Patient Education: Chronic Renal Failure (Chronic Kidney Disease – CKD)

What It Is

Chronic renal failure means your kidneys have been damaged over a long time and can’t work as well as they should. Healthy kidneys clean waste and extra fluid from your blood, help control blood pressure, and balance minerals. CKD happens slowly and can get worse over months or years.

Stages of Chronic Kidney Disease

Kidney function is measured by GFR (glomerular filtration rate). The lower the GFR, the worse the kidney damage.

1. Stage 1: Kidney damage with normal function (GFR 90 or higher) — usually no symptoms, but changes may show on blood or urine tests.
   
   

2. Stage 2: Mild loss of function (GFR 60–89) — still few symptoms, but damage is present.
   
   

3. Stage 3: Moderate loss of function (GFR 30–59) — waste starts to build up; symptoms may begin (fatigue, swelling).
   
   

4. Stage 4: Severe loss of function (GFR 15–29) — more symptoms; preparing for dialysis or transplant may be needed.
   
   

5. Stage 5: Kidney failure (GFR less than 15) — kidneys can’t keep you alive without dialysis or transplant.
   
   

Causes and Risk Factors

Common Causes:

• Diabetes (high blood sugar damages kidney blood vessels)
  
  

• High blood pressure
  
  

• Chronic infections of the kidneys or urinary tract
  
  

• Polycystic kidney disease (genetic condition)
  
  

• Long-term use of medicines that harm kidneys (NSAIDs like ibuprofen)
  
  

Risk Factors:

• Family history of kidney disease
  
  

• Older age
  
  

• Heart disease
  
  

• Smoking
  
  

• Being overweight
  
  

• Uncontrolled diabetes or high blood pressure
  
  

Signs and Symptoms

Early warning signs:

• Swelling in ankles, feet, or around eyes
  
  

• More or less urination than normal
  
  

• Fatigue or weakness
  
  

• Trouble concentrating
  
  

Later symptoms:

• Nausea or vomiting
  
  

• Loss of appetite
  
  

• Muscle cramps
  
  

• Shortness of breath
  
  

• Itchy skin
  
  

• Metallic taste in the mouth
  
  

Complications if Untreated or Not Following Care Plan

• Fluid buildup in lungs or around heart
  
  

• Severe high blood pressure
  
  

• Weak bones (bone disease)
  
  

• Anemia (low red blood cells)
  
  

• Heart attack or stroke
  
  

• Complete kidney failure, needing dialysis or transplant
  
  

Treatment and Self-Care Measures

Treatment Goals: Slow down damage, manage symptoms, and prevent complications.

Medical Treatment May Include:

• Controlling blood pressure and blood sugar
  
  

• Medicines to lower potassium, phosphorus, or cholesterol
  
  

• Dialysis or transplant in Stage 5
  
  

Self-Care Measures:

• Take all medicines exactly as prescribed
  
  

• Monitor blood pressure at home
  
  

• Keep blood sugar in target range if diabetic
  
  

• Follow diet guidelines
  
  

• Weigh yourself daily to check for fluid buildup
  
  

Common Types of Medications

• ACE inhibitors / ARBs (lisinopril, losartan) — protect kidneys and lower blood pressure. Side effects: cough, high potassium, low blood pressure.
  
  

• Diuretics (furosemide) — remove extra fluid. Side effects: dehydration, low potassium.
  
  

• Phosphate binders (calcium acetate) — lower phosphorus. Side effects: constipation, nausea.
  
  

• Erythropoiesis-stimulating agents (ESAs) — treat anemia. Side effects: high blood pressure, blood clots.
  
  

Dietary Needs

(Follow your doctor’s or dietitian’s instructions — may change by stage)

• Limit sodium (less than 2,000 mg/day)
  
  

• Limit potassium if high (avoid bananas, oranges, potatoes)
  
  

• Limit phosphorus if high (avoid dairy, nuts, dark sodas)
  
  

• Get enough protein but not too much — your provider will tell you how much
  
  

• Follow fluid limits if ordered
  
  

• Avoid high-salt processed foods
  
  

Lifestyle Changes

• Quit smoking
  
  

• Exercise as advised (walking, gentle activity)
  
  

• Control blood sugar and blood pressure
  
  

• Avoid alcohol or limit it strictly
  
  

• Keep a healthy weight
  
  

Safety Considerations

• Check all new medicines, vitamins, or herbal supplements with your provider first
  
  

• Avoid NSAIDs (ibuprofen, naproxen) unless approved
  
  

• Get regular lab work to monitor kidney function and electrolytes
  
  

• Stand up slowly to avoid dizziness if on diuretics or blood pressure medicine
  
  

