What are the symptoms and management strategies for a patient with stage 3a Chronic Kidney Disease (CKD)?

Symptoms of Stage 3a Chronic Kidney Disease

Most patients with stage 3a CKD (eGFR 45-59 mL/min/1.73 m²) are asymptomatic, as symptoms typically do not manifest until kidney function declines below 30 mL/min/1.73 m² (stage 4 or worse). 1, 2

Common Symptoms When Present

While stage 3a CKD is generally asymptomatic, when symptoms do occur, they include:

• Fatigue and lack of energy are the most frequently reported symptoms, though these are more common in advanced stages 1
• Sleep disturbances may develop as kidney function declines 1
• Itching or skin problems can occur but are typically mild at this stage 1
• Pain or discomfort may be present depending on the underlying cause of kidney disease 1

Clinical Complications That May Cause Symptoms

Complications of CKD that become prevalent when eGFR falls below 60 mL/min/1.73 m² can produce symptoms:

• Elevated blood pressure may cause headaches, though hypertension is often asymptomatic 1, 3
• Volume overload can manifest as peripheral edema, shortness of breath, or weight gain 1
• Anemia may cause fatigue, weakness, and reduced exercise tolerance, though this becomes more prevalent in later stages 1, 4
• Electrolyte abnormalities including hyperkalemia or metabolic acidosis are typically asymptomatic but can cause muscle weakness or cardiac arrhythmias in severe cases 1, 2
• Metabolic bone disease is usually asymptomatic at stage 3a but can cause bone pain in advanced cases 1

Important Clinical Context

• The vast majority of stage 3 CKD patients do not progress to end-stage renal disease but die primarily from cardiovascular causes, making cardiovascular risk reduction the priority 1, 5
• Approximately 48% of stage 3 CKD patients do not progress beyond stage 3 over 10 years, with stage 3a patients having significantly lower progression risk than stage 3b patients 5
• Less than 5% of patients with early CKD are aware of their disease, highlighting the asymptomatic nature of early-stage kidney disease 2

Monitoring Recommendations

Patients with stage 3a CKD should be evaluated every 6-12 months for:

• Blood pressure and weight assessment at each clinical contact 1, 3
• Laboratory evaluation including serum electrolytes, hemoglobin, calcium, phosphate, PTH, and vitamin 25(OH)D 1, 3
• eGFR and albuminuria monitoring to assess disease progression 3, 6, 2