Understanding the 5 stages of Chronic Kidney Disease

We do not have to stress out or even define what CKD is because we have discussed it in this blog in several articles and we already know what it is all about.

Instead today we are going to take a deep look at the 5 stages of Chronic Kidney Disease that were developed or designed by the National Kidney Foundation (NKF) in order to understand better Kidney diseases and to give doctors  some sort of guideline that will help them identify the evolution of the kidney disease and know how to give the patient the best care possible for each stage.

FIVE_5 stages of Chronic Kidney Disease

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Let’s take a look at those 5 stages.

Stage 1 and 2:

Somebody that is in stage 1 or 2 of CKD has a small kidney damage and his or her glomerular filtration rate (GFR) is normal or a bit higher than 90 ml/min. in this stage, symptoms are not common and the kidneys are still working normally. If the person is to find out he or she is on stage 1 CKD it is because the person was being tested for other things and the results came out with certain amount of creatinine levels or they discovered blood or protein in the urine or there was an imaging test and the results said there was a kidney damage.

For people that are in this stage the treatment only focuses on a healthy diet including whole grains, fresh fruits and vegetables, no fats or low fat diets, control the intake of sugar and sodium, have a good weight and exercise very regularly, take vitamins recommended by doctors and definitively stop smoking and having bad habits for the body.

When it comes to stage 2, the description is just the same with the disease having no symptoms and the kidney working at a very good level. The only difference here is that the kidney already has a mild damage and it is getting a bit late to discover it or to treat it and the glomerular filtration rate is around 60-89 ml/min.

Stage 3:

Here the person has already a moderate kidney damage. This stage has two parts which are called A and B. in stage 3A the glomerular filtration rate is 45-59 mL/min, and in stage 3B the glomerular filtration rate is 30-44 mL/min.  Here the disease is already noticeable and patients start to feel the symptoms. A condition called uremia appears and secondary complications such as high blood pressure, anemia and bone disease start to appear as well.

The symptoms for this stage are the feeling of being tired all the time, high retention of fluids, extremities start to swell and the patient starts feeling that his or her breath is just not enough, urine changes color to a more reddish, brownish color or it even contains blood which will make it red, lower back pain, problems with sleep and muscle cramps.

In this stage, the kidney is working at a 50% performance and the idea is to help the patient keep their kidneys working as long as possible.

In this stage, a very controlled diet and medications are essential to make the kidney live longer. When it comes to medications ( the diet is very important even since stage 1) in this stage they become essential to control glucose levels and have a very good blood pressure in order to maintain the kidney working for as long as possible. The medications doctors prescribe in this stage are ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers).

Stage 4:

Here the patient has a real problem that needs to be tackled as soon as possible and with the correct treatment. Their glomerular filtration rate is 15-30 ml/min. and treatments are now very viable options. Unfortunately, a patient with stage 4 CKD will have to get a kidney transplant in the near future. In this stage conditions like anemia, uremia, bone disease, high blood pressure, heart complications and cardiovascular diseases start to become present.

The symptoms in this stage are fatigue, hard kidney pain in the lower back, sleeping problems, nausea, vomiting, a  metallic taste in their mouth, bad breath, loss of appetite due to the flavor in their mouth, difficulty in concentrating and numbness or tingling in the toes or fingers.

In this stage, there are 3 different types of treatments which are Hemodialysis, Peritoneal dialysis and, Kidney transplant

Stage 5:

Unfortunately, at this stage, the person has no options and it is a terminal disease called end-stage renal disease (ESRD) that has a glomerular filtration rate of 15 ml/min or less. In this stage, the kidneys no longer work and don’t have the ability to do anything at all. In this stage dialysis or a kidney transplant will be needed to survive.  

It is very important to understand these five stages so patients and doctors can find out about the disease in the early stages and give patients the option of having a very good quality of life.

Be sure to also read this post about how to choose the right treatment in case of renal failure?


