Kidney disease stages

The five stages of CKD range from being at risk through to kidney failure, when your kidneys stop working. But only around one in 50 people with CKD ends up with kidney failure. Most people can manage their condition with treatment that slows down its progress.

Doctors divide chronic kidney disease (CKD) into five stages. These stages are a way of explaining how well your kidneys are working.

CKD may get worse over time so the different stages help your healthcare team understand what’s going on and make decisions. At each stage, your doctors will try to slow down the damage and help keep your kidneys working as well as possible, for as long as possible.

Only around one in 50 people with CKD ends up with kidney failure.

How doctors check your CKD stage

Your doctor will carry out a blood test that measures levels of a waste product called creatinine in your blood. They look at the results of this, along with your age, size, ethnic group and gender, to calculate how much waste your kidneys are filtering every minute. The calculation is called your estimated glomerular filtration rate, usually shortened to eGFR.

Healthy kidneys should be able to filter more than 90ml/min. To get a fuller picture of your kidney function, doctors will carry out tests on your wee to look for blood and protein, which can be present if your kidneys aren’t working properly.

Find out more about tests for CKD.

Stages of CKD

Your eGFR is above 90ml/min (normal) but some other tests suggest you may have some kidney damage – for example, you have protein in your wee.

How you might feel: As your kidneys are still working well, you’re unlikely to have symptoms. But some people have high blood pressure, some swelling in their hands and feet and urinary tract infections.

How doctors will treat you: They’ll try to slow down kidney damage for as long as possible. That will probably involve making sure underlying conditions, like high blood pressure and diabetes, are well managed. You may also be given lifestyle advice to help you support your kidneys.

Your eGFR is 60-89ml/min, plus you have some other signs of kidney damage. Tests may show protein and blood in your wee, and kidney damage may show in a test like an ultrasound or CT scan.

How you might feel: Your kidneys should still be able to filter your blood so you may not notice any signs of a problem. But, as in stage 1, some people have a few of the tell-tale symptoms.

How doctors will treat you: Again, at this stage it’s all about slowing down the damage. This will mean keeping your blood pressure in a healthy range and managing your blood glucose if you have diabetes.

This is split into two stages: 3a and 3b.

At 3a, your eGFR is 45-59ml/min. At 3b, your eGFR is 30-44ml/min.

Kidney damage is now mild to moderate and your kidneys are beginning to struggle with filtering waste and extra fluid out of your blood.

How you might feel: This is the stage when a lot of people begin to notice signs of a problem, as waste starts to build up and begins to affect different parts of the body. Symptoms can include:

- swelling in your hands and feet

- dry, itchy skin

- feeling tired and weak

- trouble sleeping

- muscle cramps

- foamy wee

- a change in how often you need to wee.

How doctors will treat you: They may prescribe medicines that treat your symptoms as well as underlying conditions like high blood pressure and diabetes. Healthy lifestyle changes are crucial at this stage, including moving around more and eating a kidney-friendly diet. The good news is that with treatment and lifestyle changes, lots of people stay stable at stage 3 and their CKD doesn’t get worse.

Your eGFR is 15-29ml/min. This stage means your kidneys have severe damage and waste products are building up in your blood.

How you might feel: Stage 4 is likely to result in health problems, including high blood pressure, anaemia, heart disease and bone problems. You may have symptoms including:

- feeling weak and tired

- not feeling hungry

- swelling in your arms and/or legs

- shortness of breath

- feeling and/or being sick

- muscle cramps.

How doctors will treat you: You’ll be seen by a specialist kidney doctor called a nephrologist. They’ll treat you with medicines to address diabetes and high blood pressure, and other medicines to help with symptoms. Some people may need dialysis or a kidney transplant at this point.

In this stage, your eGFR is less than 15ml/min. It means your kidneys have stopped working or are close to stopping. This is called kidney failure, end-stage kidney disease (ESKD) or end-stage renal disease (ESRD). It sounds scary but remember most people with CKD don’t get to this stage. CKD can usually be managed well and people with it can live long lives.

How you might feel: Your kidneys have stopped filtering waste and fluid from your blood so you are likely to have a range of serious health issues at this stage, including anaemia, high blood pressure and a build-up of substances including acid in your body. Along with the symptoms listed in the earlier stages, you may have other symptoms including trouble breathing and leg or ankle swelling.

How doctors will treat you: Most will need renal (kidney) replacement therapy (RRT). This means either dialysis to clean your blood, or a kidney transplant. If you’re older or frailer, you might prefer supportive care, with no dialysis or transplant. You may also be prescribed a range of medicines and a special kidney-friendly diet. You may need to limit fluids and foods containing salt and the minerals potassium and phosphate, which build up in your body when your kidneys aren’t working.

CKD/eGFR at a glance

This diagram may help you understand CKD and eGFR a bit more.

Normal eGFR is the higher number range on the right. As kidneys stop working so well, eGFR begins to drop.

Stages of chronic kidney disease (CKD)

AstraZeneca has contributed to the funding of this material as part of a Patient Advocacy Group Partnership between Kidney Care UK and AstraZeneca UK Limited. AstraZeneca has had no editorial input into or control over the content which has been independently owned and created by Kidney Care UK.