidney Diseases (CKD).


  • The first consequence of undetected CKD is the risk of developing progressive loss of kidney function that can lead to kidney failure (also called end-stage renal disease, ESRD) which means regular dialysis treatment or a kidney transplant is needed to survive.
  • The second consequence of CKD is that it increases the risk of premature death from associated cardiovascular disease (i.e. heart attacks and strokes). Individuals who appear to be healthy who are then found to have CKD have an increased risk of dying prematurely from cardiovascular disease regardless of whether they ever develop kidney failure.

Treatable: If CKD is detected early and managed appropriately, the deterioration in kidney function can be slowed or even stopped, and the risk of associated cardiovascular complications can be reduced.

How is kidney function measured?

The main indicator of kidney function is your blood level of creatinine, a waste product of the body produced by muscles and excreted by the kidneys. If kidney function is reduced, creatinine accumulates in the blood leading to an elevated level when a blood test is checked.

Kidney function is best measured by an indicator called GFR (Glomerular Filtration Rate) which measures the blood filtration rate by kidneys. This indicator allows doctors to determine if the kidney function is normal, and if not, to what level the reduced kidney function has deteriorated. In everyday practice, GFR can easily be estimated (eGFR), from measurement of the blood creatinine level, and taking into account, age, ethnicity and gender.

Stages of Chronic Kidney Disease (CKD)

Usually, kidney disease starts slowly and silently, and progresses over a number of years. Not everyone progresses from Stage 1 to Stage 5. Stage 5 is also known as End-Stage Renal Disease (ESRD).

StageDescriptionGFR Level
Normal Kidney FunctionHealthy Kidneys90mL/min or more
Stage 1Kidney damage with normal or high GFR90ml/min or more
Stage 2Kidney damage and mild decrease in GFR60 to 89mL/min
Stage 3Moderate decrease in GFR30 to 59mL/min
Stage 4Severe decrease in GFR15 to 29 mL/min
Stage 5 (ESKD)Established kidney failureLess than 15mL/min or on dialysis

GFR: Glomerular Filtration Rate

CGA: Cause, GFR and Albuminuria categories

Source: “KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease”.

Causes of CKD

High blood pressure (hypertension) and diabetes are the most common causes of kidney disease. The high blood pressure causes just over a quarter of all cases of kidney failure. Diabetes has been established as the cause of around one-third of all cases and is the commonest cause of ESRD in most developed countries.

Other less common conditions include inflammation (glomerulonephritis) or infections (pyelonephritis). Sometimes CKD is inherited (such as polycystic disease) or the result of longstanding blockage to the urinary system (such as enlarged prostate or kidney stones).

Some drugs can cause CKD, especially some pain-killing drugs (analgesics) if taken over a long time. Often doctors cannot determine what caused the problem.


A person can lose up to 90% of their kidney functions before experiencing any symptoms.

Most people have no symptoms until CKD is advanced. Signs of advancing CKD include swollen ankles, fatigue, difficulty concentrating, decreased appetite, blood in the urine and foamy urine.



The majority of individuals with early stages of CKD go undiagnosed. On WKD we are calling on everyone to check if they are at risk for kidney disease and encouraging people with any risk factors to take a simple kidney function test.

Kidney disease usually progresses silently, often destroying most of the kidney function before causing any symptoms. The early detection of failing kidney function is crucial because it allows suitable treatment before kidney damage or deterioration manifests itself through other complications.

Simple laboratory tests are done on small samples of blood (to measure creatinine content and estimate GFR) and on urine (to measure creatinine and albumin excretion).

Your doctor uses the results of your Serum Creatinine measured in the blood to estimate your overall kidney function, or Glomerular Filtration Rate (GFR) and your blood sugar to be sure you do not have diabetes. A simple “dipstick” test may be used to detect excess protein in the urine.

  • Serum Creatinine: Creatinine is a waste product in your blood that comes from muscle activity. It is normally removed from your blood by your kidneys, but when kidney function slows down, the creatinine level rises. Your doctor can use the results of your serum creatinine test to calculate your kidney function, or GFR.
  • Glomerular Filtration Rate (GFR): Your GFR tells how much total kidney function you have. It may be estimated from your blood level of creatinine. Normal is about 100 ml/min, so lower values indicate the percentage of normal kidney function which you have. If your GFR falls below 60 ml/min you will usually need to see a kidney disease specialist (called a nephrologist), If the treatment you receive from the nephrologist does not prevent a further reduction in GFR, your nephrologist will speak to you about treatments for kidney failure like dialysis or kidney transplant. A GFR below 15 indicates that you may need to start one of these treatments soon.
  • Urine albumin. The presence of excess protein in the urine is also a marker of CKD and is a better indicator of the risk for progression and for premature heart attacks and strokes than GFR alone. Excess protein in the urine can be screened for by placing a small plastic strip embedded with chemicals that change color when protein is present (urine dipstick) into a fresh urine specimen or can be measured more accurately with a laboratory test on the urine.

Treating CKD

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.

The main treatments are a proper diet and medications, and for those who reach ESRD, long term dialysis treatment or kidney transplantation. In the early stages of kidney disease, a proper diet and medications may help to maintain the critical balances in the body that your kidneys would normally control. However, when you have kidney failure, wastes and fluids accumulate in your body and you need dialysis treatments to remove these wastes and excess fluid from your blood, dialysis can be done either by machine (hemodialysis) or by using fluid in your abdomen (peritoneal dialysis). In suitable patients a kidney transplant combined with medications and a healthy diet can restore normal kidney function. Dialysis and kidney transplantation are known as renal replacement therapies (RRT) because they attempt to “replace” the normal functioning of the kidneys and are discussed in more detail below.

