Your kidneys don’t ask for much attention, and that’s part of the problem. Every day, they filter a large volume of blood – producing roughly 180 litres of filtrate – removing waste while quietly balancing fluids, electrolytes, and everything else that keeps your body running. When that function starts slipping, it often does so just as quietly.
Most people with chronic kidney disease notice little to nothing in the early stages. By the time symptoms actually show up, the disease may already be fairly advanced. That’s exactly why knowing what to watch for matters – it’s often the difference between catching something early and finding out too late.
What Happens When the Kidneys Begin to Fail?
In most cases, kidneys don’t fail suddenly. It’s a gradual decline, and doctors track it using GFR (glomerular filtration rate) – essentially an estimate of how well your kidneys are filtering blood.
- GFR 90 or higher: normal or high function, though kidney disease can still be present if there’s other evidence of damage
- GFR 60–89: mildly decreased – on its own, this doesn’t confirm CKD and needs to be read alongside other findings
- GFR 30–59: moderately decreased
- GFR 15–29: severely decreased
- GFR below 15: kidney failure
A CKD diagnosis generally requires evidence of kidney damage or reduced function that’s persisted for at least three months. Urine albumin and eGFR are the two markers doctors lean on most to evaluate it.
As function declines, waste products like creatinine build up in the blood, and the body starts struggling to manage fluid, electrolytes, acid-base balance, and blood pressure. Catching this early gives doctors room to find the cause, manage complications, and slow things down before they progress further.
10 Signs Your Kidneys Are Failing
Some of these are hard to miss. Others get blamed on ageing, stress, or something else entirely. And plenty of people with early kidney disease feel nothing at all – which is exactly why blood and urine testing matters for anyone at risk, symptoms or not.
1. Swelling in the Feet, Ankles, or Face
When kidneys can’t clear enough extra fluid and salt, that fluid settles into body tissue instead – showing up as swelling in the legs, feet, ankles, or sometimes the hands and face. Swelling has plenty of other causes too, so it’s not something to assume is kidney-related on its own. But if it’s persistent or unexplained, it’s worth getting checked.
2. Persistent Fatigue and Weakness
Healthy kidneys produce erythropoietin, a hormone that tells your body to make red blood cells. When kidney disease advances, this can lead to anaemia – and anaemia tends to bring tiredness, weakness, and a general drop in energy along with it. Fatigue has a long list of possible causes, so testing is really the only way to know if kidneys are behind it.
3. Changes in Urination
As kidney disease progresses, urination patterns often shift – more frequent trips at night, persistent foaminess, blood in the urine, or a noticeable drop in how much you’re passing. Foamy urine specifically can point to albumin leaking through, though foam alone isn’t proof of anything. A urine albumin-to-creatinine ratio (UACR) test is what actually confirms whether albumin is present.
4. Shortness of Breath
In advanced kidney disease, breathlessness can stem from fluid buildup, anaemia, or both. That said, plenty of heart, lung, and other conditions cause the same symptom. If it’s severe or comes on suddenly, especially while resting, that needs prompt evaluation regardless of the cause.
5. Persistent Nausea and Vomiting
Once kidney function drops significantly, waste products accumulate in the blood and can bring on nausea, vomiting, appetite loss, taste changes, and weight loss. These symptoms overlap with plenty of other conditions, but persistent nausea or an unexplained loss of appetite – particularly in someone already diagnosed with kidney disease – deserves a closer look.
6. Blood Pressure That Won’t Respond to Medication
Kidneys and blood pressure influence each other constantly. Kidney disease can push blood pressure up, and uncontrolled hypertension can damage kidneys right back. If your numbers stay high despite treatment, it’s usually worth reviewing medications, lifestyle factors, and adherence – though on its own, this doesn’t mean kidney failure has set in.
7. Muscle Cramps and Bone Pain
Advanced kidney disease throws off mineral and electrolyte balance, which can show up as cramps, weakness, numbness, or general bone and muscle discomfort. Calcium and phosphorus levels are particularly affected as kidney function declines, and other electrolyte shifts can follow.
8. Metallic Taste in the Mouth and Bad Breath
Waste buildup can alter taste perception, sometimes leaving a metallic taste behind or contributing to unpleasant breath. Appetite changes often tag along with this too. None of these are specific enough to kidney disease to self-diagnose from, but they’re worth mentioning to a doctor.
9. Skin Itching and Dryness
Persistent itching shows up fairly often in advanced kidney disease, usually tied to shifts in mineral balance and substances building up in the blood. Dry or altered skin can accompany it. Itching has a lot of possible triggers, though, so it shouldn’t be assumed to be kidney-related without a proper look.
10. Difficulty Thinking Clearly
As kidney disease advances, waste buildup and metabolic changes can start affecting the nervous system – trouble concentrating, confusion, memory slips, or a general mental fog. Sudden confusion or any sharp change in mental status needs urgent attention, not a wait-and-see approach.
Symptoms That Should Never Be Ignored
A few symptoms call for urgent evaluation, not a wait-and-watch approach:
- Blood in the urine
- Sudden or severe swelling
- Severe breathlessness at rest
- Chest pain, especially with breathing difficulty or major fluid retention
- Confusion or altered consciousness
- A sudden, major drop in urine output, or almost none at all
These can stem from different causes, some quite serious. If you or someone close to you experiences any of them, don’t wait – seek urgent care or head to an emergency department.
