Mid Stage:

1. Same as early stage
2. To do some more blood and urine test at monthly or quarterly interval
3. Tests: Haemoglobin, serum creatinine, potassium, sodium, albumin, calcium, phosphorus, uric acid, lipid profile, routine urine examination etc as per prescribed guidelines.

People who have chronic kidney disease are also at increased risk of acute kidney injury.

Last Stage:

1. Continue previous treatment
2. Preparations for renal replacement treatment e.g. Dialysis or Transplantation. As even with the best management, chronic kidney disease sometimes progresses to later stages and only conservative management may not be helpful.
3. When you have end stage kidney disease your body cannot get rid of extra water and waste products. Dialysis is removal of the water and waste products.

Once he/she diagnosed to have CKD, should be managed comprehensively before six months of initiation of RRT.

1. Early access creation- functioning fistula or PD catheter before initiation of RRT.
2. Regular nephrologist clinic visit, includes education regarding modality of RRT, special dietary instructions.
3. Cardiovascular risk reduction (smoking, physical activity and lipids).
4. Blood pressure control.
5. Referral to cardiologist to rule out any coronary artery disease.
6. Management of mineral and bone health by control of calcium, phosphorus and PTH levels in normal range.
7. Vaccination includes Hepatitis B, Pneumococcal and influenza.
8. Anaemia management.
9. Renoprotection (use of ACEIs/ARBs and probiotics) prolongation of RRT.
10. Assessment of renal transplant options before initiation of RRT.