Introduction
Chronic kidney disease (CKD) affects over 37 million adults in the U.S., yet many remain unaware until their kidneys have progressed to more serious stages. Knowing the five stages of renal failure—based on eGFR and proteinuria—can help you preserve kidney health, delay complications, and make informed decisions with your medical team.
- Introduction
- How Kidney Function Is Measured and Staged
- CKD Stages 1 through 5
- Stage 1 CKD – Kidney damage with normal/excellent function (eGFR ≥ 90)
- Stage 2 CKD – Mild decline in function (eGFR 60–89)
- Stage 3 CKD – Moderate function loss (eGFR 30–59)
- Stage 4 CKD – Severe decline (eGFR 15–29)
- Stage 5 CKD – Kidney failure / End-Stage Renal Disease (eGFR <15)
- Albuminuria: A Critical Risk Enhancer
- Slowing CKD Progression: Key Strategies
- Targeted interventions include:
- When to Seek Specialist Care
- Frequently Asked Questions (FAQs)
- Conclusion
This guide walks through each CKD stage, treatment options, risk factors, and when it’s time to consider advanced therapies.
How Kidney Function Is Measured and Staged
Kidney function is quantified using the estimated glomerular filtration rate (eGFR), calculated from serum creatinine adjusted for age, sex, and body size. It represents how effectively your kidneys filter waste from your blood AAFPNational Kidney Foundation.
CKD staging relies on both eGFR and evidence of damage—often measured via urine albumin-to-creatinine ratio (uACR). Kidney damage should be present for at least 3 months to confirm chronic disease National Kidney Foundation+1American Kidney Fund+1.
In 2024 guidelines by KDIGO, CKD categories are given as G1–G5, often combined with albuminuria stages A1–A3 to assess progression risk more precisely KDIGO+1NCBI+1.
CKD Stages 1 through 5
Stage 1 CKD – Kidney damage with normal/excellent function (eGFR ≥ 90)
- eGFR ≥ 90 mL/min/1.73m² plus markers of kidney damage (e.g., proteinuria, hematuria, structural abnormalities) kidney-international.org+15National Kidney Foundation+15National Kidney Foundation+15.
- Typically no symptoms, but risk factors like hypertension or diabetes are often present.
- Management includes lifestyle changes, medication to control blood pressure or blood sugar, and annual monitoring of kidney tests and urine albumin levels verywellhealth.com+1verywellhealth.com+1.
Stage 2 CKD – Mild decline in function (eGFR 60–89)
- eGFR between 60–89 with evidence of kidney damage texaskidneyinstitute.com+2en.wikipedia.org+2en.wikipedia.org+2.
- Symptoms are still uncommon; focus remains on risk factor control, such as using ACE inhibitors or ARBs, dietary guidance, and regular screening National Kidney Foundationverywellhealth.com.
Stage 3 CKD – Moderate function loss (eGFR 30–59)
Split into two substages:
- Stage 3A (GFR 45–59): mild-to-moderate loss
- Stage 3B (GFR 30–44): moderate-to-severe loss health.com+4American Kidney Fund+4verywellhealth.com+4en.wikipedia.org+15AAFP+15en.wikipedia.org+15National Kidney Foundation+4NCBI+4davita.com+4
What may appear:
- Stage 3A often asymptomatic; some develop fatigue, itchy skin, or mild fluid retention.
- Stage 3B presents more noticeable issues: anemia, difficulty concentrating, leg swelling, and weakness.
- Treatment expands to managing complications like anemia, metabolic acidosis, and bone disorders. Stronger emphasis on specialist referral in Stage 3B en.wikipedia.orgverywellhealth.com.
Stage 4 CKD – Severe decline (eGFR 15–29)
- eGFR between 15–29 mL/min/1.73m² en.wikipedia.org+1en.wikipedia.org+1.
- Symptoms become pronounced: increasing fatigue, nausea, muscle cramps, hyperkalemia, hyperphosphatemia, and fluid retention.
- At this point, conversations must begin about dialysis or transplant planning, creation of access sites, and advance care planning verywellhealth.com.
Stage 5 CKD – Kidney failure / End-Stage Renal Disease (eGFR <15)
- eGFR below 15 for over three months or on dialysis indicates kidney failure American Kidney Fund+2National Kidney Foundation+2my.clevelandclinic.org+2.
- Life-sustaining treatment such as hemodialysis, peritoneal dialysis, or kidney transplant becomes necessary.
- Some may choose conservative/palliative care, focusing on comfort and quality of life instead of aggressive treatments. Median survival varies depending on age and overall health, but symptom dilution becomes critical health.comverywellhealth.com.
Albuminuria: A Critical Risk Enhancer
uACR helps identify kidney damage earlier than eGFR decline alone and shapes risk stratification:
- A1: <30 mg/g (normal/mild)
- A2: 30–300 mg/g (moderate)
- A3: >300 mg/g (severe) NCBI+2KDIGO+2American Kidney Fund+2
Even with a normal or mildly reduced eGFR, increasing albuminuria can significantly raise risk for progression and cardiovascular complications.
Slowing CKD Progression: Key Strategies
Targeted interventions include:
- Control of underlying factors, especially high blood pressure and diabetes. ACE inhibitors, ARBs, and SGLT2 inhibitors can slow progression even in non-diabetic CKD KDIGONational Kidney Foundation.
- Dietary management: Restrict sodium, processed protein, phosphorus, and potassium as needed, while maintaining adequate nutrition.
- Lifestyle changes: Smoking cessation, weight control, regular exercise, and fluid balance.
- Monitoring and labs at planned intervals depending on stage.
When to Seek Specialist Care
Referral to a nephrologist is encouraged in:
- Stage 3B or Stage 4 CKD
- Rapid GFR decline (e.g. a drop of ≥25% or ≥15 mL/min in 12 months)
- Severe albuminuria (A3) verywellhealth.com+1National Kidney Foundation+1en.wikipedia.org+1National Kidney Foundation+1ukkidney.org+1NCBI+1.
Frequently Asked Questions (FAQs)
How common is CKD progression to end-stage?
Only around 2% progress to ESRD—largely older adults with comorbidities. Many die from cardiovascular causes before requiring dialysis verywellhealth.com.
What symptoms appear in early stages?
Stages 1 and 2 are typically silent. Symptoms usually arise in Stage 3B or later, such as fatigue, nausea, cognitive fog, muscle issues, or volume overload verywellhealth.comen.wikipedia.org.
Is GFR adjustment for age important?
Yes. GFR naturally declines with age. In elderly people, isolated GFR decline without albuminuria may not indicate significant kidney disease en.wikipedia.org.
Can CKD be reversed?
CKD is largely irreversible. However, treatment and lifestyle changes can stabilize or slow progression—even improve quality of life and delay progression to kidney failure.
Conclusion
Understanding the five stages of renal failure empowers you to partner effectively with your healthcare team. Early detection (stages 1 & 2) offers the greatest opportunity to preserve kidney function. As CKD progresses through stages 3 to 5, treatment shifts to preventing complications and preparing for renal replacement therapy.
If you have risk factors—such as hypertension, diabetes, or a family history—ask your doctor about routine testing (eGFR, uACR). With proactive care and shared decision-making, you can significantly slow progression and maintain control over your kidney health.