Kidney Transplantation

A kidney transplant is an operation to place a healthy (donor) kidney in your body to perform the functions your own diseased kidneys can no longer perform.

Kidney transplantation is considered the best treatment for many people with severe CKD because quality of life and survival are often better than in people who use dialysis. However, there is a shortage of organs available for donation. Many people who are candidates for kidney transplantation are put on a transplant waiting list and require dialysis until an organ is available.

A kidney can come from a living relative, a living unrelated person, or from a person who has died (deceased or cadaver donor); only one kidney is required to survive. In general, organs from living donors function better and for longer periods of time than those from donors who are deceased.

Overall, transplant success rates are very good. Transplants from deceased donors have an 85 to 90% success rate for the first year. That means that after one year, 85 to 90 out of every 100 transplanted kidneys are still functioning. Live donor transplants have a 90 to 95% success rate. Long-term success is good for people of all ages.

WKD 2012 was devoted to spreading the message about the importance of organ donation and kidney transplantation for people with ESRD.


Healthy kidneys clean blood and remove extra fluid in the form of urine. They also make substances that keep our body healthy. Dialysis replaces the blood cleaning functions when kidneys no longer work.

There are two types of dialysis: hemodialysis and peritoneal dialysis.

In hemodialysis, your blood is pumped through a dialysis machine to remove waste products and excess fluids. You are connected to the dialysis machine through a needle in a vein that is surgically enlarged (vascular access) or through a temporary plastic catheter placed in a vein. This allows blood to be removed from the body, circulate through the dialysis machine for cleansing, and then return to the body. Hemodialysis can be done at a dialysis center or at home. When done in a center, it is generally done three times a week and takes between three and five hours per session. Home dialysis is generally done three to seven times per week and takes between three and ten hours per session (often while sleeping).

Peritoneal dialysis is another form of dialysis used to remove waste products and excess water. It works on the same principle as hemodialysis, but your blood is cleaned while still inside your body rather than in a machine by adding clean fluid to your abdomen, letting it accumulate waste products from the blood and then draining it out. It is typically done at home. Some patients can perform peritoneal dialysis continuously while going about normal daily activities (continuous ambulatory peritoneal dialysis, CAPD)

To find out more about these possible treatments and how they work, visit https://www.uptodate.com/contents/dialysis-or-kidney-transplantation-which-is-right-for-me-beyond-the-basics

Prevalence of CKD

About 1 in 10 people have some degree of CKD. It can develop at any age and various conditions can lead to CKD.

Kidney disease can affect people of all ages and races. African Americans, Hispanics, American Indians and people of South Asian origin (those from India, Bangladesh, Sri Lanka or Pakistan) have a higher risk of CKD. This risk is due in part to high rates of diabetes and high blood pressure in these communities.

CKD can occur at any age, but r becomes more common with increasing age and is more common in women. Although about half of people aged 75 or more have some degree of CKD, many of these people do not actually have diseases of their kidneys; they have normal ageing of their kidneys. Simple blood and urine tests can detect CKD and simple, low cost treatments can slow the progression of the disease, reduce the risk of associated heart attacks and strokes and improve quality of life.

Cost of CKD

The prevalence of kidney disease is increasing dramatically and the cost of treating this growing epidemic represents an enormous burden on healthcare systems worldwide. Even in high income countries, the very high cost of long term dialysis for increasing numbers of people is a problem. In low and middle income countries long term dialysis is unaffordable. The best hope for reducing the human and economic costs of chronic kidney disease and end-stage renal disease therefore lies in prevention, for the following reasons:

  • Chronic kidney diseases are not curable and can cause people to need care for the rest of their lives.
  • If CKD is not detected early enough, the patient may progress to kidney failure which requires Renal Replacement Therapy (dialysis or transplantation) that is extremely costly and weighs heavily on healthcare budgets.
  • Chronic Kidney Diseases trigger other healthcare issues like cardiovascular diseases (heart attack and stroke), which will lead to premature death or disability and multiply the amount of amount of money needed for the healthcare of a patient.

In developed countries, ESRD is a major cost driver for patients, their families and the taxpayer. Patients with ESRD require dialysis or kidney transplantation, which are highly costly and consume a sizeable portion of the health budget.

For instance:

  • According to a recent report published by NHS Kidney Care, in England Kidney Disease costs more than breast, lung, colon and skin cancer combined.
  • In Australia, the cost of treating all current and new cases of ESKD to 2020 is estimated at $12 billion. The annual cost of dialysis per patient per year varies between 50,000 and 80,000 AUD depending on the type of treatment.
  • In the US, treatment of CKD (…) is likely to exceed $48 billion per year, and the ESRD program consumes 6.7% of the total Medicare budget to care for less than 1% of the covered population.
  • In China, the economy will lose US$558 billion over the next decade due to effects on death and disability attributable to chronic cardiovascular and renal disease.
  • In Uruguay, the annual cost of dialysis is close to $ US 23 million, representing 30% of the budget of the National Resources Fund for specialized therapies.

In middle-income countries, access to life-saving therapies has progressively increased over the same period yet renal replacement therapy remains unaffordable for the majority of patients.

