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CKD Staging
Stages 1 to 5
Stage Progression
Life Expectancy
With each stage of CKD, the function of your kidneys progressively worsens and requires different treatments to slow down kidney damage and to keep them working for as long as possible.Renal (kidney) failureoccurs when the kidneys are no longer functioning, at which timedialysisor akidney transplantis needed to keep you alive.
This article explains how chronic kidney disease is staged and what each stage means regarding treatment, complications, and the risk of renal failure.
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Acute vs. Chronic Kidney Disease
How Is Chronic Kidney Disease Staged?
Chronic kidney disease is staged to categorize the severity of the loss of renal function and to direct the appropriate course of treatment.
The five stages are categorized based on the results of aneGFR blood test. The eGFR is a mathematical calculation used to determine how much blood is filtered clean through the filtering units of your kidneys, calledglomeruli, every minute.
The calculation is based on aserum creatinine blood test, which measures the amount of a muscle breakdown product calledcreatininein your blood. If your kidneys are not functioning as they should, creatinine will not be cleared from the body in urine andblood creatinine levels will start to increase.
Despite the usefulness of the test, creatinine levels alone cannot determine the stage of CKD as “normal” creatinine levels can vary based on your body size and other factors. Creatinine levels also naturally decline with age.
The eGFR offers a standardized means of measuring kidney function across all body sizes, ages, sexes, and racial/ethnic groups.
In most adults, a normal eGFR is 90 or above. As kidney function starts to decline, the eGFR will also decrease. Based on these findings, CKD can be staged as follows:
How Chronic Kidney Disease Is Treated
CKD Stages 1 Through 5 Based on eGFR
In the early stages of CKD (stages 1 to 3), your kidneys are still largely functional. In the later stages (stages 4 and 5), your kidneys have to work harder to filter blood and may stop working altogether.
Stage 1 CKD
With stage 1 CKD, the damage to your kidneys is mild. Because of this, you may not have symptoms.
You will invariably have an increased amount of protein in your urine (proteinuria). This is because damaged glomeruli allow more protein to escape into your urine rather than being filtered and returned to the bloodstream.
Treatment at stage 1 is largely focused on managing the underlying cause of kidney damage to slow disease progression.
This may include:
Stage 2 CKD
With stage 2 CKD, the damage to your kidneys is still mild, but the kidneys are starting to function at less than their optimal capacity. As symptoms generally do not start until stage 3, many people with stage 2 CKD may not know they have kidney disease.
If symptoms do occur, they may again involve foamy urine and/or an increased risk ofurinary tract infections (UTIs),especially in females.
With stage 2 CKD, your healthcare provider may recommend certain lifestyle changes in addition to managing your blood pressure and diabetes.
These may include:
Stage 3 CKD
Stage 3 CKD is when your kidneys sustain significant enough damage to start producing symptoms. There are two substages. Stage 3a is kidney function loss that’s mild to moderate.Stage 3b is kidney function loss that’s moderate to severe.
Increasing damage to the kidneys can cause the loss of important nutrients likecalciumand vitamin D, affecting bone health. It can also cause a buildup of acid in your blood (metabolic acidosis) and a decrease in red blood cells (anemia).
Symptoms of stage 3a CKD may include:
With stage 3b, a person may additionally experience:
With stage 3 CKD, additional interventions will likely be needed to control blood pressure and/or blood sugar while reducing the risk of disease complications.
Stage 4 CKD
Stage 4 CKD means that your kidneys are moderately to severely damaged, increasing the likelihood of disease complications like anemia, high blood pressure, bone disease, and metabolic acidosis.
The damage can also cause the excessive buildup of potassium (hyperkalemia) and phosphorus (hyperphosphatemia) in your blood, both of which can contribute toheart rhythm disordersand an increased risk of heart disease or stroke.
In addition to an increased risk of the above-listed symptoms, stage 4 CKD can also cause:
Additional aggressive treatments will be started to preserve what kidney function you have.
