Manage Or Prevent Heart Disease
People with stage 4 kidney disease have a high risk of having heart disease. In fact, most people with kidney disease do not die of kidney failure – they die of heart disease. Why? Because, in addition to kidney disease, they usually have one or more of the following health risks:
You can help slow – or possibly prevent – heart problems by following your treatment plan. Ask your healthcare professional what you need to do to keep your heart healthy.
Protect The Bodys Natural Filter
Kidneys are responsible for keeping the body clean and fully functioning. Maintaining good health habits and regular consultation with a doctor can aid in avoiding chronic kidney disease. Early detection and treatment are vital to stopping or slowing down CKD progression to prevent complete kidney failure or even death.
Stage 4 Kidney Disease Lifestyle Changes
There are other lifestyle changes to help prevent further damage to your kidneys. These include:
- Not smoking, if you smoke. Smoking damages blood vessels and arteries. It increases the risk of clotting, heart attack, and stroke. If you have trouble quitting, talk to your healthcare provider about smoking cessation programs.
- Exercise. Aim to exercise 30 minutes a day, at least 5 days a week.
- Take all prescribed medications as directed. In addition to taking all prescribed medications, ask your healthcare provider before adding over-the-counter medications or supplements.
- See your healthcare provider regularly. Be sure to report and discuss any new and worsening symptoms with your healthcare provider.
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What Causes Stage 5 Kidney Disease To Occur
The end-stage of renal failure does not just happen overnight. Like other phases of CKD, stage 5 chronic kidney disease occurs over time as the result of ongoing unmanaged CKD.
However, many people can lose up to 90% of their kidney function without even realizing it. This is how many people only learn about their kidney damage in stage 4 or 5.
Estimated Glomerular Filtration Rate Indicates The 5 Stages Of Chronic Kidney Disease
The creatine clearance is the same as the estimated glomerular filtration rate . This number also takes into account the age, body size, and gender of a person. So it is the most accurate measure of kidney function.
Your doctor can calculate your specific eGFR. It is a percent range that goes as high as 100. Lower numbers will indicate poorer functioning kidneys. Below is a breakout of the eGFR for each stage of kidney disease.
CKD Stage 1 eGFR
Stage 1 has some kidney damage, however, there is still about 90 to 100 percent kidney function left. So things are pretty normal.
CKD stage 1 eGFR is 90 mL/min or higher.
CKD Stage 2 eGFR
Stage 2 damage has occurred and there is a mild loss of function. In addition, the kidneys are still working pretty well with between 60 to 89 percent of function left.
CKD stage 2 eGFR is between 60 and 89 mL/min.
CKD Stage 3 eGFR
There are two eGFR levels for stage 3 CKD. They are 3A and 3B. Function varies from mild to severe in these stages.
CKD Stage 3A eGFR
Mild to moderate loss of kidney function occurs in stage 3A. So now the kidneys are functioning between 45 to 59 percent capacity.
CKD Stage 3A eGFR is between 45 and 59 mL/min.
CKD Stage 3B eGFR
There is moderate to severe damage in 3B with significant loss of function. Consequently, the kidneys are working at only 30 to 40 percent of function.
The CKD stage 3B eGFR is between 30 and 40 mL/min.
CKD Stage 4 eGFR
The CKD stage 4 eGFR runs between 15 and 29 mL/min.
CKD Stage 5 eGFR
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Increased Acid Production And Metabolic Acidosis
Metabolic acidosis is when there is too much acid in the body. There will be a pH of less than 7.35 and a low bicarbonate level.
Uremia can lead to metabolic acidosis in stage 5 kidney disease. Kidney cells regulate the acid-base balance of the body. Damage to them will prevent them from being able to do their job.
This will cause a decrease in hydrogen ions. As a result, acid production will run rampant. In addition, the kidneys will no longer be able to excrete ammonium. Eventually phosphate and organic acids such as lactic acid, sulfuric acid, hippuric acid buildup to toxic levels.