Some significant concepts about the Renal Compensation

As we have seen in different posts, the renal function is vital for human’s living. Through this process, the human body can filter the toxins and different substances from the blood, which cleans it and gives to people what they need to have a good quality living. If the renal system does not work adequately, a renal failure may occur. This problem could be defined in a few words like the impossibility for the body to process the different substances from the blood. A renal failure could be acute or chronic. Let’s see some of the most imperative concepts about this topic and some of its elements.

Acute renal failure

This renal failure is when the human body loses an important blood amount, or if for some reason a particular person ingests a toxic substance, causing the kidneys to fail and eventually to generate renal failures. In other words, an acute renal affectation could be generated by different external situations that change the normal functioning of the human body.

Chronic renal failure

This affectation is generated for some diseases or healthy hereditary problems, causing failures in the renal system. In some occasions, these issues are incurable and may require constant medical intervention, like dialysis or surgeries.

These two concepts are vital to understanding what the Renal Compensation is because they explain in a few words how the renal system works and which are its affectations. Having this clear, we can talk about other important concepts like the respiratory compensation, the respiratory acidosis, the respiratory alkalosis or the Glomerular Filtration Rate. However, it is important to understand firstly what the Renal Compensation is.

Renal Dialysis Technician

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The Renal Compensation concept

It could be defined as the process where the kidneys can regulate the acidity in the plasma, that is to say, that through the Renal Compensation, the human body can establish and control the pH in the blood.

When the plasma pH differs from 7.4, the body could suffer acidemia or alkalemia. Acidemia is when the blood acidity is lesser than 7.4, which means lack of acids which must be in the blood. Alkalemia occurs when the plasma pH is higher than 7.4 and means an excess of acid substances in the blood. When some of these problems occur, the human body can suffer respiratory or metabolic problems, and they could happen if there is a lack of Renal Compensation.

The Glomerular Filtration Rate

This concept refers to the filtered fluid volume in time by the human body, from the renal system to the Bowman capsule, which is part of the renal functioning where all the body substances to be excreted are filtered. Through this rate, the correct working of the renal system is measured, in other words, the Glomerular Filtration Rate is used for knowing if the kidneys and other elements from the renal circuit are operating in an adequate way.

Usually, the Glomerular Filtration Rate is measured through different techniques. Some of the most important are the measurement using inulin, the measurement with radioactive tracers, the estimation using the Cockcroft-Gault formula, the MDRD formula or the Starling Leonardo technique. Each one of these methods is developed to know and understand how the level of filtered fluids in the blood by the renal system, is working.

The Glomerular Filtration Rate is measured millimeters per minutes. In men, the adequate rate is 90 ± 14 millimeters per minute, in women is 60 ± 10 millimeters per minute.

hemodialysis_renal compensation

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Respiratory compensation

It is a medical method to change the blood acidity varying the respiratory rate. Put differently, the Respiratory compensation is a mechanism to alter the breathing way in the human body so the plasma pH can vary, depending on what the person needs.

The normal breathing rates in humans are measured in breaths per minute and are distributed like this:

In children, the normal rates are: from birth to six weeks of living, between 30 to 40 breaths per minute, from 6 months to three years, between 25 to 40 breaths per minute, from three to six years, 20 to 30 breaths per minute, and from six years to ten years, between 17 to 23 breaths per minute.

In adults, the rates are 12 to 18 breaths per minute, older than 65 years, between 12 to 28 breaths per minute, and older than 80 years, 10 to 30 breaths per minute.

We have seen some of the most used and recognized concepts in the Renal compensation process, but there are much more that must be understood to have a fuller picture of this term and its functioning. For example, other important notions about it are the Creatinine clearance, the Kt/V and its standardization, the Renal blood flow, the Ultrafiltration, the Filtration fraction, the PaH clearance, among other elements that are fundamental for the renal system understanding and its renal compensation.

