Why not Stage 4a and Stage 4b?

[Sophiebun11]

Anyone else wondering why Stage 4 isn't divided into Stage 4a & 4b like Stage 3.

I don't know that it would necessarily change anything treatment wise but it would make it seem a little better from an emotional perspective.

I know when I was Stage 3a, I said to myself that it wasn't so bad it's only 3a. Little did I realize how quickly I would progress to Stage 4. Stage 4a would be a nice next step to wrap my brain around it. I'll probably be Stage 4b soon enough if there were one so I'd like to enjoy a Stage 4a as long as possible.

It does seem like more symptoms set in as your eGFR gets lower into Stage 4, so to me a Stage 4a and Stage 4b make sense. Anyone else agree? BTW I'm in Stage 4a : )

[Bassetmommer NKF Ambassador]

The reason is the amount of difference between the levels. There is twice as much difference in stage 3 : 59 - 45 and 44-30. Stage 4 is only 14 points different. You can call it what ever you want. The issue with this is the attitude of I am only 3a and NOT 3 b. Time to do something is stage 2.

[Sophiebun11 in reply to Bassetmommer]

Hi Bassetmommer, I see your point of having more of a point spread in Stage 3, so now the A & B makes more sense to me. I wasn't being flippant when I said I was "only Stage 3a". I just meant I was still trying to be as positive as possible with my own attitude as I've had to do for decades with my autoimmune disease destroying my lungs, heart, and now my kidneys as well. Attitude is everything, denial is stupidity!! Thanks for clearing things up, that helped.

[Bassetmommer NKF Ambassador in reply to Sophiebun11]

Wasn't thinking you were being flippant. Unfortunately, most providers, patients and other medical folks dismiss CKd at stage 3 A and B. That was what I meant.

[Hily in reply to Bassetmommer]

My GP did not inform me or refer me to a nephrologist when my Creatinine was 45 on the 3a/3b border line. 12 months later discovered I was eGFR 17, stage 4 nearly 5!

[Skeptix]

But think. You could have stage 3a to stage 3z. Only trouble then is that you'd be flying through the stages and get the sense of being on a runaway train.

It would take a fair dose of cognitive dissonance to rest happy because of a letter after a number when your eGFR is slithering down inexorably like Jello thrun agin' a wall.

😀

[Sophiebun11 in reply to Skeptix]

I wasn't thinking of A - Z LOL that would be a bit much. Bassetmom's reply of the larger number of points in Stage 3 (to be divided into A and B) and Stage 4 (with less of a point spread) does pretty much answer my querry. I think it will be a long time before primary care physicians start getting their patients aware that they are even in Stage 2 much less having them do anything until they are in 3B or even 4 as I was. I'll still look on the brighter side and consider myself Stage 4A even though I am doing all I can and have been doing a lot for years without realizing it such as the plant diet. Thanks for the reply.

[Bassetmommer NKF Ambassador in reply to Skeptix]

"slithering down inexorably like Jello thrun agin' a wall......" OMG you crack me UP! If we could, I would love to go have a pint with you. I bet you're a hoot after a few.

[Skeptix in reply to Bassetmommer]

I've a low tolerance for alcohol so after a few I'd be staggering around talking sh!t in all likelyhood.

[Bassetmommer NKF Ambassador in reply to Skeptix]

Me too. I haven't had hooch in so long. Miss the occasional glass of wine though.

[RhenDutchess123 in reply to Skeptix]

Kinda like people who run their gas gauge down to E...they say the E stands for Enough...lol

[Blackknight1989 in reply to RhenDutchess123]

Hey…it is enough until it’s not!

[RhenDutchess123 in reply to Blackknight1989]

Lol...that's true...

[Skeptix in reply to Blackknight1989]

True story.

I drove motorcycles for years, a 24/7 type. Motorbikes have smallish tanks so you tended to want to run it to near empty before having to refill, otherwise you'd be forever in filling stations.

On one particular bike that I had later on, a Yamaha 600cc, the petrol low-level warning light used to come on at half a tanks worth - so I ignored that. There was a needle-based dial which wasn't that precise either. You had to really look closely at it to estimate where you were on remaining fuel

Given all of that: the desire to delay til the last moment + imprecise indicators, I ran out of fuel on occasion on that Yamaha.

7 occasions to be precise. When the bike ran out there'd be little warning. You'd be running along fine, then there'd be a sudden spluttering which would last for about a 1/4 mile or so then the engine would die. I'd pull the clutch in a coast to a halt.

On each of those 7 occasions I coasted in, with dead engine, to a petrol station forecourt...

God or wot?

