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Stages of Chronic Kidney Disease

About Chronic Kidney Disease

Chronic kidney disease (CKD) is a disease whereby the kidneys have trouble removing waste products and fluid from the body. Usual causes of CKD include Diabetes Mellitus, high blood pressure and chronic glomerulonephritis. People with CKD often have no symptoms although the kidney function is severely affected.

With chronic kidney disease (CKD), the kidneys don't usually fail all at once. Instead, kidney disease often progresses slowly over a period of years. This is good news because if CKD is caught early, medicines and lifestyle changes can possibly help delay disease progression.
 

CKD stages

 
To help improve the quality of care for people with kidney disease, the National Kidney Foundation (NKF) created guidelines to help doctors classify different stages of kidney disease so that treatment strategies can be better tailored to their needs. Patients at each of the five stages of CKD require different tests and treatments.

NKF guidelines define the stages of CKD based on measured or estimated glomerular filtration rate (GFR) and corresponding decline in kidney function.
 

The table below shows CKD and GFR for each stage:

 

Stage

GFR*

Description

1

With normal or high GFR

90+

Normal kidney function but tests show early signs of kidney damage

2

Mild CKD

60-89

Mildly reduced kidney function, test results point to some signs of kidney damage

3

Moderate CKD

30-59

Moderately reduced kidney function

4

Severe CKD

15-29

Severely reduced kidney function

5

End-stage CKD

<15 or on dialysis

Established kidney failure, kidney dialysis or transplant may be needed
 

Stages 1 and 2 CKD

 
Description
People with Stage 1 CKD have kidney damage with normal or high GFR greater than 90 ml/min. They generally do not experience any symptoms of kidney damage even if the kidneys are no longer functioning at full capacity. Most people are diagnosed with Stage 1 CKD in the process of being tested for another condition such as diabetes or high blood pressure, which are the two leading causes of kidney disease.

Other signs of Stage 1/2 CKD:
  • Higher than normal levels of creatinine or urea in the blood
  • Blood or protein in the urine
  • Evidence of kidney damage in an MRI, CT scan, ultrasound or contrast X-ray
  • A family history of polycystic kidney disease
 
What should you do if you have Stage 1/2 CKD?

Here's how to take care of your kidneys:

  • Have regular checkups with your doctor. He should test your urine for protein and blood which are indicators of kidney damage.
  • Eat a healthy, balanced diet that is low in fat and salt. Pay special attention to protein, potassium and phosphorus intake. See our nutrition section for more information.
  • Control your blood pressure
    • 125/75 for people with diabetes
    • 130/80 for people without diabetes or proteinuria
    • 125/75 for people without diabetes, but who have proteinuria
  • Keep your blood sugar or diabetes under control
  • Take medicines as prescribed by your doctor
  • Exercise regularly
  • Stop smoking

You can't reverse kidney damage, but it may be possible to maintain your kidney function and prevent it from deteriorating. In many cases, getting the right treatment and making changes in your lifestyle can help your kidneys working longer and better.
 

Stage 3

 
Description

A person with Stage 3 CKD has kidney damage with a moderate decrease in the GFR of 30-59 ml/min. As kidney function declines, waste products and toxins begin to build up in the blood. Once toxins reach a certain level, uremia occurs and complications of kidney disease such as high blood pressure, anemia (a shortage of red blood cells) and/or early bone disease are more likely.
 
What can you expect with Stage 3 CKD?

People diagnosed with Stage 3 CKD may begin to experience some physical changes. Talk to your doctor about how you're feeling. There are treatment or lifestyle changes you can make to alleviate any discomfort.

  • Fatigue often as the result of anemia.
  • Too much fluid that leads to swelling (edema) in your lower legs, hands or face, particularly around the eyes.
  • Changes in your urine that makes it appear foamy as a result of protein or dark colored as a result of blood. You may also need to urinate more or less than usual.
  • Kidney pain, which is more common with polycystic kidney disease or infections.
  • Sleep problems due to itching, muscle cramps or restless legs.

How can you take care of yourself when you have Stage 3 CKD?

  • See a nephrologist. MD physicians specialise in kidney disease (Nephrologists) and can use their expertise to help preserve your kidney function for as long as possible as well as keeping you healthy.
  • See a renal coordinator. Renal coordinators can help organize your medical care and arrange for you to meet with other healthcare professionals.
  • Consult a dietitian. What you eat when you have kidney disease can have an impact on how well you can maintain kidney function. A dietitian who is familiar with kidney disease patients can recommend a meal plan individualized for your needs. See our nutritional tips for more ideas on how to plan your daily diet
  • Keeping your glucose level under control and maintain a healthy blood pressure. Many people who develop chronic kidney disease have diabetes or high blood pressure. To help preserve your kidney function, keep your glucose levels under control and maintain a healthy blood pressure. If you are prescribed medication, take it exactly as directed by your doctor.
  • Make healthy choices. It's important to eat well, exercise regularly, and quit smoking to keep yourself as healthy as possible. Just as important, managing stress and taking the time to relax will help you live life to the fullest.

