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.
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.
To assign a CKD stage, two tests are required to assess how well your kidneys work, according to the National Kidney Foundation (NKF).
The first is a urine test to assess your albumin-creatinine ratio (uACR). This shows if protein leaks into the urine, which may be a sign of kidney damage. A higher level indicates more kidney damage.
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% |
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
Symptoms
Typically, there are no symptoms when kidneys function at 90% or better.
Treatment
The
- 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.
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
It’s essential to address the underlying cause and to manage any conditions, such as diabetes, high blood pressure, or heart 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 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),
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 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
- 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
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
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 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.
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
What stage of kidney failure is fatal?
Stage 5, or end-stage kidney disease, is fatal without dialysis or a kidney transplant.
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.