When should I worry about CKD?

When should I worry about CKD?

Stage 4 CKD (with a GFR under 30 ml/min) – is when you be worried about CKD. But it is not as simple as that (see later)

[” .. is it ever?!” MyHSN Ed].

Let’s go through the 5 stages, and discuss more about when you should be worried.

5 CKD Stages

These are the 5 stages (with stage 3 split into two) in the CKD classification, which are based on something called an estimated GFR (eGFR) (normal is 90-120 mls/min).

eGFR is a blood test which estimates the level of function of the kidney. GFR is in turn is based on the blood creatinine level. The lower creatinine and CKD stage, and higher the GFR, the better.

When should I worry about CKD? Does CKD always progress?

CKD does not always progress. Thinking that is does, is a common false belief. But for some patients, it does slowly ‘progress’ – i.e. worsen, from a very mild problem (CKD1-2) to kidney failure (CKD5) that is life-threatening.

So, if your CKD is not progressing (worsening), it may not be a huge concern. But if it is progressing, then, yes, it is a concern, as dialysis and/or a kidney transplant is possible one day.

CKD Stage 1+2 – Kidney damage or structural kidney problem (with normal kidney function) (eGFR 60-120 mls/min)

• Symptoms: no symptoms
• Doctors concern (and therefore yours!): little. There is no specific treatment needed for this stage of CKD. Risk factors for CKD should be looked at and treated if needed (for example high blood pressure).

CKD3A – Early mild CKD (eGFR 45-60 mls/min)

• Symptoms: no symptoms (usually)
• Doctors concern: mild. Doctors will focus on treating the cause of CKD and making sure blood pressure and blood sugars are in the correct range (if diabetic). This will help stop CKD worsening.

CKD3B – Later mild CKD (eGFR 30-45 mls/min)

• Symptoms: no or mild symptoms
• Doctors concern: some. Doctors will focus on treating the cause of CKD and making sure blood pressure and blood sugars are in the correct range (if diabetic). This will help stop CKD worsening
• GP (primary care): should discuss you with a nephrologist (specialist kidney doctor).

Note 1. CKD3B is worse than CKD3A
Note 2. CKD symptoms usually start if patients move from CKD3B to CKD4.

CKD4 – Moderate CKD (eGFR 15-29 mls/min)

• Symptoms: moderate
• Doctors concern: significant. A nephrologist should find the cause and treat your CKD, ensuring blood pressure and blood sugars are in the right range.
• GP (primary care): should refer you to a nephrologist (and you be seen in 4-6 weeks ideally, faster if deteriorating rapidly). The nephrologist will now usually start taking the lead in your care. Specific treatments for your cause of CKD may also be required.

Note. CKD4 means you may require dialysis or a kidney transplant one day.

CKD5 – Severe CKD (kidney failure) (eGFR < 15 mls/min)

• Symptoms: severe
• Doctors concern: high. Nephrologist should now lead, and be starting dialysis and/or preparing you for a kidney transplant, or giving supportive care (i.e no dialysis/transplant)
• GP: should stay in communication with nephrologist, and deal with non-kidney problems.

Note. CKD5 means you require dialysis, or a kidney transplant, or supportive care (no dialysis).

Importance of age and rate of decline

It is not just about the level of kidney function (and stage). The age of the patient and rate of decline are often more important than the number. Only then can a doctor understand whether it has significant meaning.

For example, a 29 year old with CKD1 (creatinine 64 mcmol/L, i.e. normal) that progresses to CKD3B (creatinine say 108, high-normal) in 6 months, is of more concern to a doctor than and 89 year old with stable CKD4 (creatinine 254).

The latter is likely to die with the problem, not of it. The former may need dialysis (or a kidney transplant) 5 years later, which has a major effect on longevity (how long you may live for).

Summary

We have described when you should worry about CKD. Stage 4 CKD. But not all patients progress. The patient’s age and rate of decline of GFR are important as well. We hope it has been helpful.

Other resource

At what CKD stage should you see a nephrologist?