Stages - KTEN.com - No One Gets You Closer

Stages

I just found out I have kidney failure. Does this mean I am going to die?
No. Dialysis or a kidney transplant can keep you alive when your kidneys fail. The more you learn and take part in your treatment, the better you can feel. Some people live for decades with kidney failure.

What are the stages of chronic kidney disease (CKD)?
In chronic kidney disease, the kidneys don't usually fail all at once. Instead, kidney disease often progresses slowly over a period of years. This is good news because if CKD is caught early, medications and lifestyle changes may help slow its progress and keep you feeling your best for as long as possible. With early diagnosis, it may be possible to slow, stop, or even reverse CKD depending on the cause. The National Kidney Foundation (NKF) recently published information on the stages of Chronic Kidney Disease (CKD). In the table below, the "GFR level," (or glomerular filtration rate) is a measure of how well your kidneys are cleaning your blood. Your doctor can calculate your GFR, based on a formula.

Stages of Chronic Kidney Disease

Stage Description GFR Level
Normal kidney function Healthy kidneys 90 mL/min or more
Stage 1 Kidney damage with normal or high GFR 90 mL/min or more
Stage 2 Kidney damage and mild decrease in GFR 60 to 89 mL/min
Stage 3 Moderate decrease in GFR 30 to 59 mL/min
Stage 4 Severe decrease in GFR 15 to 29 mL/min
Stage 5 Kidney failure Less than 15 mL/min or on dialysis

In Stage 1 and Stage 2 CKD, there are often few symptoms. Early CKD is usually diagnosed when there is:

  • High blood pressure
  • Higher than normal levels of creatinine or urea in the blood
  • Blood or protein in the urine
  • Evidence of kidney damage in an MRI, CT scan, ultrasound, or contrast X-ray
  • A family history of polycystic kidney disease

    In Stage 3 CKD, anemia (a shortage of red blood cells) and/or early bone disease may appear and should be treated to help you feel your best and reduce problems down the road.

    When CKD has progressed to Stage 4, it's time to begin preparing for dialysis and/or a kidney transplant.

    How many people in the U.S. have chronic kidney disease?
    The National Kidney Foundation estimates that about 20 million adults in the U.S. have some degree of chronic kidney disease (CKD). Of these, about 300,000 have Stage 5 CKD, or kidney failure-they are on dialysis or have a glomerular filtration rate (GFR) of less than 15 mL/min. Another 400,000 have Stage 4 CKD (severe), and about 7.5 million are at Stage 3 (moderate). The rest have some kidney damage, but have normal or only mildly reduced kidney function (CKD Stages 1 and 2). Trends in the data show that the numbers of people with CKD are rising. Many people with CKD do not know they have it. Symptoms are normally subtle until late in the course of the disease. With early detection, the course of CKD can usually be slowed.

    What is the difference between creatinine clearance, glomerular filtration rate, (GFR) and percent kidney function?

    All three of these tests measure how well your kidneys are working. Even though they are different, the terms are often used interchangeably.

    Creatinine is a waste that healthy kidneys can remove. Creatinine clearance is tested by taking a 24-hour urine sample and a blood sample, and calculating how quickly your kidneys "clear" your blood of creatinine. Another way to determine creatinine clearance is by using an equation that gives an approximate value based on blood creatinine level, height, weight, and age. Creatinine clearance is reported in milliliters per minute (mL/min). For healthy men, a normal creatinine clearance is 97-137 mL/min. For healthy women, a normal creatinine clearance is 88-128 mL/min.

    Glomerular filtration rate (GFR) tells how quickly your kidneys are cleaning your blood. GFR is also reported in milliliters per minute. A normal GFR is greater than 90 mL/min.

    Percent kidney function is an estimate of how much function the kidneys have left. Because a GFR of 100 milliliters per minute (mL/min) is in the normal range, it is convenient to assume that 100 mL/min is about equal to 100% kidney function. So a creatinine clearance or GFR of 30 mL/min would be called "30% kidney function."

    If you're interested in the technical aspects of estimating GFR, see "Estimation of GFR," Guideline 4 of the K/DOQI Clinical Practice Guidelines for CKD at: http://www.kidney.org/professionals/doqi/kdoqi/toc.htm

    Laboratory Values Showing You Have Kidney Failure

    Test Names Diabetes No Diabetes
    Creatinine 6.0 mg/dl or higher 8.0 mg/dl or higher
    Creatinine clearance 15 ml/min or lower 10 ml/min or lower
    Glomerular Filtration Rate (GFR) calculated from creatine, age, sex, race 15 mL/min / 1.73m2 or lower 10 mL/min / 1.73m2 or lower

    When should I be referred to a nephrologist?
    You should be under the care of a nephrologist if your creatinine clearance, a measure of your kidney function, is 30 mL/min or lower. This translates to stage 4 chronic kidney disease (CKD).

    When you first find out you have CKD (even if it is stage 2 or 3), seeing a nephrologist at least once can help you develop a plan of care. A nephrologist can help you and your primary care doctor to:

  • Slow the rate of decline of your kidney function
  • Decide if a kidney biopsy might be useful
  • Diagnose the type of kidney disease and whether it might be reversible with treatment
  • Manage complications of kidney disease, such as anemia, high blood pressure, metabolic acidosis, and changes in mineral balance

    Where can I learn more about kidney disease?
    It's great that you want to learn more about kidney disease and dialysis so you can make more informed decisions. DaVita offers a class for people who have kidney disease as well as their families. Depending on where you live in the U.S. , there may be a class near you. Call Guest Services at 1-800-244-0680 (operating hours: Pacific time: 5am to 6:30pm / Eastern time: 8am - 9:30pm). Learn more about our classes at www.keyconnections.com (DaVita's kidney health education program).