Stages of Chronic Kidney Disease
- Ioannis Panteleimon Varvoudakis
- Jul 23
- 7 min read
Medically reviewed by Mia Armstrong, MD — Written by Ann Pietrangelo — Updated on January 23, 2024
Chronic kidney disease has five stages. These start from a mildly damaged kidney and may end with kidney failure. Early diagnosis and treatment can help stop the disease from progressing.
View video transcript
Chronic kidney disease (CKD) is a condition that affects the ability of your kidneys to function properly.
Kidneys are responsible for filtering your blood by removing waste, toxins, and surplus fluids. However, damaged kidneys don’t filter blood as well as they should. This can lead to serious health concerns.
There are five stages of CKD, and different symptoms and treatments are associated with each stage.
Overview of stages
To assign a CKD stage, two tests are required to assess how well your kidneys work, according to the National Kidney Foundation (NKF).
ACR levels are staged as follows:
A1 | lower than 3mg/mmol, a normal to mild increase |
A2 | 3–30mg/mmol, a moderate increase |
A3 | higher than 30mg/mmol, a severe increase |
The second is a blood test called the estimated glomerular filtration rate (eGFR). This shows how well your kidneys are filtering your blood. A GFR of 100 mL/min is normal. GFR shows how much blood your kidneys filter in 1 minute.
To classify your kidney damage into a stage, these tests must be repeated to monitor long-term kidney damage, which is damage of at least 3 months.
The table below highlights the five stages of CKD. More information about each stage follows the table.
Stage | Description | GFR | Percent of kidney function |
1 | normal to highly functioning kidney | greater than 90 mL/min | >90% |
2 | mild decrease in kidney function | 60–89 mL/min | 60–89% |
3A | mild-to-moderate decrease in kidney function | 45–59 mL/min | 45–59% |
3B | mild-to-moderate decrease in kidney function | 30–44 mL/min | 30–44% |
4 | severe decrease in kidney function | 15–29 mL/min | 15–29% |
5 | kidney failure | less than 15 mL/min | <15% |
Stage 1 kidney disease
In stage 1, there’s very mild damage to the kidneys. They’re quite adaptable and can adjust for this, allowing them to keep performing at 90% or better.
At this stage, CKD is likely to be discovered by chance during routine blood and urine tests. You may also have these tests if you have diabetes or high blood pressure. These are the top causes of CKD in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD)Trusted Source.
Symptoms
Typically, there are no symptoms when kidneys function at 90% or better.
Treatment
The NIDDKDTrusted Source suggests taking the following steps to help slow disease progression:
Manage blood sugar levels if you have diabetes.
Manage blood pressure if you have hypertension.
Maintain a healthy, balanced diet.
Don’t use tobacco.
Try to get 7–8 hours of sleep each night.
Reduce stress and anxiety with relaxation techniques.
Engage in physical activity for 30 minutes daily, at least 5 days a week.
Try to maintain an appropriate weight for your body.
A doctor may refer you to a kidney specialist, called a nephrologist. They can provide more tailored advice for you.
Stage 2 kidney disease
In stage 2 CKD, kidneys are functioning between 60–89%.
Symptoms
At this stage, you might still be symptom-free. Or symptoms are nonspecific, such as:
frequent urinary tract infections (UTIs)
high blood pressure
swelling in your hands and feet
blood in your urine
Treatment
There’s no cure for CKD, but following the NIDDKD’s recommendationsTrusted Source and early treatment can slow or stop progression.
It’s essential to address the underlying cause and to manage any conditions, such as diabetes, high blood pressure, or heart disease.
Stage 3 kidney disease
Stage 3A CKD is when your kidney is functioning between 45–59%. Stage 3B means kidney function is between 30–44%.
The kidneys aren’t filtering waste, toxins, and fluids well, which are starting to build up.
According to the NKF, this is the first stage when people are typically diagnosed with CKD because it’s when an eGFR blood test alone can detect it.
Symptoms
Not everyone has symptoms at stage 3. However, you may experience:
back pain
fatigue
loss of appetite
persistent itching
sleep problems
swelling of the hands and feet
urinating more or less than usual
weakness
Complications may include:
anemia
bone disease
high blood pressure
Treatment
A healthcare professional may recommend you make dietary changes, such as reducing your intake of sodium, calcium, potassium, and phosphorate.
It’s important to manage underlying conditions to help preserve kidney function. This may include taking:
high blood pressure medications, such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers
diuretics to relieve fluid retention
cholesterol-lowering medications
erythropoietin supplements for anemia
A healthcare professional may also recommend you stop taking some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs).
