{"id":3424,"date":"2019-11-28T10:31:25","date_gmt":"2019-11-28T10:31:25","guid":{"rendered":"http:\/\/edren.org\/ren\/?page_id=3424"},"modified":"2019-12-13T11:44:59","modified_gmt":"2019-12-13T11:44:59","slug":"ckd-1-3","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/education\/textbook\/chronic-kidney-disease\/ckd-1-3\/","title":{"rendered":"CKD (1-3)"},"content":{"rendered":"

Most early kidney disease is asymptomatic – people are unaware of it. It is usefully divided into stages.\u00a0 Symptoms are usually unimpressive before late stage 4.<\/p>\n

The 5 K\/DOQI CKD stages (Kidney Diseases Outcome Quality Initiative – KDOQI<\/a> (NKF, USA)<\/p>\n\n\n\n\n\n\n\n\n
\n
Stage<\/b><\/span><\/div>\n<\/td>\n
\n
GFR<\/b><\/span><\/div>\n<\/td>\n
\n
Description<\/b><\/span><\/div>\n<\/td>\n
\n
Management, comments<\/b><\/span><\/div>\n<\/td>\n<\/tr>\n
\n
1<\/span><\/strong><\/div>\n<\/td>\n
\n
90+<\/div>\n<\/td>\n
Normal kidney function but urine or other abnormalities point to kidney disease<\/td>\nStages 1-3<\/span> <\/strong>(5-10% of the population?)
\nNeed assessment, long term monitoring, control of blood pressure and CV risk factors<\/td>\n<\/tr>\n
\n
2<\/span><\/strong><\/div>\n<\/td>\n
\n
60-89<\/div>\n<\/td>\n
Mildly reduced kidney function; but must also have urine or other abnormalities (e.g. anatomical, genetic) to be classified as CKD<\/td>\n<\/td>\n<\/tr>\n
\n
3<\/span><\/strong><\/div>\n<\/td>\n
\n
30-59<\/div>\n<\/td>\n
Moderately reduced kidney function; may be subdivided into 3a, 3b according to GFR over or under 45; and proteinuric or not.<\/td>\nFew or no symptoms still<\/td>\n<\/tr>\n
\n
4<\/span><\/strong><\/div>\n<\/td>\n
\n
15-29<\/div>\n<\/td>\n
Severely reduced kidney function<\/td>\n0.2% of the population. Planning for endstage renal failure<\/a> if progressive.\u00a0 Symptoms at lower GFRs.<\/td>\n<\/tr>\n
\n
5<\/span><\/strong><\/div>\n<\/td>\n
\n
14 or less<\/div>\n<\/td>\n
Very severe kidney failure. Sometimes used to imply endstage<\/a>, ESRF or ESRD, but average GFR\u00a0for starting dialysis is below 10.<\/td>\n0.2%<\/strong><\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Stage 3 CKD is common – estimates of incidence vary, but it may be round about 5% of the population, mostly elderly.\u00a0 Stages 1 and 2 could add nearly as many again, but this data is less reliably collected.\u00a0 Stage 4 is much less common, and stage 5 is uncommon.<\/p>\n

The widespread adoption of eGFR<\/a> reporting and in the UK, the QOF (quality outcomes framework) in general practice have led to many more people becoming aware that they have proteinuria or reduced kidney function.\u00a0 Most of these are elderly – the incidence of stage 3+ CKD rises very steeply over the age of 70 – and most never develop ESRF<\/span><\/strong>.\u00a0 The most important risk factors for developing ESRF are:<\/p>\n