My Autobiography: David Balleza K(C)atague: The Five Stages of Chronic Kidney Disease

Monday, August 4, 2025

The Five Stages of Chronic Kidney Disease

This posting is inspired from my recent visit to my nephrologist and my current CKD Diagnoses.

Chronic kidney disease (CKD) is classified into five stages, based on how well your kidneys are filtering waste from your blood. This is typically measured by a calculation called the estimated glomerular filtration rate (eGFR):

Stage 1: Kidney function is normal (eGFR 90 or greater).
Stage 2: Mild loss of kidney function (eGFR 60–89).
Stage 3: Moderate loss of kidney function, further divided into:
- 3a: eGFR 45–59
- 3b: eGFR 30–44
Stage 4: Severe loss of kidney function (eGFR 15–29, or roughly 15–29% kidney function).
Stage 5: Kidney failure or end-stage renal disease (eGFR less than 15, or less than 15% kidney function).

If a person is in Stage 4 kidney disease, this means their kidney function is between 15% and 29%, so "only 20% of his kidney is functioning" is a correct way to describe someone at Stage 4. This stage often requires close monitoring by a kidney specialist, and preparations may begin for dialysis or transplant if kidney function continues to decline.

In stage 4 chronic kidney disease (CKD), symptoms are more pronounced and can significantly affect daily life, compared to earlier stages where a person may have few or no symptoms. Here’s how symptoms in stage 4 typically differ from the earlier stages :

Common symptoms appearing or worsening in stage 4 CKD:

Fatigue and weakness: Due to anemia and buildup of waste products, people often feel very tired and weak, more so than in earlier stages.
Swelling (edema): Noticeable swelling in legs, ankles, feet, and sometimes hands and face, due to fluid retention; swelling is usually mild or absent in earlier stages.
Shortness of breath: Fluid buildup in lungs or anemia can cause difficulty breathing.
Nausea and vomiting: As toxins accumulate, nausea and occasional vomiting become more common in stage 4.
Loss of appetite: Eating less and weight loss are more prominent.
Changes in urination: Either more frequent urination at night, foamy urine, or much less urine (sometimes unable to urinate).
Difficulty concentrating/confusion: The buildup of waste affects mental sharpness and can lead to confusion.
Muscle cramps and restless legs: More frequent and severe.
Itching: Increased due to high levels of phosphorus and other waste in the blood.
High blood pressure: Worsens or may become difficult to control.

Comparison with earlier stages:

Early CKD (stages 1-2) is often asymptomatic, sometimes only identified with blood or urine tests.
By stage 3, mild symptoms such as fatigue, mild swelling, or urination changes may be present, but often are not severe.
Symptoms increase in severity and number by stage 4, with a higher risk of complications affecting multiple body systems.

Summary: Stage 4 CKD is marked by more severe symptoms and complications (especially fatigue, swelling, appetite loss, and mental changes) than the earlier stages, meaning patients typically feel much sicker and daily life is often affected .

What is the expected survival rate of persons with Stage 4, that is what is the average time, this person will lead a fairly normal life?

The expected survival and ability to lead a fairly normal life with stage 4 chronic kidney disease (CKD) is highly variable and depends on factors like age, overall health, how well other conditions are managed (such as diabetes or high blood pressure), and how closely treatment recommendations are followed.

On average, studies suggest that older adults (e.g., age 70) newly diagnosed with stage 4 CKD have a life expectancy of about four years. However, this is just an estimate, and many people can live longer—sometimes several years—if they follow their medical plan and maintain a healthy lifestyle.
For older patients with high comorbidity or poor health, the median survival has been reported between 1–4 years, with 1-year survival rates ranging from 29% to more than 80% depending on age, severity, and whether dialysis is started.
Many people with stage 4 CKD can lead a fairly normal life, especially during the initial part of this stage, if they manage symptoms, control blood pressure, eat a kidney-friendly diet, and remain physically active. However, as kidney function continues to decline, symptoms usually worsen, and normal activities may become progressively more difficult.

Summary: Life expectancy in stage 4 CKD can range from 1 to several years, with some patients living as long as four years or more. The period during which a person leads a "fairly normal" life depends greatly on their overall health, adherence to treatment, and other health conditions. Adhering strictly to medical advice can slow progression and maintain quality of life for as long as possible .

What is the quality of life of a person under Dialysis?

The quality of life (QoL) for patients on dialysis is generally lower compared to healthy individuals and is affected by multiple physical, psychological, and social factors:

Patients on hemodialysis often experience chronic fatigue, poor sleep quality, pain, nausea, vomiting, and limitations in physical activity which impact their daily life. They may also suffer from emotional challenges such as anxiety, depression, and feelings of helplessness. The strict dialysis schedule and dependency on equipment and dialysis centers can limit their ability to travel, work, or engage in social activities .

Patients on peritoneal dialysis tend to report somewhat better QoL in some areas, such as more flexibility, less dietary restriction, less dependence on healthcare personnel, and a greater sense of life meaning and social engagement, although they may face other challenges like depression.