Prevention and Maintenance Tips

• Follow your diet plan closely
  
  

• Take all medications as directed
  
  

• Keep medical appointments for checkups and labs
  
  

• Report new symptoms early
  
  

• Manage other chronic conditions aggressively
  
  

When to Call for Help

Call Your Home Health Nurse or Doctor If:

• You notice swelling in your legs, ankles, feet, or face
  
  

• You urinate much less or much more than normal
  
  

• You gain more than 2–3 pounds in 1–2 days
  
  

• You feel more tired than usual or have trouble concentrating
  
  

• You have new nausea, vomiting, or loss of appetite
  
  

• Your blood pressure is higher or lower than normal for you
  
  

Call 911 or Go to the Emergency Room If:

• You have chest pain or pressure
  
  

• You have trouble breathing or severe shortness of breath
  
  

• You are confused, faint, or have sudden trouble speaking
  
  

• You have seizures
  
  

• Your heart is beating very fast, very slow, or irregularly
  
  

© 2025 Judith Regan / K.N.O.W. – Knowledge for Nurturing Optimal Well-Being. All rights reserved. | Educational use only | Not a substitute for medical advice | In emergencies call 911

Patient Homework / Assessment

Instructions: Circle True or False for each statement. Correct any false statements.

1. True / False – Chronic kidney disease happens suddenly.
   
   

2. True / False – There are five stages of chronic kidney disease.
   
   

3. True / False – Diabetes and high blood pressure are leading causes of kidney disease.
   
   

4. True / False – Stage 5 kidney disease is kidney failure.
   
   

5. True / False – You can stop taking medicines if you feel fine.
   
   

6. True / False – Swelling in the ankles may mean fluid buildup.
   
   

7. True / False – Limiting salt can help control blood pressure and swelling.
   
   

8. True / False – Smoking helps protect your kidneys.
   
   

9. True / False – Some herbal supplements can harm your kidneys.
   
   

10. True / False – Dialysis may be needed in later stages.
    
    

11. True / False – Potassium levels can become dangerous in CKD.
    
    

12. True / False – It is okay to take ibuprofen daily for pain without asking your doctor.
    
    

13. True / False – Quitting smoking can slow kidney damage.
    
    

14. True / False – Daily weights can help track fluid changes.
    
    

15. True / False – All patients with CKD should follow the same diet.
    
    

16. True / False – Phosphate binders help control phosphorus levels.
    
    

17. True / False – Skipping lab tests is okay if you feel well.
    
    

18. True / False – High blood pressure can make kidney disease worse.
    
    

19. True / False – Shortness of breath may be a sign of fluid in the lungs.
    
    

20. True / False – You should call 911 for chest pain or trouble breathing.
    
    

Individualized Patient Questions

1. What stage of CKD are you in based on your last GFR?
   
   

2. Do you know your last blood pressure reading?
   
   

3. Are you following a low-sodium, low-potassium, or low-phosphorus diet?
   
   

4. What was your last potassium and phosphorus level?
   
   

5. Are you on a fluid limit? If so, how much?
   
   

6. Are you taking ACE inhibitors, ARBs, diuretics, or phosphate binders?
   
   

7. Have you noticed swelling or weight gain this week?
   
   

8. Do you know your target blood sugar range (if diabetic)?
   
   

9. Do you have a dialysis plan if your disease progresses?
   
   

10. Can you list at least two signs that mean you should call your nurse right away?
    
    

Answer Key with Explanations

1. False – CKD develops slowly over time.
   
   

2. True – There are 5 stages based on GFR.
   
   

3. True – Diabetes and high blood pressure are top causes.
   
   

4. True – Stage 5 is end-stage kidney failure.
   
   

5. False – Never stop medicines without your provider’s advice.
   
   

6. True – Swelling can be a sign of fluid buildup.
   
   

7. True – Less salt helps reduce swelling and blood pressure.
   
   

8. False – Smoking damages blood vessels and kidneys.
   
   

9. True – Some herbs and supplements can be harmful to kidneys.
   
   

10. True – Dialysis may be required in advanced CKD.
    
    

11. True – High potassium can be dangerous to the heart.
    
    

12. False – NSAIDs like ibuprofen can damage kidneys.
    
    

13. True – Quitting smoking improves circulation and kidney health.
    
    

14. True – Weight gain can mean fluid retention.
    
    

15. False – Diet plans vary based on stage, labs, and other health issues.
    
    

16. True – Phosphate binders lower phosphorus in the blood.
    
    

17. False – Skipping labs can miss dangerous changes.
    
    

18. True – High blood pressure speeds kidney damage.
    
    

19. True – Fluid in lungs can cause shortness of breath.
    
    

20. True – These are medical emergencies.
    
    

If you want,