Chronic metabolic acidosis causes protein breakdown leading to malnutrition-inflammation-atherosclerosis syndrome. MIA is a condition that occurs in ESRD. It is classified by having malnutrition, inflammation, and atherosclerosis all at the same time.
Symptoms of metabolic acidosis include:
- Hyperventilation
- Hyperkalemia
Help Keep Your Kidney Disease From Getting Worse
Good self-management will help you to live a long, fulfilling life and continue to do the things you love. It can also help to slow or even stop kidney disease from getting worse – and it may even stop or delay kidney failure. Good self-management starts with:
- Controlling other health problems you may have
- Treating complications of kidney disease
- Managing or preventing heart disease
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Hardening Of The Arteries And Plaque Build
When the body sees damaged blood vessels, the immune system will respond by sending cells to heal the damage. These cells will cause plaque to build upon the artery walls. This also happens in the kidneys. So damaged kidney blood vessels are at risk for atherosclerosis.
In addition, those with stage 5 kidney disease have fewer immune cells and are susceptible to increased inflammation.
Accelerated atherosclerosis occurs in the later stages of CKD. It may arise from hypertension, inflammation, anemia, and MBD disorders.
The risk of atherosclerosis increases with age. It may also be the result of smoking, high cholesterol, diabetes, metabolic acidosis, and excessive blood clotting.
Do What You Can To Manage The Complications Of Kidney Disease
Kidney disease can cause other health problems throughout your body including:
- Heart and blood vessel problems
- Anemia
- Mineral and bone problems
- High blood pressure
- Poor nutritional health
If you have stage 4 kidney disease, you are probably experiencing some of these problems already. Your healthcare professional will work with you to develop a treatment plan to help manage these problems and keep them from getting worse. Treatment may include diet, exercise, and medications. It is very important that you follow your treatment plan because it can greatly improve your quality of life and how long you live. It can also help to slow or even stop kidney disease from getting worse – and it may even stop or delay kidney failure.
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Slowing Down The Progression Of Kidney Disease
Early diagnosis is very important in making your condition more manageable. You can slow down the progression of your kidney disease if you have complete knowledge of stages of kidney disease. Here are some of the steps that will help improve your life expectancy with kidney disease if diagnosing it early.
1. Control the Blood Pressure
You can slow the rate of your kidney disease by maintaining good blood pressure. This is especially beneficial for people with diabetes and protein in their urine. Work with your physician to learn how you can keep your blood pressure below 130/85 to slow the rate of kidney disease. People with diabetes should strive to keep their blood pressure below 125/75. Exercising, losing weight, eating less, meditation and lowering your salt intake will also help keep your blood pressure in check. Your doctor may prescribe ACE inhibitors to help keep your blood pressure within the desired level. Meantime, be sure to take your medication as prescribed by your doctor to control the rate of damage to your kidneys.
2. Control the Blood Glucose
3. Adjust Diet and Lifestyle
With proper knowledge about different stages of kidney disease, you can learn what types of changes you need to make to your diet and lifestyle to slow the progression of your disease. Eat food loaded with antioxidants and anti-inflammatory vitamins. Use fish oil but limit your phosphorus and protein intake if your kidney disease is at an advanced stage.
4. Repair the Damage
How Can Doctors Tell If I Have Ckd
Many people with Stage 1 CKD do not have any symptoms. However, if you have a family history of kidney disease, or a health condition that can damage your kidneys, such as diabetes or high blood pressure, your doctor may test the health of your kidneys.
To find out if you have CKD, doctors will do tests, such as:
- Urine tests
- eGFR blood tests
- Blood pressure checks
- Imaging tests to take detailed pictures of the inside of your body, such as ultrasound, CT scan or MRI
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What Steps Can I Take To Manage Stage 5 Ckd
At Stage 5 CKD, there is usually no cure and you cannot reverse the damage to kidney function. There are treatment options for kidney failure that can help you live life.
