Chronic Kidney Disease

This leaflet is for people with chronic kidney disease (CKD). It is also useful for people with high blood pressure and/or diabetes as these conditions put you at a higher risk of developing CKD. It explains the tests which show how well your kidneys are working and what can be done to help prevent further problems.

Where are my kidneys?

Most people have two kidneys, one on each side of the spine, at the back of the waist. Each kidney is about the size of a clenched fist.

What do my kidneys do?

Healthy kidneys have several functions:

• Remove waste products and toxins from the body by filtering the blood, which then leave the body in the urine you pass
• Control of the amount of water removed from the body (depending on how much we drink) by varying the amount of urine we pass
• Regulate chemicals in your body, like potassium, sodium, calcium and phosphate
• Help to control blood pressure
• Tell your body to produce red blood cells
• Help keep your bones healthy.

Who is more likely to get kidney disease?

Anyone can develop chronic kidney disease, but it is more common with increasing age and in people of South Asian or African Caribbean origin.

What causes kidney problems?

The most common causes of kidney problems are:

• High blood pressure and diabetes. It usually takes many years living with these conditions before the kidneys become effected
• Inflammation (glomerulonephritis) or infection of the kidney (pyelonephritis)
• Inherited kidney problems, for example polycystic kidney disease
• Kidney problems can also be the result of a blockage such as an enlarged prostate or kidney stones
• Some tablets can cause kidney damage if taken regularly over a long period of time. For example, some pain killers such as ibuprofen, diclofenac, and naproxen. Also, another group of drugs called Proton Pump Inhibitors (PPI’s)
• Sometimes it is not possible to say what has caused the kidney problem.

Are my kidney problems curable?

Some kidney problems can be treated so that the kidney function improves. Some problems are not curable. The earlier the kidney problem is found, the better the opportunity to slow or stop any further damage occurring. Most importantly your involvement with your GP and the Renal Team can advise and support you to help preserve your kidney function as much as possible.

What are the tests for kidney disease?

Both blood and urine tests are used to diagnose and monitor kidney disease. Sometimes scans and X-ray tests help with the diagnosis. A kidney biopsy is sometimes necessary to find out the cause of kidney disease.

Urine tests

Protein or blood in the urine might suggest kidney problems.

Urine is tested in clinic with dipsticks. These test for blood and protein in the urine as well as some other measurements that can help guide diagnosis and management.

A sample of urine can be tested by the laboratory to show if it contains protein (called proteinuria or microalbuminuria). This is best done on the first urine that you pass in the morning. The amount of protein/albumin leaking from the kidneys is often a good marker of how stressed the kidneys are. The most common measurement of this is urine albumin/creatinine ratio (UACR, measured in mg/mmol).  In Dorset the laboratories require samples to be in yellow tubes, otherwise they will not be analysed.

If you make kidney stones, and for some rarer conditions, we sometimes need you to collect all the urine in a 24-hour period to help decide on best management.

Urine is also sent to the laboratory to detect infection in the urine. This requires a green tube.

Blood tests

The main way to check how well your kidneys are working is through a blood test. The test measures a substance called creatinine. This is used to estimate glomerular filtration rate, (eGFR). The estimated glomerular filtration is an estimate of how well the kidneys are working. A result of 60-90ml/min is normal. Some people call this a percentage.

To get the most reliable estimate, it is recommended (but not essential) not to eat meat for a few hours, and to avoid intense exercise, before a blood test.

See details below regarding where to have your blood tests taken.

What do my results mean?

There are five stages of kidney disease:

What can be done to prevent kidney function declining?

After the age of 30 everyone’s kidney function slowly deteriorates with age. However, there are several things that you can do to help slow down the speed at which your kidneys decline.

Blood pressure

Blood pressure is particularly important for people with kidney problems. High blood pressure makes the heart work harder, speeds up damage to the kidneys and increases the risk of stroke. It pays to keep your blood pressure well controlled.

Have your blood pressure checked regularly and note down your numbers. Most people with kidney damage should have a blood pressure below 140 (top number/systolic) and below 90 (bottom number/diastolic). If you have kidney damage and diabetes, the numbers should be below 130 (top number) and below 80 (bottom number).

It is helpful to be able to measure your blood pressure at home.  Blood pressure monitors with a cuff on the upper arm are usually more reliable than those that use a cuff around the wrist.

If you have CKD your blood pressure will need to be monitored regularly, and you must ensure that you take your blood pressure tablets as prescribed. Blood pressure is usually best controlled with a combination of tablets rather than just one tablet.

You can improve your blood pressure by reducing salt intake, losing weight if you are overweight, exercising regularly, stopping smoking, and avoiding heavy alcohol intake.

Diabetes

If you have diabetes, it is important that your blood sugars are controlled as well as possible. Keep your appointments with the GP or hospital for diabetes monitoring. You may also be prone to high blood pressure. Therefore, it is vital that you take your medication as prescribed.

It is important to continue with all your diabetes care, including retinal screening and foot clinics as well as kidney clinic appointments.

Eating well

It is important that you try to eat a healthy well-balanced diet.

