Chronic Kidney Disease (CKD) is a condition where kidney function gradually declines, assessed by an estimated Glomerular Filtration Rate (eGFR) below 60 ml/min/1.73 m² or kidney abnormalities such as protein leakage in the urine or structural abnormalities of the kidney found by ultrasound or CT scan. These conditions must persist for more than 3 months.
Common causes of chronic kidney disease include diabetes, high blood pressure, chronic nephritis, genetic diseases such as Polycystic Kidney Disease, and prolonged use of certain medications such as NSAIDs. This disease often shows no symptoms in the early stages, but as it progresses, patients may experience symptoms from waste accumulation such as fatigue, nausea, vomiting, loss of appetite, or swelling.
Meanwhile, acute kidney injury (Acute Kidney Injury: AKI) is a condition where kidney function rapidly declines within hours to days, resulting in the kidney’s inability to properly excrete waste or maintain water and electrolyte balance. Common causes include kidney ischemia from shock or severe dehydration, bloodstream infections, nephrotoxic drugs or toxins, or acute urinary tract obstruction.
The key differences between these two conditions lie in the duration of onset, severity, and recovery potential. Acute kidney injury has a chance of kidney function recovery if treated promptly, whereas chronic kidney disease usually results in permanent deterioration and requires long-term care.
Warning signs of kidney deterioration: When should you see a doctor?
Early observation of kidney deterioration symptoms is very important because patients in this stage often have no clear symptoms, causing many to be unaware of bodily abnormalities. This leads to gradual disease progression and complications. Warning signs to watch for include
- Fatigue, more tired than usual
- Loss of appetite, nausea
- Swelling in legs, feet, or face due to fluid and electrolyte retention
- Abnormal urination such as foamy urine, dark color, or decreased volume
- High blood pressure that is difficult to control
- Frequent nighttime urination
Diagnosis of chronic kidney disease requires laboratory tests combined with symptom evaluation and medical history. Generally, urine tests are done to detect proteinuria or hematuria, which may be early signs of kidney abnormalities.
If abnormalities are found in urine tests, further tests such as blood creatinine levels should be performed to assess kidney function and calculate GFR (Glomerular Filtration Rate), which is used to stage chronic kidney disease.
How many stages of kidney deterioration are there? Understanding severity and symptoms in each stage
Chronic kidney disease is divided into 5 stages based on kidney function in filtering waste from the blood (GFR). The lower the GFR, the more severe the symptoms and disease progression, as follows:
| Stage of Kidney Disease | GFR Value (ml/min) | Symptoms and Findings |
| Stage 1 | ≥90 | No clear symptoms yet, but kidney abnormalities are detected such as protein in urine or structural abnormalities found by ultrasound |
| Stage 2 | 60–89 | Mild kidney deterioration, may have no or very mild symptoms but abnormalities similar to stage 1 are detected |
| Stage 3 | 30–59 | Symptoms such as fatigue, pallor, leg swelling, high blood pressure, and increased waste accumulation in the body begin to appear |
| Stage 4 | 15–29 | More obvious symptoms such as easy fatigue, loss of appetite, nausea, vomiting, difficult blood pressure control, and significantly reduced kidney waste excretion |
| Stage 5 | <15 | Kidney function is insufficient to sustain life, requiring dialysis, peritoneal dialysis, or kidney transplantation |
Treatment guidelines for chronic kidney disease at each stage
Treatment of chronic kidney disease aims to slow kidney deterioration, prevent complications, and maintain the patient’s quality of life as long as possible. Treatment guidelines for each stage are as follows:
- Stage 1: Kidney function begins to decline but still works well (GFR≥90)
Start care by controlling underlying diseases such as diabetes and hypertension, avoid nephrotoxic drugs especially NSAIDs, adjust diet by reducing sodium, sugar, and fat, drink enough water, and monitor kidney function and urine at least once a year. - Stage 2: Mild kidney deterioration (GFR 60-89)
Focus on monitoring proteinuria. Doctors may consider prescribing blood pressure medications such as ACE inhibitors or ARBs to reduce protein leakage and slow kidney deterioration. Additional risk factors such as high blood lipids and overweight should be assessed and managed if necessary. - Stage 3: Moderate kidney deterioration (GFR 30-59)
Emphasize blood pressure control, especially medications that reduce proteinuria. Adjust diet to reduce kidney workload by lowering protein, sodium, potassium, and phosphorus intake as advised by doctors and dietitians. Closely monitor blood and urine tests to watch for complications such as anemia or electrolyte imbalances. - Stage 4: Severe kidney deterioration (GFR 15-29)
Closely manage complications such as treating anemia with erythropoiesis-stimulating agents (ESA), using phosphate binders to reduce hyperphosphatemia, and controlling blood potassium levels. Begin planning for kidney replacement therapy. - Stage 5 or end-stage chronic kidney disease (GFR<15)
Kidney function rapidly declines with increased symptoms such as fatigue, vomiting, and body swelling. If symptoms worsen, kidney replacement therapy is necessary, including hemodialysis, peritoneal dialysis, or kidney transplantation if suitable. Care should cover both physical and mental health to ensure the best quality of life.
When to start dialysis? Recognizing signs of end-stage kidney disease
Generally, doctors recommend starting dialysis when GFR is below 15 ml/min along with severe symptoms such as extreme fatigue, severe swelling, nausea, vomiting, loss of appetite, high blood waste levels, electrolyte imbalances, uncontrolled fluid overload, or other complications like acidosis. There are two main dialysis methods:
- Hemodialysis: This uses a dialysis machine to filter blood through a dialyzer to remove waste, excess water, and electrolytes. A vascular access such as an AV fistula or graft is prepared for dialysis. This method suits patients who cannot care for themselves or lack a clean environment for home dialysis. It offers high filtration efficiency and medical team supervision, reducing infection risk.
- Peritoneal Dialysis: This method uses the peritoneal membrane as a filter by instilling dialysis fluid into the abdominal cavity through a catheter, allowing waste to diffuse before draining it out. It can be done manually (Continuous Ambulatory Peritoneal Dialysis; CAPD) 4-6 times daily or automatically at night (Automated Peritoneal Dialysis; APD). This method suits patients who can self-care and have a clean environment but requires strict hygiene due to infection risk. It reduces hospital visits but is unsuitable for those with abdominal adhesions, prior abdominal surgery, hernias, or frequent abdominal infections.
Besides dialysis, kidney transplantation is an option, which involves replacing the kidney from a donor. This is the best way to restore kidney function but requires lifelong immunosuppressive medication to prevent rejection and close follow-up to maintain quality of life and prolong kidney survival.
Chronic kidney disease can be prevented and slowed with proper care
We can effectively slow kidney deterioration if screened and managed properly from the early stages, especially in high-risk groups such as the elderly, diabetic patients, hypertensive patients, those with high blood lipids, family history of kidney disease, or regular NSAID users. Kidney health should be checked at least once a year to monitor abnormalities and plan appropriate care.
Phyathai Phaholyothin Hospital has a specialized kidney disease medical team and advanced medical technology, providing comprehensive services including diagnosis, treatment of chronic kidney disease at all stages, dialysis, and kidney transplantation to restore health and improve patients’ quality of life.
Dr. Thanachai Siripochanakul
Nephrologist
Phyathai Phaholyothin Hospital
