The 5 Stages of Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a serious condition that affects millions of people worldwide. Understanding the stages of CKD is important for managing the disease and preventing further complications.

In this article, we explore the 5 stages of CKD — from the early stages with mild symptoms to the advanced stages requiring dialysis or transplantation. By understanding these stages, patients and healthcare providers can work together to better manage and treat CKD.

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Stage 1: Kidney Damage with Normal or Increased GFR (≥90 mL/min)

In this stage, there is evidence of kidney damage despite having a normal or high glomerular filtration rate (GFR). Kidney damage might be indicated by the presence of protein in the urine or physical damage detected through imaging tests.

Individuals in this stage typically do not exhibit noticeable symptoms, but early intervention and lifestyle changes can slow disease progression.

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Stage 2: Mild Reduction in GFR (60–89 mL/min)

In stage 2, there is a mild decrease in GFR along with evidence of kidney damage. Similar to stage 1, symptoms are often absent.

Regular monitoring and addressing risk factors such as high blood pressure and diabetes are crucial to prevent further decline in kidney function.

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Stage 3: Moderate Reduction in GFR (30–59 mL/min)

Stage 3 is characterized by a moderate reduction in GFR and is often divided into two subcategories:

• Stage 3a: GFR 45–59 mL/min
• Stage 3b: GFR 30–44 mL/min

At this stage, some individuals may begin to experience symptoms such as fatigue, swelling in the hands and feet, and changes in urine output. More intensive management — including medications and dietary modifications — is typically necessary to manage symptoms and complications.

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Stage 4: Severe Reduction in GFR (15–29 mL/min)

In stage 4, the GFR is significantly reduced, indicating severe kidney damage. Symptoms become more apparent and can include swelling, nausea, itching, and decreased appetite.

This stage requires close monitoring and preparation for potential kidney replacement therapy, such as dialysis or kidney transplantation. A comprehensive treatment plan is essential to manage complications and slow the progression to end-stage renal disease.

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Stage 5: Kidney Failure (GFR <15 mL/min)

Stage 5, also known as end-stage renal disease (ESRD), occurs when the kidneys have lost nearly all their ability to function. At this point, symptoms are severe and can include uremia, fluid retention, and severe fatigue.

Dialysis or a kidney transplant becomes necessary to sustain life. Treatment choices, including dialysis options and transplant evaluation, should be thoroughly discussed with a healthcare provider.

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Understanding Albuminuria

Another important way to assess your risk is based on the amount of protein (albumin) in the urine. This helps your healthcare provider understand how well the filters of the kidneys (nephrons) are working.

By combining albuminuria levels with the GFR-based stages listed above, we can categorize patients into risk groups and predict the chances of developing end-stage kidney disease in the future.

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Putting It All Together

The KDIGO (Kidney Disease Improving Global Outcomes) Guidelines use a combined GFR + albuminuria risk chart to give a more complete picture of your kidney health and prognosis. Your kidney doctor can walk you through what your results mean and what steps to take next.

If you have been told you have CKD — or if you have risk factors like diabetes, high blood pressure, or a family history of kidney disease — schedule a consultation with Dr. Mocanu. Early referral to a kidney specialist can make a meaningful difference in preserving your kidney function.