Understanding kidney disease & ESRD
A gentle, complete overview for patients and families who've just heard the words “kidney disease” — what it means, how it progresses, and what you can do today to protect what you have.
Adapted with permission from renalcarematters.com.
What your kidneys do
Your two kidneys are quiet, hard-working organs about the size of your fist. Every day they filter roughly 200 litres of blood, removing waste and extra fluid, keeping your salts and minerals in balance, helping control your blood pressure, and making hormones that keep your blood and bones healthy. When they are working well, you never feel them — and that is exactly the point. Because they do their job silently, damage can build up for a long time before you notice anything at all.
What “chronic kidney disease” means
Chronic kidney disease (CKD) means the kidneys' ability to filter has been slowly — and often silently — declining for three months or longer. It is found through blood tests, urine tests, and imaging, not by how you feel. Many people in the early stages feel completely normal.
The word “chronic” matters. Unlike a sudden kidney injury, which can often recover, CKD usually reflects lasting change to the kidney itself. That does not mean nothing can be done — it means the goal shifts to slowing it down and protecting the healthy filtering units you still have. About 1 in 10 Filipinos lives with CKD, so if this is you, you are far from alone.
Knowing your stage — the eGFR number
The key number your doctor watches is your eGFR. Think of it as the percentage of your kidneys' filtering capacity that is still working. A healthy eGFR is above 90. Doctors use this number to group CKD into five stages:
- Stage 1 & 2 — filtering is normal or only mildly reduced. Usually no symptoms; found only because a urine or blood test flags early damage.
- Stage 3 — filtering is moderately reduced. Many people still feel well, though some notice mild tiredness or waking at night to pass urine. This is when your doctor starts watching more numbers closely.
- Stage 4 — filtering is severely reduced. Fatigue, swelling, poor appetite, and harder-to-control blood pressure become more common. This is the time to start planning ahead.
- Stage 5 — the kidneys can no longer do enough on their own. This is also called end-stage kidney disease, and it is when dialysis or a transplant is considered.
Here is the encouraging part: with early, steady treatment, many people stay in the earlier stages for years or even decades. Moving from one stage to the next is not inevitable — it depends heavily on how well the underlying causes are controlled.
Why your urine matters as much as your blood
Your eGFR is only half the picture. The other half is protein in the urine. A healthy kidney filter keeps large protein molecules in the blood where they belong. When the filter becomes leaky, protein — especially albumin — spills into the urine. This shows up as foamy or bubbly urine, and on a test called UACR (urine albumin-to-creatinine ratio).
The more protein leaking, the higher the risk that CKD will progress and the more the heart is strained. This is why your doctor stages CKD on two numbers together — how well you filter (eGFR) and how much protein you leak (UACR). A simple “spot” urine sample is now preferred over a full 24-hour collection — it is easier for you and just as accurate. Reducing protein leak is one of the most powerful ways to protect your kidneys.
What causes CKD in the Philippines
The great majority of CKD here comes from two common, treatable conditions. Understanding your cause guides your whole treatment plan.
- Diabetes — chronically high blood sugar damages the tiny filters and is the number one cause of kidney failure in the Philippines.
- High blood pressure (hypertension) — over years, uncontrolled pressure scars the small blood vessels that feed each filter, slowly destroying them.
Less common causes include repeated kidney infections, blockages to the flow of urine, overuse of pain relievers (NSAIDs), certain contrast dyes used in scans, and inherited kidney conditions. Kidney health and heart health are also deeply linked — damaged kidneys raise blood pressure, worsen anemia, and add strain to the heart — which is why your doctor watches your kidneys, blood pressure, blood sugar, and heart all at the same time.
