Is Stage 3 Chronic Kidney Disease Close to Uremia?

In recent years, the number of patients newly diagnosed with chronic kidney disease (CKD) worldwide has been rising. Some patients may progress to end-stage renal disease (uremia), requiring dialysis or kidney transplantation. As a result, many patients closely monitor their serum creatinine levels and kidney function, especially those diagnosed with stage 3 CKD.

To clarify, stage 3 CKD is defined by kidney function, specifically a glomerular filtration rate (GFR) of 30–59 ml/min/1.73m². This is distinct from pathological classifications (e.g., IgA nephropathy Lee grade 3 or Henoch-Schönlein purpura nephritis grade III), as kidney function and pathology are not equivalent.

If you’re unsure about glomerular filtration rate, you can use the GFR calculator tool available through the provided mini-program.

Many patients ask: “Does reaching stage 3 mean I’m close to uremia? Will I inevitably need dialysis?”
We consulted Dr. Liu Yan to address this common concern.

Will Stage 3 CKD Inevitably Progress to Uremia?
The answer is no. Stage 3 CKD does not necessarily lead to uremia. Let’s examine the evidence.

(Note: GFR, short for glomerular filtration rate, is measured in ml/min/1.73m², omitted hereafter for brevity. Stage 3 CKD is subdivided into 3a (GFR > 45) and 3b (GFR < 45).)

A retrospective study from South Korea followed 347 stage 3 CKD patients (194 males, 153 females, average age 64.1 ± 12.6 years, average GFR 46.4 ± 8.7) for over a decade. The cohort included 236 patients with hypertensive nephropathy (68.0%), 64 with diabetic nephropathy (18.4%), 14 with chronic glomerulonephritis (4.0%), 11 with polycystic kidney disease (3.3%), and 22 with other conditions (6.3%).

After ten years, 167 patients (48.1%) maintained stable or improved kidney function, with stage 3a patients faring better. Of the 180 patients (51.9%) whose kidney function declined, only 50% required dialysis. This study shows that after a decade, half of the patients maintained their kidney function, and some even improved, demonstrating that stage 3 CKD, when well-managed, can remain far from dialysis.

Why Do Some Progress While Others Don’t?
Why do outcomes vary so widely among stage 3 CKD patients? Beyond the well-known factors—proteinuria, hypertension, and blood sugar control—several other factors influence the rate of kidney function decline:

• Accuracy in Predicting Decline: Patients often ask, “With a creatinine level of 150, how long until I develop uremia?” or “If I control proteinuria, will I avoid uremia?” These questions are challenging to answer definitively. Predicting the exact progression of CKD is unreliable due to individual variability and multiple influencing factors.

While CKD stages (1–4) provide a framework, they cannot precisely predict progression speed. Factors like medication misuse or seeking unverified treatments can covertly harm the kidneys, adding unpredictability. However, doctors can identify and manage controllable factors that accelerate CKD progression, offering patients actionable steps to slow decline.

Rather than fixating on when uremia might occur, patients should collaborate with their doctors to address each risk factor diligently in their daily lives. This proactive approach is the cornerstone of preventing CKD worsening.

Dietary Considerations for Stage 3 CKD
For patients with GFR ≥ 60 (stages 1–2 CKD), dietary restrictions are generally unnecessary, provided healthy eating habits are maintained. There’s no conclusive evidence that low-protein diets prevent progression in these stages, and such diets may risk malnutrition.

For patients with GFR < 60 (stage 3 and beyond, excluding dialysis), a low-protein diet (0.6–0.8 g/kg daily) under a nutritionist’s guidance is recommended. This reduces urea nitrogen, toxins, and phosphorus intake, potentially slowing CKD progression.

Emerging Treatments for Stage 3 CKD
What new developments are there in preventing stage 3 CKD progression? Several promising therapies are under investigation:

• Complement Inhibitors: Drugs like eculizumab (a monoclonal antibody targeting complement C5) are being studied for conditions like membranoproliferative glomerulonephritis, post-infectious glomerulonephritis, hemolytic uremic syndrome, and IgA nephropathy, where complement activation plays a role.
• JAK/STAT Inhibitors: Drugs like baricitinib target inflammation in diabetic nephropathy, a key factor in its progression.

These are just a few examples of therapies in clinical trials. While not yet available, they highlight the growing focus on CKD research. Patients should remain hopeful, stay informed, and adhere to treatment plans, knowing that medical advancements are on the horizon.

No matter the stage of CKD, patients should not lose heart. By learning about their condition and following treatment diligently, they can live well each day.