Developing countries, with a combined population of over 600 million people, cannot afford renal replacement at all—resulting in the death of over 1 million people annually from untreated kidney failure. Indeed, more than 80% of individuals receiving renal replacement therapy (RRT) live in the developed world because in developing countries it is largely unaffordable. In countries such as India and Pakistan, less than 10% of all patients who need it receive any kind of renal replacement therapy. In many African countries there is little or no access to RRT, meaning many people simply die. RRT is also used to treat acute kidney injuries where recovery of kidney function usually occurs if the patient can be kept alive by dialysis until that happens. The lack of available RRT results in the preventable deaths of many thousands of children with diarrheal diseases and women with complications of pregnancy in the developing world every year (see below). WKD 2013 was dedicated to spreading the message of the importance of acute kidney injury (AKI).

Examples of costs from other regions of the world: https://www.academia.edu/3633811/Chronic_kidney_disease_global_dimension_and_perspectives

CKD in elderly people

About 1 in 10 people have some degree of CKD. It can develop at any age and various conditions can lead to CKD. It however becomes more common with increasing age. After the age of 40, kidney filtration begins to fall by approximately 1% per year. On top of the natural aging of the kidneys, many conditions which damage the kidneys are more common in older people including diabetes, high blood pressure and heart disease.

It is estimated that about one in five men and one in four women between the ages of 65 and 74, and half of people aged 75 or more have CKD. In short, the older you get the more likely you are to have some degree of kidney disease. This is important because CKD increases the risk of heart attack and stroke, and in some cases can progress to kidney failure requiring dialysis or transplantation. Regardless of your age, simple treatments can slow the progression of kidney disease, prevent complications and improve quality of life.



8 Golden Rules

of Prevention

What can you do for your kidneys?

Kidney diseases are silent killers, which can largely affect your quality of life. There are several ways to reduce the risk of developing kidney disease.


Keep fit, Be active

This can help to maintain an ideal body weight, reduce your blood pressure and the risk of Chronic Kidney Disease.

The concept On the move for kidney health” is a worldwide collective march involving the public, celebrities and professionals moving across a public area by walking, running and cycling. Why not join them – by whatever means you prefer! Check out the events section of the WKD website for more information.


Eat a healthy diet

This can help to maintain an ideal body weight, reduce your blood pressure, prevent diabetes, heart disease and other conditions associated with Chronic Kidney Disease.

Reduce your salt intake. The recommended sodium intake is 5-6 grams of salt per day. This includes the salt already in your foods. (around a teaspoon). To reduce your salt intake, try and limit the amount of processed and restaurant food and do not add salt to food. It will be easier to control your salt intake if you prepare the food yourself with fresh ingredients. .


Check and control
your blood sugar

About half of people who have diabetes do not know they have diabetes. Therefore, you need to check your blood sugar level as part of your general body checkup. This is especially important for those who are approaching middle age or older. About half of people who have diabetes develop kidney damage; but this can be prevented/ limited if the diabetes is well controlled. Check your kidney function regularly with blood and urine tests.


Check and control
your blood pressure

About half of people who have high blood pressure do not know they have high blood pressure. Therefore, you need to check your blood pressure as part of your general body checkup. This is especially important for those who are approaching middle age or older. High blood pressure can damage your kidneys. This is especially likely when associated with other factors like diabetes, high cholesterol and Cardio-Vascular Diseases. The risk can be reduced with good control of blood pressure.

Normal adult blood pressure level is 120/80. Hypertension is diagnosed if, when measured on two different days, the systolic blood pressure readings on both days is ≥140 mmHg and/or the diastolic blood pressure readings on both days is ≥90 mmHg (WHO).

If your blood pressure is persistently elevated above the normal range (especially if you are a young person), you should consult your doctor to discuss the risks, the need for lifestyle modification and medication treatment.

The American Heart Association and the American College of Cardiology revised the guidelines for high blood pressure (2017) and suggested that high blood pressure should be treated earlier with lifestyle changes and medication at 130/80 mm Hg rather than 140/90 mm Hg. However, not all health organizations around the world have adopted this recommendation. Best to consult your doctor.


Take appropriate fluid intake

The right level of fluid intake for any individual depends on many factors including exercise, climate, health conditions, pregnancy and breastfeeding.

Normally this means 8 cups, approximately 2 liters (quarts) per day for a healthy person in a comfortable climate condition.

This needs to be adjusted when in severe climate condition. Your fluid intake may need to be adjusted if you have kidney or heart or liver disease. Consult your doctor on the appropriate fluid intake for your condition.


Don’t smoke

Smoking slows the flow of blood to the kidneys. When less blood reaches the kidneys, it can decrease their ability to function normally. Smoking also increases the risk of kidney cancer by about 50 per cent.


Don’t take over-the-counter anti-inflammatory/pain-killer pills regularly

Common drugs such as non-steroidal anti-inflammatory (NSAIDS)/ pain-killer (e.g. drugs like ibuprofen) can harm the kidneys if taken regularly.

If you have kidney disease or decreased kidney function, taking just a few doses can do harm to your kidneys. If in doubt, check with your doctor or pharmacist.


Get your kidney function checked if you have one or more of the ‘high risk’ factors

  • you have diabetes
  • you have hypertension
  • you are obese
  • you have a family history of kidney disease

Hot topics

Certain conditions like diabetes or hypertension are linked to kidney disease, which can be more common in specific populations. Dive into our in-depth discussion on kidney health below to discover valuable insights and help you maintain optimal kidney health.

