Understanding Chronic Kidney Disease (CKD) Stage 3: A Comprehensive Guide

Andrew Kowalski, MD, FASN

Chronic Kidney Disease (CKD) is a long-term condition where the kidneys gradually lose their ability to function properly. It is classified into five stages, with stage 3 often acting as a pivotal point for patients and healthcare providers alike. In this blog post, we will focus on CKD Stage 3, what it means, its causes, symptoms, and ways to manage it effectively.

What is CKD Stage 3?

CKD Stage 3 is defined by a moderate decrease in kidney function. At this stage, the kidneys are still working, but not as efficiently as they should. Kidney function is measured by the glomerular filtration rate (GFR), which estimates how well your kidneys are filtering waste and excess fluids from your blood.

• Stage 3A: GFR between 45–59 mL/min

• Stage 3B: GFR between 30–44 mL/min

For reference, a normal GFR is usually above 90 mL/min. In CKD Stage 3, although there is noticeable kidney damage, patients are not usually symptomatic in the way they might be in later stages. However, it’s crucial to take steps to slow the progression.

Common Causes of CKD Stage 3

Several conditions can lead to CKD Stage 3. The most common causes include:

1. Diabetes: High blood sugar levels can damage the small blood vessels in the kidneys, impairing their ability to filter blood effectively.

2. High Blood Pressure: Chronic high blood pressure can damage the arteries around the kidneys, reducing their functionality.

3. Glomerulonephritis: This is inflammation of the kidney’s filtering units and can occur due to infection or an autoimmune disease.

4. Polycystic Kidney Disease (PKD): A genetic disorder that causes cysts to grow on the kidneys, leading to impaired function.

Symptoms of CKD Stage 3

One of the challenging aspects of CKD Stage 3 is that many patients may not exhibit noticeable symptoms. However, as kidney function declines, some signs may start to appear:

• Fatigue: With reduced kidney function, the body may struggle to remove toxins efficiently, leading to tiredness.

• Swelling: Fluid retention in the lower extremities (legs, ankles, and feet) may occur because the kidneys are less able to balance fluid levels.

• Changes in Urination: Some patients might notice urinating more or less frequently.

• Back Pain: Some may experience discomfort around the kidney area.

• Anemia: As kidney function diminishes, the production of erythropoietin (a hormone that helps in the production of red blood cells) decreases, potentially leading to anemia.

Managing CKD Stage 3

Although CKD Stage 3 is not yet severe, it’s important to take immediate steps to manage the condition and prevent it from progressing to later stages. Management typically focuses on treating the underlying causes and maintaining kidney function as long as possible. Here are some key strategies:

1. Control Blood Pressure

Keeping your blood pressure under control is crucial. Patients with CKD should aim for a target blood pressure of less than 130/80 mmHg. Medications such as ACE inhibitors or ARBs are often prescribed to help protect the kidneys from further damage.

2. Manage Blood Sugar Levels

For those with diabetes, it’s important to keep blood sugar levels in check to avoid further damage to the kidneys. Regular monitoring and working with a healthcare provider to adjust medication or insulin doses may be necessary.

3. Dietary Changes

Diet plays a significant role in managing CKD. A renal dietitian may recommend the following changes:

• Limit protein intake: Eating too much protein can make the kidneys work harder. Choosing lean proteins and consuming them in moderation is often suggested.

• Reduce sodium: High sodium intake can increase blood pressure and strain the kidneys. Aim for less than 2,300 mg of sodium per day.

• Monitor potassium and phosphorus: As kidney function declines, the body may have trouble regulating these minerals. Foods high in potassium (like bananas and oranges) and phosphorus (such as dairy products) may need to be limited.

4. Exercise and Weight Management

Maintaining a healthy weight through regular physical activity can reduce stress on the kidneys. Exercise also helps in controlling blood pressure and blood sugar levels, both of which are essential for managing CKD.

5. Regular Monitoring

Patients with CKD Stage 3 should undergo regular check-ups, including blood tests to monitor GFR, electrolyte levels, and other key indicators. This helps in detecting any signs of progression early.

6. Medications

In addition to blood pressure and diabetes management, some patients may be prescribed medications to lower cholesterol levels, manage anemia, or address fluid retention. It’s important to take these medications as directed and consult with healthcare providers regularly.

Outlook and Progression

The good news is that many people with CKD Stage 3 can live long and healthy lives with proper management. However, it’s critical to be proactive in addressing the condition, as unmanaged CKD can progress to Stage 4 or Stage 5, where dialysis or kidney transplantation might be required.

Final Thoughts

CKD Stage 3 is a serious but manageable condition. Early detection, lifestyle adjustments, and close collaboration with healthcare professionals can help slow the progression of the disease and maintain quality of life. If you have been diagnosed with CKD Stage 3, now is the time to take control of your health through informed decisions and consistent care.

Remember, CKD is a progressive disease, but with the right steps, its impact can be minimized significantly. Stay informed, stay proactive, and prioritize your kidney health.