Your doctor will recommend that you:
- Have visits with a nephrologist to check your blood levels and overall health.
- Meet with a dietitian to help you create and follow a kidney-friendly eating plan. Your eating plan may involve limiting certain things to prevent them from building up in your body, such as fluids, potassium, salt or phosphorus. Learn more about a kidney-friendly diet for CKD.
- Keep your blood pressure at a healthy level. They may prescribe blood pressure medicines like ACE inhibitor and ARBs.
- Keep your blood sugar at a healthy level if you have diabetes.
- Be active for at least 30 minutes on most days of the week. This can be anything from walking or riding a bike to swimming or dancing.
- Quit smoking or using tobacco.
How Is Stage 5 Kidney Disease Treated
How is stage 5 kidney disease treated?
The best treatment for you is the one that makes the most sense for your unique lifestyle and health requirements. Your nephrologist will go over your treatment options with you, which may include:
- Kidney transplant: This is regarded as one of the most effective treatments for ESRD. A kidney transplant involves receiving a new, healthy kidney from a living or deceased donor. Keep in mind that you must be in good overall health, have a suitable donor match, and be at the right time.
- Dialysis is a life-extension treatment that filters your blood to remove unwanted toxins, waste products, and excess fluids. Dialysis is classified into two types: peritoneal and hemodialysis.
- Hemodialysis: A dialysis machine filters your blood to remove toxins, waste, and excess fluid. Blood enters the machine, is filtered, and returned to your body. Because your kidneys have entirely failed, the dialysis machine will perform the functions of your kidneys.
- Peritoneal dialysis: This method filters and cleans your blood by using the blood vessels in the lining of your abdomen as the bodys natural filter, in conjunction with a dialysate solution.
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Learn About Kidney Failure
Even if you get treatment in stage 4 and are careful about your health, your kidneys may still fail. Kidney failure happens when:
- 85-90% of kidney function is gone
- GFR falls below 15
- Kidneys don’t work well enough to keep you alive
There is no cure for kidney failure, but with treatment it is possible to live a long, fulfilling life. Having kidney failure is not a death sentence. People with kidney failure live active lives and continue to do the things they love.
What Treatments Are Available For Stage 5 Ckd
If you have not already, you will need to see a nephrologist immediately to determine and start treatment, which will be either dialysis or a kidney transplant. In some instances, a person with ESRD will have both forms of treatment. If your kidneys have failed, you will need to be on dialysis for the rest of your life unless you have a kidney transplant.
- Dialysis helps clean your blood by removing waste that your kidneys can no longer remove on their own, as well as helping to maintain healthy levels of potassium, sodium, bicarbonate, and other chemicals and control your blood pressure. There are two different types of dialysis: hemodialysis and peritoneal dialysis . You can receive dialysis in a dialysis center or at home.
With stage 5 CKD, you will eventually need a kidney transplant, or you will need to be on dialysis for the rest of your life.
- A kidney transplant means you will receive a healthy kidney from a donor. Surgery will be performed to remove your failing kidney and transplant the new healthy kidney in its place. You will need to take anti-rejection medicines post-transplant to prevent your body from rejecting the healthy kidney. Most transplants are successful and last for many years some people, however, will need multiple transplants in their lifetime.
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Medical Treatment Of Chronic Kidney Disease Stage 5
Your doctors will provide medical advice and possibly prescribe medications to manage underlying conditions like hypertension and diabetes.
Once someone goes past stage 3, the kidneys will have trouble clearing substances from the body. Consequently, there will be restrictions on certain medications. These include
- Cefepime
- Other nonsteroidal anti-inflammatory drugs
- Selective COX-2 inhibitors
Medication doses can also change depending on how it affects the kidneys. Some doses will be lower while other doses may need to be higher as seen with loop diuretics furosemide and torasemide.
