When Is Dialysis the Next Best Step?

Having chronic kidney disease (CKD) doesn’t automatically mean you’ll need dialysis. Whether or not that day arrives depends on variables like your overall health, the extent of your kidney damage, and when you start treatment.

Seeking early treatment from Dr. Deon Middlebrook can slow or stop progressive kidney damage and help you avoid dialysis.

At our practice, Deon D. Middlebrook MDPC, we work closely with each person, helping them prevent CKD when possible, providing exceptional kidney care, and offering ongoing support should they need dialysis. Here, Dr. Middlebrook explains progressive CKD and when it’s time for dialysis.

When you need dialysis

CKD develops when health conditions like diabetes and hypertension (high blood pressure) damage your kidneys. Treatment can slow or stop kidney disease, but once the tissues are damaged, they can’t heal and that part of the kidney stops working.

Without treatment, CKD progresses, damaging more tissues. Eventually, extensive kidney damage leads to kidney failure. That’s when you need dialysis to take over the kidneys’ job of filtering wastes from your blood.

Stages of chronic kidney disease

As CKD progresses, it goes through five stages. We can determine the stage because each is defined by the results of two lab tests: estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR).

The eGFR is a blood test reflecting how well the kidneys are working. This number falls to specific levels in each stage.

We run a uACR test to measure protein levels in your urine. Healthy kidneys eliminate little to no protein, so the higher your uACR, the worse your kidney disease and the higher your risk for kidney failure and complications like heart disease.

These are the five stages of CKD:

Stages 1 and 2

Stages 1 and 2 are early stages with few or no symptoms other than foamy urine. Some people may notice other signs of kidney problems, like blood in their urine. Or they may have frequent urinary tract infections.

The eGFR may drop slightly in stage 2 but usually stays within an acceptable range. That means your uACR is the primary test for diagnosing kidney disease in stages 1 and 2.

Stage 3a: Mild to moderate loss of kidney function

Most people are diagnosed during stage 3, which is divided into two substages: 3a and 3b.

During stage 3a, the eGFR falls below normal. Your kidneys are working at 45-59% of their average ability, leading to symptoms such as:

Urinating more or less often than usual
Itchy and dry skin
Fatigue
Nausea
Loss of appetite

Without an appetite, you may lose weight even though you’re not trying to diet.

Stage 3b: Moderate to severe loss of kidney function

At this stage, your kidneys function at 30-44% of their full capacity. You may have additional symptoms, including:

Difficulty concentrating
Muscles aches and cramps
Shortness of breath
Swelling or numbness in your arms, legs, ankles, or feet

If you reach stage 3b, you have a high risk of progressing to stage 4.

Stage 4: Severe loss of kidney function

At stage 4, your kidney function drops to 15-29%. Your chances of advancing to kidney failure significantly increase and your risk for heart disease is very high.

You may have a hard time sleeping and notice your breath has an ammonia or fishy odor. Many people experience CKD complications during stage 4, such as:

Anemia (too few red blood cells)
Metabolic acidosis (acid buildup in your blood)
Mineral and bone disorders
High potassium levels (hyperkalemia)

Uncontrolled hypertension often becomes a challenge during stage 4.

Stage 5: Kidney failure

Kidney failure, called end-stage renal disease (ESRD), occurs when your kidneys work at less than 15% of normal function (due to extensive damage and scarring). At this stage, you need dialysis or a kidney transplant to survive.

Should I get screened for CKD?

There aren’t currently any official guidelines recommending CKD screenings. However, screening is the only way to catch the disease at an early stage, before you have symptoms and when it’s easier to prevent progression to kidney failure.

For that reason, you should consider scheduling a consultation if you have high blood pressure or diabetes (the top two causes of CKD) or you're over age 50.

Call Deon D. Middlebrook MDPC or use online booking if you have questions about kidney disease or want to schedule an appointment.