Chronic Kidney Disease

What is chronic kidney disease?

Chronic kidney disease, or CKD, refers to abnormal kidney blood tests, abnormal kidney urine tests, or abnormal kidney imaging, that continues for at least 3 months. Kidney disease is considered a “silent disease” and most patients do not have any symptoms until the kidney disease has progressed to a more advanced stage.  This is why it is so important for a patient to have regular appointments with a doctor to check labs and screen for kidney disease.

At the Rogosin Institute, our physicians have long been recognized for our expertise in the diagnosis and management of chronic kidney disease.

What are the stages of Chronic Kidney Disease?

There are five stages of chronic kidney disease, based on how well the kidneys are doing their main job, cleaning the blood.  The stages start with stage 1, the most mild form of kidney disease, and progress to stage 5, the most advanced stage of kidney disease. The stages are based on a patient’s estimated glomerular filtration rate, or eGFR.  The eGFR is approximately (though not exactly) the percent of normal kidney function that a patient still has working, out of 100%.

  • CKD Stage 1, with an eGFR 90 or greater — This is the earliest stage of CKD, when a patient may only have abnormal kidney urines tests and / or kidney imaging.
  • CKD Stage 2, with an eGFR between 60 and 89 — As with stage 1, this stage is very mild, and may be consistent with normal aging, as the kidneys lose some function with normal aging.  A patient may have abnormal kidney blood tests, abnormal kidney urine tests, and / or abnormal kidney imaging.
  • CKD Stage 3a, with an eGFR between 45 and 59 — In this stage, there is a moderate decrease in kidney function, and there are abnormal kidney blood tests, often with abnormal kidney urine tests, and / or abnormal kidney imaging, as well.  Many patients are referred to a kidney specialist, a nephrologist, at this stage (if they have not been referred already).  The nephrologist will work with the patient to slow the progression of kidney disease.
  • CKD Stage 3b, with an eGFR between 30 and 44 — In this stage, there is a bit more decrease in kidney function, compared to stage 3a, and there are abnormal kidney blood tests, often with abnormal kidney urine tests, and / or abnormal kidney imaging, as well.  The nephrologist will continue to work with the patient to slow the progression of kidney disease.
  • CKD Stage 4, with an eGFR between 15 and 29 — This is a more advanced stage of kidney disease.   There are abnormal kidney blood tests, usually with abnormal kidney urine tests, and abnormal kidney imaging, as well.  The nephrologist will continue to work with the patient to slow the progression of kidney disease.  During this stage, the nephrologist will also educate the patient, even more, on what advanced kidney disease is, and what symptoms a patient might expect.  The patient will also be educated on dialysis alternatives, including transplant, and dialysis options, including dialysis at home.  This education is provided in case the kidney disease continues to progress, and the patient’s kidneys do eventually fail.  At Rogosin, patients are referred to our PEAK program (Program for Education in Advanced Kidney Disease) where a multidisciplinary team work with you for comprehensive education, guidance and support to help you be prepared and best take care of yourself.
  • CKD Stage 5, with an eGFR less than 15 — This is the most advanced stage of kidney disease.  There are abnormal kidney blood tests, almost always with abnormal kidney urine tests, and abnormal kidney imaging, as well.  The nephrologist works with the patient to discuss the patient’s goals of kidney care, including making preparations for the transition from advanced kidney disease to kidney failure.  This includes a kidney transplant before ever having complete kidney failure of the original kidneys and preparing for home dialysis (peritoneal dialysis and home hemodialysis) or in-center hemodialysis, in case the patient cannot get a kidney transplant prior to kidney failure.

The potential signs Of Early Kidney Disease

Many people with early stages of the disease may not have any indication that something is wrong. Some symptoms may be a sign that you either have chronic kidney disease or you are at risk for developing damage to your kidneys include:

  • Having poorly controlled high blood pressure or diabetes
  • Having a family history of kidney disease

What are the causes?

The most common causes of chronic kidney disease include the following:

  • Diabetes
  • Hypertension/High blood pressure
  • Polycystic Kidney Disease
  • Glomerular diseases
  • Lupus
  • Complications due to certain medications such as NSAIDs (non-steroidal anti-inflammatory drugs like Aleve or Motrin)
  • Other rare diseases and birth defects

The symptoms of Chronic Kidney Disease

Kidney disease is considered a “silent disease” and most patients do not have any symptoms until the kidney disease has progressed to a more advanced stage. However, some patients may have symptoms, as early as stage 3a or stage 3b, while others may not recognize any symptoms until stage 4, or even sometimes stage 5.  Some possible symptoms may include the following:

  • feeling tired or fatigued
  • decreased appetite
  • findings that some foods are no longer desirable
  • having a metallic or funny taste in the mouth
  • swelling in the ankles or other parts of the body
  • itchy skin
  • bruising more easily
  • and more

In order to treat some of a patient’s symptoms, as well as some of the complications of kidney disease, the nephrologist checks labs and examines patients.  Some examples of conditions that might be treated, as they arise, as part of your kidney disease care, include the following:

  • high blood pressure
  • fluid overload
  • electrolyte issues, such as abnormalities in the potassium, acid, calcium, phosphorus, etc.
  • anemia, and iron deficiency
  • bone disease, including low vitamin levels, like vitamin D
  • nutrition

How is chronic kidney disease diagnosed?

To accurately diagnose chronic kidney disease, your doctor or a nephrologist at the Rogosin Kidney Center may perform laboratory or image testing. These may include one or more of the following, in addition to other kidney function testing options:

  • Blood testing
  • Urine testing
  • Ultrasound

How quickly does Kidney Disease progress?