Chronic Kidney Disease in

Disadvantaged Populations

We are not all equal with regard to kidney disease and access to treatment. Some communities in both higher and lower income countries are at greater risk than others because of their ethnic origin, socioeconomic status and/or where they live. This has major public health implications because of the terrible impact of kidney failure and the extremely high cost of renal replacement therapy

We are not all equal with regard to kidney disease and access to treatment. Some communities in both higher and lower income countries are at greater risk than others because of their ethnic origin, socioeconomic status and/or where they live. This has major public health implications because of the terrible impact of kidney failure and the extremely high cost of renal replacement therapy.

African, American Indian, Hispanic, Asian and Aboriginal populations are known to suffer from higher rates of diabetes and high blood pressure, which are leading causes of chronic kidney disease (CKD). These populations are therefore at higher risk of developing severe kidney disease and ultimately kidney failure.

In the US, for example:

  • Hispanic Americans have a 1.5 times greater risk for developing kidney failure than non-Hispanic Americans
  • ESRD rates nearly 4-fold higher among African Americans in comparison to US Whites, despite similar prevalence rate of early CKD ; Hypertension is most prevalent among African Americans (33%) and a major cause of ESRD in this population
  • Native Americans are about 1.8 times more likely to be diagnosed with kidney failure. Diabetes is the leading cause of kidney failure among American Indians.

In Australia :

  • Kidney disease is 10 times more common among Indigenous people than among non-Indigenous people
  • Indigenous Australians are almost 4 times as likely to die with CKD as a cause of death than non-Indigenous Australian.

In Canada :

  • Canadian Aboriginal people experience End Stage Renal Disease (ESRD) at rates 2.5-4 times higher than the general population

Socioeconomic and cultural factors also contribute to a disproportionate burden of kidney disease.  Language barriers, education and literacy levels, low income, unemployment, lack of adequate  health insurance, and certain culture-specific health beliefs and practices all increase the risk of developing kidney disease and limit access to preventive measures and treatment.

  • A study conducted in the UK (Sheffield) reported a greater risk of developing CKD associated with a lower socioeconomic status independently of the ethnicity of the studied population
  • Access to kidney care is limited in resource poor nations. Approximately 80% of the world’s Renal Replacement Therapy (RRT) patients live in Europe, Japan or North America. By contrast, less than 10% of Indian End Stage Kidney Disease (ESKD) patients receive RRT, while up to 70% of those starting dialysis die or stop treatment, due to cost, within the first 3 months.
  • For most Low Middle Income Countries, transplantation is rare due to lack of infrastructure, and survival can be complicated by the affordability of immunosuppressive drugs, malnutrition and infectious disease, in particular tuberculosis


CKD & Possible Environmental Factors

In addition to the traditional risk factors of Chronic Kidney Disease, such as diabetes and hypertension, and genetic traits that contribute to increase the predisposition of certain ethnicities to develop this disease, there are also other independent and, in some cases, less clear causes of CKD.

Amongst others these can be environmental conditions, exposure to heavy metals and other toxins and pollutants, dietary habits and use of non-conventional medications (traditional drugs, herbal medications..).

Examples of CKD caused by these risk factors are:

  1. Mesoamerican Nephropathy [SD4]
    Mesoamerican Nephropathy (MeN) is an alarming epidemic form of Chronic Kidney Disease of unknown origin (CKDu), prevalent in the Pacific Ocean coastal low lands of the mesoamerican region that most commonly affects young men working in sugarcane plantations.
  2. The case of Sri Lanka [SD5] Chronic kidney disease of unknown etiology is a major health care problem in the North Central Province of Sri Lanka. It is not related to common risk factors like diabetes and hypertension and is predominantly observed in low-income male agricultural laborers and paddy farmers. Heavy metal toxicity, genetic susceptibility and the possible role of repeated dehydration are the main, still debated, causes.
  3. Aristolochic acid nephropathy (AAN) [SD6]
    Aristolochic acid nephropathy (AAN), a progressive renal interstitial fibrosis frequently associated with urothelial malignancies . It was originally called Chinese Herbal Nephropathy because it is caused by the aristolochic acid contained in Chinese herbs.  Aristolochic acid nephropathy (AAN), first reported in Belgium as “Chinese herbal nephropathy”, is characterised by progressive fibrosing interstitial nephritis leading to renal failure and severe anaemia.

There is some good news though! Taking steps to live a healthy lifestyle clearly helps to reduce risk, and early detection and treatment can slow or prevent the progression of kidney disease to kidney failure, and reduce the increased incidence of cardiovascular disease associated with kidney disease.

Find out more at:


kidney injury

The rapid loss of kidney function over just a few days or even hours is a condition known as Acute Kidney Injury (AKI).

This sudden loss of kidney performance can be linked to multiple causes, such as a drop in blood flow or poisoning.

Luckily, the kidney can recover almost fully, if immediate treatment, which includes the replacement of lost fluids and minerals, or, in some cases, dialysis may be required.

To ensure early detection and intervention that can prevent complete kidney failure greater awareness of AKI among the community, and in particular those with risk factors is needed.

What  causes acute kidney injury?

  • Acute kidney injury has three main causes:

    • A sudden, serious drop in blood flow to the kidneys.
    • Damage from some medicines, poisons, or infections.
    • A sudden blockage that stops urine from flowing out of the kidneys.
  • You have a greater chance of getting acute kidney injury if:

What are the symptoms?

Symptoms of acute kidney injury may include:

  • Passing little or no urine.
  • Swelling, especially in your legs and feet.
  • Not feeling like eating.
  • Nausea and vomiting.
  • Feeling confused, anxious and restless, or sleepy.

