Chronic kidney disease (CKD) means the kidneys are damaged and cannot filter the blood as well as they should. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), most people in the early stages have no symptoms, so blood and urine tests are the only way to know. Care at home supports the plan the person’s doctors set: medicines taken as prescribed, blood pressure and blood sugar under control, and early reporting of changes.
What is chronic kidney disease, and what do the stages mean?
NIDDK describes CKD as kidneys damaged or structurally changed so that waste and extra fluid build up in the body. It often develops slowly, and advanced CKD typically cannot be reversed, though not everyone progresses to kidney failure. NIDDK estimates that more than 35 million U.S. adults, over 1 in 7, have it, and the CDC says as many as 9 in 10 do not know they have it.
Doctors stage CKD using a blood test result called eGFR plus a urine test. The National Kidney Foundation uses these stages, and each needs the result to last 3 months or more:
| Stage | eGFR | What it means |
|---|---|---|
| G1 | 90 or higher | Kidneys still filter well, with signs of damage such as protein in the urine |
| G2 | 60 to 89 | Mild decrease, with signs of damage |
| G3a | 45 to 59 | Mild to moderate loss of function |
| G3b | 30 to 44 | Moderate to severe loss of function |
| G4 | 15 to 29 | Severe loss of function |
| G5 | Below 15 | Kidney failure, or already on dialysis |
Who is at risk for kidney disease?
NIDDK lists diabetes, high blood pressure, heart and blood vessel disease and a family history of kidney disease, and says risk rises with age and with the number of years someone has had these conditions. The National Kidney Foundation adds obesity, smoking and a past episode of acute kidney injury. See our guides to diabetes care at home and heart failure care.
Can you have kidney disease and not know it?
Yes, and it is common. NIDDK says many people have no symptoms until the disease is advanced. Swelling (edema) in the legs, feet, ankles and, less often, the hands or face can appear when the kidneys cannot remove extra fluid and salt. As CKD advances, NIDDK lists:
- loss of appetite, nausea or vomiting, and weight loss
- tiredness, sleep problems or trouble concentrating
- a change in how often the person urinates, or foamy urine
- itching, dry or darkened skin, numbness and muscle cramps
- chest pain, shortness of breath and worsening swelling
Many of these look like ordinary aging, so a family member who notices a pattern should mention it to the doctor.
How is kidney disease diagnosed?
NIDDK names two tests. A blood test estimates how well the kidneys filter (GFR, based on a waste product called creatinine). A urine test looks for albumin, a protein that leaks through damaged kidneys. Above 30 mg/g may be a sign of kidney disease, and the provider may repeat the test to confirm. NIDDK advises yearly testing for people with diabetes, and a talk with the provider about timing for those with high blood pressure, heart disease or a family history of kidney failure.
Two Medicare Part B benefits are worth asking about. Kidney disease education is for people with stage 4 CKD who are referred by their doctor: up to 6 sessions, with 20% of the Medicare-approved amount after the Part B deductible. Medical nutrition therapy with a registered dietitian covers people with kidney disease, with a doctor’s referral, at no cost if they qualify: 3 hours in the first year and 2 hours each year after.
What does daily management of CKD look like at home?
NIDDK’s ten ways to manage CKD focus on the conditions that damage the kidneys:
- Blood pressure. NIDDK calls it the most important step; the goal comes from the person’s provider. See our guide to home blood pressure monitoring.
- Blood sugar. With diabetes, the target and how often to check come from the care team.
- Regular kidney checks. Keep the eGFR and urine albumin results together and ask whether they changed.
- Medicines as prescribed (see below).
- A meal plan from a dietitian. Food and drink changes may be needed as kidney function falls.
- Activity, sleep, weight, no smoking and stress. Each person should ask their provider what fits.
Diet and fluids are individual. NIDDK’s healthy eating page says people with CKD may need to limit liquids and watch sodium, potassium and phosphorus, and that a dietitian or health care professional works out the amounts. Do not copy a plan from the internet or another patient. Our nutrition guide covers everyday eating; kidney-specific limits come from the care team.
Which medicines affect the kidneys?
