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 very brief article, we will 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.

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.

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.

Stage 3: Moderate Reduction in GFR (30-59 ml/min)

​Stage 3 is characterized by a moderate reduction in GFR.

This stage 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.

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.

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, with a GFR of less than 15 ml/min.

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.

Albuminuria

Another way to assess your risk is based on the amount of protein (albumin) in the urine. This helps your health care provider understand how well the filters of the kidneys (nephrons) are working. By combining this method with the stages listed above, we can categorize patients into risk groups and predict the chances of developing end stage kidney disease in the future.

If you'd like to esimate your kidney failure risk, you can do it here.

Putting It All Together:

To better understand your prognostic, please refer to the visual chart below, adapted from the Kidney Disease Improving Global Outcomes (KDIGO) Guidelines, 2024, published in Kidney International. You may want to discuss about your results with your kidney doctor.