What are the 5 stages of kidney disease?

 What are the 5 stages of kidney disease?

Upon receiving a diagnosis of chronic kidney disease (CKD), it's common to feel overwhelmed. However, understanding the stage of your condition is crucial, as CKD is classified into five stages based on kidney function. According to Richard Glassock, MD, a professor emeritus at the David Geffen School of Medicine at the University of California in Los Angeles, knowing your CKD stage is essential for taking appropriate steps to manage the condition and potentially slow its progression.

Stage 1 CKD

• eGFR level of 90 or above

, characterized by an eGFR level of 90 or above, indicates mild kidney damage despite the kidneys functioning well, as per the AKF. Typically, individuals with stage 1 CKD do not exhibit symptoms apart from the presence of protein in their urine, detectable through a urine test at their healthcare provider's office. Additional indicators may include high blood pressure or leg swelling, noted Robert Greenwell, MD, chief of nephrology at Mercy Medical Center in Baltimore.

• Treatment for Stage 1 CKD

Treatment for Stage 1 CKD primarily focuses on addressing underlying medical conditions. "High blood pressure and type 2 diabetes are two of the most common causes of stage 1 chronic kidney disease, so it's really important to take steps to get them under control," emphasized Dr. Greenwell. Monitoring blood pressure and blood sugar levels is essential, and individuals may require medications to manage these conditions effectively.

Stage 2 CKD:

• eGFR levels ranging between 60 and 89

characterized by eGFR levels ranging between 60 and 89, signifies that while the kidneys are still functioning well, they exhibit evident signs of physical damage, noted Dr. Glassock. Despite this damage, some individuals may not experience any symptoms, akin to stage 1. Protein in the urine, similar to stage 1, is also common in stage 2.

"Healthy kidneys remove extra fluid and waste from your blood but let proteins return to your bloodstream," explained Dr. Glassock. "When they're damaged, they let albumin escape through their filters, so they end up in your urine."

As protein aids in controlling fluid levels in the body, individuals may observe fluid retention, particularly in the hands and feet.

• Treatment for Stage 2 CKD

Treatment for Stage 2 CKD typically mirrors that of stage 1, according to Dr. Glassock. If high blood pressure is present, patients may already be on hypertension medication such as angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs), as recommended by the American Heart Association. However, if medication has not been initiated, healthcare providers may advise its commencement.

"These drugs also help to protect your kidneys from further damage," elucidated Dr. Glassock.

Implementing certain lifestyle adjustments can also aid in managing CKD. This includes engaging in at least 30 minutes of physical activity daily, ceasing smoking, and adopting a kidney-friendly diet. Consulting with a dietician can provide tailored guidance on optimal dietary choices.

Stage 3 CKD:

• eGFR levels ranging between 30 and 59

characterized by eGFR levels ranging between 30 and 59, marks a critical phase where kidney damage becomes evident, prompting the necessity of consulting a nephrologist—a healthcare specialist proficient in kidney-related health matters. At this juncture, the kidneys are functioning below optimal levels, as emphasized by Dr. Glassock.

Stage 3, as delineated by the AKF, is further subdivided into two categories based on eGFR:

• Stage 3a: eGFR between 45 and 59.
• Stage 3b: eGFR between 30 and 44.

In addition to the symptoms that may manifest during stages 1 and 2, Dr. Glassock noted an escalated risk of encountering two serious health issues.

• Treatment for Stage 3 CKD

Treatment for Stage 3 CKD emphasizes the continuation of essential measures undertaken during earlier stages, as emphasized by Dr. Glassock. These measures include managing diabetes and blood pressure, abstaining from smoking, adopting a nutritious diet, and maintaining regular physical activity. Consulting with a dietitian remains crucial if not already done.

Additionally, supplementation with vitamin D, calcium, and iron is recommended to support bone health and address anemia. Notably, certain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and arthritis medication may exacerbate kidney damage, as highlighted by the AKF. Hence, it is imperative to discuss and review your medication regimen with your healthcare provider.

stage 4 CKD:

• eGFR levels between 15 and 29

In stage 4 CKD, with eGFR levels between 15 and 29, the kidneys are severely damaged, nearing kidney failure. Symptoms may include fatigue, swelling in the arms or legs, frequent urination, lower back pain, muscle cramps, nausea or vomiting, and loss of appetite. Jaundice, characterized by yellowing of the eyes' whites, can also occur.

Additionally, individuals at this stage are likely to experience complications such as heart problems, anemia, electrolyte imbalances, bone and mineral disease, high blood pressure, and poor nutritional health.

• Treatment for stage 4 CKD

Treatment for stage 4 CKD involves managing complications and preparing for kidney failure. Dialysis, which removes waste products from the body when the kidneys fail, may be necessary. Hemodialysis involves circulating blood through a machine for filtration at a clinic, typically three times per week. Alternatively, peritoneal dialysis entails dialysis solution introduction into the abdominal cavity, allowing waste absorption, usually performed at home during sleep.

Determining the appropriate treatment approach is crucial and should be discussed with a healthcare provider.

stage 5 CKD:

• eGFR of less than 15

In stage 5 CKD, with an eGFR of less than 15, kidney failure occurs, leading to the accumulation of waste in the blood, causing severe illness. Symptoms may include trouble breathing, changes in skin color, headaches, and producing little to no urine.

• Treatment options for stage 5 CKD

Treatment options for stage 5 CKD are limited to kidney dialysis or kidney transplant. Kidney transplantation is preferred for its better quality of life and survival rates. However, due to a national kidney shortage, patients often need to wait on a transplant list while continuing dialysis. Kidneys can be donated by living or deceased individuals, with kidneys from living donors generally offering better outcomes.

For individuals ineligible for kidney transplants, lifelong dialysis is necessary. Post-transplantation, patients require ongoing medication and monitoring to prevent organ rejection, which may lead to severe infections, diabetes, and increased cancer risk.