According to NIDDK, kidneys that filter less can let medicines build up, so the provider may change how often a person takes one, lower the amount, switch it or stop it. That is the prescriber’s decision, never the family’s or the aide’s.
NIDDK also warns that pain relievers and cold medicines called NSAIDs, including ibuprofen and naproxen, can damage the kidneys and lead to acute kidney injury, especially in people with kidney disease, diabetes and high blood pressure. Brand names vary, so NIDDK says to ask a pharmacist or provider whether a product is safe. Practical steps from NIDDK:
- Keep one updated list of all medicines, vitamins and supplements, and bring it or the bottles to every visit.
- Use one pharmacy or chain so the pharmacist can check combinations, and ask before buying any over-the-counter product.
Our guide to medications linked to dementia risk covers another reason to review an older adult’s medicine list with a pharmacist, and our medication management guide shows how a home routine can support the prescriber’s plan.
How are dehydration and kidney disease connected?
NIDDK’s page on keeping kidneys safe explains that during flu or diarrhea, blood pressure can drop, and kidney pressure with it. Taking certain blood pressure medicines or NSAIDs while dehydrated may then harm the kidneys, and people with CKD already have a higher risk of acute kidney injury.
NIDDK suggests asking the provider or pharmacist ahead of time which medicines to avoid while ill, when to restart them, and what to do about blood pressure medicine during diarrhea or vomiting. Our guide to dehydration in older adults lists the signs. If the doctor has set a fluid limit, ask what to do on hot days or during illness, because the usual advice to drink more may not apply.
When does dialysis come up, and what should families know?
NIDDK defines kidney failure as less than 15 percent of normal kidney function. MedlinePlus says people usually start dialysis at about 10 to 15 percent, and that the provider discusses it long before it is needed. There are four paths, according to NIDDK’s kidney failure pages:
| Option | What it involves |
|---|---|
| Hemodialysis at a center | Usually three times a week, about 4 hours each, on a fixed schedule |
| Hemodialysis at home | More flexible schedule; most centers require a trained partner at home, and training can take 3 to 8 weeks |
| Peritoneal dialysis | Done at home, using the lining of the belly to filter the blood |
| Kidney transplant | A donated kidney, with daily medicines afterward to prevent rejection |
| Conservative management | Ongoing care without dialysis or transplant, focused on symptoms and quality of life |
One tip families can act on early: NIDDK says people who may need dialysis should remind providers to draw blood and place IV lines only in veins below the wrist, because arm veins damaged by repeated needles may not be usable for dialysis access.
Medicare coverage and getting to dialysis
For people with end-stage renal disease, Medicare.gov says Part B helps cover outpatient dialysis, home dialysis training and equipment, with usually three hemodialysis treatments a week; the person generally pays 20% after the deductible, and Part A covers inpatient dialysis. It adds that Medicare does not cover paid dialysis aides to help with home dialysis. Ambulance transport to a dialysis facility is covered only when any other vehicle could endanger the person’s health.
For people who already have Medicare because of age, physician-ordered preparation such as fistula placement is covered before dialysis begins, per the ESRD page. Costs can differ under Medicare Advantage, so call the plan.
Getting to dialysis three times a week is a real issue in New York City. Our guides to senior medical transportation in NYC and transportation for seniors explain the choices. NIDDK says a dialysis social worker can help families with costs and life changes, so ask early.
How can home care help someone with kidney disease?
Home care does not replace the kidney team, and aides do not perform dialysis or change medicines. Where the care plan includes it, an aide can ease the daily routine and notice changes.
| Area | Who decides | How home care can help |
|---|---|---|
| Diet and meals | Doctor and dietitian | Prepare and serve meals as planned, report poor appetite |
| Fluid limits | Doctor or nephrologist | Track intake only if instructed, and report swelling or other changes |
| Medicines | Prescriber and pharmacist | Remind the person per the plan; raise questions with the nurse or family |
| Safety after dialysis | Dialysis team | Watch for dizziness; NIDDK says low blood pressure can make a fall more likely |
Our personal care services cover daily help, and nurse services cover nursing needs at home. For doctor visits, our medical escort service sends a home health aide who goes along, helps with the conversation and writes down the doctor’s instructions. Our fall prevention guide covers the home itself.