Some people may not have any symptoms. And for people who are already quite ill, the problem that’s causing the acute kidney failure may be causing other symptoms.

Acute Kidney Injury prevalence

In the developed world AKI is often seen in hospital settings: U.S. data suggests that 5% to 20% of critically ill patients (patients in the intensive care unit) experience an episode of AKI during the course of their illness, and development of AKI has a major negative impact on outcomes of any illness. So greater awareness of AKI is needed among all health workers. There are also important opportunities for prevention, especially by careful attention to prescription medicines management in elderly people.

In the developing world, AKI has a different pattern, with many cases developing because of infections and severe dehydration (including for example gastroenteritis and malaria). Victims of crush injuries in natural disasters such as earthquakes often die of acute kidney failure. Many cases of AKI can be prevented simply by educating the community, and local workers about prevention and early warning signs requiring immediate intervention.

Kidney Disease and

Cardiovascular Disease

Most organs of our body have strong links and interdependency. Heart and kidneys are not an exception. There is a strong connection between kidney disease and cardiovascular (heart and blood vessels) disease. People with CKD are known to have an increased risk of a stroke or heart at a younger age, because of changes in the circulation aused by kidney disease.

What is heart disease?

Heart disease includes any problem that keeps your heart from pumping blood as well as it should. The problem might start in your blood vessels or your heart.

Heart and blood vessel problems include:

  • the build-up of a substance called plaque in the walls of the blood vessels
  • a blood clot that blocks the flow of blood to the heart
  • heart attack-heart damage caused by a lack of blood and oxygen to the heart

Who gets heart and kidney disease?

You are more likely to develop heart disease if you have:

  • Diabetes
  • High blood pressure
  • Kidney disease
  • High blood cholesterol
  • A family history of early heart disease
  • and if you: smoke; are overweight; don’t exercise; are a man age 45+; are a woman age 55+

How are kidney disease and heart disease related?

Your heart and kidneys are connected and dependent on each other. And both heart disease and kidney disease share a number of the same risk factors, including:

• Diabetes

If you have diabetes, you have too much glucose, also called sugar, in your blood. Too much glucose in your blood for a long time can damage many parts of your body, including your heart and kidneys.

• High Blood Pressure

Blood pressure is the force of your blood pushing against the walls of your blood vessels. With high blood pressure, your heart works harder to pump blood, which can strain your heart. High blood pressure can damage your blood vessels. If high blood pressure damages the small blood vessels in your kidneys, your kidneys will not filter your blood as well as they should.

High blood pressure is not only a cause of kidney disease; kidney disease is also a cause of high blood pressure. When you have damaged kidneys, they may be unable to filter extra water and salt from your body. The high blood pressure that results can then make kidney disease worse. Worsening kidney disease can raise blood pressure again. A dangerous cycle results as each disease makes the other worse.

Kidney Disease and


Diabetes is the leading cause of kidney failure. In many countries, half of all people starting dialysis have kidney failure caused by diabetes.

What is Diabetic Kidney Disease?

Chronic Kidney Disease caused by diabetes is called Diabetic Nephropathy, (diabetic kidney disease). If you have diabetes, you have too much glucose (sugar), in your blood. Too much glucose in your blood for a long time can damage many parts of your body, including your heart and kidneys. Many people with diabetes also develop high blood pressure.  High blood pressure and diabetes are considered the leading causes of kidney disease.

High blood sugar, when diabetes is uncontrolled, damages the tiny blood vessels in the kidneys and alters filtration by the kidneys. In most cases, diabetic kidneys disease does not manifest itself with any symptoms. The only way to diagnose it is to do tests (blood and urine).The first sign of this damage is finding albumin in the urine. This can be detected by a urine strip test, often called a dipstick. If there is albumin in the urine, a blood test to check kidney function (eGFR) is also needed. 

Who is at higher risk of diabetic kidney disease?

You are at higher risk if you:

  • have had diabetes for a long time
  • have diabetes and your blood sugar is too high
  • have diabetes and your blood pressure is too high
  • have diabetes and smoke
  • don’t follow your diabetes eating plan & eat foods high in salt
  • are not active
  • are overweight
  • have heart disease
  • have a family history of kidney failure

African Americans, American Indians, and Hispanics/Latinos develop diabetes, kidney disease, and kidney failure at a higher rate than Caucasians.

You should get tested every year for kidney disease if you
1) Have type 2 diabetes
2) Have had type 1 diabetes for more than 5 years

How can you keep your kidneys healthy if you have diabetes?

The best way to slow or prevent diabetes-related kidney disease is to try to reach your blood glucose and blood pressure goals. Healthy lifestyle habits and taking your medicines as prescribed can help you achieve these goals and improve your health overall.

  • Reach your blood glucose goals
    Do an A1C blood test to see your average blood glucose level over the past 3 months. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months. The A1C goal for many people with diabetes is below 7 percent. Ask your health care team what your goal should be. Reaching your goal numbers will help you protect your kidneys.
  • Control your blood pressure
    High blood pressure can cause heart attack, stroke, and kidney disease.
    The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask your health care team what your goal should be. Medicines that lower blood pressure can also help slow kidney damage.
  • Develop or maintain healthy lifestyle habits
    Healthy lifestyle habits can help you reach your blood glucose and blood pressure goals. Following the steps below will also help you keep your kidneys healthy:
    • Work with a dietitian to develop a diabetes meal plan and limit salt and sodium
    • Stop smoking
    • Make physical activity part of your routine.
    • Stay at or get to a healthy weight.
    • Get enough sleep. Aim for 7 to 8 hours of sleep each night.
    • Take medicines as prescribed

Talk to your healthcare professional or pharmacist about all of the medicines you take, including over-the-counter medicines. Many over-the-counter medicines for headaches, colds, or fever are nonsteroidal anti-inflammatory drugs (NSAID’s) and can be harmful to your kidneys.

