Chronic kidney disease (CKD) is a progressive condition characterized by a loss of kidney function over time. The severity of CKD is divided into stages based on the glomerular filtration rate (GFR), a measure of how well the kidneys filter waste from the blood.
Healthmap Solutions (Healthmap), a kidney population health management company, proactively manages patients living with kidney disease to slow their progression through the stages of CKD. By helping patients understand the different stages of CKD and working with their providers to deliver stage-appropriate interventions, Healthmap helps slow disease progression for patients in our Kidney Population Health Management program. This article is intended as a guide to help patients, their loved ones, and their care team understand how to manage CKD in each stage.
For more information on managing CKD, patients can review Healthmap’s helpful resource, “What is Chronic Kidney Disease?”
Stage 1: Minimal Kidney Damage (90 mL/min or more)
In Stage 1, kidney function remains mostly normal, but signs of kidney damage, such as protein in the urine, may be present. This stage often goes unnoticed, as there are typically no obvious symptoms. Early intervention is key—managing blood pressure, controlling blood sugar levels, and adopting a healthy diet and lifestyle can help slow CKD progression. Regular monitoring through checkups is crucial to ensure that any issues are caught early and treated appropriately.
Stage 2: Mild Kidney Damage (60 – 89 mL/min)
In Stage 2, there is a mild decrease in kidney function, but most people won’t notice any difference in how they feel. This stage offers an opportunity to reinforce preventive strategies. Patients should focus on controlling underlying conditions like hypertension, diabetes, and obesity, which are common contributors to CKD and its progression. If these conditions remain uncontrolled, kidney function tends to deteriorate more rapidly. Healthcare providers may suggest lifestyle changes, medications, and more frequent testing to slow disease progression.
Stage 3: Moderate to Severe Kidney Damage (30 – 59 mL/min)
Stage 3 is often divided into two sub-stages, 3a (GFR 45 – 59) and 3b (GFR 30 – 44), with moderate loss of kidney function becoming more apparent. At this point, symptoms such as fatigue and swelling in the legs may arise. Managing complications becomes a priority, including an increased focus on cardiovascular health. Routine follow-up with healthcare providers is essential to adjust care plans based on changes in kidney function.
Stage 4: Severe Kidney Damage (15 – 29 mL/min)
In Stage 4, the kidneys are severely damaged, and patients experience more pronounced symptoms, including swelling, anemia, deteriorating bone health, and more difficult to control blood pressure. At this stage, it is important for patients to see a nephrologist regularly. They should begin discussing renal replacement therapy options, such as dialysis or kidney transplantation, with their nephrologist. Modifications to diet and medications become even more important in managing electrolyte imbalances and preventing worsening of kidney function. In addition, patients should continue to see their primary care provider and other specialists to ensure they are receiving any necessary preventive and subspecialty care to stay healthy.
Stage 5: Very Severe Kidney Damage (GFR < 15 mL/min)
In Stage 5, the kidneys are severely damaged and are nearing failure. At this point, it is critical for patients to choose a renal replacement therapy option if they have not done so already and begin preparing for dialysis or transplant. Depending on the type of dialysis chosen, these preparations may include scheduling a surgical procedure to obtain dialysis access via a catheter or fistula. Beginning these preparations before progressing to kidney failure helps avoid starting dialysis in a chaotic setting (such as in the emergency department) and increases the likelihood of receiving a transplant prior to needing dialysis. For patients who are preparing for dialysis but are unsure about which type would work best for them, Healthmap offers a helpful three-part guide to “Choosing the Right Dialysis Type.” Healthmap also educates patients in our Kidney Population Health Management program about their renal replacement therapy options and connects them to resources to help them begin preparing for treatment, as demonstrated in our white paper, “Easing Into End-Stage Kidney Disease.”
End-Stage Renal Disease (GFR < 15 mL/min and Kidneys Are Unable to Function)
End-stage renal disease (ESRD), also called “kidney failure,” occurs when the kidneys are no longer able to remove excess toxins and water from the blood. At this stage, renal replacement therapy (dialysis or kidney transplant) is necessary in order to survive. ESRD patients and their care teams focus on managing symptoms, maintaining treatment adherence, and addressing emotional and physical challenges associated with this stage.
Preventive and Management Strategies Across All Stages
Regardless of the CKD stage, there are key strategies that patients and their providers should follow to preserve kidney function:
Manage underlying conditions like diabetes, hypertension, obesity, and heart disease. (See “Diabetes: Preventing Complications.”)
Adopt a healthy diet such as one low in sodium, or as recommended by healthcare providers. (See “The Mediterranean Eating Style.”)
Stay active and hydrated to promote overall health.
Schedule regular checkups to monitor kidney function and adjust treatment as necessary.
How Healthmap Supports CKD/ESRD Care
Healthmap is dedicated to improving outcomes for individuals with CKD and ESRD by providing personalized, holistic care coordination. Our use of advanced, proprietary analytics enables us to identify patients early in their CKD journey and recommend evidence-based interventions to slow their disease progression. Our multidisciplinary clinical teams then work with patients and healthcare providers to develop tailored treatment plans that improve patient outcomes, enhance quality of life, and prepare patients for renal replacement therapy when necessary. We support whole-person care at every stage of CKD to ensure that patients in our Kidney Population Health Management program have access to the resources and information they need to make informed decisions about their health.
Conclusion
Understanding the stages of CKD is essential for patients and caregivers to manage the condition effectively. With early detection, proper care, and the coordinated support offered by Healthmap, patients can navigate CKD with confidence, and providers can deliver effective care that maximizes results while minimizing treatment costs.