Chronic kidney disease
Also called: CKD, chronic renal disease, chronic kidney failure, kidney disease
Chronic kidney disease (CKD) is a long-term condition where the kidneys slowly lose their ability to clean the blood. It is mostly caused by diabetes and high blood pressure, often has no early symptoms, and is found with blood and urine tests. Treatment can slow it down.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
The kidneys are two bean-shaped organs that filter the blood. They remove waste and extra water as urine, and they also help control blood pressure, keep bones healthy and tell the body to make red blood cells. In chronic kidney disease (CKD), the kidneys are damaged and cannot filter the blood properly. The damage builds up slowly, usually over many years.
CKD is common, and it becomes more likely as people get older. People of South Asian origin are more likely to have it. The two main causes are diabetes and high blood pressure. Most people feel well in the early stages, so many only find out when a routine blood or urine test is done. Doctors describe how serious CKD is by two numbers: how well the kidneys are filtering (the eGFR blood test) and how much protein is leaking into the urine.
There is no cure, but treatment can slow the damage and lower the high risk of heart attack and stroke that comes with CKD. Only a small number of people go on to kidney failure (end-stage kidney disease), where the kidneys almost stop working. At that point dialysis (a machine or fluid that cleans the blood) or a kidney transplant is needed. Many people with CKD live a long life when it is found early and managed well.
In Pakistan: what studies show
Community studies suggest CKD is common in Pakistan: 12.5% of adults aged 40 and over in Karachi had it, and a South Asia review reported 23.3% in one Pakistani study. Dialysis is costly, about Rs 550,000-700,000 a year, and an estimated 22,000 new patients may need it every year.
- A 2018 review of population studies from South Asia found the highest reported rate of CKD in Pakistan, at 23.3%, but this came from a small study of 301 people.[1] (systematic review, data not stated)
- A community study of 2,873 adults aged 40 and over in 12 neighbourhoods of Karachi found that 12.5% had chronic kidney disease.[2] (community-based cross-sectional, data not stated)
- In the same Karachi study, older age, high blood pressure and diabetes were linked to CKD, and only 48.7% of people with both CKD and high blood pressure were taking blood pressure medicines.[2] (community-based cross-sectional, data not stated)
- Kidney doctors at a Karachi hospital estimated that about 22,000 new patients in Pakistan need dialysis every year.[3] (report, data not stated)
- The same paper says haemodialysis in Pakistan costs a patient on average about Rs 550,000-700,000 a year, which is far more than an average income.[3] (report, data not stated)
- The paper also reports that there were 5,935 patients on haemodialysis using 891 machines in the whole country.[3] (report, data not stated)
- A review of 41 hospitals in Punjab found 3627 kidney transplants from 2014 to 2023, an average of 362 a year, and only some districts had a transplant centre.[4] (retrospective cross-sectional review of secondary data, data Jan 2014 - Dec 2023)
- At one dialysis centre in Karachi, 110 patients on regular haemodialysis had an average quality of life score of 52.0 on a kidney disease questionnaire, showing a heavy burden from treatment.[5] (retrospective cross-sectional, data June - December 2019)
What we do not know yet: There is no national CKD survey for Pakistan; the Karachi study (12.5%) and the single Pakistani study in the South Asia review (23.3%, only 301 people) give different rates and do not say when data were collected. GBD figures for CKD deaths in Pakistan, and dialysis access outside big cities, were not available on the pages opened.
