A person with stage 1 chronic kidney disease (CKD) has kidney damage with a glomerular filtration rate (GFR) at a normal or high level greater than 90 ml/min. There are usually no symptoms to indicate the kidneys are damaged. Because kidneys do a good job even when they’re not functioning at 100 percent, most people will not know they have stage 1 CKD. If they do find out they’re in stage 1, it’s usually because they were being tested for another condition such as diabetes or high blood pressure (the two leading causes of kidney disease).

Symptoms of stage 1 kidney disease

Other ways a person may discover they are in stage 1 CKD include:

• 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 (PKD)

Treating stage 1 kidney disease

Regular testing for protein in the urine and serum creatinine can show whether the kidney damage is progressing. Living a healthy lifestyle can help slow the progression of kidney disease. It is recommended that people in stage 1 CKD:

Eat a healthy diet:

• • Include a variety of grains(especially whole grains),, fresh fruits and vegetables.
  • Change to a diet that is low in saturated fat and cholesterol and moderate in total fats.
  • Limit intake of refined and processed foods high in sugar and sodium.
  • Choose and prepare foods with less salt or high-sodium ingredients.
  • Aim for a healthy weight and include physical activity each day.
  • Keep protein within a healthy level, as recommended by a renal dietitian.
  • Consume adequate calories.
  • Consume vitamins and minerals as recommended by a doctor.
  • Potassium and phosphorus are usually not restricted unless blood levels are above normal
• Keep their blood pressure at a healthy level.
  • 125/75 for those with diabetes
  • 130/85 for non-diabetes and non-proteinuria
    • 125/75 for non-diabetes with proteinuria
• Keep their blood sugar or diabetes under control.
• Have regular checkups with their doctor and include a serum creatinine test to measure GFR.
• Take medicines as prescribed by their doctor.
• Exercise regularly.
• Stop smoking.

Living with stage 1 kidney disease

There is no cure for kidney disease, but it may be possible to stop its progress or at least slow down the damage. In many cases, the correct treatment and lifestyle changes can help keep a person and their kidneys healthier longer.

A person with stage 2 chronic kidney disease (CKD) has kidney damage with a mild decrease in their glomerular filtration rate (GFR) of 60-89 ml/min. There are usually no symptoms to indicate the kidneys are damaged. Because kidneys do a good job even when they’re not functioning at 100 percent, most people will not know they have stage 2 CKD. If they do find out they’re in stage 2, it’s usually because they were being tested for another condition such as diabetes or high blood pressure–the two leading causes of kidney disease.

Signs of stage 2 kidney disease

Other ways a person may discover they are in stage 2 CKD include:

• 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 (PKD)

Treating stage 2 kidney disease

Regular testing for protein in the urine and serum creatinine can show whether the kidney damage is progressing. Living a healthy lifestyle can help slow progression of kidney disease. It’s recommended that people in stage 2 CKD:

Eat a healthy diet

• Include a variety of grains (especially whole grains), fresh fruits and vegetables.
• Change to a diet that is low in saturated fat and cholesterol and moderate in total fats.
• Limit intake of refined and processed foods high in sugar and sodium.
• Choose and prepare foods with less salt or high-sodium ingredients.
• Aim for a healthy weight, consume adequate calories and include physical activity each day.
• Keep protein intake within a healthy level, as recommended by a renal dietitian.
• Consume vitamins and minerals as recommended by a doctor.
• Potassium and phosphorus are usually not restricted unless blood levels are above normal

Keep their blood pressure at a healthy level.

• 125/75 for those with diabetes
• 130/85 for non-diabetes and non-proteinuria
• 125/75 for non-diabetes with proteinuria

Keep their blood sugar or diabetes under control.

Have regular checkups with their doctor and include a serum creatinine test to measure GFR.

Take medicines as prescribed by their doctor.

Exercise regularly.Stop smoking.

Living with stage 2 kidney disease
There is no cure for kidney disease, but it may be possible to stop its progress or at least slow down the damage. In many cases, the correct treatment and lifestyle changes can help keep a person and their kidneys healthier longer.

A person with stage 3 chronic kidney disease (CKD) has moderate kidney damage. This stage is broken up into two: a decrease in glomerular filtration rate (GFR) for Stage 3A is 45-59 mL/min and a decrease in GFR for Stage 3B is 30-44 mL/min. As kidney function declines waste products can build up in the blood causing a condition known as “uremia.” In stage 3 a person is more likely to develop complications of kidney disease such as high blood pressure, anemia (a shortage of red blood cells) and/or early bone disease.
Symptoms of stage 3 CKD

Symptoms may start to become present in stage 3:

• Fatigue
• Fluid retention, swelling (edema) of extremities and shortness of breath:
• Urination changes (foamy; dark orange, brown, tea-colored or red if it contains blood; and urinating more or less than normal)
• Kidney pain felt in their back
• Sleep problems due to muscle cramps or restless legs

Seeing a doctor when you have stage 3 CKD

As stage 3 progresses, a patient should see a nephrologist (a doctor who specializes in treating kidney disease). Nephrologists examine patients and perform lab tests so they can gather information about their condition to offer the best advice for treatment. The nephrologist’s goal is to help their patient keep their kidneys working as long as possible.