Kidney Disease and


Hypertension is the medical term for high blood pressure. For most people, a blood pressure of 140/90 or higher is considered abnormal.

What is Hypertension?

Hypertension is the medical term for high blood pressure. For most people, a blood pressure of 140/90 or higher is considered abnormal.

Blood pressure is the force of blood pushing against blood vessel walls as the heart pumps out blood. Hypertension is the medical term for high blood pressure – an increase in the amount of force that blood places on blood vessels as it moves through the body.

Blood pressure test results are written with two numbers separated by a slash. The first number is called systolic blood pressure and it measures the blood pressure when the heart beats; the second number – diastolic blood pressure – measures the pressure in your blood vessels when your heart rests between beats.

For most people, a blood pressure of 120/80 is considered normal, while anything over 140/90 is considered abnormal (hypertension).

Link between Hypertension and Kidney Disease

Hypertension can cause kidney disease and is an important cause of kidney failure in many countries. High blood pressure can damage blood vessels in the kidneys, reducing their ability to function properly. If the blood vessels in the kidneys are damaged, they may stop removing wastes and extra fluid from the body. Having extra fluid in blood vessels may then raise the blood pressure even more, creating a dangerous cycle.

But kidney disease can also cause high blood pressure, and when this happens the high blood pressure makes the kidneys deteriorate more quickly. About nine out of ten people with CKD stages 3-5 have high blood pressure. Hypertension is considered to be a leading cause of CKD.

What are symptoms of high blood pressure and kidney disease?

Hypertension has no initial symptoms but can lead to long-term disease and complications, including damage to the heart, eyes, and kidneys. The damage can happen gradually over many years, without you feeling it. In some cases of hypertension patients may experience headaches.
Kidney disease also does not have symptoms in the early stages. Read more about Chronic Kidney Disease.

High blood pressure is diagnosed over a series of blood pressure tests, measured with a blood pressure cuff. Hypertension is diagnosed id blood pressure is consistently over 140/90.
Kidney disease is diagnosed with urine and blood checks.

Can hypertension and kidney disease be prevented or slowed down?

Taking steps to lower blood pressure will help to slow or prevent kidney disease.
Blood pressure can be controlled with medication, as well as with a simple change of lifestyle.

Lifestyle changes include:

  • Healthy eating – adopt Dietary Approaches to Stop Hypertension – DASH which:
    • Is low in fat and cholesterol
    • Features fat-free or low-fat milk and dairy products, fish, poultry and nuts
    • Suggests less red meat, sweets, added sugars, and sugary beverages
    • Is rich in nutrients, protein, and fiber
  • Physical activity
  • Maintaining a healthy weight
  • Quitting smoking
  • Managing stress

Controlling the blood pressure with medication and lifestyle changes helps to protect the kidneys from further damage. This is why it is so important for people with high blood pressure to get tested for kidney disease.

Find out more at:

High Blood Pressure and Kidney Disease – National Institutes of Health

La presión arterial alta y la insuficiencia renal – National Institutes of Health

Kidney Disease and


While kidney disease can affect people of all ages and races, women tend to face more specific challenges linked to kidney disease. The risk of developing Chronic Kidney Disease (CKD) is at least as high in women as in men and may even be higher. CKD affects approximately 195 million women worldwide and it is currently the 8th leading cause of death in women, causing 600,000 deaths each year [1].

What types of kidney disease are more common in women?

Lupus Nephritis (LN) is  a kidney damage, caused by an autoimmune disease (systemic lupus erythematosus, aka SLE) —a disorder in which the body’s immune system attacks the body’s own cells and tissues. Kidney disease caused by lupus may get worse over time and lead to kidney failure. SLE is much more common in women than in men and most often strikes during the child-bearing years. Nine out of 10 people who have SLE are women.

Pyelonephritis (kidney infection) is a type of urinary tract infection (UTI) that is most commonly caused by bacteria and starts in the lower urinary tract. If  not treated, it moves upstream to one or both kidneys. Kidney infections may lead to sepsis, which can be life threatening. UTI is more common in women and girls due to their anatomy.

What are the challenges unique to women?

Conception –  CKD is considered to be a risk factor for reduced fertility, especially in its advanced stage, when dialysis is required. While conception on dialysis may be challenging, it is still possible and the results improve with intensive treatment (daily or nearly daily) sessions.

Pregnancy-related complications – both Acute Kidney Injury (AKI) and preeclampsia (PE) may lead to the development of CKD. Preeclampsia  – a complication of pregnancy, caused by placental insufficiency or maternal factors/diseases, and  leading to high blood pressure and kidney damage in the mother. It does not only pose threats to maternal health, but is also associated with intrauterine and perinatal death, preterm delivery and restricted intrauterine growth.
Any kind of  pre-existing kidney disease in the mother has a negative effect on pregnancy and may pose a threat to the health of mother and the fetus.  There is an increase chance of adverse pregnancy outcomes in women with CKD, including preeclampsia, AKI,  CKD progression, spontaneous abortion, stillbirth, malformations, and other long-term issues.