These include:
Treating stage 4 CKD can be challenging because many of the medications you take to manage high blood pressure and diabetes can suddenly place stress on the kidneys and promote kidney damage.
Stage 5 CKD
Stage 5 is the most advanced stage of CKD, in which you experience kidney failure. Also known asend-stage renal failure (ESRD), stage 5 CKD is when your kidneys are no longer functional enough to support your body’s needs.
Stage 5 CKD is associated withuremia, a potentially dangerous condition in which waste products build up in your blood.
This can lead to potentially severe symptoms like:
At this stage of the disease, the only options for treatment are:
In the absence of treatment, death will eventually occur, However, the time of progression to death is variable.
Kidney Failure: What to Expect
CKD Stages Progression
Chronic kidney disease usually progresses slowly over the course of years. Even so, many people do not realize that they have the disease until it is advanced and symptoms are severe enough to seek treatment. Of the estimated 37 million adults living with CKD in the United States, 1 in 9 people are unaware that they have the disease.
Even so, the progression of CKD can be slowed or even stopped if the disease is diagnosed and treated early. With the appropriate treatment and healthy life changes, many people with stage 1, 2, or 3 CKD will never progress to stage 4 or 5.
Among the factors that can increase the risk of CKD progression are:
Being over 70 is also a factor, given that aging is associated with a natural decline in kidney function and the progression of chronic diseases like diabetes.
How Diabetes and Kidney Disease Are Connected
Effect of CKD on Life Expectancy
Chronic kidney disease is one of the leading causes of mortality (death) worldwide and one of the few noncommunicable diseases (those not passed to others through contact) in which annual deaths worldwide have increased over the past two decades.
In the United States, deaths from CKD are mainly due toheart disease,
CKD and heart disease often co-occur as they share many of the same risk factors, including high blood pressure, diabetes, and older age.Nearly one-third of the 1,938,505 deaths reported in people with CKD in the United States from 1999 to 2020 were due to heart disease.
Other common causes of death in people with CKD include:
How Long Can I Live With ESRD?
What You Need to Know About Organ Transplants
If you are diagnosed with CKD, it is essential to monitor your eGFR and other kidney function tests regularly. Depending on your CKD stage, this may involve testing at least once annually. If and when CKD progresses, more frequent testing may be needed.
The testing should involve the following blood and urine tests:
Routine testing may be recommended every four to six months if albumin levels are high and/or you have stage 3 CKD or higher.
Some health experts recommend testing every two months for people with stage 4 CKD and every month for those with stage 5 CKD.
Is Chronic Kidney Disease Reversible?Although CKD is irreversible, it is possible for your eGFR to improve. Studies suggest that up to 8% of cases categorized as stage 5 will regress to stage 4 within two years.However, this is not because your kidney function has suddenly improved but more often because a factor involved in the eGFR calculation has changed. This might include a change in your body weight or the resolution of an acute kidney injury.A regression in your eGFR won’t necessarily alter the recommended treatments.
Is Chronic Kidney Disease Reversible?
Although CKD is irreversible, it is possible for your eGFR to improve. Studies suggest that up to 8% of cases categorized as stage 5 will regress to stage 4 within two years.However, this is not because your kidney function has suddenly improved but more often because a factor involved in the eGFR calculation has changed. This might include a change in your body weight or the resolution of an acute kidney injury.A regression in your eGFR won’t necessarily alter the recommended treatments.
Although CKD is irreversible, it is possible for your eGFR to improve. Studies suggest that up to 8% of cases categorized as stage 5 will regress to stage 4 within two years.
However, this is not because your kidney function has suddenly improved but more often because a factor involved in the eGFR calculation has changed. This might include a change in your body weight or the resolution of an acute kidney injury.
A regression in your eGFR won’t necessarily alter the recommended treatments.
Understanding Kidney Function Test Results
Summary
How to Cope and Live Well With Kidney Disease
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32 Sources
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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American Kidney Fund.Stages of kidney disease.