Tests Used to Check Kidney Function
If you’re noticing symptoms or carry risk factors for kidney disease, a nephrologist will typically choose from a set of tests based on your history and presentation:
- Serum creatinine and eGFR – blood tests that assess filtration; creatinine is used to calculate eGFR
- Urine albumin-to-creatinine ratio (UACR) – detects albumin leaking into urine, a key marker of kidney damage
- Urinalysis – checks for blood, protein, and other abnormalities
- Blood urea nitrogen (BUN) – often checked alongside other kidney function markers
- Kidney ultrasound – used when structure, obstruction, or other abnormalities need a closer look
- 24-hour urine test – reserved for select situations needing more detailed information
For routine CKD evaluation, a spot UACR is usually enough – a full 24-hour urine collection isn’t needed for everyone. eGFR and urine albumin remain the two markers doctors rely on most for detecting and tracking CKD.
When Do Doctors Recommend Dialysis?
Not everyone with kidney disease ends up needing dialysis, and the decision is never based on one number alone – it comes from the full clinical picture.
Doctors typically consider it when kidney failure causes complications that medical treatment alone can’t control:
- Persistent symptoms or signs directly caused by kidney failure
- Fluid overload that medication can’t manage
- Blood pressure that resists control
- Electrolyte or acid-base abnormalities that don’t respond to treatment
- Significant uraemic symptoms – persistent nausea, confusion, or appetite loss
- Progressive nutritional decline tied to advanced kidney disease
An eGFR below 15 signals kidney failure, but that number alone doesn’t trigger dialysis automatically. KDIGO guidelines call for weighing symptoms, quality of life, patient preference, GFR level, and lab findings together – and in practice, dialysis often (though not always) begins somewhere between a GFR of 5 and 10 mL/min/1.73 m².
Plenty of patients show signs of declining function well before dialysis becomes necessary. Catching it early, and treating it appropriately, can manage complications and sometimes delay the need for kidney replacement therapy altogether.
Can Dialysis Be Prevented?
For some people with chronic kidney disease, the right treatment can slow the decline and push back the need for dialysis. Progression looks different for everyone, though, and not every case of advanced kidney disease is avoidable.
What tends to help:
- Keeping diabetes under control, since diabetic kidney disease is a leading cause of CKD
- Managing blood pressure consistently
- Being cautious with medications that can stress the kidneys, including certain NSAID painkillers
- Talking to your doctor before contrast-based imaging if you have significant kidney disease
- Following a kidney-appropriate diet, adjusted for sodium, protein, potassium, and other nutrients as needed
- Staying hydrated in line with your specific condition and your doctor’s advice
- Getting referred to a nephrologist early, once kidney disease or major risk factors are identified
Managing conditions like diabetes and high blood pressure does real work here – it protects kidney function and can meaningfully slow CKD’s progression.
Treatment Options for Advanced Kidney Disease
When kidney function drops critically, the main paths forward are:
- Haemodialysis – blood passes through a machine that removes waste and extra fluid; in-centre sessions are commonly done three times a week, around four hours each, though schedules vary
- Peritoneal dialysis – uses the abdominal lining as a natural filter, often manageable at home on a prescribed schedule
- Kidney transplant – a healthy donor kidney takes over filtering duties, an option for eligible patients with kidney failure
- Conservative management – treatment without dialysis or transplant, focused on symptom control and quality of life where appropriate
What’s right depends on kidney function, symptoms, other health conditions, and a conversation with your care team – not a one-size-fits-all answer.
Frequently Asked Questions
What are the signs that dialysis is needed?
Dialysis may come into consideration when kidney failure causes symptoms or complications that medical treatment alone can’t control – persistent fluid overload, resistant high blood pressure, serious electrolyte imbalances, or significant uraemic symptoms. eGFR alone doesn’t determine when it starts.
Can kidney failure be treated without dialysis?
In early and moderate stages, yes – treatment focuses on managing the underlying cause, controlling blood pressure and diabetes, and slowing further decline. Once kidney failure becomes advanced, the options expand to haemodialysis, peritoneal dialysis, transplant, or conservative management, depending on the individual.
Is dialysis always permanent?
Not always. Some kidney failure stems from potentially reversible causes, and function can sometimes recover depending on severity and cause. In established chronic kidney failure, though, dialysis is generally ongoing unless transplantation or another treatment changes that.
How often is dialysis required?
In-centre haemodialysis is typically three sessions a week, around four hours each. Peritoneal dialysis can run daily or overnight, depending on the prescribed method. The exact schedule comes down to what the nephrologist decides fits the patient’s condition.
Conclusion
Kidney disease often does its damage quietly, well before symptoms become obvious. If you’re noticing persistent or unexplained signs – especially alongside diabetes, high blood pressure, or another risk factor – don’t wait them out. A simple blood and urine test can tell you where things stand, and early evaluation gives your doctor the best shot at managing it well.
Reviewed by Dr. Sashidhar CH, Nephrologist, Hyderabad
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Please consult a qualified nephrologist for concerns about your kidney health.