The progression of kidney disease can be very different from patient to patient. In general, there are several things that can make kidney disease progress faster, which include the following:

  • long-term use or large doses of certain pain medications, called NSAID medications, including Advil, Aleve, ibuprofen, Motrin, naproxen, and more
  • uncontrolled blood sugars / diabetes
  • uncontrolled blood pressure
  • uncontrolled cholesterol
  • obesity
  • smoking
  • and more

Is Kidney Disease curable?

While kidney disease isn’t curable, it is certainly treatable and manageable. At the Rogosin Kidney Center, we have a multi-prong approach to kidney disease:

– Our first goal is to keep a patient’s original kidneys working as long as possible, hopefully for the patient’s whole life.  We do this by slowing the progression of the patient’s kidney disease, by decreasing the stress on the kidneys, with the following strategies:

  • avoid dehydration, often with drinking water throughout the day
  • avoid or limit the use of certain pain medications, called NSAID medications, including Advil, Aleve, ibuprofen, Motrin, naproxen, and more
  • control and optimize blood sugars / diabetes
  • control and optimize blood pressure
  • control and optimize cholesterol
  • encourage an optimal body weight
  • encourage smoking cessation

– Our second goal, for patients with advanced Kidney disease and approaching kidney failure, is to get the patient a kidney transplant, as an alternative to dialysis. This is especially possible, when a patient has a living donor, willing to donate a kidney to the patient. We hope to get patients a kidney transplant prior to ever reaching kidney failure and needing dialysis.

  • in the United States, patients may be evaluated for a kidney transplant and put their names on the kidney transplant list at an eGFR of 20
  • patients may receive a kidney transplant from someone who is alive and donates one of their two kidneys, or from someone who dies and donates a kidney
  • we help patients coordinate a pre-transplant evaluation, and to put their names on the transplant list, as soon as possible
  • we encourage patients to complete their transplant work-up quickly, so they are ready to receive a kidney transplant as soon as possible
  • we encourage all patients with a possible living donor to have the donor also complete their work-up as quickly as possible, so that the donor is also ready to donate a kidney, when the time comes

– Our third goal is to educate patients with advanced kidney disease on all dialysis options, in the case that dialysis is needed.  We encourage patients to make an informed decision ahead of time, as to what the patient will do, if they cannot receive a kidney transplant before their
kidneys fail.  We try very hard to avoid a patient ever reaching kidney failure in an emergency situation and ending up in the hospital or emergency room.  If dialysis is needed, we prefer a smooth transition to dialysis, as an out-patient, without ever needing the hospital.

  • we review the pros and cons of home dialysis options (peritoneal dialysis and home hemodialysis) vs. the traditional in-center hemodialysis that many people are already familiar with
  • we explain that, for many patients, dialysis is only temporary, until the patient can get a kidney transplant
  • After learning all about their options, many of our patients choose to do dialysis in the comfort of their own home (peritoneal dialysis and home hemodialysis), only coming to the dialysis center one time per month, (instead of 13 times per month), after training.  Patients do their own dialysis, on their own schedule, in the comfort of their own home.  Dialysis can often be done at night, allowing patients to be a “regular person” for 14 hours of the day, just like someone who is not on dialysis
  • We have a special program, PEAK that emphasizes a team approach, with a doctor, a nurse practitioner, a nurse educator, a social worker, and a dietitian.  This allows patients to receive more counseling and education from a variety of specialists

No matter what, our overall goal is to optimize the quality of life for each and every one of our patients.  We try to find the treatments that work for patients, and that the patients tolerate.  We understand that being diagnosed with advanced kidney disease and discussing kidney
failure can be very overwhelming for many people.  We try to give all of our patients the best quality of life, often with home dialysis (peritoneal dialysis and home hemodialysis), until they can get their kidney transplant.

The risks of Chronic Kidney Disease if left untreated

Chronic kidney disease can lead to complications and progression to end stage renal disease (ESRD) when left untreated. These typically occur when the kidneys are functioning at or below 10% to 15% of their full capacity.

  • Kidney failure
  • ESRD

How is chronic kidney disease treated?

Early detection and treatment of the underlying causes of kidney disease may help prevent progression. When chronic kidney disease is diagnosed prior to developing into kidney failure or ESRD, some of the following modifications or treatments could help restore kidney function by addressing the underlying cause for kidney disease:

  • Dietary adjustments
  • Medication to treat anemia or high blood pressure
  • Modification of current medications, such as NSAIDs

Why choose the Rogosin Institute

Rogosin has a unique program, PEAK (Program for Education of Patients with Advanced Kidney Disease) if you have advanced CKD patients (CKD 4 or CKD 5) to coordinate care and provide education about CKD, dialysis modalities and general kidney health. PEAK is an intensive, multidisciplinary education program designed to give you information about treatment options and help you manage your transition to ESRD and be a part of important decision-making. The program also gives you greater access to your care team while also developing close relationships and a more personalized approach.

Treatments for advanced kidney disease

When chronic kidney disease progresses to kidney failure or ESRD, medication and dietary adjustments are not enough. Instead, you may require one of the following more services or treatments offered at the Rogosin Institute:

How can I make an appointment to see a Rogosin Nephrologist and get more information?

For a new patient appointment or for a second opinion with a kidney specialist, please call  212.746.6974 or fill out the form on this page to schedule an appointment with us any time.

Rogosin is recognized as one of the country’s premier centers for the diagnosis and management of kidney disease. Our doctors lead the way in chronic kidney disease treatment for patients in the New York Metropolitan Area and beyond.