You may also require frequent follow-up visits and tests so adjustments can be made if necessary.
Stage 4 kidney disease
Stage 4 CKD means you have moderate-to-severe kidney damage. They’re functioning between 15–29%, so you may build up more waste, toxins, and fluids in your body.
At this stage, it’s important to do everything you can to prevent progression to kidney failure.
According to the Centers for Disease Control and Prevention (CDC), 40%Trusted Source of people with severely reduced kidney function aren’t even aware they have it.
Symptoms
Symptoms can include:
back pain
chest pain
decreased mental sharpness
fatigue
loss of appetite
muscle twitches or cramps
nausea and vomiting
persistent itching
shortness of breath
sleep problems
swelling of the hands and feet
urinating more or less than usual
weakness
weight loss
Complications can include:
anemia
bone disease
high blood pressure
You’re also at increased risk of heart disease and stroke.
Treatment
In stage 4, it’s important to work closely with healthcare professionals. You should also start discussing treatments like dialysis and kidney transplants in case your kidneys fail.
In addition, stage 4 CKD can lead to further health complications requiring treatment. For example, it’s not uncommon to develop metabolic acidosis due to CKD. Depending on blood bicarbonate levels, doctors may prescribe oral bicarbonate replacement therapy.
Stage 5 kidney disease
Stage 5 CKD means your kidneys are working at less than 15% capacity or you have kidney failure.
When this happens, the buildup of waste and toxins becomes life threatening. This is end-stage renal disease.
Symptoms
Symptoms of kidney failure can includeTrusted Source:
back and chest pain
breathing problems
confusion and trouble focusing
weight losss
fatigue
little to no appetite
muscle twitches or cramps
nausea or vomiting
persistent itching
trouble sleeping
severe weakness
swelling of the hands and feet
urinating more or less than usual
A significant drop in kidney function puts more stress on the heartTrusted Source, increasing the risk of heart disease and stroke.
Treatment
Once you have complete kidney failure, life expectancy is only a few months without dialysis or a kidney transplant.
Dialysis isn’t a cure for CKD but a process to help remove waste and fluid from your blood. There are two types of dialysis: hemodialysis and peritoneal dialysis.
Hemodialysis
You will receive hemodialysis either at a dialysis center or at home. Hemodialysis at a medical center typically occurs on a set schedule around three times a weekTrusted Source.
However, with training, you can administer hemodialysis at home, although it requires a surgical procedure to create vein access. You and a doctor can tailor home dialysis schedules to fit your lifestyle better. Home hemodialysis is typically more frequent but lasts for less time per session.
During the treatment, you or a healthcare professional will insert two needles into an access point on your body. These attach to a dialyzer, which is a machine sometimes referred to as an artificial kidney. Your blood then pumps through the filter and returns to your body.
Peritoneal dialysis
For peritoneal dialysis, a surgeon will place a catheter into your abdomen.
During treatment, dialysis solution flows through the catheter into the abdomen, after which you can go about your normal day. A few hours laterTrusted Source, you can drain the catheter into a bag and discard it. It’s necessary to repeat this multiple times per day.
A kidney transplant involves replacing your kidney with a healthy one. Kidneys can come from living or deceased donors. You won’t need dialysis, but you’ll have to take anti-rejection medication for the rest of your life.
Frequently asked questions
How long can you live with kidney failure?
In people with CKD, life expectancy can be difficult to estimate. While disease progression typically reduces a person’s life expectancy, other factors such as age at diagnosis, other health conditions, and treatment options can all significantly impact life expectancy.
What stage of CKD do you need dialysis?
You will typically require dialysis at stage 5 or end-stage kidney failure.
Will drinking more water increase my GFR?
Staying hydrated is crucial for overall kidney health and maintaining GFR. However, drinking more water will not significantly improve GFR results in the short term. That said, some people with kidney disease may need to limit their fluid intake, so ask your doctor if you have any restrictions on drinking water.
How quickly does kidney failure progress?
This can vary from person to person, but generally, it progresses slowlyTrusted Source from stage to stage of kidney failure.
What stage of kidney failure is fatal?
Stage 5, or end-stage kidney disease, is fatal without dialysis or a kidney transplant.
Takeaway
There are five stages of CKD. Stages are determined with blood and urine tests and the degree of kidney damage.
While CKD is a progressive disease, not everyone will go on to develop kidney failure.
Symptoms of early-stage kidney disease are mild and can be easily overlooked. That’s why it’s important to have regular checkups if you have diabetes or high blood pressure, the leading causes of kidney disease.
Early diagnosis and management of coexisting conditions can help slow or prevent progression.
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