In this guide 6 sections
Kidney disease is quiet. There are usually no symptoms until late, so the diagnosis often arrives as a number on a lab report the doctor mentions almost in passing: “her kidney function is down a bit”. The number matters, and understanding it is the first job.
The number and the stage
The key figure is eGFR, estimated glomerular filtration rate, a measure of how well the kidneys filter, calculated from a blood test. Normal is 90 or above. Chronic kidney disease is diagnosed when eGFR is below 60 for three months or more, or when there is kidney damage such as protein in the urine.
CKD stages by eGFR
1–2
- eGFR
- 60 and above (with kidney damage)
- What it generally means
- Mild. Monitor, control blood pressure and diabetes.
3a
- eGFR
- 45–59
- What it generally means
- Mild to moderate. Most common stage at diagnosis in older adults. Focus on slowing progression.
3b
- eGFR
- 30–44
- What it generally means
- Moderate to severe. Nephrology referral is often recommended. Medication doses may need adjusting.
4
- eGFR
- 15–29
- What it generally means
- Severe. Nephrology care, kidney disease education, and planning for what comes next.
5
- eGFR
- Below 15
- What it generally means
- Kidney failure. Dialysis, transplant or conservative care.
| Stage | eGFR | What it generally means |
|---|---|---|
| 1–2 | 60 and above (with kidney damage) | Mild. Monitor, control blood pressure and diabetes. |
| 3a | 45–59 | Mild to moderate. Most common stage at diagnosis in older adults. Focus on slowing progression. |
| 3b | 30–44 | Moderate to severe. Nephrology referral is often recommended. Medication doses may need adjusting. |
| 4 | 15–29 | Severe. Nephrology care, kidney disease education, and planning for what comes next. |
| 5 | Below 15 | Kidney failure. Dialysis, transplant or conservative care. |
A second test, urine albumin, measures protein leaking into the urine and predicts how fast the disease may progress. Ask for both numbers and the trend over time. A stable eGFR of 40 in an 84-year-old is a very different situation from a rapidly falling one in a 68-year-old.
Who should see a nephrologist
Guidelines generally recommend nephrology referral when eGFR is below 30, when it is falling quickly, when there is significant protein in the urine, or when the cause is unclear. Many stage 3 patients are managed well by primary care. If the referral is recommended, Medicare covers it, and the first visit will usually include a review of medications, blood pressure, diet and what to expect.
Medications: the most urgent review
Failing kidneys clear many medications more slowly, so doses that were fine become too high. Some common medications damage kidneys directly. In the first month, every medication she takes, prescription and over the counter, should be reviewed with a pharmacist or the nephrologist:
- NSAIDs such as ibuprofen and naproxen are hard on kidneys and are often the first thing stopped. Acetaminophen is usually preferred for pain.
- Metformin, some diabetes medications, certain antibiotics and some blood pressure drugs need dose adjustment or replacement.
- Contrast dye for CT scans needs planning. Tell every imaging center.
- Some medications actually protect kidneys: ACE inhibitors, ARBs and SGLT2 inhibitors slow progression for many patients. Ask whether she should be on one.
- Supplements and herbal products can be harmful. Bring the whole bag to the review.
Blood pressure, diabetes and diet
The two conditions that cause most kidney disease, high blood pressure and diabetes, are also what drive it forward. Tight control of both is the main treatment at stage 3. Diet matters too, and the renal diet is genuinely confusing: limits on sodium and sometimes protein, potassium and phosphorus depending on labs. Medicare covers medical nutrition therapy with a registered dietitian for chronic kidney disease. Ask for the referral; it is one of the most useful and least used benefits in kidney care.
At stage 4: the classes and the conversation
Medicare covers up to six sessions of kidney disease education for stage 4 patients, delivered by a doctor or a qualified educator, covering how to slow progression, the treatment options, and how to prepare. Ask for it. This is also when the conversation about what happens if the kidneys fail should begin, calmly and early: in-center hemodialysis, home dialysis, transplant evaluation, or conservative kidney management without dialysis, which is a legitimate choice many older adults make with palliative support. Decisions made in an emergency are worse than decisions made over months.
Tell every doctor
The cardiologist, the orthopedist, the dentist prescribing antibiotics, the urgent care that reaches for ibuprofen: all of them need to know her kidney function. Put it on a card in her wallet. Ask the primary care office to flag it in the chart. This is the kind of information that does not travel between offices on its own.
Questions families ask
What does stage 3 kidney disease mean for an older adult?
Moderately reduced kidney function, eGFR between 30 and 59. In many older adults it progresses slowly or not at all with good blood pressure and diabetes control and careful medication use. It does mean every medication should be reviewed for kidney safety, and that the trend should be watched.
Does Medicare cover kidney disease education?
Yes. Medicare Part B covers up to six sessions of kidney disease education for people with stage 4 CKD when referred by their doctor. Medicare also covers medical nutrition therapy with a registered dietitian for chronic kidney disease.
Which medications are dangerous with kidney disease?
Over-the-counter NSAIDs such as ibuprofen and naproxen are the most common problem. Many prescription drugs need dose adjustment. Some supplements and herbal products are harmful. Every medication should be reviewed by a pharmacist or nephrologist, and every prescriber should know her kidney function.
Will my mother need dialysis?
Many people with stage 3 never do. At stage 4, the possibility should be discussed early so that if kidney function keeps falling, the family has had time to consider in-center dialysis, home dialysis, transplant or conservative management. Deciding calmly over months is far better than deciding in an emergency.
How can a navigator help with kidney disease?
By coordinating the nephrology, dietitian and education referrals, helping with the medication review, making sure other doctors and imaging centers know about the kidneys, helping the family understand the coverage rules if dialysis becomes likely, and solving the transportation problem if it does.
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