National Kidney Foundation.Acute kidney injury (AKI).
Centers for Disease Control and Prevention.Chronic kidney disease basics.
National Kidney Foundation.Estimated glomerular filtration rate (eGFR).
American Kidney Fund.Blood test: eGFR (estimated glomerular filtration rate).
Pottel H, Hoste L, Dubourg L, et al.An estimated glomerular filtration rate equation for the full age spectrum.Nephrol Dial Transplant.2016;31(5):798–806. doi:10.1093/ndt/gfv454
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National Kidney Foundation.Stage 1 chronic kidney disease (CKD).
American Kidney Fund.Stage 2 chronic kidney disease (CKD).
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National Kidney Foundation.Stage 2 chronic kidney disease (CKD).
National Kidney Foundation.Stage 3a chronic kidney disease (CKD).
National Kidney Foundation.Stage 3b chronic kidney disease (CKD).
American Kidney Fund.Stage 3 chronic kidney disease (CKD).
American Kidney Fund.Stage 4 chronic kidney disease (CKD).
National Kidney Foundation.Stage 4 chronic kidney disease (CKD).
National Kidney Foundation.5 drugs you may need to avoid or adjust if you have kidney disease.
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Wulczyn KE, Zhao SH, Rhee EP, Kalim S, Shafi T.Trajectories of uremic symptom severity and kidney function in patients with chronic kidney disease.Clin J Am Soc Nephrol. 2022;17(4):496-506. doi:10.2215/CJN.13010921
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Kovesdy CP, Isaman D, Petruski-Ivleva N, et al.Chronic kidney disease progression among patients with type 2 diabetes identified in US administrative claims: a population cohort study.Clin Kidney J.2021;14(6):1657–1664. doi:10.1093/ckj/sfaa200
Chen TK, Knicely DH, Grams ME.Chronic kidney disease diagnosis and management: a review.JAMA.2019;322(13):1294–1304. doi:10.1001/jama.2019.14745
Hannan M, Ansari S, Meza N, et al.Risk factors for CKD progression; overview of findings from the CRIC Study.Clin J Am Soc Nephrol.2021;16(4):648–659. doi:10.2215/CJN.07830520
Totoli C, Carvalho AB, Ammirati AL, Draibe SA, Canzaini MEF.Associated factors related to chronic kidney disease progression in elderly patients.PLoS One.2019;14(7):e0219956. doi:10.1371/journal.pone.0219956
Kovesdy CP.Epidemiology of chronic kidney disease: an update 2022.Kidney Int Suppl (2011).2022;12(1):7–11. doi:10.1016/j.kisu.2021.11.003
Centers for Disease Control and Prevention.Cardiovascular disease Is common in older US adults and is the leading cause of death in people with chronic kidney disease.
Kobo O, Abramov D, Davies S, et al.CKD-associated cardiovascular mortality in the United States: temporal trends from 1999 to 2020.Kidney Med. 2022;5(3):100597. doi:10.1016/j.xkme.2022.100597
Aune D, Sun X, Nie J, et al.Self-reported chronic kidney disease and the risk of all-cause and cause-specific mortality: outcome-wide association study of 54 causes of death in the National Health Interview Survey.BMC Nephrol.2023;23:165. doi:10.1186/s12882-022-02771-1
Gupta R, Woo K, Yi JA.Epidemiology of end-stage kidney disease.Semin Vasc Surg.2021 Mar;34(1):71–78. doi:10.1053/j.semvascsurg.2021.02.010
National Institute of Diabetes and Digestive and Kidney Diseases.Monitoring chronic kidney disease progression.
Hirano K, Kobayashi D, Kohtani N, et al.Optimal follow-up intervals for different stages of chronic kidney disease: a prospective observational study.Clin Exp Nephrol.2019;23(5):613–620. doi:10.1007/s10157-018-01684-4
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