Stage 3 of Chronic Kidney Disease

A person with stage 3 chronic kidney disease (CKD) has moderate kidney damage. This stage is broken up into two: a decrease in glomerular filtration rate (GFR) for Stage 3A is 45-59 mL/min and a decrease in GFR for Stage 3B is 30-44 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 of stage 3 CKD

Symptoms may start to become present in stage 3:

• Fatigue
• Fluid retention, swelling (edema) of extremities and shortness of breath:
• Urination changes (foamy; dark orange, brown, tea-colored or red if it contains blood; and urinating more or less than normal)
• Kidney pain felt in their back
• Sleep problems due to muscle cramps or restless legs

Seeing a doctor when you have stage 3 CKD

As stage 3 progresses, a patient should see a nephrologist (a doctor who specializes in treating kidney disease). Nephrologists examine 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.

Meeting a dietitian when you have stage 3 CKD

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.

Diet and stage 3 CKD

For stage 3 CKD, a healthy diet is likely to consist of:

• Eating high-quality protein and potassium (if blood levels are above normal)
• Consuming some grains, fruits and vegetables (potassium and phosphorus are at normal levels)
• Limiting phosphorus to help PTH levels remain normal, prevent bone disease and even preserve existing kidney function
• Lowering calcium consumption
• Cutting back carbohydrates for those with diabetes
• Decreasing saturated fats to help lower cholesterol
• Lowering sodium for people with high blood pressure or fluid retention by cutting out processed and pre-packaged foods
• Limiting calcium if blood levels are too high
• Taking water soluble vitamins such as C (100 mg per day) and B complex, or completely avoiding over-the-counter dietary supplements (unless approved by the nephrologist)

It’s helpful to work with a registered renal dietitian because as the stages of CKD change, so will the diet.

Medications and stage 3 CKD

Many people who develop CKD 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.

More ways to manage stage 3 CKD

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.

Get help when you have stage 3 CKD

There is no cure for 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.