Chronic Kidney Disease (CKD)

Many people who have CKD don’t have symptoms. Any symptoms you experience will depend on the stage of the disease.

Stages of kidney disease and kidney failure

There are 5 stages of chronic kidney disease — from stage 1, which is very mild, to stage 5, which is kidney failure. 

Please note that the term stage is used to define the severity of CKD, but it isn’t a cancer-related disorder. The stages are based on how well your kidneys can filter out waste from your blood. This is determined with a blood test that measures your global kidney function or the estimated glomerular filtration rate (eGFR).

Early-stage CKD (stages 1 and 2) symptoms

Stage 1 CKD means you have a normal eGFR of 90 or more. Your kidneys may not be showing symptoms outwardly. However, even with a normal eGFR, you may be leaking protein into your urine or have structurally abnormal kidneys (multiple cysts or some internal scarring).

Stage 2 CKD means your eGFR is between 60 and 89. This indicates mild damage to your kidneys. Again, you’re unlikely to have any symptoms, but you may have features associated with mild kidney damage.

Symptoms of stage 1 and 2 CKD can include:

• high blood pressure

• swelling in your hands or feet

• proteinuria (protein in your urine), which can be detected by a urine test

• hematuria (blood in your urine)

Moderate CKD (stage 3) symptoms

Stage 3 CKD means you have an eGFR between 30 and 59. This is mild to moderate damage to your kidneys, which may begin to cause symptoms. With the right treatment and some healthy lifestyle changes, many people with stage 3 CKD do not progress to stage 4 or 5.

CKD stage 3 is often not associated with symptoms and is most usually detected by blood tests. Occasionally, certain symptoms can occur on top of the previously listed symptoms, which may include:

• feeling weak and tired

• swelling in your hands or feet

• dry or itchy skin

• muscle cramps

• trouble sleeping 

• restless leg syndrome

• urinating more often than normal

• dark or foamy urine

Moderate CKD (stage 4) symptoms

Stage 4 CKD means you have an eGFR between 15 and 29, and the damage to your kidneys is moderate to severe. Your kidneys no longer work as well as they should, so you’re likely to notice symptoms.

Symptoms of stage 4 CKD may include:

• feeling weak and tired

• swelling in your arms or legs

• urinating more often than normal

• muscle cramps

• feeling sick or vomiting

• a reduced appetite

• poor concentration

• itchy skin

Perhaps one of the most important consequences of CKD is that it’s associated with a higher risk of other problems, most particularly high blood pressure, bone disease, and heart disease.

End-stage kidney disease (stage 5) symptoms

Stage 5 CKD means you have an eGFR of less than 15, your kidneys are severely damaged, and you’re close to kidney failure.

When your kidneys have stopped working, waste products are no longer filtered out of your body. This means they start to build, which can make you sick.

Symptoms of stage 5 CKD include:

• feeling weak and tired

• swelling in your arms, hands, legs or feet

• headaches

• lower back pain

• muscle cramps

• feeling sick or vomiting

• reduced appetite

• trouble breathing or shortness of breath

• changes in your skin colour

• poor concentration

• itchy skin

Chronic kidney disease is caused by kidney damage that usually happens over the course of several years. However, on occasions, chronic kidney disease can be acute.

Common health conditions that damage your kidneys and lead to the development of chronic kidney disease include:

• diabetes

• high blood pressure

• glomerulonephritis (an inflammatory type of kidney disease)

• autoimmune diseases, such as lupus nephritis 

• polycystic kidney disease (PKD) 

Risk factors

Anyone can get chronic kidney disease, but certain factors can increase your risk. These include:

• ageing: kidney function naturally declines with age

• ethnicity: there’s a higher prevalence of CKD in Black, South Asian, and Hispanic populations

• a family history of kidney disease

• certain health conditions, including those listed above

• having an abnormal kidney structure or size

• smoking

• obesity

• poor diet

• excessive alcohol consumption

• a long history of nonsteroidal anti-inflammatory drug (NSAID) use

At Welbeck, our consultants use diagnostic techniques to accurately diagnose and identify the stage of the condition so they can provide you with the most appropriate management plan.

Kidney health check

Your consultant will assess your kidney health. The key parameters we look for are the blood test for GFR, urine abnormalities, the presence of the protein albumin, and how well your blood pressure is controlled. These elements together comprise the basic kidney health check.

Diagnostic tests

Your consultant may run other tests to help them determine the stage of your CKD. This may include:

• blood tests

• urine tests

• ultrasounds

• MRI scans

• CT scans

• kidney biopsy

You may be able to prevent CKD from reaching a more advanced stage by seeking treatment, and/or:

• managing high blood pressure

• eating a healthy and well-balanced diet

• stopping smoking

• exercising regularly

• maintaining a healthy weight

• avoiding excessive amounts of alcohol

If CKD is diagnosed, treated, and managed at an early stage, you can go on to live a near-normal life.

However, if the disease has advanced to a later stage, some complications can occur:

• anaemia (a low red blood cell count)

• weakened bones

• gout

• heart disease

• blood vessel disease

• increased risk of stroke and heart attack

• nerve damage

• weakened immune system

• increased risk of infections

Over the last 10 years, there have been extraordinary advances in the management of CKD. New drugs can effectively and safely slow down the deterioration of your kidney function if you have CKD. 

At Welbeck, our consultants are committed to ensuring that you have the underlying cause specifically treated and are optimised on the best management to preserve your kidney function. Your options will vary depending on your unique circumstances. 

Lifestyle changes and medication

Treatment options and lifestyle advice can include:

• dietary changes, such as reducing your salt and protein intake

• blood pressure control

• SGLT2 inhibitors or flozins

• nonsteroidal mineralocorticoid receptor antagonists (nMRA)

• diabetes management

• staying active 

• diuretic medications

• iron supplements 

• stopping certain medications

• treating the underlying cause

Treatment for kidney failure (stage 5)

 If you have stage 5 CKD, your kidneys are very close to failure or have failed. The treatment options are dialysis, a kidney transplant, or maximal supportive therapy.

Dialysis

Dialysis is a treatment that uses machines to remove waste products from your body when your kidneys can’t. There are 2 major types of dialysis: haemodialysis and peritoneal dialysis.

Hemodialysis circulates your blood through a machine that removes waste products and excess water and salt before returning it to your body. Each haemodialysis treatment takes approximately 4 hours and is generally done 3 times a week.

In peritoneal dialysis, a dialysis solution is inserted directly into your abdomen through a catheter to absorb waste before being removed via the same catheter. This can be repeated 4 times a day, or a machine can be used overnight to automatically fill, remove, and refill the fluid.

Kidney transplant

Unlike other types of organ donation, a donor kidney can come from 2 sources: living donors and deceased donors.

If you’re put on a transplant list to receive a kidney from a deceased donor, it may take a few years for a suitable match to be found. Getting a kidney from a living donor tends to be quicker, as the donation usually comes from a family member, partner, or friend. 

Maximal supportive therapy

With proper discussion and explanation, some people choose not to have dialysis or a transplant and receive symptomatic treatment only.

At Welbeck, our nephrologists are experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.  

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.

Get in touch today to book an appointment.