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Understanding CKD Stage Progression

May 3, 2024

Chronic kidney disease is divided into five different stages based on how well the kidneys are functioning. As the stages progress, kidney damage becomes worse, resulting in kidney function loss. It is important to understand the stages of CKD progression and the steps you can take to help slow down the damage to your kidneys.

In this article, we discuss the five stages of kidney disease, how they are determined, common symptoms, and the impact on the kidneys.

Key Points

  • There are five stages of CKD, and they are based on estimated glomerular filtration rate (eGFR).
  • The stages of CKD also help guide treatment and management decisions.
  • Early detection of CKD is important to help slow disease progression and manage associated conditions.

About CKD

The kidneys are two bean-shaped organs about the size of a fist that play an essential role in cleaning the blood in your body. They filter blood, removing waste products, toxins, and excess water that would otherwise build up in the body, making you very sick and causing other life-threatening conditions.

The kidneys also play many important roles, such as:

  • Helping maintain healthy bones
  • Helping make red blood cells
  • Helping maintain blood pressure
  • Balancing essential minerals

When you have CKD, it means that your kidneys have become damaged, negatively affecting the way they can filter blood. The main risk factors for developing CKD are heart disease, diabetes, high blood pressure (hypertension), and a family history of kidney disease.

There is no cure for CKD, and it can progress to kidney failure, although not everyone who has CKD will develop kidney failure. Without treatment, kidney damage tends to worsen quicker. If the kidneys do fail, there are treatments such as dialysis and kidney transplantation available.

How Does CKD Progress?

CKD occurs when the kidneys have been damaged for at least three months. Unless kidney damage is caused by a single traumatic injury, CKD progresses slowly; symptoms typically only begin to show in the later stages of disease progression.

Risk factors for developing CKD or increasing disease progression include:

  • Diabetes
  • Hypertension (high blood pressure)
  • Heart disease or heart failure
  • Obesity
  • A family history of CKD or kidney disease
  • Being over the age of 60
  • Smoking or using other tobacco products

Lifestyle changes are implemented in conjunction with medicines and other interventions to help slow or prevent CKD progression.

How do doctors determine the stage of CKD?

The stages of CKD are determined using two simple tests: a blood test called the estimated glomerular filtration rate (eGFR) and a urine test called the urine albumin-creatinine ratio (uACR). Both these two tests help provide a clear picture of how well the kidneys are functioning.

eGFR shows how well the kidneys are filtering blood, and uACR shows if there is protein (albumin) leaking into the urine, which is an indicator of kidney damage.

How Many Stages of CKD Are There?

There are five stages of CKD, which classify how well the kidneys can filter blood. In the early stages (Stages 1-3), the kidneys can still filter blood relatively well; thus, many people only begin to show symptoms of kidney damage after the early stages. In the later stages (Stages 4-5), the kidney damage is substantial, resulting in the kidneys not being able to filter blood and potentially failing (completely stop working).

The treatment goal of each stage of CKD includes implementing lifestyle changes to slow down the damage to the kidneys and keep them functioning as long as possible. It’s also important for CKD patients to educate themselves on disease progression and treatment options as much and as early as possible.

Stage 1 of CKD

Stage 1 CKD means that you have a normal eGFR of 90 or higher. In Stage 1 CKD, kidney damage is mild, and they are still able to work well. There are typically no symptoms of kidney damage; however, there may be signs such as a protein (albumin) has been detected in your urine or physical damage.

At Stage 1 CKD, the main focus is to slow and prevent kidney damage, keeping them working well for as long as possible. Doctors will work with you to determine if you need to start or stop any medicines to protect the kidneys, help you keep your blood pressure at a healthy range, and control blood sugar if you have diabetes.

Stage 2 of CKD

Stage 2 CKD means that your eGFR has dropped to the range of 60 to 89. The damage to the kidneys is still mild, and they are still able to work well filtering blood. There still may not be any noticeable symptoms. Protein (albumin) may or may not be detected in your urine.

The treatment goal in Stage 2 CKD is to slow and prevent further kidney damage. This may be achieved by controlling blood sugar if you have diabetes, managing blood pressure levels, or stopping or starting medications to protect the kidneys.

Stage 3 of CKD

Stage 3 CKD is the middle stage of kidney disease, with your eGFR between 30 and 59. The kidneys have mild to moderate damage, but they are still functioning well enough that you do not need a kidney transplant or dialysis. Stage 3 CKD is split into two sub-categories:

  • Stage 3a means eGFR is between 45 and 59
  • Stage 3b means eGFR is between 30 and 44

For many people, they begin to notice symptoms such as:

  • Insomnia (trouble sleeping)
  • Pain in the lower back
  • Swelling in the hands or feet
  • Feeling tired or weak
  • Restless leg syndrome
  • Muscle cramps
  • Skin that feels itchy or dry
  • Urine that is dark or foamy
  • Urinating less or more often than normal

With treatment and lifestyle changes, many people who have Stage 3 CKD do not progress to Stage 4 or Stage 5.

Stage 4 of CKD

In Stage 4 CKD, the eGFR has dropped between 15 and 29, and the kidneys are moderately or severely damaged.. The kidneys are not functioning well, with waste products beginning to build up in the blood, which can cause other conditions such as high blood pressure, heart disease, anemia, metabolic acidosis, bone disease, high potassium, and high phosphorus.

Other symptoms that may present in Stage 4 CKD include:

  • Swelling in the legs or arms
  • Nausea and vomiting
  • Feeling less hungry than normal

A nephrologist will treat Stage 4 CKD with medications to help treat your symptoms and other associated conditions such as high blood pressure and diabetes. Your nephrologist will work with you to help you understand potential next steps for your treatment, including whether you need to start dialysis treatment and/or consider a kidney transplant.

Stage 5 of CKD

Stage 5 CKD means that your kidneys have failed or are very close to failing. The eGFR is less than 15, meaning the kidneys are severely damaged and are not functioning. This leads to waste products and excess water building up in the blood, causing additional health conditions.

Additional symptoms that begin to present in Stage 5 CKD include:

  • Changes in skin color
  • Making little or no urine
  • Headaches
  • Swelling in the feet, legs, hands, or arms
  • Trouble breathing

A nephrologist will discuss two treatment options with you:

  • Dialysis: this is a treatment that copies your kidney function by cleaning your blood.
  • A kidney transplant: This is a surgery that replaces one of your damaged kidneys with a donated healthy one from a living or deceased organ donor.

Panoramic Health

Panoramic Health is an integrated provider group delivering the future of kidney care. Our mission is to improve patient outcomes by slowing disease progression and improving their quality of life. We do this through the distinctive capabilities of our comprehensive care model, which brings together an integrated provider group with operational support, clinical support, and data and analytics at scale.

Through partnerships with practices, providers, payers, and health systems, we work to advance the usage of clinically validated best practices and cutting-edge data analytics across a continuum of reimbursement models.

*No information presented here should be construed as medical advice. Every patient is unique, and patients should consult a qualified physician to determine what is best for them.