Chronic Kidney Disease: Symptoms, Diagnosis & NHS Treatment

Chronic kidney disease (CKD) affects approximately 3 million people in the UK — around 6% of the adult population — though the majority are unaware they have it. CKD is a long-term condition where the kidneys don’t work as well as they should, gradually losing their ability to filter waste and excess fluid from the blood. When detected and managed early, CKD progression can be significantly slowed, and many people live full lives without ever reaching kidney failure.

How CKD Is Staged

CKD is staged based on eGFR (estimated glomerular filtration rate) — a measure of how well the kidneys filter blood — and urine albumin-to-creatinine ratio (ACR) — measuring protein leakage in urine (proteinuria), a marker of kidney damage. Both are measured by routine blood and urine tests at your GP surgery.

  • Stage 1 — eGFR ≥90 ml/min with evidence of kidney damage (e.g. proteinuria); kidneys functioning normally but damage present
  • Stage 2 — eGFR 60–89 ml/min with kidney damage
  • Stage 3a — eGFR 45–59 ml/min (mild-moderate reduction)
  • Stage 3b — eGFR 30–44 ml/min (moderate-severe reduction)
  • Stage 4 — eGFR 15–29 ml/min (severe reduction); preparation for kidney replacement therapy
  • Stage 5 — eGFR <15 ml/min; kidney failure requiring dialysis or transplant

Causes and Risk Factors

  • Diabetes — the most common cause of CKD in the UK; see our type 2 diabetes guide
  • High blood pressure (hypertension) — the second most common cause; see our hypertension guide
  • Glomerulonephritis — inflammatory kidney disease
  • Polycystic kidney disease (PKD) — inherited condition
  • Recurrent kidney infections
  • Kidney stones
  • Certain medications — NSAIDs (ibuprofen, naproxen), contrast dye, some antibiotics
  • Lupus and other autoimmune conditions
  • Age — kidney function naturally declines with age; Stage 3 CKD is common in people over 75 and not always progressive

Symptoms

CKD is often asymptomatic until Stages 4–5. When symptoms do appear, they may include:

  • Fatigue and weakness
  • Ankle, leg, or eye swelling (oedema)
  • Shortness of breath
  • Poor appetite and weight loss
  • Nausea and vomiting
  • Itching (uraemic pruritus)
  • Muscle cramps
  • Changes in urination (more or less frequent, foamy urine from proteinuria)
  • High blood pressure (CKD both causes and is worsened by hypertension)

NHS Monitoring of CKD

All CKD patients registered with a GP in England are included on the Quality and Outcomes Framework (QOF) CKD register. Monitoring frequency depends on stage:

  • Stage 1–2: Annual blood tests (eGFR, creatinine, ACR) and blood pressure
  • Stage 3a: Annual or 6-monthly
  • Stage 3b–4: 3–6 monthly; monitoring for anaemia, bone disease, electrolytes
  • Stage 4–5: Referral to nephrology; preparation for kidney replacement therapy discussion

NHS Treatment for CKD

Protecting Kidney Function (Slowing Progression)

  • Blood pressure control — target below 140/90 mmHg (130/80 in CKD with diabetes or proteinuria ≥1 ACR); ACE inhibitors or ARBs are preferred (nephroprotective and antiproteinuric)
  • Diabetes control — target HbA1c individualised (often 48–53 mmol/mol in CKD)
  • SGLT2 inhibitors — dapagliflozin (Forxiga) and empagliflozin are NICE-approved for CKD with proteinuria regardless of diabetes status (TA775, TA939); these drugs significantly slow CKD progression and reduce cardiovascular events — a major recent advance
  • Avoid NSAIDs — ibuprofen and other NSAIDs are contraindicated in CKD as they reduce renal blood flow and accelerate progression
  • Protein restriction — not routinely recommended in UK CKD guidelines for most patients (unlike US guidelines)
  • Smoking cessation
  • Weight management

Managing CKD Complications

  • Anaemia of CKD — iron deficiency corrected first; if Hb remains low, erythropoiesis-stimulating agents (ESAs like darbepoetin) are prescribed; target Hb 100–120 g/L
  • CKD-mineral and bone disorder (CKD-MBD) — phosphate restriction and binders if phosphate elevated; activated vitamin D analogues (alfacalcidol)
  • Hyperkalaemia (high potassium) — dietary potassium restriction; patiromer (NICE approved 2020) or sodium zirconium cyclosilicate (SZC) for persistent hyperkalaemia
  • Metabolic acidosis — sodium bicarbonate supplementation may slow CKD progression
  • Cardiovascular protection — statins recommended for all CKD patients regardless of cholesterol level if cardiovascular risk is elevated

Kidney Replacement Therapy (Stage 5)

  • Haemodialysis (HD) — 3 sessions per week, each 4 hours; in dialysis unit or at home
  • Peritoneal dialysis (PD) — daily exchanges; can be done at home overnight (automated PD/APD); preserves residual kidney function longer than HD
  • Kidney transplant — best outcome; living donor preferred; average wait for deceased donor in UK is 2–3 years
  • Conservative management — for elderly or frail patients who choose not to start dialysis; focus on quality of life and symptom control

UK Support and Resources

  • Kidney Care UK — kidneycareuk.org | Helpline: 01420 541424 | UK’s leading kidney patient charity
  • National Kidney Federation — kidney.org.uk | Patient advocacy and support
  • Renal Association — renal.org | UK clinical guidelines for CKD management
  • NHS Organ Donation — organdonation.nhs.uk | Register as an organ donor

What Major Health Sites Often Miss About CKD

1. SGLT2 Inhibitors: Transforming CKD Treatment Beyond Diabetes

The CREDENCE and DAPA-CKD trials showed dapagliflozin and canagliflozin dramatically slow CKD progression — by approximately 40% — and reduce cardiovascular events in CKD patients, even those without diabetes. NICE approved dapagliflozin (TA775, 2021) for CKD with proteinuria regardless of diabetic status. This is one of the most significant advances in nephrology in decades, yet most patient-facing health content focuses on SGLT2 inhibitors only in the context of diabetes. If you have CKD Stage 2–3 with proteinuria, ask your GP or nephrologist about SGLT2 inhibitors.

2. Age-Related eGFR Decline vs Progressive CKD

eGFR naturally declines with age — at approximately 1 ml/min per year after age 40. Stage 3a CKD (eGFR 45–59) is very common in people over 75 and is often “age-related CKD” that will never progress to kidney failure. UK nephrologists and the NICE guideline (NG203) emphasise the importance of calculating eGFR decline rate (not just a single snapshot) to distinguish truly progressive CKD from stable age-related decline. This nuance prevents over-medicalisation and unnecessary anxiety in older patients.

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