CKD Stage with 15% Kidney Function
With 15% kidney function (GFR approximately 15 mL/min/1.73 m²), you are at Stage 5 CKD, which represents kidney failure. 1, 2
CKD Stage Classification
The National Kidney Foundation K/DOQI guidelines define Stage 5 CKD as:
- GFR <15 mL/min/1.73 m² or requiring dialysis 1, 2
- This stage represents kidney failure, where the kidneys have lost approximately 85% or more of their function 1
- At this level, most patients (approximately 98%) develop signs and symptoms of uremia 1
Clinical Significance of Stage 5 CKD
Stage 5 is the most severe stage of chronic kidney disease and typically requires kidney replacement therapy. 1, 3
Key characteristics include:
- Uremic symptoms commonly develop, including nausea, vomiting, fatigue, confusion, and fluid overload 3
- Multiple complications are present, including severe anemia, mineral bone disease, electrolyte abnormalities (hyperkalemia, metabolic acidosis), and cardiovascular disease 2, 3
- Kidney replacement therapy (dialysis or transplantation) becomes necessary when uremic symptoms develop or complications cannot be managed conservatively 1, 3
Distinction from Earlier Stages
To understand the severity, the staging system is:
- Stage 1: GFR ≥90 mL/min/1.73 m² with kidney damage 2
- Stage 2: GFR 60-89 mL/min/1.73 m² with kidney damage 2
- Stage 3: GFR 30-59 mL/min/1.73 m² (moderate decrease) 2
- Stage 4: GFR 15-29 mL/min/1.73 m² (severe decrease, requires preparation for dialysis) 2, 3
- Stage 5: GFR <15 mL/min/1.73 m² or dialysis (kidney failure) 1, 2
Important Clinical Considerations
The decision to initiate dialysis should be based on clinical symptoms and complications, not solely on the GFR number. 3
- Some patients with Stage 5 CKD can be managed conservatively for extended periods if they remain asymptomatic 3, 4
- Indications for dialysis initiation include: uremic symptoms unresponsive to medical management, severe fluid overload despite diuretics, refractory hyperkalemia or metabolic acidosis, uremic pericarditis or pleuritis, and severe malnutrition 3
- Conservative management without dialysis may be appropriate for some patients with multiple comorbidities or significant frailty 3
Common Pitfall
Do not confuse Stage 5 CKD with "end-stage renal disease" (ESRD). ESRD is an administrative term in the United States indicating a patient is receiving dialysis or transplantation for Medicare payment purposes, whereas Stage 5 CKD is a clinical classification based on kidney function that includes patients not yet on replacement therapy. 1