Pakistan studies cited
- Hasan M, Sutradhar I, Das Gupta R, et al. Prevalence of chronic kidney disease in South Asia: a systematic review. BMC Nephrology 2018;19(1). doi:10.1186/s12882-018-1072-5. Open source
- Jessani S, Bux R, Jafar TH Prevalence, determinants, and management of chronic kidney disease in Karachi, Pakistan - a community based cross-sectional study. BMC Nephrology 2014;15(1):90. doi:10.1186/1471-2369-15-90. PMID 24927636. Open source
- Imtiaz S, Alam A Is haemodialysis the most feasible dialysis modality for Pakistan?. Journal of the Pakistan Medical Association 2021;71(2). doi:10.47391/JPMA.129. Open source
- Asghar RS, Saleem J, Javaid U, et al. Ten-year review of renal transplants in Punjab Province, Pakistan. Eastern Mediterranean Health Journal 2025;31(3):191-197. doi:10.26719/2025.31.3.191. Open source
- Saleem I, Dhrolia M, Qureshi R, et al. "Haemodialysis burden" overweighs the associations of demographic, social and clinical factors on quality of life: a single centre study from Pakistan. Journal of the Pakistan Medical Association 2022;72(5):886. doi:10.47391/JPMA.3051. Open source
Symptoms
- Often no symptoms at all in the early stages
- Tiredness and feeling generally unwell
- Poor appetite, feeling sick or vomiting, and losing weight without trying
- Swelling of the ankles, feet or hands because the body holds on to fluid (oedema)
- Shortness of breath
- Itchy or dry skin
- Muscle cramps or twitching
- Needing to pass urine more often, especially at night, or blood in the urine
- Trouble sleeping, headaches, or difficulty concentrating
- Sexual problems such as erectile dysfunction, or missed periods in women
Causes and risk factors
Causes
- Diabetes, where high blood sugar damages the tiny filters in the kidneys
- High blood pressure, which damages the small blood vessels in the kidneys
- Glomerulonephritis (inflammation of the kidney filters) or autoimmune diseases such as lupus
- Inherited conditions such as polycystic kidney disease (many fluid-filled cysts in the kidneys)
- Repeated kidney infections, or blockages to the flow of urine such as kidney stones or an enlarged prostate
- Long-term use of certain medicines, such as lithium and some painkillers called NSAIDs
What makes it more likely
- Diabetes
- High blood pressure
- Heart disease, including heart failure
- A close family member with kidney disease
- Being overweight or obese
- Older age
- South Asian or Black family background
- Smoking, which can also make existing kidney disease worse
Complications
The biggest danger of CKD is to the heart and blood vessels: people with CKD have a higher chance of heart attack and stroke, even when the kidney disease is mild. As kidney function falls, other problems can appear. These include anaemia (too few red blood cells, causing tiredness), weak bones and bone pain, and unsafe levels of potassium, phosphate or calcium in the blood. High potassium can upset the heart rhythm. Fluid can build up in the legs and lungs. Infections become more likely, and appetite, mood and quality of life can suffer. In a small number of people the kidneys fail completely, and dialysis or a transplant is then needed to stay alive.
When to see a doctor
- Severe shortness of breath, or chest pain: go to the emergency department straight away
- A fit (seizure), or becoming very drowsy or confused
- Swelling of the legs, face or body that gets worse quickly, especially with breathlessness
- A very slow, fast or irregular heartbeat, or sudden muscle weakness (possible signs of high potassium)
- Vomiting, diarrhoea or fever that stops you keeping fluids down; ask your doctor which of your medicines to pause
- Vomiting blood, or black or bloody stools
- A sudden, very painful, swollen joint (possible gout)
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Diagnosis
CKD is found with simple tests. A blood test measures creatinine (a waste product) and uses it to work out the eGFR (estimated glomerular filtration rate), which shows how well the kidneys are filtering. A urine test checks for protein (albumin) leaking into the urine, which can appear months or years before any symptoms. CKD is diagnosed when these results stay abnormal for more than three months. The eGFR and urine protein together give the stage of CKD, which tells the doctor how serious it is and how often to check it again. People with diabetes, high blood pressure or heart disease should have these tests regularly.
Other tests may be used to find the cause or look for problems. These include an ultrasound, CT or MRI scan of the kidneys, and sometimes a kidney biopsy (a tiny piece of kidney tissue looked at under a microscope). Blood tests for blood count, potassium, calcium, phosphate, vitamin D and cholesterol help spot complications.
Treatment
- Treat the cause: keep blood sugar well controlled if you have diabetes, and keep blood pressure at the target your doctor sets.
- Make healthy lifestyle changes: stop smoking, eat less salt, stay active and keep a healthy weight.
- Take medicines that protect the kidneys and heart, usually an ACE inhibitor or ARB, often with an SGLT2 inhibitor and a statin. Your doctor decides the medicine and dose.
- Have regular blood and urine tests so your doctor can track your kidneys and adjust treatment; a small dip in eGFR after starting some medicines is expected.
- Treat complications as they appear, such as anaemia, high phosphate, high potassium, acid build-up or fluid swelling.
- Avoid medicines that can harm the kidneys, and get every new medicine, supplement or herbal product checked first.
- If the kidneys are failing, plan early with a kidney specialist (nephrologist) about dialysis, a transplant or supportive care.
