My nephrologist (kidney specialist) sent me a letter that my serum creatinine is 3.0 mg/dL and I have stage 3 CKD. What does this mean?

Stage 3 CKD indicates a moderate decrease in GFR. At this stage of CKD, we start to see problems related to the decline in renal function. Your nephrologist will start to look for potential renal-related issues such as higher blood pressure, anemia (low red blood cell count), electrolyte abnormalities (high potassium, high phosphorus), and fluid retention (weight gain or swelling in the legs). It’s time to start thinking about renal replacement therapy

Renal replacement therapy is just as it sounds: It is therapy that is going to replace or take over the job of your kidneys. There are two types of renal replacement therapy: transplantation and dialysis.

Transplantation is a surgical procedure in which a healthy kidney from another person (donor) is placed into your body to assume the work of your nonfunctioning kidneys. Dialysis is a life-sustaining treatment. Dialysis literally takes over the job of your kidneys. There are two major types of dialysis: hemodialysis and peritoneal dialysis.

Hemodialysis involves a dialysis machine with a filter that “cleans” your blood by removing toxins, correcting your electrolytes and removing excess fluid from your body. Typically, you attend an outpatient dialysis center three times a week for your dialysis treatment. Most treatments last between 3 and 4 hours.

During a dialysis treatment blood is removed from your body and pumped through a dialysis filter. The “cleaned” blood is returned to your body. To perform dialysis we need access to your blood supply. A catheter (a tube) can be placed in a large vein in your body, such as the jugular vein in your neck, subclavian vein in your chest, or femoral vein in your groin. The catheter has two ports, one for removing blood to go through the dialysis filter and one to return the “clean” blood to your body. A catheter is a temporary access.

A permanent access is an arteriovenous fistula. A surgeon performs an operation to attach a vein and an artery in your arm to form an arteriovenous fistula. If your veins are small, an alternative access is a graft. A surgeon performs an operation using a soft tube to link an artery and vein together. The fistula and graft are both under the skin. They look like large veins. The dialysis staff is able to access the fistula or graft by placing two needles. The needles are connected to tubing. One needle draws blood from the fistula or graft and the blood is pumped through the dialysis filter. The “clean” blood is then returned via the second needle to the patient

In peritoneal dialysis your peritoneal membrane (the covering of your abdominal organs) acts as a filter. A catheter is placed into your abdominal cavity. You fill the abdominal cavity with peritoneal dialysis fluid.

The peritoneal membrane filters toxins and fluids from your blood into the peritoneal dialysis fluid. The peritoneal fluid containing the toxins is drained from your body after several hours and replaced with fresh peritoneal dialysis fluid. This procedure is called an exchange.

In continuous ambulatory peritoneal dialysis, you will perform on average four exchanges in a 24-hour period, 7 days a week. In automated peritoneal dialysis, a cycler machine performs the exchanges automatically while you are sleeping.