Stages of chronic kidney disease

If you’ve recently been diagnosed with chronic kidney disease (CKD), one of the first things your doctor will do is determine how far the disease has progressed. When kidneys are damaged, they usually don’t fail all at once. Chronic kidney disease slowly becomes worse over time. Early diagnosis can help slow the progression of CKD and prolong kidney function.

There are five stages of chronic kidney disease. The different stages help doctors determine the type of treatment necessary for patients. These stages and treatment guidelines have been made by the National Kidney Foundation (NKF).  

One indicator of how well your kidneys are functioning is your GFR, or glomerular filtration rate, which shows how well your kidneys are cleaning your blood. When you are first diagnosed, your doctor will use a special formula to determine your GFR. Your health care providers will continue to monitor your GFR in the future.

Stages of chronic kidney disease

Stage

Description

GFR

Normal kidney function

Healthy kidneys

> 90 ml/min

Stage 1

Kidney damage with normal or high GFR

90 ml/min or more

Stage 2

Kidney damage with mild decrease in GFR

60 to 89 ml/min

Stage 3

Moderate decrease in GFR

30 to 59 ml/min

Stage 4

Severe decrease in GFR

15 to 29 ml/min

Stage 5

Kidney failure

Less than 15 ml/min

Stages 1 and 2 of chronic kidney disease

If you are found to be in Stage 1 or Stage 2 of chronic kidney disease, you may have few, if any, symptoms. Other indicators may show that you have the disease, including:

  • Blood pressure that is higher than normal
  • Presence of blood or protein in your urine
  • Higher than normal levels of creatinine or urea in your blood
  • Kidney damage confirmed by an MRI, CT scan, ultrasound or contrast X-ray
  • Polycystic kidney disease (PKD) runs in your family

Stages 3 and 4 of chronic kidney disease

If you are diagnosed with Stage 3 CKD, you may have anemia (a shortage of red blood cells) and/or early signs of bone disease. Your health care providers will treat these disorders so that you can feel better and reduce the chance of future complications. 

When your chronic kidney disease progresses to Stage 4, you should see a nephrologist (kidney doctor). This is also the time when your health care team can talk to you about dialysis and/or a kidney transplant. 

Stage 5 of chronic kidney disease

Stage 5 CKD, also known as end stage renal disease (ESRD), happens when your GFR level is at 15 ml/min or less. This means your kidneys hardly work or do not work at all. These are some symptoms when you have Stage 5 of chronic kidney disease: 

  • Nausea
  • Loss of appetite
  • Headaches
  • Skin color changes
  • Swollen ankles and eyes
  • Fatigue
  • Body cramps

Once kidney disease advances to stage 5, you need to be on dialysis or receive a kidney transplant in order to live. You can choose different dialysis treatments, including peritoneal dialysis (PD), home hemodialysis (HHD), nocturnal dialysis and in-center hemodialysis. When you’re on dialysis, your diet will change and you will work with a dietitian to help you learn about the best food choices for your individual needs.   

Summary

Chronic kidney disease progresses slowly over time. You may be surprised to learn you have it, since in its early stages, there are few symptoms. Once you are diagnosed with CKD, your health care team will determine your stage of kidney disease by calculating your glomerular filtration rate (GFR). One of the key indicators of the disease’s progression is decreases in your GFR, which will be monitored on a regular basis by your health care providers. It is important to get all the facts about CKD and how it affects your body so that you can feel empowered and begin taking steps to support your health.

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