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
- NSAID painkillers (Ibuprofen, Diclofenac, Naproxen, Mefenamic Acid): can harm the kidneys and can cause CKD with long-term use; do not take them unless a doctor advises it
| Group | Role | Medicines |
|---|---|---|
| ACE inhibitors and angiotensin receptor blockers (ARBs) | first choice for high blood pressure or protein in the urine; they protect the kidneys and slow damage. Your doctor checks kidney function and potassium after starting or changing them | Enalapril (37 brands), Lisinopril (21 brands), Ramipril (7 brands), Losartan (129 brands), Valsartan (9 brands), Telmisartan (25 brands), Irbesartan (3 brands), Candesartan Cilexetil (4 brands) |
| SGLT2 inhibitors | slow kidney damage and lower the risk of kidney failure and heart problems, in people with or without diabetes; usually continued until dialysis or transplant | Dapagliflozin (14 brands), Empagliflozin (162 brands), Canagliflozin (7 brands) |
| Statins | lower cholesterol and the high risk of heart attack and stroke; recommended for most adults with CKD | Atorvastatin (86 brands), Rosuvastatin (6 brands), Simvastatin (121 brands) |
| Other blood pressure medicines and water tablets (diuretics) | calcium channel blockers are added when blood pressure stays above target; water tablets remove extra fluid and reduce swelling | Amlodipine (175 brands), Nifedipine (17 brands), Furosemide (35 brands) |
| Medicines for CKD complications | iron and red-cell-boosting injections for anaemia; phosphate binders and vitamin D when phosphate is high or vitamin D is low; sodium bicarbonate for high potassium or acid build-up. Used only when tests show a need | Ferrous sulfate (9 brands), Iron sucrose (8 brands), Ferric carboxymaltose (2 brands), Epoetin alfa (6 brands), Epoetin beta (2 brands), Calcium acetate (4 brands), Calcium carbonate (3 brands), Cholecalciferol (135 brands), Sodium bicarbonate (5 brands) |
Also used (not yet in our price list): Sodium zirconium cyclosilicate (for high potassium in some people), Non-steroidal mineralocorticoid receptor antagonists (for some people with diabetes and CKD), GLP-1 receptor agonists (for blood sugar control in diabetes, when needed), Ezetimibe (added to a statin when needed)
Self-care and prevention
Self-care
- Take your medicines every day as prescribed, and ask what each one is for
- Eat less salt and fewer processed and ultra-processed foods
- Eat more vegetables, whole grains, pulses and other plant foods; a dietitian can tell you if you need to limit protein, potassium or phosphate
- Stay physically active and keep a healthy weight
- Stop smoking or using tobacco
- Do not buy painkillers such as ibuprofen, vitamins, supplements or herbal remedies without asking your doctor or pharmacist first
- Ask for a written sick-day plan for which medicines to pause during vomiting or diarrhoea, and when to restart them
- Keep up to date with vaccines such as flu, pneumococcal and hepatitis B
Prevention
- Keep diabetes and blood pressure well controlled
- Have regular kidney blood and urine tests if you have diabetes, high blood pressure, heart disease or a family history of kidney disease
- Stop smoking, eat less salt, stay active and keep a healthy weight
- Avoid regular use of NSAID painkillers unless a doctor advises it
Common questions
Can chronic kidney disease be cured?
No, CKD cannot be cured, and damaged kidney tissue does not grow back. But treatment can slow it down or stop it getting worse. Most people with CKD never need dialysis, especially when it is found early.
What are the stages of kidney disease?
Doctors stage CKD using two results: the eGFR blood test, which shows how well the kidneys filter, and the amount of protein in the urine. The stage goes from mild to kidney failure. It helps your doctor decide how often to test you and which treatment you need.
Which painkiller is safe if I have kidney disease?
Painkillers called NSAIDs, such as ibuprofen, diclofenac and naproxen, can harm the kidneys and should be avoided unless your doctor says otherwise. Always ask your doctor or pharmacist before taking any painkiller, supplement or herbal product.
When is dialysis needed?
Dialysis is needed when the kidneys have almost stopped working and can no longer keep the body safe. It cleans the blood using a machine (haemodialysis) or special fluid in the belly (peritoneal dialysis). A kidney transplant is another option for some people, and it is best to learn about these choices early.
What should I eat with kidney disease?
Eat less salt and processed food, and more vegetables, whole grains and plant foods. As CKD gets worse, you may need to limit protein, potassium, phosphate or fluids. A dietitian can make a plan that suits your test results.
Sources
- KDIGO. Top 10 Takeaways on Management for Primary Care Physicians from the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (2024).
- KDIGO. Top 10 Takeaways for People Living with CKD from the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (2024).
- CDC. Chronic Kidney Disease Basics (2024).
- CDC. Risk Factors for Chronic Kidney Disease (2024).
- NHS. Chronic kidney disease (2023).
- NHS. Chronic kidney disease - Treatment (2023).
- MedlinePlus. Chronic kidney disease: MedlinePlus Medical Encyclopedia (2025).
- BMC Nephrology (Hasan et al.). Prevalence of chronic kidney disease in South Asia: a systematic review (2018).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
High blood pressure (hypertension)Type 2 diabetes mellitusHeart failureKidney stonesGoutIron-deficiency anaemia