The mental health and emotional well-being of dialysis patients can be significantly affected due to the chronic nature of kidney failure and dialysis treatment. Many experience worry, helplessness, and a negative outlook on the future, which further reduces their QoL.

Caregivers of dialysis patients also experience a reduced quality of life, especially physically and mentally, reflecting the burden of caring for someone on dialysis.

Despite these challenges, many patients do feel better after starting dialysis as it reduces toxin buildup and treats anemia, which can improve energy levels and well-being compared to pre-dialysis kidney failure. However, the overall impact of dialysis on daily life remains substantial.

In summary, dialysis patients generally face a reduced quality of life with multiple physical and psychological burdens. However, quality of life can vary depending on the type of dialysis, support systems, and individual coping mechanisms. Personalized care, psychological support, and flexible treatment options can help improve outcomes for dialysis patients .

What is hemodialysis versus peritoneal dialysis

Hemodialysis and peritoneal dialysis are two types of dialysis treatments used to filter and remove waste, excess fluid, and toxins from the blood when the kidneys are no longer functioning adequately.

Hemodialysis:

Blood is removed from the body and filtered through a machine called a dialyzer (artificial kidney).The machine cleans the blood and then returns it to the body.Usually performed in a dialysis center or hospital, but can sometimes be done at home. Typically requires about three to four-hour sessions, three times a week.Needles are placed in a vein at each treatment to access the blood.Causes intermittent filtration and fluid removal.Suitable for patients who want healthcare professionals to manage the treatment .

Peritoneal Dialysis:

Uses the body's own peritoneum (lining of the abdominal cavity) as a natural filter.A dialysis solution (dialysate) is infused into the abdomen through a surgically placed catheter. Waste products and excess fluids pass from blood vessels in the peritoneum into the dialysis fluid. The fluid is later drained and replaced; this exchange can be done multiple times daily or overnight using a machine.Can be done at home, work, or any clean space, providing more independence and flexibility. Less dietary restrictions, continuous filtering means less buildup of waste and fluid. Patients do not require needles as with hemodialysis but require training to perform the exchanges .

Summary of Differences:

Feature	Hemodialysis	Peritoneal Dialysis
Filtering mechanism	Machine-based extracorporeal blood filtration	Uses body's peritoneum as a natural filter
Frequency & duration	About 3-4 hours, 3 times/week	Continuous or daily exchanges, time varies
Location	Usually in-center, sometimes at home	Usually at home or anywhere clean and private
Invasiveness	Requires needle access to veins	Requires catheter surgically placed in abdomen
Lifestyle impact	More disruption; fixed schedule	More flexible; performed by the patient
Dietary restrictions	More restrictive	Less restrictive
Suitable for	Patients needing healthcare supervision	Patients able to manage self-care, no abdominal issues

Choosing between them depends on individual health conditions, lifestyle, personal preference, and kidney function .

Meanwhile, here's my Photo of the Day

Lastly, here's my posting on Food and Drinks to Avoid if you have CKD

https://chateaudumer.blogspot.com/2025/08/food-and-drinks-to-avoid-if-you-have.html

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Highlights of My Professional Career

In my more than 40 years of professional career, I have experienced both working rank and file, as well as supervising the work of subordinates. I have worked in four private firms and the Federal Government, the Food and Drug Administration (FDA), where I retired. I enjoyed the challenges and difficulties of both types of job situations. This is the highlights of my work experience story.

My first job after completing my doctorate degree was a Chemist for Chemagro Corporation in Kansas City, Missouri. It was a subsidiary of Bayer Corporation, a German conglomerate. I worked for the analytical chemistry department comprised of about fifty people; half that number was either chemists or biologists. My specific task was to develop analytical methods for the detection of pesticide residues in plant and animal tissues. I worked on my own, similar to six other bench chemists, and we all reported to the same supervisor.

The firm sponsored my visa conversion from a student to a permanent resident, and I was able to legally work and reside in the United States with my family. The company generously took care of its employees. At the end of each successful year, everyone received a 13th month salary bonus. The employees and their families celebrated wonderful annual Christmas parties in a downtown Kansas City hotel, with dancing and free drinks for the whole night.

Inasmuch as I enjoyed and loved working for Chemagro for five years, I found a new job which offered a substantially higher pay. Due to my exemplary work performance, my supervisor preferred and lobbied for me to stay with the company. I had to turn him down because they could not match the package presented by my new employer. It was also a chance for me and my family to move and live in the US west coast, where the mild winter climate is bearable compared to the Midwest.

My next job was at the agricultural research division of Shell Development Company in Modesto, California. I was a Research Chemist, and again I worked individually, same as five other chemists who all reported to a supervisor. My specific duty was similar to my previous job. I worked for them for five years, until the company decided to get out of the pesticide business. They closed their research facility affecting the jobs of more than 200 employees.

