The 5 Stages of Kidney Disease

If you've recently learned that you have chronic kidney disease (CKD), you're probably more than a little overwhelmed. But once you've been diagnosed, your healthcare provider will explain a crucial aspect of your condition: the "stage" of your disease. CKD has five stages, determined by how well your kidneys are functioning.

"It's really important to know this [stage], so you can take the right steps to get your CKD under control, or at least slow its progression," said Richard Glassock, MD, professor emeritus at the David Geffen School of Medicine at the University of California in Los Angeles. 

The Stages of Kidney Disease

Chronic kidney disease is a condition in which the kidneys are damaged, making it difficult for them to filter blood, according to the National Kidney Foundation (NKF) 

There are five main stages of kidney disease, ranging from mild (stage 1) to kidney failure (stage 5), per the American Kidney Fund (AKF). The stages are based on how well your kidneys filter out waste and fluid from your blood, said Dr. Glassock.

Filteration Rate—GFR and eGFR

Your healthcare provider can determine your kidney disease stage by measuring your glomerular filtration rate (GFR) and estimated glomerular filtration rate (eGFR). 

The NKF says those tests check how well your kidneys filter your blood by calculating the amount of creatine—a waste product found in your blood. Diet, muscle mass, malnutrition, or other diseases may affect creatine levels.

Stage 1 CKD

eGFR Levels: 90 or Above

If you have stage 1 CKD, it means your kidneys are working well, but you have signs of mild kidney damage, according to the AKF. 

At that stage, you probably don't have any symptoms other than protein in your urine if you took a urine test in your healthcare provider's office. Other warning signs can include high blood pressure or swelling in your legs, said Robert Greenwell, MD, chief of nephrology at Mercy Medical Center in Baltimore.

Treatment for Stage 1 CKD

To start treatment, you should first look at underlying medical conditions. "High blood pressure and type 2 diabetes are two of the most common causes of stage 1 chronic kidney disease, so it's really important to take steps to get them under control," said Dr. Greenwell. 

To do that, you need to monitor your blood pressure and blood sugar levels. You may also need to go on high blood pressure or diabetes medication to control those diseases, as well.

Stage 2 CKD

eGFR Levels: Between 60 and 89

In stage 2, the good news is your kidneys are still healthy and working well. However, the bad news is they are showing clear signs of physical damage, and some people still don't have any symptoms, said Dr. Glassock. Like stage 1, there may be protein in your urine in stage 2. 

"Healthy kidneys remove extra fluid and waste from your blood but let proteins return to your bloodstream," explained Dr. Glassock. "When they're damaged, they let albumin escape through their filters, so they end up in your urine." 

Since protein helps control the amount of fluid in your body, you may notice fluid building up, particularly in your hands and feet.

Treatment for Stage 2 CKD

At this point, treatment is pretty much the same as stage 1, said Dr. Glassock. If you have high blood pressure, you may already be on hypertension medication like angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs), according to the American Heart Association. But if you aren't on any medication, your healthcare provider may recommend you go on them. 

"These drugs also help to protect your kidneys from further damage," explained Dr. Glassock.

Certain lifestyle changes can also help to treat CKD. That includes being active for at least 30 minutes every day, quitting smoking, and eating kidney-friendly foods. Meet with a dietician to figure out what foods are best for you.

Stage 3 CKD

eGFR Levels: Between 30 and 59

When you reach this stage, your kidneys show the real damage and it's time to make an appointment with a nephrologist—a healthcare provider who specializes in health issues related to the kidneys. As a result, they're not working as well as they should, said Dr. Glassock.

According to the AKF, stage 3 is separated into two stages based on your eGFR:

• Stage 3a: You have an eGFR between 45 and 59.
• Stage 3b: You have an eGFR between 30 and 44.

Along with the symptoms that may occur during stage 1 and stage 2, Dr. Glassock said you also have an increased risk of two serious health conditions; anemia and bone mineral disorder.

Mineral and Bone Disorder

Since your kidneys can't filter out waste like they normally do, levels of important bone-building minerals (like calcium and phosphorus) become imbalanced, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 

That puts you at an increased risk of developing mineral and bone disorders when the bones, heart, and blood vessels become affected.

Anemia

One out of seven people with CKD develop anemia, and it often shows up at this late stage, said Dr. Glassock. When you have kidney disease, your kidneys cannot make enough of a hormone known as erythropoietin (EPO), which helps your body develop red blood cells, Dr. Glassock explained. As a result, your red blood cell count drops, according to the NIDDK.

