Living with Chronic Kidney Disease (CKD)

Chronic kidney disease, also called CKD, happens when your kidneys have been damaged or not working well for more than three months.

Treatment focuses on slowing the progression of kidney damage, usually by controlling the cause. The earlier chronic kidney disease is diagnosed and treated, the more opportunity there is to delay or prevent end-stage kidney disease.  

I’ve been referred to see a kidney specialist. What does that mean? 

Your doctor or nurse practitioner feels you should see a kidney specialist (nephrologist) to assess how well your kidneys are working. 

You will be seen at the Provincial Renal Clinic at the Queen Elizabeth Hospital in Charlottetown. 

Bring the following to your appointment:

• your PEI Health Card
• your medications including any vitamins, supplements, or herbal remedies
• home blood pressure readings
• a list of any questions/ concerns you may have

What will happen at my kidney clinic appointment?

You may be asked to see a specialized health care team who will assess your needs and provide you with a treatment plan. The plan may include medication, diet, and kidney education. 

The kidney specialist will send a report to your doctor or nurse practitioner outlining the details of the assessment and all recommendations.

Your kidney clinic health care team includes: 

• A nephrologist (kidney doctor) and/or nurse practitioner will assess and manage your kidney health.
• A nurse will assess you and provide kidney health education.
• A dietitian will discuss your nutritional needs.
• A social worker will provide information regarding supports and services you may need.
• A pharmacist will provide information about medications needed to treat your kidney disease.
• A clerk will book you for your first appointment and will call you when you are scheduled for a follow-up appointment.

What are the signs of chronic kidney disease? 

Chronic kidney disease can be silent and painless. There are usually no symptoms until 80 percent of kidney function is gone.

At this point symptoms may start to show and can include:

• foaming, bloody (resembling cola or tea), or cloudy urine
• decreased urine output (less than 2 cups per day)
• swelling
• having to pee during the night
• nausea and vomiting
• persistent, ongoing itching all over your body
• bone or joint pain
• shortness of breath

How is chronic kidney disease determined?

Your family doctor or nurse practitioner checks your kidneys with routine blood and urine tests. They will ask the lab for your eGFR (estimated Glomerular Filtration Rate) and ACR (albumin creatinine ratio).

What is eGFR?

Your estimated (e) GFR is a measure of how well your kidneys filter waste, salt, and water from your blood. Normal GFR is around 100 ml/min.

What is Albumin:Creatinine ratio (ACR)?

Albumin is the most common type of protein in the urine. Creatinine is a waste product that comes from the normal breakdown of muscle tissue. When your kidneys aren’t working well, albumin and creatinine may stay in the blood and not be filtered out. ACR is calculated by dividing albumin concentration in milligrams and creatinine concentration in grams.

If I have chronic kidney disease, does that mean my kidney(s) will eventually stop working? 

For many people, the risk of kidney failure can be reduced or prevented with early diagnosis and treatment. 

In some cases, kidney damage is not preventable. Some medical and genetic conditions, such as lupus and polycystic kidney disease, can contribute to kidney damage. 

What are the stages of chronic kidney disease?

The amount of damage to your kidneys is categorized into five stages.

Stage 1: normal or high function

The kidneys work normally. 

• Kidney function measured by Creatine Clearance or eGFR is at a normal or high level (greater than 90 ml/min).
• There are usually no symptoms to indicate the kidneys are damaged.  

People are typically diagnosed with Stage 1 chronic kidney disease because they were tested for other conditions such as diabetes or high blood pressure: the two leading causes of kidney disease. Otherwise, most people will not know they have Stage 1 chronic kidney disease.

Treatment in Stage 1 is to stop or slow down the progress of kidney disease. In many cases, making healthy lifestyle changes and following your treatment plan, can help keep your kidneys healthy longer.

Stage 2: mildly decreased function

There is damage to the kidneys. 

• There is a decrease in kidney function measured by Creatine Clearance or eGFR.
• Waste products build up in the blood causing a condition known as uremia. 