What kind of healthcare do you need?

People in Stage 3 CKD will usually need to visit their doctor every three to six months. At your appointments, you will probably have blood tests to check your creatinine, haemoglobin, calcium and phosphorus levels to see how well your kidneys are functioning. The doctor will also monitor your blood pressure and glucose levels and make sure you're in good overall health.
 

Stage 4

 
Description

A person with Stage 4 CKD has advanced kidney damage with a severe decrease in GFR to 15-30 ml/min. It is likely someone with Stage 4 CKD will need dialysis or a kidney transplant in the near future.

As kidney function declines, waste products and toxins build up in the blood causing a condition known as "uremia." At Stage 4, complications such as high blood pressure, anemia (a shortage of red blood cells), bone disease, heart disease and other cardiovascular diseases become more likely so it is important that people at Stage 4 CKD pay careful attention to their health.
 
What can you expect with Stage 4 Kidney Disease?

When you've been diagnosed with Stage 4 kidney disease, you may continue to experience some of the symptoms that are common at Stage 3 kidney disease, such as fatigue, fluid retention, changes in your urine, kidney pain, and sleep issues. You may also begin to experience new symptoms as well. Talk to your doctor about how you're feeling. There are treatments or lifestyle changes you can make to alleviate any discomfort.

Patient in this stage of CKD may experience symptoms such as:

  • Nausea and/or vomitting
  • Taste changes
  • Loss of appetite
  • Bad breath caused by uremia
  • Difficulty concentrating
  • Nerve problems causing numbness or tingling in your toes or fingers

How can you take care of yourself when you have Stage 4 CKD?

  • See a nephrologist. MD physicians specialize in kidney disease (Nephrologists) and can use their expertise to help preserve your kidney function for as long as possible as well as keeping you healthy.
  • Consult a dietitian. What you eat when you have kidney disease can have an impact on how well you can maintain kidney function. A dietitian who is familiar with kidney disease patients can recommend a meal plan individualized for your needs. See our nutritional tips for more ideas on how to plan your daily diet.
  • Keeping your glucose level under control and maintain a healthy blood pressure. Many people who develop chronic kidney disease have diabetes or high blood pressure. To help preserve your kidney function, keep your glucose levels under control and maintain a healthy blood pressure. If you are prescribed medication, take it exactly as directed by your doctor.
  • Make healthy choices. It's important to eat well, exercise regularly, and quit smoking to keep yourself as healthy as possible. Just as important, managing stress and taking the time to relax will help you live life to the fullest.

What kind of healthcare do you need?

People in Stage 4 CKD will usually need to visit their doctor every three months or more frequently if required. At your appointments, you will probably have blood tests to check your creatinine, haemoglobin, calcium and phosphorus levels to see how well your kidneys are functioning. The doctor will also monitor your blood pressure and glucose levels and make sure you're in good overall health.

At this stage, the nephrologist will also help prepare you for dialysis or a kidney transplant. The National Kidney Foundation guidelines recommend starting dialysis when kidney function drops to 15% or less.
Time to Plan for Dialysis

If you are at Stage 4 CKD, it's time to start thinking about the different types of dialysis options: haemodialysis or peritoneal dialysis. Our online dialysis planner will help you think through the different decisions you will need to make about dialysis. Plan early and gain control over your health!

You can find more information on dialysis options, under My Plan.
 

Stage 5

 
Description

A person with Stage 5 CKD has end stage renal disease (ESRD) with a GFR of 15 ml/min or less. At Stage 5 kidney disease, your kidneys are no longer able to remove waste and fluids from the body effectively which leads to a build-up of toxins in the blood. Most people at Stage 5 CKD will need dialysis or a kidney transplant.

Patient in this stage of CKD may experience symptoms such as:

  • Loss of appetite
  • Nausea and/or vomiting
  • Headaches
  • Fatigue
  • Trouble concentrating
  • Itching
  • Little or no urine
  • Swelling, especially around the eyes and ankles
  • Muscle cramps
  • Tingling in hands or feet
  • Changes in skin color
  • Increased skin pigmentation

How can you take care of yourself when you have Stage 5 CKD?

  • See a nephrologist. MD physicians specialize in kidney disease (Nephrologists) can use their expertise to help preserve your kidney function for as long as possible as well as keeping you healthy. For more information on treatment options, including dialysis, see My Plan.
  • Consult a dietitian. Once you begin dialysis, you will need to make changes in what you eat and drink. Your diet is a big part of your treatment, so you will be working with a dietitian who can recommend a meal plan individualized for your needs. See our nutritional tips for more ideas on how to plan your daily diet.
  • Keeping your glucose level under control and maintain a healthy blood pressure. Many people who develop chronic kidney disease have diabetes or high blood pressure. You will feel better if you keep your glucose levels under control and maintain a healthy blood pressure. If you are prescribed medication, take it exactly as directed by your doctor.
  • Make healthy choices. It's important to eat well, exercise regularly, and quit smoking to keep yourself as healthy as possible. Just as important, managing stress and taking the time to relax will help you live life to the fullest.

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