Usually, anemia worsens the more that CKD progresses. You are at a greater risk of developing anemia with CKD if you have diabetes or are older than 60.

Treatment for Stage 3 CKD

All the steps you took during stages 1 and 2—control your diabetes and blood pressure, don't smoke, eat a healthy diet, and be active most days of the week—are still vital, Dr. Glassock stressed. If you haven't yet met with a dietitian, you'll want to do so.

You should also consider taking vitamin D, calcium, and iron supplements for bone health and anemia. According to the AKF, some medications, like nonsteroidal anti-inflammatory drugs (NSAIDs) and arthritis medication, can worsen kidney damage. 

It's important to review the medications you're taking with your healthcare provider.

Stage 4 CKD

eGFR Levels: Between 15 and 29

If you have stage 4, the last stage before kidney failure, your kidneys are severely damaged. Along with the symptoms of previous stages, you may develop jaundice, including yellowing of the whites of your eyes, according to the NKF. You may also be feeling any of the following symptoms:

• Fatigue
• Swelling in your arms or legs
• Frequent urination
• Lower back pain
• Muscle cramps
• Nausea or vomiting
• Loss of appetite

At stage 4, you are likely experiencing other complications of chronic kidney disease. That can include heart problems, anemia, high potassium, and phosphorous levels, bone and mineral disease, high blood pressure, and poor nutritional health, according to the NKF. 

If you have other conditions that can worsen kidney disease, like high blood pressure or type 2 diabetes, it's important to get them under good control now.

Treatment for Stage 4 CKD

Your healthcare provider will decide if you need to start treatment for kidney failure, according to the AKF. That may include dialysis, a procedure that uses machines to remove waste products from your body when your kidneys no longer can. There are two major types of dialysis:

• Hemodialysis: A treatment, in which your blood circulates through a machine to remove waste and fluid. It is then returned to your body. You go to a clinic to get hemodialysis, which is very time intensive—four hours, roughly three times per week.
• Peritoneal Dialysis: A treatment that involves dialysis directly into your peritoneal cavity—a sack-like area in your abdomen that holds your stomach, liver, and intestines—to absorb waste. The waste leaves your body through a catheter. You can do peritoneal dialysis yourself, at home. Most people choose to do it when they're asleep so they can work and do other activities during the day, according to the NKF. However, you need to be comfortable running the machine and inserting and removing equipment from your abdomen.

Stage 5

eGFR: Less Than 15

If you have stage 5 chronic kidney disease, you are in kidney failure. Since your kidneys are no longer working, waste builds up in your blood, making you very sick. If left untreated, you'll die, said Dr. Glassock. According to the AKF, in addition to stage 4 symptoms, symptoms at stage 5 can also include:

• Trouble breathing
• Changes in your skin color
• Headaches
• Producing little to no urine

Treatment for Stage 5 CKD

According to the AFK, treatment involves only two options: kidney dialysis or kidney transplant. "Of these two, kidney transplantation is considered the treatment of choice because it offers a better quality of life and survival rates," said Dr. Greenwell.

Unfortunately, the NIDDK tells us there's a national kidney shortage, so you'll need to be placed on a transplant waiting list and continue dialysis until a kidney becomes available. 

A live or dead person can provide a kidney for transplant. But in general, kidneys from living donors work better and for longer, noted Dr. Greenwell. Sometimes, a family member or friend may even donate a kidney since you only need one of your two kidneys to live. 

Some people may not be eligible for a kidney transplant. In those cases, you'll most likely need to stay on dialysis for the rest of your life. If you qualify for a kidney transplant and get one, there will still be challenges post-surgery, stressed Dr. Greenwell.

After kidney transplantation, you will take medications and have frequent monitoring to minimize the chance of organ rejection. That must continue for your entire lifetime. The medications can have significant side effects, including an increased risk of severe infections, diabetes, and some cancers, says the NIDDK.

A Quick Review

There are five stages of chronic kidney disease. The symptoms and treatment can vary based on which stage you are in. 

There is no cure for CKD and you cannot reverse kidney damage. The further the disease progresses, the more your kidney function declines. So, it's important to recognize the symptoms and treat any underlying conditions as soon as possible to prevent further disease progression. 

If you have CKD, work with your healthcare provider to determine the best course of treatment.