For someone with stage 3 chronic kidney disease (CKD), this means there is moderate kidney damage. While stage 1 and stage 2 are generally asymptomatic, physical symptoms start to present themselves in stage 3. If you or someone you love has stage 3 CKD, it’s important to understand potential symptoms, what doctors to talk to, and how to manage disease progression moving forward.

At stage 3 CKD, your eGFR is between 30 and 59, which means that your kidneys are working at between 30% and 59% capacity. It’s a sign that your kidneys have sustained some damage and are not working as well as they should be. 

When your kidney function declines, your kidneys are less able to filter waste products, such as urea and excess fluids out of your blood. This can cause a waste build-up called uremia. Uremia can lead to complications, including:

• High blood pressure
• Anemia (shortage of red blood cells to transport oxygen)
• Early bone disease
• Diabetes

To diagnose stage 3 CKD, your doctor will likely perform the following tests:

• eGFR tests (which will be repeated every 90 days from the initial diagnosis)
• Blood pressure readings
• Urine tests
• Imaging tests (to rule out a more advanced stage of CKD)

As previously mentioned, the first two stages of CKD are largely asymptomatic. Kidney disease symptoms typically start to appear in stage 3 CKD.

Back pain, specifically in your lower back, can be an indication of kidney disease.
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Potential symptoms of stage 3 kidney disease include:

• Unexplained fatigue: You may feel weak and exhausted even after a full night’s sleep.
• Fluid retention: Excess fluid buildup of fluid in the body can cause severe swelling in the arms and legs.
• Swelling (edema) of extremities: An accumulation of fluid in the tissues can lead to swelling of the hands, feet, and ankles.
• Shortness of breath: You feel out of breath even when at rest or doing light activities.
• Changes in urination: You may notice changes in your urine color (dark orange, brown, blood-tinged); amount (less or more than usual); and/or consistency (foamy). 
• Back pain: You feel chronic and persistent pain, specifically in your lower back, by your kidneys. 
• Trouble sleeping: Restless legs, spasms, cramping, and tingling or burning sensations in your limbs can interfere with the duration and quality of your sleep. 

It is important to note that these symptoms may not be indicative solely of stage 3 kidney disease. If any of these symptoms are present, it is best to consult with a doctor for diagnosis and treatment. Early detection and management can help improve the long-term prognosis. 

While stage 3 kidney disease indicates a decline in kidney function, there are still many treatment options available to manage the disease and symptoms, as well as slow disease progression. Treatment options vary depending on an individual’s overall condition, but often involve lifestyle changes, as well as medications to treat underlying related conditions.

From a lifestyle standpoint, you should:

• Control your blood sugar if you have diabetes.
• Do not smoke or use tobacco, and quit if you do.
• Manage your blood pressure.
• Eat healthily, and follow a kidney-friendly diet.
• Maintain a healthy weight.
• Get 30 minutes of physical activity five days a week.

Regular exercise is one of the important lifestyle changes you can make to slow disease progression.
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If you haven’t already done so, this would be an appropriate time to make an appointment with a nephrologist (kidney doctor). They will develop a treatment plan that fits your unique situation, including regular kidney check-ups.

If making dietary changes feels overwhelming, or you feel like you don’t know where to start, you can meet with a renal dietitian. Diet is crucial to the successful management of kidney disease, as it can preserve remaining kidney function and improve your overall health. Your renal dietitian will create a specialized meal plan for you to follow, while taking your all-around needs into consideration.

At stage 3, you do not yet need dialysis or a kidney transplant. Lifestyle changes play a large role in CKD treatment, but certain medications may also be prescribed. It’s common for people with CKD to develop diabetes or high blood pressure as a result. To control your glucose level and maintain healthy blood pressure, your doctor will probably prescribe a blood pressure medicine.

The two most frequently prescribed blood pressure medications are:

• ACE (angiotensin-converting enzyme) inhibitors
• ARBs (angiotensin receptor blockers)

Research has shown that both of these medications help to slow kidney disease progression—“even in people with diabetes who do not have high blood pressure,” according to DaVita Kidney Care.

Other treatments that may be prescribed to help with the symptoms and side effects of CKD include:

• Calcium and/or vitamin D supplements to prevent bone fractures
• Chlorestol-lowering drugs
• Diuretics to treat edema
• Iron supplements for anemia

Your nephrologist and renal dietitian will help you develop a comprehensive plan of care to maximize your existing kidney function, and optimize your overall health.