Key dietary messages

• Enjoy your food.
• Eat a wide variety of foods. 
• Try to eat foods in their most natural form if possible. If you can, you should avoid processed foods, ready meals, convenience foods, or any foods that have undergone any form of processing or manufacturing as these are often high in salt and contain additives that are not good for people with kidney disease.
• Eat less salt.
• Eat regular meals – try not to skip meals.
• Eat to be a healthy weight.
• Eat fruit and vegetables every day (five a day if possible).
• Drink alcohol only in moderation. No more than 14 units per week for men and women. Try to spread this over the week and try to have two to three ‘alcohol-free’ days. One unit is the same as half a pint of beer or lager, 1 small glass of wine or 1 pub measure of spirits.
• Only follow a special diet for your kidneys if you are advised to by your doctor, dietitian or nurse.

Cutting down on salt

Eating too much salt is linked with high blood pressure and heart disease which can damage your kidneys.  Everyone should cut down on the amount of salt they eat.  You should have no more than 6g salt (around 1 teaspoon) per day.  Most of the salt we eat is already present in the foods that we buy so it is important to check the labels on your foods and to try to avoid processed or convenience foods as much as you can.

To reduce the amount of salt you eat, try these suggestions:

• Do not add salt to your food at the table
• Try to cook without salt. There are lots of ways to add flavour to your cooking without using salt. Try adding dried herbs to pasta, meat, fish and vegetable dishes or you could marinate your meat and fish in advance to give them more flavour
• Cut down on manufactured and processed foods. Try using fresh or frozen meat, fish, and vegetables rather than pre-prepared dishes or ready meals
• If buying tinned vegetables, choose those labelled ‘no added salt’ or ‘reduced salt’
• Do not use salt substitutes e.g. Lo-Salt, pink salt, Himalayan salt or any other salt substitute. These are not suitable for people with kidney problems

For most people, eating a healthy and well-balanced diet with no added salt is all they need to do. If you are unsure whether you need to make any changes to your diet, you can contact your dietitian on the phone number on the last page

The Kidney Kitchen is also a very good online resource from Kidney Care UK, that provides kidney friendly recipes: kidneycareuk.org/get-support/healthy-diet-support/kidney-kitchen

Keeping fit

Try to be as active as you can. To stay healthy or to improve health, all adults need two types of regular physical activity.

There are no special exercises for people with kidney problems – all adults should try to be active every day. Some activity however light, is better for your health than none at all. However, many daily activities such as housework are not sufficient on their own because the work isn’t hard enough to increase your heart rate.

If you would like help with this then Kidney Beam is an online service offering access to exercise programmes and community support for people with chronic conditions: www.beamfeelgood.com

Smoking

Smoking is thought to have several effects on the kidneys, particularly because it raises blood pressure. This is known to increase your risk of cardiovascular disease, partly through the hardening and narrowing of your arteries, including those arteries in the kidneys, therefore making any kidney damage worse.

If you stop smoking:

• After 20 minutes your blood pressure and pulse will return to normal
• After 8 hours nicotine and carbon monoxide levels in your blood are halved
• After 72 hours your breathing becomes easier, and your energy levels increase
• After 2 to 12 weeks your circulation improves, and exercise can be easier
• After 3 to 9 months any coughs, wheezing and breathing problems improve
• After 5 years the risk of heart attack is halved
• After 10 years the risk of lung cancer is halved, and the risk of heart attack is at the same level as non-smokers

Support is available in Dorset: www.nhs.uk/live-well/quit-smoking/nhs-stop-smoking-services-help-you-quit

Acute kidney injury

Having chronic kidney disease increases the risk of the kidneys becoming injured and suddenly getting worse. If you know you have chronic kidney disease and are due to have any of the procedures below, you should speak to the person organising the procedure if there is anything that can be done to reduce the risk of acute kidney injury.

• Surgery
• CT scan that requires an injection of contrast
• Coronary angiogram
• Angiogram for peripheral vascular disease
• Colonoscopy.

Sick day rules

If you become very unwell with a fever, sweats and shaking (unless only minor) or experience an episode of diarrhoea or vomiting (unless only minor), then some medicines should be stopped until you are feeling well and/or eating and drinking normally (approximately 24 to 48hrs). Once recovered the medicines can be restarted. Your renal team will advise you of which drugs are relevant to you, and you should be given a ‘Sick Day Rules’ card.

These drugs include:

• ACE- inhibitors, drug names ending in ‘-pril’ e.g. ramipril, lisinopril, enalapril
• ARBs, drug names ending in ‘-sartan’ e.g. Losartan, Candesartan, Telmisartan, Valsartan, Olmesartan
• Diuretics, such as furosemide, bumetanide, indapamide or bendroflumethiazide, spironolactone
• Metformin, an antidiabetic medication
• NSAIDs, such as ibuprofen, naproxen, diclofenac
• SGLT-2 inhibitors, drug names ending in ‘-gliflozin’ e.g. empagliflozin, dapagliflozin
• GLP-1 agonists, drug names ending in ‘-atide’; e.g. semaglutide
• Sulfonylureas, such as gliclazide and glipizide.