Access to healthcare – socioeconomic and cultural issues may affect women’s wellbeing. Septic abortion after an illegal procedure is the leading cause of AKI in countries with no access to legal abortion. The burden of those maternal complications is particularly high for women in developing countries, due to insufficient access to universal and timely prenatal care, improper management of women with preeclampsia, and lack of availability of dialysis for severe AKI [2].
Access to Renal Replacement Therapies (RRT), including dialysis and transplantation, may be of concern for some women and girls in many societies. While women are more likely to donate a kidney for transplantation, they are less likely to receive one, when in need [3].

In 2018, World Kidney Day’s theme was “Women & Kidney Disease”. In partnership with the Taskforce on Women and Non-Communicable Disease,  World Kidney Day has developed a policy document  on “Kidney Disease & Women”. The statement highlights current evidence and key challenges in the areas of kidney disease and maternal and child health, access to kidney care and prevention of kidney disease and sets out concrete policy recommendations to address these issues.

You can also read a Scientific Editorial written on occasion of World Kidney Day 2018 : What we do and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Women’s Day.

[1] Data on prevalence and mortality in women taken from GBD website: https://vizhub.healthdata.org/gbd-compare/

[2] Maternal mortality from preeclampsia/eclampsia: https://www.ncbi.nlm.nih.gov/pubmed/22280867
[3] Chronic Kidney Disease, Gender, and Access to Care: A Global Perspective: https://www.ncbi.nlm.nih.gov/pubmed/28532558

Kidney Disease and


Being overweight may increase the risk of developing a number of health issues, including diabetes, cardiovascular disease, hypertension, kidney disease, and, many more.

By 2025, obesity will affect 18% of men and 21% of women worldwide. In some nations, obesity is already present in more than one-third of the adult population and contributes significantly to overall poor health and high annual medical costs.

What is Obesity?

World Health Organization (WHO) defines overweight and obesity as “abnormal or excessive fat accumulation that may impair health”.

Definitions of obesity are most often based on Body Mass Index or BMI (BMI = weight in kg divided by height squared in m2). In adults, BMI between 18.5 and 25 kg/m2 is considered by the WHO to be normal weight, a BMI between 25 and 29.9 kg/m2 as overweight, and a BMI of more than 30 kg/m2 as obese.

It is important to note that in children and adults, different cut-off points may be used.

You can find more detailed information on how obesity is measured on World Obesity Federation website.

What is the link between Kidney Disease and Obesity?

Kidney disease is more likely to develop in obese people including in those with diabetes and hypertension.

Additionally, as an indirect cause, obesity increases the risk of the major CKD risk factors – type 2 diabetes and high blood pressure. A direct cause would be when the kidneys have to work harder, filtering above the normal level, called hyperfiltration, to meet the metabolic demands of the increased body mass index (BMI) in individuals affected by obesity. This increase in normal function is also associated with a higher risk of developing CKD in the long-term.

People who are overweight or obese have 2 to 7 more chances of developing End Stage Kidney Disease (ESKD) compared to those of normal weight. Obesity may lead to CKD both indirectly by increasing type 2 diabetes, hypertension and heart disease, and also by causing direct kidney damage by increasing the workload of the kidneys and other mechanisms.

People suffering from extra weight are also at a higher risk of Acute Kidney Injury (AKI), a serious condition that develops suddenly, often lasts a short time and may disappear completely once the underlying cause has been treated, but it can also have long-lasting consequences with life-long problems.

Can obesity be prevented and/or treated?

While in many cases, obesity is preventable, it is also treatable. Usually, the problem can be solved with lifestyle changes, however, sometimes, the patient may require medical assistance to lose weight.

If you are overweight, losing as little as 5% of your body weight may lower your risk for several diseases. Slow and steady weight loss of 0,5 to 2 pounds or one kilogram per week, and not more than 3 pounds per week, is the safest way to lose weight.

Here are some examples of ways to lose weight safely and healthily (when possible):

  • At least 300min a week of physical activity
  • Muscle strengthening exercise (like push-ups or sit-ups) at least twice a week
  • Healthy eating and portion control
  • In some cases, bariatric (weight-loss) surgery may be an option

To prevent overweight and obesity you should take three simple steps:

  1. Limit energy intake from total fats and sugars;
  2. Increase consumption of fresh fruits and vegetables
  3. Engage in regular physical activity (60min a day for children and 150 minutes spread through the week for adults)

In 2017, World Kidney Day’s theme was “Kidney Disease & Obesity”. You can find past campaign materials here. In partnership with the World Obesity Federation, World Kidney Day has produced a joint position ; the document summarizes some key data on kidney disease, obesity and their relation, and includes a few population based policies and strategies that governments and policy makers should implement to increase prevention of obesity and kidney disease.

Organ donation

Organ donation refers to when a person allows his/her organ(s) to be removed, legally, with their consent while they are alive or with the consent of their next of kin if the donor is deceased. Organs can be donated either by living or deceased donor.

Who are organ donors?

There are two types of donors: living and deceased donors.

Living donor – a healthy individual who is willing to donate an organ. Usually, living donors are over 18 years old and are subjected to a number of health assessments, both mental and physical to determine that the person willing to donate an organ understands the risks and implications that donation can have on his life later. Rules for living organ donation slightly vary from country to country.

Deceased donors – deceased individual who has expressed his/her wish to donate their organs. While a number of people register to become deceased donors, only some of them are suitable.  Deceased donor has to be brain dead – the majority of deceased donors are brain aneurism/stroke patients or patients with severe head trauma.