My third industrial job was with the agricultural research division of Stauffer chemical company, located in Richmond, California. I was a Senior Research Chemist doing the same project as my two previous jobs. I worked for twelve continuous years for the company, with outstanding annual job performance. I became a Principal Research Chemist, the highest attainable non-supervisory position.

One day in 1986, my supervisor informed me that my job had been eliminated, and I had one day to vacate the facility. It was the most dreadful lay off experience in my life. I felt anger, sadness and humiliation to be dismissed from work with one day notice, after all the years of hard work invested for the company. This was an unforgettable incident and was the gloomiest point in my professional career.
The company terminated sixty research employees, who were upset of the bad news.

One of the chemists was distressed and expressed his outrageous anger by threatening the company and its workers. He told his supervisor of his intention to bomb and burn down the laboratory. He was immediately escorted by the security staff out of the building and into his car. He was informed to leave behind his personal belongings; they will be mailed to his residence. He was warned never to show up again near the company premises or risk getting arrested.

My supervisor was kind and allowed me to take my time to pack up my belongings. It took me two days to clear up my workplace, after toiling for a long period in the same jobsite. We were provided clerical help and office space, in preparation to look for another job, such as updating our resumes, and using the computer and copy machine. We were given six weeks of separation pay plus benefits.

Fortunately, with the help of a friend who is a Church parishioner, I found another job thirty days after leaving Stauffer chemical company. He hired me as a senior research chemist and as a group leader with two technicians to supervise. It was in the same field as my expertise in my previous three jobs spanning the last twenty one years. My new employer was Chevron Chemical Company, and which was located in the same area as my former employer.

This job gave me the introduction and basic knowledge of managing the work of subordinates. I worked for Chevron Company for four and a half years. The company decided to consolidate their research facilities in Texas, and lay off all its research employees. This time I had enough distress and agony from working, and eventually getting laid off from several private companies. To avoid going through any more miserable layoffs, I made a vow that I would never again work for a private company.

In my work experiences, there were noticeable and unavoidable jobsite occurrences. One can never miss the office romantic relationships between co-workers, both illicit and permitted. Though it was frowned upon, there was a boss and staff relationship, which was used as a ploy to get ahead in the company. Some relationships had chemistry, no pun intended, but some never worked out. Oftentimes, there was a sense of distrust among bench chemists for some workers who unjustly obtained preferred work assignments.

Some employees resorted to bribing superiors to get special privileges, such as being able to attend choice conferences and meetings in exciting venues or locations. Likewise, politics was always present at the worksites. It was during an era when various forms of harassment, equal opportunity and discrimination laws were not yet enforced in the workplace. Occasionally, an unexpected chemical explosion happens in a laboratory setting, where luckily no one got seriously hurt.

In the three private companies I worked for, I was able to publish scientific journals for some of the research studies and analytical methods which I developed for the respective companies of Chemagro, Shell Development and Stauffer.

After deciding and making a vow to avoid working in the private sector, I made my new goal which was either to work for the state of California, or the Federal government in Washington, D.C. Four months after I lost my job in Chevron, I was lucky and joyful to be hired by the Food and Drug Administration as a review chemist in the fall of 1990.

In 1994 I was promoted as an Expert Research Chemist with a GS-14 rating. My expertise was on Anti-malarial and Anti-parasitic drug products. In 1997, I was again deservingly promoted to Chemistry team leader, supervising the work of six Chemistry reviewers including five with doctorate degrees.

As team leader, I was responsible for prioritizing, assigning, and assuring the technical accuracy of all chemistry, manufacturing and control issues for all new drug applications submitted to the Division of Anti-Infective Drug Products, Center of New Drugs.

It was part of my responsibility to give advice, instruct and promote high morale and teamwork in my group. My work in the FDA is confidential, until the drug patent on the products I worked on has expired. There are manufacturing supplements that I have approved that are now open for the public in the Internet.

In 1998, I won the Equal Employment Opportunity (EEO) Award. The citation reads, “For outstanding accomplishments in fostering the objectives of the EEO Program by hiring minorities and encouraging their professional growth while providing excellent leadership.” I have received numerous certificates of appreciation, awards in leadership and communications, commendation for teamwork and excellence in the accomplishment of the FDA mission. I have also received several letters of appreciation from private industry for my review work.

There are many good things working as rank and file while enjoying doing one’s job individually. It is a humbling, satisfying and productive experience, if one can work in harmony with one’s immediate supervisor. Working individually develops one’s skills in goal setting and scheduling. But in general, the financial rewards are less than a person who has supervisory responsibilities.

Managing the work of others has its challenges. Moreover, it develops one’s skill in handling and developing people, and the compensation rewards and benefits are better. Due to additional duties, responsibilities and leadership, supervisory work can be more stressful than working as a subordinate. However, supervisory jobs give one more personal growth and satisfaction, based on my personal experience. My work in FDA as a team leader managing the work of six scientists had been the happiest and rewarding work experience in my career in Chemistry. You might also like:

Monday, August 4, 2025

The Five Stages of Chronic Kidney Disease

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