A person may experience complications of kidney disease such as high blood pressure, anemia, and early bone disease. 

Stage 3: mildly to moderately decreased function

There continues to be damage to the kidneys.

• There is a decrease in kidney function measured by Creatinine Clearance or eGFR.
• Waste products build up in the blood causing a condition known as uremia.

A person may experience complications of kidney disease such as high blood pressure, anemia, early bone disease, swelling, fatigue, urinary changes, and foamy urine.

Stage 4: moderately to severely decreased function

There is advanced kidney damage.

• There is a severe decrease in kidney function measured by Creatinine Clearance or eGFR

A person will develop complications of kidney disease such as high blood pressure, anemia, bone disease, heart disease, and other cardiovascular diseases.

A person with Stage 4 chronic kidney disease will need dialysis or a kidney transplant in the future.

Stage 5: Nearing kidney failure or kidney failure

There is total or near-total loss of kidney function. This stage is also called end-stage kidney disease.

A person with Stage 5 chronic kidney disease requires peritoneal dialysis, hemodialysis, kidney transplant, or conservative kidney management.  

How is kidney failure treated?

Dialysis and kidney transplant are the most common treatments for people whose kidneys are failing. Although dialysis and transplant can’t cure kidney failure, it can help some people live longer and feel better. 

There are two types of dialysis:

• Peritoneal dialysis is a form of dialysis done at home either by the patient or, in some cases, with the assistance of a caregiver. 
• Hemodialysis is when blood is cleaned outside of the body using a machine and artificial kidney filter. On Prince Edward Island hemodialysis is currently offered at four hemodialysis centres.

Addition options include:

• Kidney transplant: an operation to place a healthy kidney in your body.
• Conservative kidney management: a way to manage your kidney disease without dialysis.

Your treatment plan will also include:

• lifestyle changes such as diet and physical activity
• achieving a healthy blood pressure
• medications
• treating and managing diabetes, if required

If you have been diagnosed with kidney disease, regardless of stage, you should:

• Limit your salt intake.
• Be physically active.
• Stop smoking.
• Limit alcohol intake to Canadian Guidelines.
• Avoid street drugs and unregulated alcohol (moonshine).
• Take medications as prescribed.
• Aim for a healthy weight.
• Avoid anti-inflammatory pain medications such as ibuprofen, naproxen, and high-dose aspirin.
• Speak with a community pharmacist about over-the-counter medications.
• Maintain good blood pressure and know your target blood pressure.
• Maintain good blood sugar.

Complete an advance care plan 

Advance care planning is about having conversations with your close family, friends, and health care provider(s) so that they know the health care treatment you wish to have, or refuse if you become incapable of expressing your own decisions.

If you have been diagnosed with chronic kidney disease, your kidney team will suggest that you complete your advance care plan.

Should I follow a special diet if I have chronic kidney disease?

Nutrition is an important part of your kidney health and can help delay the progression of your kidney disease or minimize symptoms. Your renal dietitian will help you determine the best diet for your needs. 

Who can I ask about the medications I am taking?

People with chronic kidney disease often take a variety of medications. Talk to your doctor and/or pharmacist if you:

• are having side effects
• do not know why you are taking a medication
• think it is not working
• run out of your medication
• have changes to your medications from another doctor
• are wondering if it is safe for your kidney

About the Provincial Renal Program

Health PEI provides a range of kidney care and related services through the Provincial Renal Program to prevent, diagnose, and treat kidney disease including:  

• dialysis (in-centre hemodialysis and peritoneal dialysis)
• pre and post kidney transplant care
• conservative kidney management care
• early kidney disease prevention, education, and treatment
• support to patients and families 

Contact the PEI Provincial Renal Clinic

QEH Ambulatory Care Centre
60 Riverside Drive
Charlottetown, PE C1A 8T5

Telephone: 902-894-0019
Fax: 902-620-0497