Different stages of Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a condition in which the kidney is unable to filter out the wastes or toxins from the blood, efficiently. The condition develops and progresses gradually. Most people are not even aware of its existence, unless they are having regular Health Checkup that includes a Kidney Function Test (KFT), or till such time that the disease is in an advanced stage and is showing symptoms. There are more than a dozen conditions or ailments that can cause CKD, but prominent among them are hypertension and diabetes. CKD if detected late can lead to kidney failure, which will require regular dialysis until such time that a kidney transplant can be done. CKD also causes many complications that affect different organs of your body.

CKD progresses through stages. To define or demarcate these stages, physicians use a parameter called as estimated glomerular filtration rate or eGFR. This is an indication of how well the kidneys are filtering toxins from the blood. Higher the eGFR count, the healthier the kidney is. Lower the count, this could be a sign of CKD. In addition to eGFR, the doctors may also call for a serum creatinine level test. Creatinine is a substance found in the blood, and a waste product of the body’s metabolism, which the kidneys eliminate through the urine. A high creatinine level in the blood indicates the kidneys are not functioning properly. An albumin test of the blood will reveal if protein is leaking into the urine, which is another sign of CKD. The doctors may also call for an MRI, CT scan or ultrasound if injury is suspected as the cause for CKD.

Stages of CKD

Stage of CKD	eGFR Score	Percentage of Kidney Function
1	>90 ml/min	>90%
2	60-89 ml/min	60-89%
3A	45-59 ml/min	45-59%
3B	30-44 ml/min	30-44%
4	15-29 ml/min	15-29%
5	<15ml/min	<15%

Stage 1

In stage 1, the condition has not been detected yet or has been detected accidentally through a health checkup. The kidneys are still working well and the damage is not significant. The person should meet a nephrologist and follow their recommendations to control the condition and prevent it from reaching stage 2. There is no specific medication for CKD at this stage. The person should keep his/her blood-sugar, BP and weight in check. He/she should consume a healthy diet, quit smoking and live an active lifestyle with regular exercise. These changes are important as CKD cannot be completely cured but can be controlled to a good extent.

Stage 2

In this stage, there is slight damage and quite often shows up as proteinuria (protein leaking into the urine). The kidneys are still performing optimally, but there are mild symptoms like weakness, sleep issues, fatigue, loss of appetite and itching. The same lifestyle changes and measures underlined under stage 1 must be followed here too. If blood-sugar and hypertension are not coming under control in-spite of the person’s best efforts, the physicians will prescribe medication for the same. Other than this, there are no medications specific to CKD.

Stages 3A and 3B

These stages indicate that there is damage to the kidneys and the disease is progressing gradually. While most patients don’t show any symptoms yet, some of them suffer from the conditions mentioned under Stage 2. In addition, there can be back pain, swelling of the hands and feet, and urination that is more or less than normal. If left untreated, there can be complications such as high blood-pressure, anemia, bone disease and the risk of Stage-4 CKD.

At this stage, the nephrologist will start medication which includes:

• (ACE) inhibitors or angiotensin II receptor blockers that will keep blood-pressure in check
• Medication for fluid retention which includes diuretics and a low-salt diet
• Medications to lower cholesterol
• Medication for anemia such as erythropoietin supplements
• Medication for weakening bones such as vitamin D supplements
• Medication for calcification in the blood vessels such as phosphate binders
• A low-protein diet as prescribed by a nutritionist or dietician

There will be frequent follow-up visits with the nephrologist and nutritionist to make any changes if required.

Stage 4

At this stage, there is moderate to significant kidney damage. The kidneys are working at very low levels of performance. As a result, fluid, wastes and toxins are building up in the blood which shows up in the form of different symptoms. These include all the symptoms found in earlier stages as well as new symptoms. All in all, these would be:

• Weakness and fatigue
• loss of appetite
• nausea and vomiting
• sleep problems
• urinating more or less than usual
• persistent itching
• shortness of breath
• foul-smelling breath
• chest pain
• back pain
• decline in mental alertness and other cognitive functions
• swelling of the hands and feet
• muscle twitches or cramps

Treatment at this stage includes the same medication outlined in Stage 4, for some patients. But for most patients, dialysis begins at this stage, at a lesser frequency than stage 5. Dialysis is the process of removing the blood out of the body, filtering or cleaning it in a machine and then sending it back to the body. The doctors will also put the patient on a kidney-transplant waiting-list and prepare him/her for a kidney transplant.

Stage 5

At this stage, the performance of the kidneys is almost nil, which is called as end-stage renal disease or kidney failure. The same symptoms as outlined in stage 4 continue but with more severity. Dialysis will happen more frequently as that is the only option for filtering the blood now. The doctors may also start looking for donors within friends and family circles who are a match. This is because dialysis is a short-term solution (less than a year) and kidney transplant is inevitable. Since waiting lists can be long, a donor that is known to the family is the first choice.

Outlook

Chronic Kidney Disease is fatal in some cases, but most people do eventually get a transplant, given the increase in number of live and cadaver (or deceased) donors. But the key takeaway from this article is the importance of maintaining a healthy lifestyle. Among the large organs (lungs, liver, heart, brain and kidneys), the kidneys are relatively more delicate or vulnerable to disease and damage than the others. By following a healthy lifestyle at any age, and certainly after the age of 50, the risk of CKD can be significantly reduced.

Another key takeaway is the importance of an annual health checkup after the age of 30 years and health checkups once in 6 months after the age of 60 years. This helps, as many conditions like early-stage CKD do not show any symptoms. So early detection will prevent progression of the disease and help win the battle against any disease. This ensures the person lives a good quality of life well into the old ages.

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Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

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