Meeting a dietitian when you have stage 3 CKD

Someone in stage 3 may also be referred to a dietitian. Because diet is such an important part of treatment, the dietitian will review a person’s lab work results and recommend a meal plan individualized for their needs. Eating a proper diet can help preserve kidney function and overall health.

Get help managing your kidney diet with free kidney-friendly cookbooks.

Diet and stage 3 CKD

For stage 3 CKD, a healthy diet is likely to consist of:

• Eating high-quality protein and potassium (if blood levels are above normal)
• Consuming some grains, fruits and vegetables (potassium and phosphorus are at normal levels)
• Limiting phosphorus to help PTH levels remain normal, prevent bone disease and even preserve existing kidney function
• Lowering calcium consumption
• Cutting back carbohydrates for those with diabetes
• Decreasing saturated fats to help lower cholesterol
• Lowering sodium for people with high blood pressure or fluid retention by cutting out processed and pre-packaged foods
• Limiting calcium if blood levels are too high
• Taking water soluble vitamins such as C (100 mg per day) and B complex, or completely avoiding over-the-counter dietary supplements (unless approved by the nephrologist)

It’s helpful to work with a registered renal dietitian because as the stages of CKD change, so will the diet.

Medications and stage 3 CKD

Many people who develop CKD have diabetes or high blood pressure. By keeping their glucose level under control and maintaining a healthy blood pressure, this can help them preserve their kidney function. For both of these conditions, a doctor will likely prescribe a blood pressure medicine. Studies have shown that ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) help slow the progression of kidney disease even in people with diabetes who do not have high blood pressure. Patients should ask their doctors about all of their medicines and take them exactly as prescribed.

More ways to manage stage 3 CKD

In addition to eating right and taking prescribed medicines, exercising regularly and not smoking are helpful to prolonging kidney health. Patients should talk to their doctors about an exercise plan. Doctors can also provide tips on how to stop smoking.

Get help when you have stage 3 CKD

There is no cure for kidney disease, but it may be possible to stop its progress or at least slow down the damage. In many cases, the correct treatment and lifestyle changes can help keep a person and their kidneys healthier longer.

A person with stage 4 chronic kidney disease (CKD) has advanced kidney damage with a severe decrease in the glomerular filtration rate (GFR) to 15-30 ml/min. It is likely someone with stage 4 CKD will need dialysis or a kidney transplant in the near future.

As kidney function declines, waste products build up in the blood causing a condition known as uremia. In stage 4, a person is likely to develop complications of kidney disease such as high blood pressure, anemia (a shortage of red blood cells), bone disease, heart disease and other cardiovascular diseases.
Symptoms of stage 4 kidney disease

Symptoms that are experienced in stage 4 include:

Fatigue
Fluid retention, swelling (edema) of extremities and shortness of breath
Urination changes (foamy; dark orange, brown, tea-colored or red if it contains blood; and urinating more or less than normal)
Kidney pain felt in their back
Sleep problems due to muscle cramps or restless legs
Nausea and/or vomiting
Taste changesa metallic taste in the mouth
Bad breath due to urea buildup in the blood
Loss of appetite: People may not feel like eating, and some people report having a metallic taste in their mouth or bad breath.
Difficulty in concentrating: Having trouble doing everyday things such as balancing a checkbook or focusing on reading the newspaper can occur.
Nerve problems: Numbness or tingling in the toes or fingers is a symptom of CKD.

Seeing a doctor when you have stage 4 CKD

At stage 4, it’s necessary to see a nephrologist (a doctor who specializes in treating kidney disease). The nephrologist examines the patient and orders lab tests to gather information to recommend treatment.

People in stage 4 CKD will usually visit their doctor at least every three months. Blood tests for creatinine, hemoglobin, calcium and phosphorus levels will be done to see how well the kidneys are working. The doctor will also monitor other conditions such as high blood pressure and diabetes. In addition to helping the patient keep their kidneys working as long as possible, the nephrologist will also help prepare the patient for dialysis or a kidney transplant.
Looking at treatment options when you have stage 4 CKD

Those with stage 4 CKD who will need treatment are told about their choices, including:

Hemodialysis: This is a treatment that can be done in a center or in a patient’s home with assistance from a care partner. A dialysis machine removes a small amount of a patient’s blood through a man-made membrane called a dialyzer, or artificial kidney, to clean out toxins that the kidneys can no longer remove. The filtered blood is then returned to the body.
Peritoneal dialysis (PD): Unlike hemodialysis, PD is a needle-free treatment and a care partner is not required to to help assist during treatment. PD can be performed at home or at work.
Kidney transplant: This is a preferred treatment and does not require as many diet restrictions as those who are on hemodialysis or PD.

