What are the stages of CKD?
A person’s eGFR is the best indicator of how well the kidneys are working. An eGFR of 90 or above is considered normal. A person whose eGFR stays below 60 for 3 months or longer has CKD. As kidney function declines, the risk of complications rises.
Moderate decrease in eGFR (30 to 59). At this stage of CKD, hormones and minerals can be thrown out of balance, leading to anemia and weak bones. A health care provider can help prevent or treat these complications with medicines and advice about food choices.
Severe reduction in eGFR (15 to 29). The patient should continue following the treatment for complications of CKD and learn as much as possible about the treatments for kidney failure. Each treatment requires preparation. Those who choose hemodialysis will need to have a procedure to make veins in their arms larger and stronger for repeated needle insertions. For peritoneal dialysis, one will need to have a catheter placed in the abdomen. A catheter is a thin, flexible tube used to fill the abdominal cavity with fluid. A person may want to ask family or friends to consider donating a kidney for transplantation.
Kidney failure (eGFR less than 15). When the kidneys do not work well enough to maintain life, dialysis or a kidney transplant will be needed.
In addition to tracking eGFR, blood tests can show when substances in the blood are out of balance. If phosphorus or potassium levels start to climb, a blood test will prompt the health care provider to address these issues before they permanently affect the person’s health.
What can be done about CKD?
Unfortunately, CKD often cannot be cured. But people in the early stages of CKD may be able to make their kidneys last longer by taking certain steps. They will also want to minimize the risks for heart attack and stroke because CKD patients are susceptible to these problems.
Controlling Blood Pressure
People with reduced kidney function and high blood pressure should control their blood pressure with an ACE inhibitor or an ARB. Many people will require two or more types of medication to keep their blood pressure below 130/80. A diuretic is an important addition when the ACE inhibitor or ARB does not meet the blood pressure goal.
Changing the Diet
People with reduced kidney function need to be aware that some parts of a normal diet may speed their kidney failure.
Protein. Protein is important to the body. It helps the body repair muscles and fight disease. Protein comes mostly from meat but can also be found in eggs, milk, nuts, beans, and other foods. Healthy kidneys take wastes out of the blood but leave in the protein. Impaired kidneys may fail to separate the protein from the wastes.
Some doctors tell their kidney patients to limit the amount of protein they eat so the kidneys have less work to do. But a person cannot avoid protein entirely. People with CKD can work with a dietitian to create the right food plan.
Cholesterol. Another problem that may be associated with kidney failure is high cholesterol. High levels of cholesterol in the blood may result from a high-fat diet.
Cholesterol can build up on the inside walls of blood vessels. The buildup makes pumping blood through the vessels harder for the heart and can cause heart attacks and strokes.
Sodium. Sodium is a chemical found in salt and other foods. Sodium in the diet may raise a person’s blood pressure, so people with CKD should limit foods that contain high levels of sodium. High-sodium foods include canned or processed foods like frozen dinners and hot dogs.
Potassium. Potassium is a mineral found naturally in many fruits and vegetables, such as oranges, potatoes, bananas, dried fruits, dried beans and peas, and nuts. Healthy kidneys measure potassium in the blood and remove excess amounts. Diseased kidneys may fail to remove excess potassium. With very poor kidney function, high potassium levels can affect the heart rhythm.
Smoking not only increases the risk of kidney disease, but it also contributes to deaths from strokes and heart attacks in people with CKD.
Anemia is a condition in which the blood does not contain enough red blood cells. These cells are important because they carry oxygen throughout the body. A person who is anemic will feel tired and look pale. Healthy kidneys make the hormone EPO, which stimulates the bones to make red blood cells. Diseased kidneys may not make enough EPO. A person with CKD may need to take injections of a form of EPO.