From the Guidelines
Stage V Chronic Kidney Disease (CKD) is diagnosed when the estimated glomerular filtration rate (eGFR) falls below 15 mL/min/1.73m², indicating severe kidney damage with very poor kidney function, as defined by the most recent guidelines 1.
Diagnostic Criteria
The diagnostic criteria for stage V CKD include:
- eGFR less than 15 mL/min/1.73m², which represents kidney failure and the need for renal replacement therapy (dialysis or kidney transplantation) 1
- Persistent albuminuria (urinary albumin-to-creatinine ratio >30 mg/g) for at least three months, though this is not always required if other evidence of kidney damage exists 1
- Markers of kidney damage, such as hematuria, pyuria, or urinary tract obstruction, and structural abnormalities detected by kidney imaging 1
Clinical Presentation
Patients with stage V CKD typically experience significant symptoms, including:
- Fatigue
- Nausea
- Vomiting
- Metallic taste in the mouth
- Itching
- Shortness of breath
- Fluid retention
Laboratory Findings
Laboratory findings often show:
- Elevated blood urea nitrogen (BUN), creatinine, potassium, and phosphorus levels
- Decreased calcium, hemoglobin, and bicarbonate levels
Management
At this advanced stage, renal replacement therapy (dialysis or kidney transplantation) is usually necessary for survival 1. Regular monitoring of electrolytes, acid-base balance, and anemia is essential, as these parameters often require medical management with medications such as phosphate binders, erythropoietin, and vitamin D analogs.
From the Research
Diagnostic Criteria for Stage V Chronic Kidney Disease (CKD)
The diagnostic criteria for stage V CKD are based on the glomerular filtration rate (GFR) and the presence of kidney damage or albuminuria.
- A GFR <15 mL/min/1.73 m(2) is sufficient to diagnose stage V CKD 2.
- Kidney damage can be ascertained by the presence of albuminuria, defined as albumin-to-creatinine ratio >30 mg/g in two of three spot urine specimens 2.
- GFR can be estimated from calibrated serum creatinine and estimating equations, such as the Modification of Diet in Renal Disease (MDRD) Study equation or the Cockcroft-Gault formula 2, 3.
- The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is also used to estimate GFR and has been shown to result in higher estimated glomerular filtration rates (eGFRs) than the MDRD formula 4, 5.
Staging of CKD
The staging of CKD is based on the level of GFR, with stage V being the most severe.
- Stage V CKD is characterized by a GFR <15 mL/min/1.73 m(2) 2.
- The use of different equations to estimate GFR can result in different prevalence rates of CKD and different classifications of CKD stage 5, 3.
- The CKD-EPI equation has been shown to be more accurate than the MDRD equation in estimating GFR in some populations 6.