Meeting with a dietitian when you have stage 4 CKD

A person in stage 4 may also be referred to a dietitian. Because diet is such an important part of treatment, the dietitian will review a person’s lab work results and recommend a meal plan individualized for their needs. Eating a proper diet can help preserve kidney function and overall health.
Diet and stage 4 CKD

For stage 4 CKD, a healthy diet is likely to consist of:

Reducing protein consumption to help decrease the buildup of protein waste
Consuming a some grains, fruits and vegetables (potassium and phosphorus are at normal levels)
Limiting phosphorus to help PTH levels remain normal, prevent bone disease and even preserve existing kidney function
Restricting potassium if blood levels are above normal
Lowering calcium consumption
Cutting back carbohydrates for those with diabetes
Decreasing saturated fats to help lower cholesterol
Lowering sodium for people with hypertension or fluid retention by cutting out processed and pre-packaged foods
Limiting calcium if blood levels are too high
Taking water soluble vitamins such as vitamin C (100 mg per day) and vitamin B complex, or completely avoiding over-the-counter dietary supplements (unless approved by the nephrologist)

Medications and stage 4 CKD

It’s recommended that people in stage 4 keep their blood pressure at a healthy level and those with diabetes keep their glucose level under control. Taking all the medicines as prescribed by the doctor may help prolong kidney function.

Managing stage 4 CKD

In addition to eating right and taking prescribed medicines, exercising regularly and not smoking are helpful in maintaining health. Patients should talk to their doctors about an exercise plan. Doctors can also provide tips on how to stop smoking.

The National Kidney Foundation (NKF) guidelines recommend starting dialysis when kidney function drops to 15 percent or less. By doing everything possible to help prolong kidney function and overall health, the goal is to put off dialysis or transplant for as long as possible.

A person with stage 5 chronic kidney disease has end stage renal disease (ESRD) with a glomerular filtration rate (GFR) of 15 ml/min or less. At this advanced stage of kidney disease, the kidneys have lost nearly all their ability to do their job effectively, and eventually dialysis or a kidney transplant is needed to live.
Symptoms of stage 5 CKD

Symptoms that can occur in stage 5 CKD include:

• Loss of appetite
• Nausea or vomiting
• Headaches
• Being tired
• Being unable to concentrate
• Itching
• Making little or no urine
• Swelling, especially around the eyes and ankles
• Muscle cramps
• Tingling in hands or feet
• Changes in skin color
• Increased skin pigmentation

Because the kidneys are no longer able to remove waste and fluids from the body, toxins build up in the blood, causing an overall ill feeling. Kidneys also have other functions they are no longer able to perform such as regulating blood pressure, producing the hormone that helps make red blood cells and activating vitamin D for healthy bones.

If you are diagnosed with stage 5 CKD, you will need to see a nephrologist immediately. This is a doctor who is trained in kidney disease, kidney dialysis and transplant. The doctor will help you decide which treatment is best for you—hemodialysis, peritoneal dialysis (PD) or kidney transplant—and will recommend an access for dialysis. Your nephrologist will develop your overall care plan and manage your healthcare team.

Dialysis treatments for people with stage 5 CKD

Most people report feeling much better once they begin dialysis. As the toxins are removed from the blood medicines replace the functions the kidneys can no longer perform, they find they can enjoy a good quality of life. There are two types of dialysis treatments for people with stage 5 kidney disease.

Hemodialysis: This treatment that can be done in a center or in a patient’s home with assistance from a care partner. A dialysis machine removes a small amount of a patient’s blood through a man-made membrane called a dialyzer, or artificial kidney, to clean out toxins that the kidneys can no longer remove. The filtered blood is then returned to the body.
Peritoneal dialysis (PD): Unlike hemodialysis, PD is a needle-free treatment and a care partner is not required to to help assist during treatment. PD can be performed at home or at work.

Kidney transplant is another treatment option

If you wish to have a kidney transplant, tell your nephrologist. Your nephrologist will explain the process of how to get on a waiting list for a cadaverous kidney or how to find a living donor.

When at stage 5 CKD, either dialysis or a kidney transplant is necessary to continue living.

Changes in the diet for people with stage 5 CKD

Once you begin dialysis, you will need to make changes in what you eat and drink. Your diet is a big part of your treatment, so you will be working with a dietitian who will coach you on how you should eat. Depending on the dialysis treatment you choose and your lab test results, your dietitian will help create a meal plan based on your individual requirements to keep you feeling your best. Your dietitian will explain what foods are restricted and which ones are recommended on the renal diet.

A healthy diet for stage 5 CKD may recommend:

Including grains, fruits and vegetables, but limiting or avoiding whole grains and certain fruits and vegetables that are high in phosphorus or potassium
A diet that is low in saturated fat and cholesterol and moderate in total fats, especially if cholesterol is high or if you have diabetes or heart disease
Limiting intake of refined and processed foods high in sodium and prepare foods with less salt or high-sodium ingredients
Aiming for a healthy weight by consuming adequate calories and including physical activity each day within your ability
Decreasing calcium intake if necessary

Limiting fluid intake
Increasing protein intake to the level determined by the dietitian’s assessment of individual needs and to replace losses in the dialysis treatment
Taking special renal vitamins high in water soluble B vitamins and limited to 100 mg of vitamin C
Vitamin D and iron tailored to individual requirements