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Chronic kidney disease usually progresses slowly. Regular blood and urine tests can help doctors to decide whether the kidneys are still working well enough, whether the treatment needs to be adjusted, or whether dialysis will be needed soon, for example.
Blood and urine tests necessary for more than just diagnosing chronic kidney disease. Regular testing is also very important after the diagnosis: It shows what stage the disease is in and whether it is progressing – and if so, how fast. That helps to adjust the treatment and to be better able to assess your risk of complications.
If the tests show that your kidneys will probably be failing soon, you can discuss the next treatment options with your doctor. Then you can plan the next steps in time.
What are the stages of chronic kidney disease?
Chronic kidney disease has five stages:
- Stage 1: Urine tests show clear signs of kidney damage. But healthy parts of the kidneys help them to keep working normally overall.
- Stage 2: Kidney function is slightly reduced, but there are no noticeable symptoms.
- Stage 3: Kidney function is moderately reduced. Even at this stage you usually won't notice any problems.
- Stage 4: Kidney function is significantly reduced. That means that the kidneys are barely able to do their job. This can cause symptoms such as itching, anemia, bone pain, fluid retention and physical weakness.
How chronic kidney disease develops will depend on what other health problems you may have. Heart disease, uncontrolled high blood pressure or diabetes can make kidney disease get worse faster. So it is important that your doctor keeps an eye both on how your kidneys are working and your overall health. Then the medications can be adjusted to meet your individual needs and your risk of kidney failure can be also be estimated better.
How are kidney function and kidney damage measured?
Various measurements that can be tested regularly at check-ups show how well your kidneys are working.
Glomerular filtration rate (GFR)
Each kidney has about one million tiny “filtering stations” in it called renal corpuscles. The glomerular filtration rate (GFR) shows how much blood is filtered per minute. This is between 85 and 135 milliliters per minute in people who are healthy. GFR gradually decreases in people with kidney disease.
It would be very difficult to measure the GFR directly. That's why it's usually estimated – for instance, using the level of creatinine in the blood. The formula for estimating the GFR also includes things like the person's age and sex.
Protein in urine
Healthy kidneys stop certain components of the blood from getting into your urine and being flushed out of the body. Examples include blood proteins like albumin. If your kidneys have been damaged, then more blood proteins are released into the urine. The amount of protein in urine is taken as a sign of how bad the damage is.
When is dialysis needed?
A kidney transplant is often the best option for people who have kidney failure, but it isn't always possible to do immediately. A suitable donor organ needs to be found first. It can take several years to receive a donor kidney from a deceased person. It is often possible to get a living donor organ faster - for example from a close relative. Some people don't want to have a transplant though. Then it’s necessary to have dialysis, which you will also need while waiting for a donor organ.
Either peritoneal dialysis or hemodialysis can be used. But it can take some time to decide on one of these types of dialysis and to prepare the treatment. So the necessary preparations should be made as soon as it is clear that the kidneys will soon be failing. That is often the case if GFR drops below 30. Kidney failure occurs in most people who have a GFR below 10.
Peritoneal dialysis or hemodialysis?
It is a good idea to get information about both methods before deciding on one type of dialysis. This decision aid may help you to weigh the advantages and disadvantages the different options have.
Sources
- Clarke AL, Young HM, Hull KL et al. Motivations and barriers to exercise in chronic kidney disease: a qualitative study. Nephrol Dial Transplant 2015; 30(11): 1885-1892. [PubMed: 26056174]
- Drawz P, Rahman M. Chronic kidney disease. Ann Intern Med 2015; 162(11): ITC1-16. [PubMed: 26030647]
- Geberth S, Nowack R. Praxis der Dialyse. Berlin: Springer; 2014.
- Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD). 2024.
- National Institute for Health and Care Excellence (NICE). Chronic kidney disease: assessment and management (NICE Clinical guidelines; No. 203). 2021.
- Pape HC, Kurtz A, Silbernagl S. Physiologie. Stuttgart: Thieme; 2014.
- Tattersall J, Dekker F, Heimbürger O et al. When to start dialysis: updated guidance following publication of the Initiating Dialysis Early and Late (IDEAL) study. Nephrol Dial Transplant 2011; 26(7): 2082-2086. [PubMed: 21551086]
- Vale L, Cody JD, Wallace SA et al. Continuous ambulatory peritoneal dialysis (CAPD) versus hospital or home haemodialysis for end-stage renal disease in adults. Cochrane Database Syst Rev 2004; (4): CD003963. [PMC free article: PMC6457584] [PubMed: 15495072]
IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.
Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.
- Chronic kidney disease: Learn More – How does chronic kidney disease progress? -...Chronic kidney disease: Learn More – How does chronic kidney disease progress? - InformedHealth.org
- UREG_02774 [Uncinocarpus reesii 1704]UREG_02774 [Uncinocarpus reesii 1704]Gene ID:8437561Gene
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