Understanding the Stages of Kidney Disease

Chronic kidney disease (CKD) is a progressive disease of kidney damage, where the kidneys slowly lose functioning over time and cannot work as they should.

Stages are a way to keep track of the progression of the disease and its severity. Through monitoring, your treatment team can help you make adjustments to any medication and alter things like diet or other health behaviors.

While the most common causes of CKD are diabetes and high blood pressure, other causes include infections, autoimmune disease, genetic disorders, and heavy metal poisoning.

This article discusses each stage of kidney disease, how it can be managed, and what happens when complete kidney failure is reached.

Stage 1

In stage 1 kidney disease, there is mild kidney damage.

The eGFR is 90 or more.

Even though the kidneys are mostly healthy and working well, there is some clinical element of kidney damage, like protein In the urine or physical damage to the kidneys.

Though it is early on in kidney disease, it’s never too early to start being proactive in:

• Controlling your blood sugar if you have diabetes
• Watching your blood pressure
• Eating a healthy diet
• Exercising
• Avoiding cigarettes and alcohol
  

Stage 2

Stage 2 kidney disease is still mild.

The eGFR of between 60 and 89.

The kidneys are still working fairly well, but there is damage. Similar to stage 1, this is still early-stage disease, proactive health behaviors are beneficial to help delay progression of the kidney disease and to keep you as healthy as possible.

Stage 3

In Stage 3 kidney disease, the kidneys are not working as well as they should.

The eGFR is between 30 and 59.

However, the stage is further broken down into two substages:

• Stage 3a means your eGFR is between 45 and 59
• Stage 3b means your eGFR is between 30 and 44

You may or may not have any symptoms at this point. If you do have symptoms, they may include:

• Swelling in the hands or feet
• Back pain
• Changes in urinary frequency

Since the kidneys play a crucial role in the regulation of salt and water balance in your body, as well as directly and indirectly affecting the production of healthy bone and red blood cells, you may have issues like:

• High blood pressure
• Anemia
• Bone disease

Now is also the time to start taking steps to slow down your kidney disease progression, if you haven’t been already. This includes:

• Changing your diet to be healthier
• Controlling blood glucose
• Managing your blood pressure

Talk with your healthcare provider about a treatment plan and monitoring schedule.

Stage 4

Stage 4 of kidney disease is the last before complete (or end-stage) kidney failure.

The eGFR is between 15 and 29.

This indicates moderate to severe damage. Symptoms and health complications are present at this point as well. At this stage, you and your healthcare provider should be working on a plan for what happens when you go into complete kidney failure (end stage kidney failure) and the kind of treatment you want (dialysis or preparing for a kidney transplant).

Stage 5

The final stage of kidney disease is stage 5, which is complete kidney failure (end stage kidney failure).

The eGFR is less than 15.

The kidneys are very close to failing completely or already have. Symptoms can include:

• Itching
• Muscle cramps
• Throwing up
• Back pain
• Breathing and sleeping problems
• Lack of appetite

You will have to prepare for dialysis or a transplant if you opt for treatment. In order to live, treatment is necessary.

Complications of Kidney Disease

Your kidneys help various organs and systems in the body work properly. If your kidneys are not functioning, this can affect other organs and cause complications.

Complications can include:

• Gout
• Anemia
• Metabolic acidosis
• Secondary hyperparathyroidism
• Bone disease and hyperphosphatemia (high phosphorus levels)
• Heart disease
• Hyperkalemia (high potassium)
• Fluid buildup, leading to heart and lung problems
  

Kidney Failure Life Expectancy

While it is possible to estimate life expectancy at each stage with the progression of kidney disease, there is still a range. This is based on:

• Age
• Overall health
• Stage of kidney disease
• Any comorbid conditions
• Lifestyle behaviors

Kidney failure in itself is a risk factor for cardiovascular disease. Therefore the risk of death from kidney failure can be linked to an increased chance of cardiovascular events like heart attacks or strokes.

For those with end-stage disease, life expectancy can vary, especially depending on whether:

• They’re getting dialysis or a transplant
• Their age
• Their sex

It can range from approximately two years for those on the older end, to more than 60 years for younger people.

Summary

Chronic kidney disease does not happen all at once; it is progressive in stages.

The stages are determined based on the eGFR, which can illustrate how well the kidneys are working (or not).

Even in the early stages of kidney disease, it’s important to take steps to slow down the damage to the kidneys and delay kidney failure for as long as possible. As the kidneys progressively lose functioning, more symptoms and complications start to appear.

Eventually, preparing for complete kidney failure with your healthcare provider is a necessity in order to have everything in place for when the time comes. Although kidney disease and kidney failure are not curable, they are treatable.

A Word From Verywell

Kidney disease may feel overwhelming, and that’s natural. There are steps you can take to adopt healthy habits, monitor your disease, and work with your treatment team to stay as healthy as possible to slow down kidney damage.