[Skeptix in reply to RhenDutchess123]

When I got my car, I put a carry can of "gas" in the boot and waited. I kept an eye on the digital petrolometer as it approached zero (it went down in 10km intervals). As soon as it hit zero I press the trip reset button to zero that

And ran the car, driving gently and conserving petrol, until it stopped. The refilled it with the carry can and got going again

E for empty for me is right down to the last km and beyond. I think it's borne from my 20's when I hadn't so much as a washer to my name. I lived with my motorcycle down on empty, even "borrowing" fuel from the cars in my neighbourhood on occasion.

Absolutely no need for it now but still I run it down.

[RhenDutchess123 in reply to Skeptix]

When I was in my early 20's I ran out of gas...all the time....but my boyfriend would come with a gas can and get me going again....you would think the Guy would learn, but instead he asked me to marry him...that was 42 years ago...and he still checks my gas gauge and takes my car to fill up....He still reminds me that "E" does not stand for enough...lol

[Marvin8]

Stage 3a is when you punch your nephrologist for never telling you when you were at Stage 1 and 2.

[Blackknight1989 in reply to Marvin8]

So disappointing to see these types of posts about docs not informing folks. Some of us discuss the new KDOQI guidelines for nutrition released by NKF in 2020 with the protein limitations as a 1A recommendation yet docs don’t refer patients to a renal dietitian and a lot of the times the dietitian knows nothing about the guidelines. With NKF, AAKP, AKF, the NIH and their specific site of NIDDK, the CDC publishing pdfs for GPs and how to diagnose and treat CKD patients, for a nephrologist to not inform you until stage 3 is nearly criminal in my humble opinion!

[lowraind in reply to Blackknight1989]

Agreed!

[Sammi_n_Munk in reply to Blackknight1989]

I definitely agree!

[Sophiebun11 in reply to Blackknight1989]

I was not informed until Stage 4!! And that was only because I had fired my older physician and found a younger one who was up to date and was shocked I had not been sent to a Neph. or dietician or had an ultrasound. I think its very common to be ignored especially among older physicians who don't stay up on the latest medical information.

[Skeptix in reply to Blackknight1989]

Its worse than that. The 1A recommendation includes a supplemented very low protein diet.

Yet you can't get a pharmaceutical-quality supplement upon which the advice depends.

You can get keto acid analogues, but first have to take a punt on the bona fides of the suppliers (Albutrix or Ketorena). The former is a motivated, intelligent ex financial services worker.

Rome wasn't built in a day, I suppose

[RoxanneKidney in reply to Marvin8]

No shit

[Sophiebun11 in reply to Marvin8]

It's usually the primary care who deserves the "punch" for never informing us or referring us to a Nephrologist.

[Marvin8 in reply to Sophiebun11]

My bad! I stand corrected.

[LuvSmallDogs in reply to Marvin8]

I feel like that... For 20 years my GFR numbers were off, but my doctors just lied to me every time I asked why, and they told me, "Oh, you're just a little dehydrated." They didn't tell me until I reached stage 4.

[Marvin8 in reply to LuvSmallDogs]

Same with me. I had a kidney stone way back when and the only thing my doc said was to drink a lot more water. My creatinine was above 1 at the time, which was borderline, but he never added "you're at the borderline of ckd" because he didn't want to scare me. I would have taken MUCH better care of my kidneys had I been made more aware.

[LuvSmallDogs in reply to Marvin8]

Sad that they hide the facts from us. If I had known I would have done so many things differently.

[Danoco]

I'm trying to get to stage 3.14159265359

[RoxanneKidney in reply to Danoco]

Lol

[drmind]

I know what you mean about the a's and b's. Even my nephologist celebrated once when I went from 4 back to 3b. I call it the GFR dance : one step back, two down. Oh, well.. staying positive with all the humor. Incidentally, I'm in 4a and with only a 14 point spread I'm doing all I can to stay away from 4b..

[Sophiebun11 in reply to drmind]

I hear you. I'm doing the same thing. Good luck to you.

[LuvSmallDogs in reply to drmind]

I too went from 4, back to 3b. But, really nothing has changed with the kidneys. The damage is still the same, but if you have been drinking more water it LOOKS LIKE your function has improved. Or if you've gone vegetarian or vegan there is a lower creatine and BUN, so it LOOKS LIKE your function has improved. But, the only thing that has improved - which is very important by the way - is that the improvement in numbers will likely mean a slower decline in your remaining kidney function.

[Kbressler NKF Peer Mentor NKF Ambassador]

I don’t believe it makes any difference clinically.

[Sophiebun11]

I did read in the American Journal of Kidney Diseases written by a Neph. posing the question if Stage 4a and 4b should be on the horizon. It is from 2014 so it's not coming soon, if ever.

ajkdblog.org/2014/02/10/ckd...