What difference can an organ donor make?

Every organ donation is a gift of life for somebody in need.

Every healthy individual can donate some organs/part of organs – kidney or a part of their liver/lung, as well as tissues, blood and bone marrow. However, most organs are collected from deceased donors.

One deceased donor can save up to eight lives, as there can be up to 8 lifesaving organs donated: 1 heart, 2 lungs, 1 liver, 1 pancreas, 2 kidneys, and intestines.

How are Donors and Patients matched?

Procedure and policies behind donor – patient matching vary from country to country. However, physiological requirements remain the same across borders; factors taken into consideration usually include:

  • Blood type – recipient’s and donor’s blood type must be compatible
  • Human leukocyte antigens (HLA) – these antigens are proteins that are responsible for differentiating tissues of your body and foreign substances
  • Cross-matching antigens – the test that is done right before the transplant: small samples of recipient’s and donor’s blood are mixed, if no reaction occurs, then the transplant can proceed.

In some cases, distance is taken into account as some organs cannot survive outside the body for more than 6 hours. The average time that kidneys can be stored outside the body is 30 hours.

Majority of living donations are done by family members, as there is a higher chance of biological match with the patient. However, due to the advance of immunosuppressant medications, there is no need for donor and recipient to be blood relatives. Lately, there was an increase in a number of altruistic donors and paired donations. 


Transplantation is the transfer (engraftment) of cells, tissues or organs from one part of the body to another or from a donor to a recipient with the aim of restoring function(s) in the body. There are two types of donors: living donors and deceased donors (cadaveric transplantation). In the latter case, the organ is removed and stored in cold until the operation. Most organs cannot be stored outside the body for longer than 12 hours.

What was an experimental, risky and very limited treatment option fifty years ago is now routine clinical practice in more than 80 countries.

Kidney Transplantation

When patients’ kidneys fail, they are offered Renal Replacement Therapy (RRT) which includes: hemodialysis, peritoneal dialysis, and transplantation. Transplantation is considered to be the best option of RRT for the patient both for quality of life and cost-effectiveness. According to World Health Organization, kidney transplantation is by far the most frequently carried out transplantation globally.

Transplantation procedure is performed in a surgery theatre under full anesthesia. A transplanted organ is expected to start working within a few hours. To keep the body of a patient from attacking newly transplanted organ patient is required to take immunosuppressant drugs for the rest of their lives, to minimize the risk of rejection. Hospital recovery for a kidney transplant patient usually takes up to five days. After 8 weeks of recovery at home, if there are no complications, most patients are able to start light activities and get back into their routines.

It is very important for patients with transplanted kidneys to follow certain rules and always be aware of risks associated with transplanted organs:

  • Take care of your transplant (keep up with all your scheduled appointments and take your medication as prescribed)
  • Limit your exposure to germs
  • Avoid prolonged sun exposure
  • Watch out for signs of rejection
    • Fever
    • Pain
    • Nausea
    • Vomiting
    • Sudden decrease of urine output

Facts and Statistics

The first successful organ transplantation happens to be a kidney transplant performed by Joseph Murray in Boston on 23rd December 1954 between identical twins. This operation gave the start to a new era for patients with ESKD. The number of successfully performed kidney transplants is steadily growing every year.

Report from Global Observatory on Donation and Transplantation for 2015 indicated that there were 84,347 kidney transplants performed worldwide, which is a 5.5% increase from 2014.

Below you can find a global map indicating kidney transplant activities in 2015 (provided by WHO ):

According to data from U.S. Government Information on Organ Donation and Transplantation, there are more than 116 000 patients on the national transplant waiting list as of August 2017. In 2016 there were a total of 41,335 donated organs that came both from deceased and living donors. The number of people on the waiting list continues to grow a lot faster than the number of donors or available transplants. There is a large gap between available organs and the demand for them.


Organ trafficking– any illegal manipulation (trade) with living or deceased persons or their organs for the purpose of monetary benefit for the trafficker.  Control over potential donor by means of coercion is illegal and punished by law in most countries.

Transplant commercialism is a policy or practice in which an organ is treated as a commodity, including by being bought or sold or used for material gain.
Travel for transplantation is the movement of organs, donors, recipients or transplant professionals across jurisdictional borders for transplantation purposes. Travel for transplantation becomes transplant tourism if it involves organ trafficking and/or transplant commercialism or if the resources (organs, professionals and transplant centers) devoted to providing transplants to patients from outside a country undermine the country’s ability to provide transplant services for its own population.

World Kidney Day supports The Declaration of Istanbul, which suggests that “organs for transplantation should be equitably allocated within countries or jurisdictions to suitable recipients without regard to gender, ethnicity, religion, or social or financial status”. Yet unethical practices of transplantology, such as organ trafficking, transplant commercialism, and transplant tourism, are, in part, an undesirable consequence of the global shortage of organs for transplantation.

To address the urgent and growing problems of organ sales, transplant tourism and organ trafficking in the context of the global shortage of organs, The Transplantation Society and the International Society of Nephrology adopted a consensus statement on the care of the living kidney donors to ensure the responsibility of communities for living donors and encourage donations.

Both living and deceased donor donations are critical for nations to develop self-sufficiency for organ transplantation.

With the help of The Transplantation Society, World Kidney Day aims to increase awareness and promotion of this life-saving procedure and the donors who make it possible.

World Kidney Day is firmly against organ trafficking or transplant tourism of any kind!