How to Prevent Kidney Failure: A Kidney Doctor on a Condition Affecting 37 Million Americans

What is kidney failure?

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Chronic kidney disease rates are increasing worldwide. Data from the Centers for Disease Control and Prevention (CDC) in 2022 estimated that 15 percent of the U.S. population—that’s about 37 million Americans—are living with declining kidney function. Meanwhile, one in three more Americans are at risk for developing the disease.

What’s also alarming is that many have no idea. “Most people are not even aware that they have chronic kidney disease,” says Khaled Boubes, MD, a nephrologist (kidney specialist) at The Ohio State University Wexner Medical Center. Dr. Boubes tells The Healthy that physical symptoms of kidney decline are generally very subtle, at least until the disease reaches end-stage kidney failure. At this point, he says, signs like frothy urine, swelling in the legs, and puffiness in the face can be key signs to recognize that something is significantly wrong.

But ahead of these significant warning bells, chronic kidney disease damage progresses more or less silently, gradually making it harder and harder for the kidneys to filter blood, get rid of waste, and maintain the body’s electrolyte balance. This kidney function decline generally occurs over five stages:

• Stage 1: urine tests show signs of damage, but they’re working well enough in general 
• Stage 2: kidneys no longer operate at full strength
• Stage 3: function becomes moderately reduced
• Stage 4: significant loss of kidney function, and symptoms start to show
• Stage 5: kidney failure, when dialysis or a kidney transplant is now required

How to prevent kidney failure

CDC data has suggested that up to 96 percent of people with early-stage chronic kidney disease aren’t even aware that they have it. This poses a pretty big problem. “Most damage is irreversible, unfortunately,” explains Dr. Boubes. So, once kidney tissue gets scarred, it won’t regenerate. (An exception to this is what’s called “acute kidney failure.” This condition is generally caused by trauma, infection or disease, a urinary tract obstruction, severe dehydration, and ingesting drugs or poisons—and it’s often curable once the cause itself is treated.)

Still, while chronic kidney disease can’t be cured, you can slow or stop its progression by controlling for the main risk factors that drive damage. Understanding which risk factors apply to you can also help you maintain kidney health, minimize your risk of damage through lifestyle changes, and prevent the disease from advancing by catching it early by planning for regular screenings.

Diabetes

One in three people with diabetes has chronic kidney disease, according to the CDC. This makes it the greatest risk factor for kidney failure.

Over time, a diabetic patient’s high blood pressure stresses the kidneys’ blood vessels, which may cause damage that limits their function. This is just one reason people with diabetes should monitor metrics like blood sugar, blood pressure, and cholesterol levels and keep up with their doctor-recommended screenings.

High Blood Pressure

Hypertension (high blood pressure) is the next big risk factor for kidney disease, says Dr. Boubes. Uncontrolled hypertension puts a lot of pressure on blood vessels throughout the body, causing them to weaken, narrow, and harden—and that includes those whose job is to supply oxygen-rich blood to your kidneys. According to the National Kidney Foundation, almost half of all U.S. adults have high blood pressure. Of these people, an estimated 20 percent develop chronic kidney disease.

Fortunately, many lifestyle changes can help keep your blood pressure in a healthy range.

Genetics

Many genetic factors can contribute to the two main risk factors for kidney disease: diabetes and high blood pressure.

Still, there are genetic conditions that specifically raise your risk for chronic kidney disease, too, Dr. Boubes explains. In fact, the Inherited Kidney Disease Clinic at the University of Michigan says there are more than 60 genetic diseases known to affect the kidneys. The most common of these conditions is polycystic kidney disease, which causes cysts to form on the kidneys. It affects about one in 800 people, and more than 30,000 people per year suffer kidney failure as a result.

Smoking

Cigarette smoking is one of the most controllable kidney disease risk factors. Research published in Frontiers in Medicine in 2018 explained how smoking slows blood flow to organs—including your kidneys—and has been shown to accelerate the progression of kidney disease.

In addition, smoking is known to worsen other risk factors like hypertension and diabetes and can even interfere with the medications used to control these conditions.

Heavy alcohol consumption

Heavy drinking (seven drinks per week for women and 14 for men) has been shown to double someone’s risk of kidney disease, according to the National Kidney Foundation. This is because heavy alcohol use:

• can cause changes to the kidneys that affect their ability to filter blood.
• dehydrates the body, impacting normal kidney function.
• often contributes to high blood pressure.
• may lead to liver disease, which puts extra pressure on your kidneys.

Obesity

Obesity can indirectly lead to kidney disease by raising your risk for developing diabetes or high blood pressure. But it’s also an independent risk factor.

According to recent research published in the Journal of the American Society of Nephrology, for people genetically predisposed to obesity, each five-kilogram increase in overall body mass index (BMI) causes an estimated 50 percent increased risk in developing chronic kidney disease.

Overuse of some medications

Over-the-counter pain medications called non-steroidal anti-inflammatory drugs (NSAIDs) can put damaging stress on your kidneys—”Especially if you take them persistently,” says Dr. Boubes, like multiple times per week.

Clinical research backs this up—a 2019 study published in Nephrology found that reducing NSAID exposure leads to much lower rates of kidney problems in healthy adults.

Your medical history

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Certain medical conditions and events can also increase your risk of chronic kidney disease. For example, even though an acute kidney injury is often curable, it can increase the risk of developing chronic kidney disease that progresses through to end-stage kidney failure by a factor of thirteen, according to the NIH.

Recurrent urinary tract infections may raise your risk as well, according to research published in the Clinical Kidney Journal. That’s because they can result in a urinary tract obstruction in the kidneys called pyelonephritis, which can damage kidney tissue. Recent research published in BMC Nephrology also points to kidney stones as an independent risk factor for chronic kidney disease.