In the U.S., over 37 million people (more than 1 in 7 adults) have CKD. The real number is estimated to be even higher, since this disease does not typically present symptoms in the early stages of disease progression. In 2002, the Nation Kidney Foundation (NKF) published work that acknowledged that despite differing causes for CKD, all kidney diseases resulted in a decline in kidney function over time.
Routine testing for early diagnosis and intervention is shown to improve patient outcomes and potentially slow the rate of disease progression.
Key Points
- A large portion of patients with Stage 1-3 (mild to moderate) CKD do not experience a predictable pattern of disease progression.
- Later stages (4-5) of CKD are thought to progress in a pattern of linear and irreversible kidney function.
- The dominant causes of CKD in adults are hypertension and nephropathy diabetes.
- Regular kidney function testing is essential for diagnosis, treatments, prevention, and slowing disease progression.
Kidney Disease Overview
Chronic kidney disease (CKD) is when kidney damage may progress until the kidneys can no longer function. The kidneys’ primary role is to filter blood, removing waste products, toxins, and excess water. They also play a role in regulating blood pressure, stimulating the production of red blood cells, maintaining bone health, and balancing electrolytes and other vital mechanisms.
Two of the most common causes of kidney disease are hypertension and diabetes. Other kidney problems that can lead to the development of CKD include kidney cancer, glomerulonephritis, and lupus nephritis.
CKD is an irreversible disease that anyone can develop. There are risk factors such as diabetes and hypertension that increase the chance of developing kidney disease. If kidney disease is diagnosed early, treatment, and lifestyle changes, can be implemented to help slow down kidney damage.
Kidney Disease Progression
CKD generally progresses slowly, leading to irreversible nephron loss, and may progress to end-stage renal disease (ESRD). Multiple factors, individually or in combination, may influence the rate of disease progression.
Potential signs that CKD progression could occur suddenly or at an increased rate include:
- Proteinuria (higher than average amounts of protein in the urine)
- Congestive heart failure (and previous cardiovascular disease)
- Low serum albumin
- Hypertension (high blood pressure)
- Chronic (long-duration of) diabetes before diagnosis
- Anemia (insufficient red blood cells)
Additional factors that have been shown to indicate an increased rate of CKD disease progression:
- Current smoker
- Acute kidney injury (AKI)
- Low hemoglobin levels
There can be multiple reasons and risk factors that can contribute to the rate of CKD progression. CKD can be further complicated by genetics, lifestyle, or related medical conditions.
Stages of Chronic Kidney Disease
The progression of CKD can be expressed as stages. The five stages are based on the estimated glomerular filtration rate (eGFR) test result. As the stages increase, so does the progression of kidney disease and the worse your kidney function is. The use of this system allows for CKD to be consistently described, and the progression of risk factors can be accurately assessed.
The early stages of CKD disease progression are represented in stages 1-3:
- Stage 1 indicates an eGFR of 90 or higher. There is mild kidney damage, but the kidneys can still function normally or very well. Typically no symptoms are present in this stage.
- Stage 2 is defined by mild kidney damage, and the kidneys still work well. eGFR is between 60-89. There may not be any symptoms present for some patients. For other patients, there may be signs of physical kidney damage or protein present in the urine.
- Stage 3a means the eGFR is 45-59, with mild to moderate kidney damage. The kidneys no longer work as well as they should, with waste starting to build up in the body. Symptoms such as fatigue, weakness, or swelling in the feet and hands may start to present in this stage.
- Stage 3b means the eGFR is 30-44, with moderate to severe kidney damage. The kidneys don’t work well, with symptoms of CKD presenting.
The later stages of CKD disease progression are represented in stages 4-5:
- Stage 4 is characterized by severe kidney damage, indicated by an eGFR of 15-29. Kidney function is close to failure. Most people only know they have CKD when it has progressed to the later stages. Due to a lack of adequate kidney function, other health problems, such as hypertension, anemia, and heart disease, may present.
- Stage 5 means that your eGFR is less than 15, and the kidneys are the most severely damaged. Kidney function has failed (ESRD) or is close to failing. Treatment options may include dialysis or a kidney transplant.
How is CKD Progression Measured?
Glomerular filtration rate
Glomerular filtration rate (GFR) is used as a measure of kidney function in disease and health. GFR is equal to the sum of the filtration rates of the nephrons in the kidney. While GFR can’t be measured directly in humans, GFR can be assessed from eGFR ( serum levels of endogenous filtration markers) and mGFR (clearance measurements).
If there is a significant loss of functioning nephrons, an increase in blood creatinine levels is typically observed. Thus, estimating GFR with equations that consider serum creatinine levels, and the variables of gender, race, weight, and age, is a more efficient way of measuring kidney function.
GFR levels, in conjunction with albuminuria levels, can be used to determine disease progression in CKD patients. GFR, routinely measured over time, is essential for detecting kidney disease, understanding its stage (severity), and making clinical decisions about treatment, diagnosis, and prognosis.
Albuminuria
Albuminuria is the increased rate of excretion of urinary albumin (protein) and is a marker used to indicate kidney damage. Albumin is the most commonly found protein in the urine. Individuals with normal functioning kidneys excrete tiny amounts of protein. Increased amounts of albuminuria in the urine can indicate kidney damage.
Albuminuria is detected by albumin-to-creatinine ratio, as a routine dipstick is often not sensitive enough to detect trace amounts of albumin in early-stage kidney disease. Monitoring the urine albumin-to-creatinine ratio (UACR) can also be used to gauge the patient’s response to therapy and disease progression.
Panoramic Health
Panoramic Health is the largest integrated value-based kidney care platform that is focused on improving patient outcomes through holistic and coordinated care.
Our patients can expect a comprehensive care model, including SDOH services, PCP coordination, pharmacy, and nutrition.
Our value-based kidney care model drives improved patient outcomes and slows kidney disease progression by leveraging data and analytics to customize treatments based on our patient’s stage and risk profile.
