Symptoms and diagnosis

Stage 3 of chronic kidney disease (CKD)

About chronic kidney disease (CKD)

With chronic kidney disease, the kidneys don’t usually fail all at once. Instead, kidney disease often progresses slowly over a period of years. This is good news because if CKD is caught early, medicines and lifestyle changes may help slow its progress and keep you feeling your best for as long as possible.

Five stages of chronic kidney disease

To help improve the quality of care for people with kidney disease, the National Kidney Foundation (NKF) created a guideline to help doctors identify each level of kidney disease. The NKF divided kidney disease into five stages. When the doctor knows what stage of kidney disease a person has they can provide the best care, as each stage calls for different tests and treatments.

Glomerular Filtration Rate (GFR)

Glomerular filtration rate (GFR) is the best measure of kidney function. The GFR is the number used to figure out a person’s stage of kidney disease. A math formula using the person’s age, race, gender and their serum creatinine is used to calculate a GFR. A doctor will order a blood test to measure the serum creatinine level. Creatinine is a waste product that comes from muscle activity. When kidneys are working well they remove creatinine from the blood. As kidney function slows, blood levels of creatinine rise.

Below shows the five stages of CKD and GFR for each stage:

• Stage 1 with normal or high GFR (GFR > 90 ml/min)
• Stage 2 Mild CKD (GFR = 60-89 ml/min)
• Stage 3 Moderate CKD (GFR = 30-59 ml/min)
• Stage 4 Severe CKD (GFR = 15-29 ml/min)
• Stage 5 End Stage CKD (GFR <15 ml/min)

Dialysis or a kidney transplant needed in order to maintain health.

If you know a serum creatinine level, you can figure out a GFR using our GFR Calculator.

Stage 3 CKD

A person with Stage 3 CKD has kidney damage with a moderate decrease in the GFR of 30-59 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 may start to become present in Stage 3, such as:

• Fatigue: Feeling tired is common for people with CKD and is often caused by anemia.
• Too much fluid: The kidneys may lose their ability to control how much fluid stays in the body. A person may notice swelling (edema) in their lower legs, hands or face around the eyes. With too much fluid someone could even feel short of breath.
• Urination changes: Urine may be foamy if there is protein in it, or dark orange, brown, tea colored or red if it contains blood. A person may urinate more or less, or get up at night to go to the bathroom.
• Kidney pain: Most people with CKD do not have kidney pain, but with some kinds of kidney problems, such as polycystic kidney disease or infections, they may have pain in their back where the kidneys are.
• Sleep problems: Some people have trouble falling asleep or staying asleep. Itching, muscle cramps or restless legs can keep them awake.

As Stage 3 progresses, the National Kidney Foundation recommends the patient see a nephrologist (a doctor who specializes in treating kidney disease). Nephrologists examine kidney 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.

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. For Stage 3 a dietitian will usually recommend eating a healthy diet with protein at the Daily Reference Intake (DRI) level of 0.8 grams protein per kilogram body, the same level recommended for all healthy people. Special attention may be given to the quality of protein eaten. Phosphorus may be limited to help keep blood phosphorus or PTH normal and prevent renal bone disease. Controlling phosphorus may also help preserve existing kidney function. Calcium may be limited if blood levels are too high. Potassium is usually not restricted in Stage 3 CKD unless blood levels are high. The dietitian will also take into consideration if the patient has diabetes and provide tips on limiting carbohydrates in their diet. They may also recommend a diet low in sodium for those with high blood pressure or fluid retention. Supplementation with water soluble vitamins may be recommended. Vitamin C may be limited to 100 mg per day from supplements. Nutrients like Vitamin A and some minerals may not be recommended because levels can build up in the blood as kidney function declines.  The dietitian may recommend avoiding over the counter dietary supplements unless approved by the nephrologist. It is helpful to work with a registered renal dietitian because as the stages of CKD change, so will the diet.

A healthy diet for stage 3 CKD may recommend:

• Including a variety of grains, fruits and vegetables, but whole grains and some fruits and vegetables may be limited if blood tests show phosphorus or potassium levels are above normal.
• 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
• Keeping protein intake within the DRI level recommended for healthy people with attention to high quality protein.
• Consuming the DRI for the water soluble vitamin B complex and C.
• Vitamin D and iron may be tailored to individual requirements
• Limiting phosphorus if blood levels of phosphorus or PTH are above normal
• Limiting calcium if blood levels are above normal
• Potassium is usually not restricted unless blood levels are above normal

Many people who develop chronic kidney disease 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.

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.

People in Stage 3 CKD will usually visit their doctor every 3-6 months. Blood tests for creatinine, hemoglobin, calcium and phosphorus levels will be performed to see how well the kidneys are functioning. The doctor will also monitor other conditions such as high blood pressure and diabetes.

There is no cure for chronic 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.

If you would like to see a doctor who specializes in the care of kidneys, called a nephrologist, you can use DaVita's Find a kidney doctor tool to locate a nephrologist in your area.