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?

What is it like to live with dialysis?

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In the United States at least 217,000 patients need to live with dialysis. This represents national costs for over $11 billion dollars every year. This procedure needs to take place when the kidneys are unable to filter fluids and their full capacity is lost. Sometimes, patients who need to live with dialysis have to do so because they were born with a kidney condition and they cannot afford a kidney transplant.

Statistically speaking, this is a dramatic situation for thousands of people in the United States. However, most patients seem to believe that dialysis is not such a terrible thing and they have adapted to a “new normal life”. But, what does it means to live with dialysis? In this article, Joe Cosgrove will share some details related to the way patients learn to have regular lives while they depend on dialysis to survive.

The Experience

First of all, when a patient decides that it is time to go under dialysis treatment it is because its kidneys are not able to do their job. This means that dialysis becomes the only alternative to survive. Keeping this in mind makes it easier and more motivating to people who need to go under treatment.

During a regular dialysis routine, the patient needs to come to the dialysis clinic and meet the nurse at the counter. Papers and forms will be filled out and a short checkup will take place. Since most patients have done this a thousand times, the process usually doesn’t take long.

After the checkup, the patient settles into one of the comfortable recliners inside the room where the process usually takes place. The patient may be the only one in the room or not, depending on the day and time it decides to go and get the treatment.

After settling, the patient will need to prop its left arm, allowing the technician to slip a couple needles into its blood vessels (close to the wrist). One of the needles is in charge of removing the blood and the other one is in charge of taking it back to the body. These needles are attached to plastic tubes that at the same time are connected to the dialysis machine.

For the next three hours, the needles will do their job and the patient’s blood will be filtered. All this is possible thanks to the dialysis machine that stands still next to the patient’s recliner. Most patients bring a book or spend this time watching a movie or a TV show on Netflix. Sometimes, this is even the perfect moment to take a nap.

Besides from the initial moment of the procedure, when the needles need to be stuck on your veins, the dialysis process doesn’t hurt. Sometimes patients may feel dazed and their blood pressure can drop. But, other than that, the process takes place in a comfortable way.

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Living with dialysis is supposed to make things easier for patients with End Stage Renal Disease (ESRD). However, the mortality rates in the United States remain to be considerably high compared to those in Japan or Europe since many patients choose to skip the procedure or don’t accept it to last for too many hours.

Related: How To Make The Most Out Of Your Time On Dialysis

How Dialysis Works

The best way to describe the dialysis process is as an artificial kidney. This means that dialysis should be able to do what your kidneys cannot do anymore. There are two different forms of dialysis: hemodialysis and peritoneal dialysis. At least 90% of the patients in the United States who live with dialysis choose to go under the hemodialysis treatment. This is the procedure that was described in the experience above.

When patients live with hemodialysis, their blood needs to be circulated outside of the body with the help of a hemodialysis device. This device cleanses the blood and then returns it back to the body of the patient.

Not everyone is a right candidate to get hemodialysis. This is why every patient needs to have the doctor’s approval before having an entrance or access (a minor surgery on the leg, arm or neck to access the blood vessels). This access is called fistula and the patient will need to keep it clean and usable for as long as it needs to go under dialysis treatment.

The fistula is something dialysis patients need to learn how to live with since it is the only way doctors have to access the blood in a fast and effective way. Fistulas are joints between arteries and veins located under the skin that form a larger vessel where needles are inserted.

When patients don’t need to live with dialysis and only go under a temporary treatment, they can get a catheter on their neck and there is no need for them to go under this minor surgery. In the case of the fistula, the wound needs to heal before the dialysis treatment takes place. However, in case patients use a catheter, they can go under the dialysis treatment right away and the procedure is slightly different.

Everything You Need to Know About Pediatric Dialysis

As Joe Cosgrove has already pointed out in previous articles, having kidney disease means that your kidneys are not properly working and are not able to filter blood anymore like they should. When this condition gets worst it is known as end-stage renal disease or ESRD and needs to be treated with dialysis.

Pediatric Emergency Department

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Most people think that ESRD only affects adults since their bodies are more deteriorated. However, ESRD also affects children. At least 1,462 children in the United States need to start dialysis treatment every year. Most of these children have congenital disorders (33%), have damaged kidneys due to glomerular disease (24,6%), or need to go on dialysis because they have glomerulonephritis (12,9%).

When we talk about adults, the most common causes of kidney failure are related to high blood pressure or diabetes. Nevertheless, when we talk about children, kidney disease is rarely related to those two conditions and it is often caused as a side effect of other treatments or because they have a hereditary condition that may affect their urinary tract.

Treating Children with ESRD in the United States

Every year over 10,000 children is treated for ESRD in the United States. Most of these children use hemodialysis as it is less invasive and easier to adapt to their bodies. This is how, every year 56 percent of these children are treated with hemodialysis and the rest just go under peritoneal dialysis, have kidney transplants or take alternative treatments.

At least 1,300 children are listed for kidney transplant every year. Over the past 20 years, this number seems to have grown dramatically since kidney diseases have become more popular among the U.S. population.

This is how treatments and medical procedures for children have also evolved. Technology has done major improvements and filtering membranes and catheters are now meant to be used in children, so their size is smaller, sometimes they are more resistant and flexible.

At first, there were many side effects related to hemodialysis in children. However, this seems to have been controlled over the past two decades. Now the morbidity rates during dialysis have considerably decreased and it is less common to experience seizures as a side effect during the treatment. The already mentioned medical advances have made it easier for children to deal with such an invasive procedure, so hypotensive episodes are quite uncommon nowadays.

A sensitive treatment

Saddest Pediatric Patient

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Two decades ago it was common for a dialysis patient to say that it was feeling pain or discomfort during the treatment. Keeping in mind that children’s bodies are more sensitive and fragile, dialysis procedures are less painful and discomforting today. The catheters used during the entire dialysis process are internal, making it impossible for children to remove it without helps. Besides, anesthetic creams are used to puncture the patient.

More sensitive and less invasive technologies have also been developed in order to reduce dramatic effects such as morbidity. These technologies can also reduce healthcare costs, making it simpler for the health care providers too.

Synthetic materials used in children are biocompatible and have a smaller size. This way, tubing and other processes related to pediatric dialysis are easier on the infant’s body. Diameter and length of tubes have been reduced so they can fit the patient’s veins. This way, the volume of filtered blood is going to be adequate both for having a successful a treatment and taking care of the child’s needs.

Machines used in pediatric dialysis are also special ones, so blood pumping is normal compared to the one that happens during the treatment adults get. Most dialysis machines used with children are designed to meet their needs and be used with pediatric patients.

The speed used when the blood is pumped in children is slower than in adults and needs to be kept that way since the capacity of patients to output blood is different and veins could be cloaked. For this reason, children need to be monitored during the entire dialysis session. Machines are always designed in a way that it is easier for healthcare providers to be in control of the dialysis process during the entire time.

Related: Is dialysis always recommendable?

Hemodialysis

Since children with ESRD will need to be exposed to dialysis for a long period, hemodialysis needs to be seen as a whole and not as a mere step of kidney disease therapy. Dialysis in children should be seen as a temporary thing. This happens because if the patient is feeling better then it will stop the treatment and if things complicate and the kidneys completely fail, then the pediatric patient will need to get a kidney transplant.

When patients have the chance to heal, then hemodialysis enables the chances for patients to improve their condition, while they can keep having a normal life. This treatment can often affect children’s physiologically when it is done in the long term, so it is recommended to give some kind of support to children while they are going through dialysis treatment.