Related: Dispelling The Most Common Myths About Kidney Disease by Joe Cosgrove

How to choose the right treatment in case of renal failure?

If you have kidney disease, you must make certain decisions about the coming treatment. If you choose so, alternatives are basically three hemodialysis, peritoneal dialysis, and kidney transplantation. Each one has advantages and disadvantages. It is also possible for you to decide not to submit to any kind of treatment. If you know your choices, you can decide wisely with the help of your doctor about what is best for you. Whatever treatment you choose, you must make some changes in your life, such as diet and the way to plan your daily activities.


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The first aspect you should consider is the status of your kidney disease is. Knowing this is so important for your doctor in order to determine the kind of treatment that best fits your health situation. Renal disease has five stages. First is kidney damage, for example, when there is protein in the urine of patients (with a filter of 90 or higher on the scale of glomerular filtration rate GFR). The second stage is kidney damage with a mild decrease (with a slight GFR decrease between 60 and 89). The third is the moderate GFR decrease; specifically, between 30 and 59. The fourth stage is a severe GFR reduction: between 15 and 29. Finally, the last stage is kidney failure, which occurs when the kidneys are not able to adequately filter toxins and other waste substances from the blood stream.

The numbers in the GFR is a way to know about how much kidney function remains for a particular patient. There are different techniques to calculate the glomerular filtration rate. These techniques generally make use of an endogenous or added substance that filters almost completely and then is almost not reabsorbed or excreted at tubular level. GFR can be determined by injecting insulin in the blood plasma, by measuring the rate of creatinine clearance, using the Cockcroft-Gault, using the MDRD formula, or the Starling Leonardo equation.

It is very important that a proper diagnosis of the current condition of your renal system is made before choosing any option.

Related article: What You Need To Know About Dialysis by Joe Cosgrove

If the GFR is below 30, your doctor should tell you about the possibilities in the dialysis treatment, and you would have a little time to take a decision. However, if the index is below 15, it is advisable to start any treatment as soon as possible, because the risk of dying is actually imminent.

Now, the first way for treating renal failure is kidney transplantation, and its great advantage is that you don’t have to undergo long and constant dialysis sessions. The downside is that, on the one hand, it is difficult to find donors and, on the other hand, sometimes it is even harder for the patient’s body to assimilate the transplanted organ. The latter usually happens because the patient’s antibody levels may be very high, so the body considers that the transplanted organ must be removed, and then triggers the immune system to attack it with all its cellular system artillery.

Another method of treating kidney failure is, of course, dialysis. There are two types of dialysis: hemodialysis and peritoneal dialysis.

Many doctors help their patients to choose treatments from a series of simple criteria: the medical affection, the lifestyle that the patient will have after it, the daily care (diet, for instance), the type of medication (and its side effects) and the treatment plan, which is different in both cases.

Hemodialysis removes wastes and the excess of fluid from the blood stream. During this process, blood is pumped through tubes to a dialysis machine and takes it through a special filter called a dialyzer, and then the machine gradually returns the blood to the patient. Each session lasts three to five hours and must be performed at least three times a week.

This treatment can be done at home (see the picture below) or in a specialized center, usually a hospital. If the dialysis session will be done at home you need to have the right equipment and enough space for it, as well as access to water and electricity. It is crucial to have an assistant for each session, which can be a nurse or a trained member of your family.


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Peritoneal dialysis is not developed outside the body. For this treatment, the inner membrane of the abdomen (peritoneum) is used as a natural filter. This process requires a dialysate circulation fluid flowing through the abdomen through a catheter. This catheter is inserted into the body through a simple surgery. After several hours, the introduced cleaning solution is drained and a new amount must be introduced. This exchange usually lasts about half an hour.

This treatment is carried out at home. It is a way to treat kidney failure for those who need more independence than those patients who prefer hemodialysis.

Recommended: Dialysis or kidney transplantation — which is right for me?