If you are unwell with one of these conditions, it is important to have your bloods checked after a couple of days to make sure your kidney function has not deteriorated.

CKD clinics

If your GP refers you for specialist renal input, initially you will be seen by a consultant nephrologist in one of our chronic kidney disease clinics either at Dorset County Hospital, Yeovil District Hospital, Royal Bournemouth Hospital or Poole General Hospital, depending on your address. We operate face to face clinics and some telephone clinics.

After your first visit we will normally ask you to have blood and urine tests just before your next visit.  It is helpful to have these results available when reviewed in clinic so that they can be discussed with you.

The Advanced Kidney Care Team

If your kidney function continues to deteriorate you will be moved into one of our Advanced Kidney Care clinics (AKCC) which are held at Dorset County Hospital and the Poole Dialysis Centre at Tower Park in Poole. This multi-disciplinary team consists of several professionals:

• Consultant Nephrologist
• Advanced Kidney Care Specialist Nurse or Renal Specialist Nurse
• Renal Dietitian
• Renal Counsellor – see separate leaflet for how to access this service.

Like CKD clinic, in AKCC the team will also review you and manage your disease aiming to slow its progression. However, it also focuses on preparation for the future in the circumstance that your kidney function keeps declining. If your kidneys fail, there are different management options available that will be discussed with you. You will be assessed and supported to make an informed decision about the best treatment option available to you. These options include:

• Renal Transplantation
• Peritoneal Dialysis
• Haemodialysis (including home haemodialysis)
• Supportive/Conservative Management – Choosing not to have dialysis.

Patient Knows Best (PKB)

Being in control of your own illness is very important and one way to help with this is to be able to view your own blood test results. Patient Knows Best is a system which allows patients to view their own blood results. Anyone with access to the internet either at home or in a library can view their results and learn more about their kidney disease. If you are interested in being able to see your blood results, please speak to one of the Kidney Care Team so that you can be registered for this service.

How to book a blood test ready for your renal clinic appointments

A blood request will be added to one of the electronic ICE systems either at Dorset County Hospital, University Hospitals Dorset or Yeovil Hospital (depending on the location of your appointment). Yeovil hospital requires a paper copy of the request. Please have this test done, ideally at least the day before your appointment. Please phone the appropriate number below to make a blood test appointment.

South Walks House Outpatient Assessment Centre, Dorchester: The SWH clinic runs from the Outpatient Assessment Centre next to Dorchester Library. Phlebotomy clinics run Monday to Friday, 8am to 4.30pm. To book an appointment, please ring 01305 254822 between 11am and 2pm. There is an answer machine after 2pm.

Weymouth Community Hospital: Phlebotomy run clinics on Mondays, Wednesdays and Fridays (Friday start date to be confirmed) from 8am – 2pm, except for Bank Holidays when there is no clinic. The clinic is situated within the Outpatients Department, East Entrance, Ground Floor, Room 4A. To book an appointment please ring 01305 254822 between 11am and 2pm. There is an answer machine after 2pm.

Yeovil Hospital: This is a walk in service, no appointment required, open 8am – 4:30pm. Please take the paper or sticker request form.

Bournemouth Hospital: 8am – 4.30 pm Monday-Friday or Christchurch Hospital 9am – 2pm Monday to Friday. To book an appointment please ring 0300 019 4781 (lines open between 10am-12pm and 2-4pm).

Poole Hospital: Outpatient department, Pink Zone, Floor 0. Please phone to book an appointment on 0300 019 8900.

Other support services / useful websites

Dorset Kidney Patient Association – A local charity based in Dorchester who provide support for kidney patients, whether they are pre-dialysis, on dialysis or have received a transplant. They also provide support for families and friends – Please email them for information: hello@dorsetkpa.org, www.dorsetkpa.org, www.facebook.com/dorsetkpa

Kidney charities – There are several national kidney charities that provide excellent and reliable information and support, for example:

• Kidney Care UK – kidneycareuk.org
• National Kidney Federation – www.kidney.org.uk
• Kidney Disease UK – www.kidneyresearchuk.org

NHS stop smoking services –  www.nhs.uk/live-well/quit-smoking/nhs-stop-smoking-services-help-you-quit

Chronic Kidney Disease Explained – ckdexplained.co.uk

Contact numbers

We hope that you have found this information useful. If you have any questions or are worried about anything, please speak to the following Dorset County Hospital staff:

West Dorset and South Somerset Renal Specialist Nurses: 01305 255349

East Dorset Renal Specialist Nurses: 01202 307433

Renal Transplant Specialist Nurses: 01305 254782

Renal Dieticians: 01305 255377

Renal Secretaries: 01305 255269

Clinic appointment enquiries: 01305 254892

About this leaflet

Authors: Leanne Brown, Advanced Kidney Care Specialist Nurse, Dr David Warland, Consultant Nephrologist, Dr Amy Riddell, Consultant Nephrologist and Joanna Pulman, Senior Renal Dietitian
Written: February 2026
Approved: May 2026
Review date: May 2029
Edition: v2

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk