Aug
After receiving a diagnosis of chronic kidney disease (CKD), it’s understandable to feel overwhelmed. However, understanding the stage of your disease is crucial for managing and slowing its progression. CKD is categorized into five stages based on the level of kidney function.
Knowing your stage empowers you to take appropriate measures to control your CKD and protect your kidney health. Richard Glassock, MD, professor emeritus at the David Geffen School of Medicine at the University of California in Los Angeles, emphasizes the importance of being aware of your stage in order to make informed decisions and seek the right interventions for your condition.
The Stages of Kidney Disease
Chronic kidney disease (CKD) is a condition characterized by the impairment of kidney function, affecting their ability to effectively filter blood, as described by the National Kidney Foundation (NKF). The progression of CKD is divided into five distinct stages, outlined by the American Kidney Fund (AKF), which range from mild (stage 1) to advanced kidney failure (stage 5).
The classification of these stages is based on the kidneys’ capacity to filter waste and fluid from the blood. Dr. Glassock emphasizes the significance of understanding your specific stage, as it provides valuable insight into the extent of kidney damage and guides appropriate management strategies.
Filteration Rate—GFR and eGFR
To determine the stage of your kidney disease, healthcare providers rely on measurements of your glomerular filtration rate (GFR) and estimated glomerular filtration rate (eGFR). These tests assess the kidneys’ ability to filter the blood effectively.
The National Kidney Foundation (NKF) explains that GFR and eGFR measurements involve evaluating the levels of creatinine, a waste product found in the blood. By calculating the amount of creatinine, healthcare providers can assess how well the kidneys are filtering the blood. It’s important to note that factors such as diet, muscle mass, malnutrition, or other underlying health conditions can influence creatinine levels, which is taken into consideration during the evaluation.
Stage 1 CKD
eGFR Levels: 90 or Above
Stage 1 of chronic kidney disease (CKD) indicates that your kidneys are functioning normally, but there may be signs of mild kidney damage, as explained by the American Kidney Fund (AKF). During this stage, you may not experience any noticeable symptoms apart from the presence of protein in your urine, which can be detected through a urine test conducted at your healthcare provider’s office. Additional warning signs to watch for include high blood pressure and swelling in the legs, as highlighted by Dr. Robert Greenwell, Chief of Nephrology at Mercy Medical Center in Baltimore.
Treatment for Stage 1 CKD
An essential aspect of treating stage 1 chronic kidney disease (CKD) is addressing underlying medical conditions, particularly high blood pressure and type 2 diabetes, which are common causes of the disease. Dr. Greenwell emphasizes the importance of taking steps to control these conditions effectively. Monitoring your blood pressure and blood sugar levels is crucial in this regard. Additionally, your healthcare provider may recommend medication to manage high blood pressure or diabetes, depending on your specific needs. By actively managing these conditions, you can help prevent further progression of kidney damage and maintain better overall kidney health.
Stage 2 CKD
eGFR Levels: Between 60 and 89
Stage 2 of chronic kidney disease (CKD) indicates that while your kidneys are still functioning well, there is evidence of physical damage. It is possible to have stage 2 CKD without experiencing noticeable symptoms. Similar to stage 1, the presence of protein in the urine may be detected during this stage.
Dr. Glassock explains that healthy kidneys filter out waste and excess fluid while retaining proteins in the bloodstream. However, damaged kidneys may allow albumin, a type of protein, to leak into the urine. This can disrupt the balance of fluid in the body, leading to fluid retention, commonly observed in the hands and feet.
Monitoring the protein levels in your urine, known as albuminuria, is crucial during this stage. Regular check-ups and appropriate management of underlying conditions, such as high blood pressure and diabetes, play a significant role in preserving kidney function and preventing further damage. Working closely with your healthcare provider can help you effectively manage stage 2 CKD and maintain optimal kidney health.
Treatment for Stage 2 CKD
During stage 2 of chronic kidney disease (CKD), the treatment approach is similar to stage 1, as mentioned by Dr. Glassock. If you have high blood pressure, it is possible that you are already taking hypertension medications like ACE inhibitors or ARBs, as recommended by the American Heart Association. However, if you are not currently on any medication, your healthcare provider may suggest starting these medications to manage your blood pressure.
Dr. Glassock emphasizes that these medications not only help control blood pressure but also play a role in protecting the kidneys from further damage.
In addition to medication, certain lifestyle modifications can contribute to the treatment of CKD. Regular physical activity, aiming for at least 30 minutes of exercise daily, is beneficial. It is also crucial to quit smoking, as smoking can worsen kidney function and increase the risk of complications. Working with a dietician can help you identify kidney-friendly foods and develop a suitable meal plan that aligns with your nutritional needs.
By implementing these lifestyle changes and adhering to medical recommendations, you can actively participate in the management of stage 2 CKD and promote kidney health. Regular communication with your healthcare team is essential for monitoring your condition and making necessary adjustments to your treatment plan.
Stage 3 CKD
eGFR Levels: Between 30 and 59
As you progress to stage 3 of chronic kidney disease (CKD), it becomes essential to consult a nephrologist, a healthcare professional specialized in kidney-related health issues. At this stage, the kidneys exhibit significant damage and are functioning below their optimal capacity, as mentioned by Dr. Glassock.
Stage 3 of CKD is further categorized into two sub-stages based on the estimated glomerular filtration rate (eGFR):
- Stage 3a: eGFR ranges between 45 and 59.
- Stage 3b: eGFR ranges between 30 and 44.
In addition to the symptoms that may manifest during stages 1 and 2, Dr. Glassock highlights two potential health complications that become more concerning during stage 3: anemia and bone mineral disorder.
Anemia refers to a condition characterized by low levels of red blood cells, which can lead to fatigue, weakness, and shortness of breath. In the context of CKD, the kidneys are less efficient in producing a hormone called erythropoietin, which stimulates red blood cell production.
Bone mineral disorder refers to imbalances in minerals like calcium and phosphorus, which can affect bone health. With diminished kidney function, the kidneys struggle to regulate these minerals, potentially leading to weakened bones and an increased risk of fractures.
During stage 3, it is crucial to work closely with a nephrologist who can monitor your condition, manage complications, and develop an appropriate treatment plan tailored to your specific needs. Regular follow-up appointments, blood tests, and imaging studies may be recommended to assess kidney function and address any emerging issues.
Adhering to the recommended lifestyle changes, medications, and interventions suggested by your nephrologist can help slow down the progression of CKD and mitigate the risk of complications. Open and honest communication with your healthcare team is vital to ensure comprehensive care and support throughout your CKD journey.
Mineral and Bone Disorder
Due to the impaired filtration function of the kidneys in stage 3 chronic kidney disease (CKD), the balance of essential minerals responsible for bone health, such as calcium and phosphorus, becomes disrupted. This information is provided by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
The imbalance of these minerals poses a higher risk of developing mineral and bone disorders. In this stage, the bones, as well as the heart and blood vessels, may be affected. The kidneys play a vital role in regulating the levels of calcium and phosphorus in the body. However, with reduced kidney function, these minerals can accumulate or become depleted, leading to complications.
When calcium and phosphorus levels are imbalanced, it can have several implications. Excess levels of phosphorus in the blood can result in a condition called hyperphosphatemia, which can weaken the bones over time. On the other hand, low levels of calcium can trigger the release of parathyroid hormone, leading to increased calcium release from the bones, further contributing to bone mineral disorders.
Moreover, imbalances in these minerals can also affect the cardiovascular system. High phosphorus levels can promote calcification in blood vessels, increasing the risk of cardiovascular complications such as heart disease and hypertension.
Managing mineral and bone disorders is an essential aspect of stage 3 CKD treatment. Healthcare providers may recommend dietary modifications, including limiting phosphorus-rich foods and ensuring adequate calcium intake. Additionally, medications and supplements may be prescribed to maintain optimal mineral levels and reduce the risk of bone complications.
Regular monitoring, including blood tests and bone density scans, allows healthcare providers to assess the status of mineral and bone health and make necessary adjustments to the treatment plan. Collaborating closely with your healthcare team and following their recommendations can help mitigate the impact of mineral and bone disorders associated with stage 3 CKD.
Anemia
Anemia is a common complication that can occur in late-stage chronic kidney disease (CKD), affecting approximately one out of seven individuals, as stated by Dr. Glassock. In CKD, the kidneys are unable to produce an adequate amount of a hormone called erythropoietin (EPO), which plays a crucial role in red blood cell production, explained Dr. Glassock. Consequently, the level of red blood cells in the body decreases, as noted by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
The prevalence and severity of anemia tend to increase as CKD progresses. Certain factors can further increase the risk of developing anemia in individuals with CKD, including diabetes and age over 60.
Anemia can have various effects on the body, such as fatigue, weakness, shortness of breath, and reduced exercise tolerance. It can impact overall well-being and quality of life. Additionally, anemia can worsen other complications associated with CKD, such as cardiovascular issues.
Managing anemia in CKD typically involves addressing the underlying cause and providing treatment to increase red blood cell production. This may involve the administration of synthetic erythropoietin or iron supplements to help stimulate the production of red blood cells. Depending on the severity and underlying factors, other interventions like blood transfusions or adjustments to medication regimens may be considered.
Regular monitoring of hemoglobin levels and collaboration with healthcare providers are essential for effectively managing anemia in CKD. This helps ensure appropriate interventions are implemented to maintain adequate red blood cell counts and mitigate the impact of anemia-related symptoms and complications.
Treatment for Stage 3 CKD
Dr. Glassock emphasizes the continued importance of the steps taken during stages 1 and 2 in managing CKD: controlling diabetes and blood pressure, refraining from smoking, maintaining a healthy diet, and engaging in regular physical activity. If you haven’t already done so, it is recommended to schedule a consultation with a dietitian to receive personalized dietary guidance.
In addition, considering the potential impact on bone health and anemia, Dr. Glassock suggests considering the use of vitamin D, calcium, and iron supplements. The National Kidney Foundation (NKF) advises that certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and arthritis medications, may have adverse effects on kidney function. It is crucial to discuss all the medications you are currently taking with your healthcare provider to ensure their compatibility with your kidney health.
Regular communication with your healthcare provider and periodic monitoring of kidney function, blood pressure, and other relevant parameters are essential in managing CKD. This allows for appropriate adjustments in treatment plans and the identification of any potential concerns or changes in your condition.
By actively addressing these aspects of your health and closely collaborating with your healthcare team, you can help manage CKD and maintain the best possible kidney function and overall well-being.
Stage 4 CKD
eGFR Levels: Between 15 and 29
In stage 4 of chronic kidney disease (CKD), which is the last stage before kidney failure, the kidneys are significantly damaged. In addition to the symptoms experienced in previous stages, such as proteinuria and fluid retention, you may also develop jaundice, characterized by yellowing of the whites of the eyes, as mentioned by the National Kidney Foundation (NKF).
Individuals in stage 4 may also experience various symptoms including:
- Fatigue
- Swelling in the arms or legs
- Frequent urination
- Lower back pain
- Muscle cramps
- Nausea or vomiting
- Loss of appetite
At this stage, individuals are likely to encounter other complications associated with CKD, such as heart problems, anemia, high levels of potassium and phosphorus, bone and mineral disorders, high blood pressure, and nutritional deficiencies. It is crucial to address these complications and manage them effectively.
If you have other conditions that can exacerbate kidney disease, such as high blood pressure or type 2 diabetes, it is vital to take steps to control and manage them effectively. Proper management of these conditions can help slow the progression of kidney disease and minimize further damage.
Regular monitoring of kidney function, blood pressure, and other relevant health parameters is important in stage 4 CKD. Your healthcare provider will work with you to develop a comprehensive treatment plan that may include medication adjustments, dietary modifications, and lifestyle changes to optimize your overall health and well-being.
Treatment for Stage 4 CKD
Your healthcare provider will assess the need for treatment if you reach the stage of kidney failure. Treatment options for kidney failure typically include dialysis, which is a procedure designed to remove waste products and excess fluid from the body when the kidneys are no longer able to perform this function. There are two primary types of dialysis:
- Hemodialysis: This treatment involves circulating your blood through a machine, known as a dialyzer, which acts as an artificial kidney. The dialyzer removes waste and excess fluid from your blood, after which the filtered blood is returned to your body. Hemodialysis is typically conducted in a dialysis clinic and requires a significant time commitment, usually around four hours per session, three times per week.
- Peritoneal Dialysis: With peritoneal dialysis, the dialysis solution is introduced directly into the peritoneal cavity, a space in your abdomen that houses organs such as the stomach, liver, and intestines. The peritoneal membrane lining this cavity acts as a natural filter, allowing waste and excess fluid to be drawn out of the bloodstream and into the dialysis solution. This process is repeated several times a day using a catheter, and it can be performed at home, providing more flexibility and independence. Many individuals choose to undergo peritoneal dialysis during sleep, allowing them to engage in regular daytime activities. It is important to note that peritoneal dialysis requires a level of comfort and skill in operating the equipment and handling the catheter insertion and removal.
The choice between hemodialysis and peritoneal dialysis depends on various factors, including your medical condition, lifestyle preferences, and the recommendation of your healthcare team. They will provide guidance and support to help you make an informed decision that best suits your needs and circumstances.
Stage 5
eGFR: Less Than 15
When you reach stage 5 chronic kidney disease, also known as end-stage renal disease (ESRD), your kidneys have significantly declined in function, and you are in kidney failure. At this point, the accumulation of waste products in your blood can lead to severe illness if not addressed. Without treatment, ESRD can be life-threatening.
In addition to the symptoms experienced in stage 4, individuals in stage 5 may also encounter the following symptoms:
- Difficulty breathing: Kidney failure can lead to fluid retention in the lungs, causing shortness of breath and difficulty breathing.
- Changes in skin color: ESRD can affect the appearance of your skin, leading to pallor (pale complexion) or yellowing of the skin, known as jaundice.
- Headaches: Headaches can be a common symptom of kidney failure, resulting from the buildup of waste products and changes in fluid balance.
- Reduced urine output: In stage 5, your kidneys are no longer able to produce a significant amount of urine, resulting in little to no urine being passed.
It is crucial to seek medical attention and discuss treatment options with your healthcare provider if you reach stage 5 chronic kidney disease. The most common treatments for kidney failure are dialysis and kidney transplantation. Dialysis helps remove waste and excess fluid from the body, while kidney transplantation involves receiving a healthy kidney from a donor to replace the non-functioning kidneys.
Your healthcare provider will work closely with you to determine the best treatment plan based on your individual needs and preferences. It is essential to address stage 5 chronic kidney disease promptly to manage symptoms, improve quality of life, and potentially prolong life expectancy.
Treatment for Stage 5 CKD
According to the AKF, there are two main treatment options for stage 5 chronic kidney disease: kidney dialysis and kidney transplant. Among these options, kidney transplantation is considered the preferred treatment due to its potential for a better quality of life and improved survival rates, as explained by Dr. Greenwell.
However, it is important to note that there is a shortage of available kidneys nationwide, as highlighted by the NIDDK. As a result, if you require a kidney transplant, you will need to be placed on a waiting list and continue with dialysis until a suitable kidney becomes available.
Both living and deceased individuals can provide kidneys for transplantation. Generally, kidneys from living donors tend to have better long-term outcomes. In some cases, family members or friends may be willing to donate a kidney since a person can live with just one functioning kidney.
It is important to recognize that not everyone may be eligible for a kidney transplant. In such cases, lifelong dialysis will likely be necessary. If you are deemed eligible for a kidney transplant and successfully receive one, there will still be challenges to address post-surgery, as emphasized by Dr. Greenwell.
Following kidney transplantation, you will need to take medications and undergo regular monitoring to minimize the risk of organ rejection. These medication regimens are essential and must be continued for your entire lifetime. However, it is important to be aware that these medications can have significant side effects, such as an increased risk of severe infections, diabetes, and certain types of cancers, as highlighted by the NIDDK.
Your healthcare provider will guide you through the treatment options, discuss the potential risks and benefits, and provide ongoing support and monitoring to ensure the best possible outcomes for managing stage 5 chronic kidney disease.