What warning signs mean calling the doctor or 911?
Ask the care team for a written list for the particular person. General signs from NIDDK and MedlinePlus:
| Sign | What to do |
|---|---|
| New or worse swelling in the face, arms, legs or belly | Contact the health care professional (NIDDK) |
| Less urine, foamy urine, poor appetite, nausea, itching or cramps | Tell the care team |
| Vomiting or diarrhea, or too sick to drink | Call the doctor or pharmacist for sick-day instructions |
| Vomiting, a racing or fluttering heartbeat, or new weakness | Contact the provider right away (MedlinePlus, on high potassium) |
| Chest pain, severe trouble breathing, fainting, sudden confusion or no urination | Call 911 (MedlinePlus says to get help right away for confusion, fainting or lack of urination) |
What if dialysis does not fit the person’s goals?
NIDDK says dialysis helps many people feel better and live longer, but it may not extend or improve life for some people who are elderly and frail or who have conditions such as dementia, heart failure or cancer. Conservative management continues care without dialysis, aimed at symptoms and quality of life. NIDDK names palliative care as part of it and says hospice may be chosen near the end of life; Medicare covers hospice.
The decision belongs to the person, with the family and care team. See palliative care versus hospice and health care proxies and MOLST.
Caregiver support: advice from our nurse director
Anna Klyauzova, RN, MSN, MPA, Director of Patient Services at ProLife Home Care, on what she sees in practice:
You can’t do all of it by yourself. Illness changes the whole family’s life, not only the patient’s. The sooner support is in place, the easier it is to keep a safe home and a familiar routine. Even a few hours of professional home care a week gives relatives time to rest. A husband or an adult daughter who has done everything alone for years has usually given up their own rest. A home health aide a few days a week can change that. We want the person safe and well cared for, and the family able to breathe.
ProLife Home Care is a licensed home care agency in Brooklyn and Queens (licence #2572L001, New York State Department of Health). We can talk through what help at home could look like alongside your doctors’ plan. Call (718) 232-2777 or use our contact page.
General information, not medical advice: kidney care depends on the person’s own results and doctors. Facts checked on 16 October 2026 against niddk.nih.gov, cdc.gov, kidney.org, medlineplus.gov and medicare.gov (some NIDDK pages carry older review dates). Medicare rules change, so confirm with 1-800-MEDICARE or the plan.
Frequently asked questions
What are the five stages of chronic kidney disease?
The National Kidney Foundation uses stages G1 to G5 based on eGFR: 90 or higher with signs of damage (G1), 60 to 89 (G2), 30 to 59 (G3, split into 3a and 3b), 15 to 29 (G4) and below 15 or on dialysis (G5). Stages need results that last 3 months or more.
Can chronic kidney disease be cured or reversed?
NIDDK says advanced, long-lasting CKD typically cannot be reversed, but the sooner it is found, the sooner steps can be taken to protect the kidneys from further damage. Controlling blood pressure and blood sugar is central.
Does everyone with CKD end up on dialysis?
No. The CDC says not all people with kidney disease progress to kidney failure, and NIDDK says some people maintain kidney function for years. Dialysis is a treatment for kidney failure, which NIDDK defines as less than 15 percent of normal function.
Is ibuprofen safe for someone with kidney disease?
Ask the pharmacist or doctor first. NIDDK warns that NSAIDs such as ibuprofen and naproxen can damage the kidneys, especially in people with kidney disease, diabetes and high blood pressure. Do not start or stop any medicine without the prescriber.
How much water should someone with kidney disease drink?
There is no single answer. NIDDK says people with CKD may need to limit liquids and should ask a dietitian or health care professional how much is right. Do not restrict or push fluids on your own.
Does Medicare cover dialysis?
Yes, for people with end-stage renal disease. Medicare.gov says Part B helps cover outpatient dialysis, usually three treatments a week, with 20% coinsurance after the deductible. It does not cover paid aides for home dialysis.
Can a home health aide help someone on dialysis?
Aides do not perform dialysis. Depending on the care plan, they can help with meals, reminders, getting ready for appointments and keeping the person safe after treatment, and they report changes to the nurse or family. Diet, fluid and medicine decisions stay with the care team.