Those with an eGFR than 20 mL/min should avoid medications that increase potassium levels:
- Potassium-sparing diuretics
- Angiotensin-receptor blockers
- Beta-blockers
People with stage 5 kidney disease are also at risk when they go for magnetic resonance imaging . MRI preparations contain a compound called gadolinium. It can cause the kidneys to become scarred and hardened.
In addition, medications will vary from person and person. It is best to ask your doctor about any possible restrictions.
Stage 5 Kidney Disease May Include Dialysis
Unlike other stages of CKD, in stage 5 kidneys are in a severely low state of function. At this low of function, dialysis will be discussed by your kidney doctor.
Ultimately, the decision to start dialysis will be up to you. This is a very personal decision and not one to take lightly. Once dialysis is started, it is generally not advised to discontinue.
What Are The Symptoms Of End
As chronic kidney disease progresses to end-stage renal disease, the following signs and symptoms may appear:
- feeling less hungry than usual,
- appetite loss,
- chest pain if fluid accumulates around the hearts lining,
- headaches,
- uncontrolled hypertension ,
- itching,
- making little or no urine,
- reduced mental acuity,
- back pain in the lower back,
- swelling, particularly near the eyes and ankles,
- cramps in the muscles,
Kidney failure worsens and can become life-threatening if dialysis or a transplant are not used.
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Stages Of Kidney Disease
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Chronic kidney disease is divided into five stages. The stages are based on the eGFR test result and how well your kidneys work to filter waste and extra fluid out of your blood. As the stages go up, kidney disease gets worse and your kidneys work less well. At each stage, it is important to take steps to slow down the damage to your kidneys.
What Is Stage 3 Ckd
In Stage 3 CKD, your kidneys have mild to moderate damage, and they are less able to filter waste and fluid out of your blood. This waste can build up in your body and begin to harm other areas, such as to cause high blood pressure, anemia and problems with your bones. This buildup of waste is called uremia.
Stage 3 CKD is split into 2 sub-stages based on your eGFR:
Stage 3a means you have an eGFR between 45 and 59, and Stage 3b means you have an eGFR between 30 and 44.
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What Are The Symptoms Of Stage 5 Ckd
You may have these symptoms in Stage 5 CKD if your kidneys begin to fail:
- Feeling weak and tired
- Swelling in your arms, hands, legs or feet
- Making little or no urine
- Headaches
- Pain in your lower back
- Muscle cramps
- Feeling sick to your stomach or throwing up
- Feeling less hungry than normal
- Trouble breathing
- Changes in your skin color
Stage 1 Early Warnings
Stage 1 CKD means your kidney is mildly damaged. It indicates a normal eGRF of 90 or greater. At this stage, your kidneys are healthy and working well, but you may face some problems. Signs of kidney damage could be the presence of protein in your urine or physical damage to your organs. At this stage, kidney damage can be caught and even reversed before it causes any significant damage.
Some effective ways to slow down kidney damage in stage 1 disease includes:
- Controlling your blood sugar if you are diabetic
- Controlling your blood pressure
- Eating a healthy diet or a kidney-friendly diet
- Giving up smoking or tobacco
- Staying active
- Asking your doctor for any medications or supplements to support kidney health
- Visiting a nephrologist for better advice on protecting your kidneys
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How Your Child Feels
In addition to the results of these tests, we also look at your childs symptoms and how he feels. Despite having a high creatinine level, if hes feeling well and going to school, its probably not time to go on dialysis or have a kidney transplant.
After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child’s condition. Then well meet with you and your family to discuss the results and outline the best treatment options.
It’s entirely natural that you might be concerned right now about your child’s health a diagnosis of chronic kidney disease can be frightening. But you can rest assured that at Boston Children’s Hospital, your child is in good hands. Our physicians are bright, compassionate and committed to focusing on all of your child’s needs, not just his condition.