Signs and symptoms to watch for
CKD is famously “silent” early on. Symptoms usually appear only once filtering drops significantly, which is exactly why routine testing matters — especially if you have diabetes or high blood pressure. As CKD advances, you may notice:
- Persistent fatigue and weakness — from anemia and waste building up
- Swelling of the feet, ankles, or face — from fluid the kidneys can't clear
- Waking at night to urinate — the kidneys losing their ability to concentrate urine
- Foamy or bubbly urine — a sign of protein leaking
- Blood in the urine — may point to active kidney inflammation
- Nausea, poor appetite, or a metallic taste — from waste build-up
- Trouble concentrating — a sign of more advanced disease
- Shortness of breath — from extra fluid or acid build-up
- Itchy skin, bone pain, or muscle cramps — from mineral imbalance
The numbers your doctor keeps an eye on
At each visit, your nephrologist checks a small set of numbers that show how CKD is affecting the rest of your body. Keeping them in a healthy range slows the disease and prevents complications. You don't need to memorise the targets — but it helps to know what they mean:
- eGFR and urine protein — the trend over time tells whether things are stable
- Blood pressure — usually aimed below 130/80 if you have diabetes or heavy protein leak
- Blood sugar (HbA1c) — if you are diabetic, kept in an individual target range
- Hemoglobin — to catch and treat the anemia that CKD causes
- Potassium, phosphate, calcium, and bicarbonate — minerals and acid balance that need to stay in a safe window as the kidneys weaken
- Cholesterol — because CKD raises heart risk, this is managed aggressively
How CKD is treated
There is no single pill for CKD. Treatment is a partnership between you and your care team, aimed at three things at once: controlling the cause, protecting the kidney function you still have, and shielding your heart. The main pieces are:
- Control the driver. If diabetes is the cause, tight blood-sugar control is essential. If it's high blood pressure, getting it into target is the priority.
- Kidney-protective medicines. A group of drugs called ACE inhibitors and ARBs lower the pressure inside the kidney's filters and reduce protein leak. Newer medicines called SGLT2 inhibitors now have strong evidence for slowing CKD and protecting the heart, in people with and without diabetes.
- Treat the complications. As kidney function falls, your team actively manages anemia, bone-and-mineral changes, acid build-up, and high potassium.
- Protect the heart. Cholesterol treatment, quitting smoking, and other heart measures are non-negotiable — your heart and kidneys are protected together.
- Plan ahead in Stage 4–5. This is when your team calmly prepares for what comes next — including creating dialysis access, completing vaccinations, and, where suitable, starting a transplant work-up.
Please tell your doctor about every supplement, herbal remedy, or traditional medicine you take. Many “kidney cleanse” products contain substances that are directly harmful to the kidneys, and some interfere with your prescribed medicines. And avoid over-the-counter pain relievers like ibuprofen and mefenamic acid unless your doctor approves them — they can reduce blood flow to the kidneys.
Eating well with kidney disease
Diet in CKD is highly individual — what's right for you depends on your stage, your lab results, and whether you are on dialysis. Never cut out whole food groups on your own; always confirm the specifics with your nephrologist or a renal dietitian. As general principles:
- Sodium (salt) — cutting back lowers blood pressure and protein leak. Go easy on processed foods, bagoong, soy sauce, and instant noodles.
- Potassium — only restricted if your blood level runs high. If needed, limit banana, coconut, kamote, and squash; boiling vegetables can cut their potassium by about half.
- Phosphorus — limit dark colas, processed cheese, nuts, and organ meats. Fresh foods are better than preserved ones.
- Protein — before dialysis, a moderate intake helps slow progression. On dialysis, you actually need more protein to stay strong.
- Fluids — usually only restricted once on dialysis; in earlier stages, staying well hydrated is helpful unless your doctor tells you otherwise.
- Enough calories — do not under-eat. Losing weight and muscle is a real danger in advanced CKD.
Foods that are usually gentle on the kidneys include white rice, bread and pasta, egg whites, apples, grapes and pineapple, and vegetables like cabbage, cauliflower, and green beans.
What ESRD and dialysis are
End-stage renal disease (ESRD), also called kidney failure, is the point where the kidneys can no longer do enough on their own to keep you well. When that happens, dialysis takes over part of their job — cleaning the blood and removing extra fluid — usually a few times each week. A kidney transplant is the other option and can be discussed early with your team.
Common questions
Will my kidneys get better? CKD is not curable, but it is very manageable. With good control of blood pressure, blood sugar, and protein leak, many people stay stable for years or decades. How the disease behaves depends heavily on how well the risk factors are managed.
Are contrast dyes and pain relievers safe for me? Be cautious. Pain relievers like ibuprofen, mefenamic acid, and naproxen can harm the kidneys — avoid them unless your doctor says otherwise. Always tell your doctor and radiologist about your CKD before any scan that uses contrast dye.
Can I take herbal or alternative medicines? Please check with your doctor first. Many herbal and “kidney cleanse” products contain substances that are directly harmful to the kidneys or that clash with your prescribed medicines. Always disclose everything you take.
How often will I see my nephrologist? It depends on your stage. Roughly: Stage 1–2 every 6–12 months, Stage 3 every 3–6 months, and Stage 4–5 every 1–3 months. Your doctor will set the right interval based on how your numbers are trending.
Adapted with permission from renalcarematters.com. Medically reviewed by a nephrologist. This guide is educational and not a substitute for consultation.