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Stages of CKD: What Each Stage Means for You

Does it shock you to learn that 1 in every 3 Americans is at risk for developing chronic kidney disease (CKD)? It might be surprising, but it’s the reality here in the US. You probably know of someone receiving dialysis treatment or who needs a kidney transplant. Chances are, that person has CKD.


Since CKD affects so many people, it makes sense to understand exactly what it in. In this post, we’ll go over the stages of CKD, plus what symptoms are likely to happen in each stage and what medications might be helpful.


First, what is chronic kidney disease (CKD)?


Chronic kidney disease is the medical way to say that your kidneys are either breaking or are already broken. They can’t do their jobs as well as they should, or maybe they can’t do their jobs at all depending on which stage of CKD you’re in. 


So if CKD is what happens when your kidneys aren’t working the way they should, it would help to know how your kidneys are supposed to work.


How do your kidneys work?


Believe it or not, if you’ve ever made a pot of coffee using a coffee filter, you’re pretty familiar with how your kidneys work. A coffee filter lets water pass through your coffee grounds so that you can get your delicious caffeinated beverage on the other side. Lucky for you, the filter keeps the grounds out of your final product. In a similar way, your kidneys filter your blood. 


Every minute, a half of a cup of blood passes through your kidneys. Your kidneys act like a filter to take out wastes, toxins, and extra water from the blood that passes through. Instead of coffee, what you’re left with is urine that’s eventually removed from your body. 


Now we’ve talked about the kidneys’ important role as filters a few times, but they also have other important jobs. Your kidneys also help control your blood pressure and keep your bones healthy by helping your body use vitamin D. They also make a hormone that makes red blood cells.


When you have CKD and your kidneys don’t work the way they’re supposed to, your body holds onto extra wastes and toxins that your kidneys should really be filtering out. Plus, your blood pressure, bone health, and red blood cell production suffers.


What causes CKD?


So, what makes those coffee filters kidneys become damaged? In most cases, a person develops CKD because of either diabetes or high blood pressure—and many times, both.


Here’s why: since your kidneys are supposed to filter your blood, they must have a large blood supply. That means there are lots of blood vessels in and around the kidneys so that the blood can get to them. Chronic conditions like high blood pressure and diabetes damage your blood vessels, including the ones around your kidneys. When their blood vessels become damaged they can’t do their jobs as well as they should. Eventually, they might stop working altogether.


CKD and diabetes


Diabetes causes almost half of all new cases of kidney failure, making it the #1 cause of kidney failure. That’s why if you have diabetes, your healthcare provider will probably prescribe medications like angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor blockers (ARBs) that help prevent or slow the onset of diabetic kidney disease or CKD. 


If you have diabetes, look out for these signs which could signal that CKD is coming:

  • Protein in your urine

  • High blood pressure (or higher than your usual blood pressure)

  • Leg swelling or leg cramps

  • Urinating more often, especially at night

  • Nausea, vomiting

  • Anemia, weakness

  • Itching

  • Diabetic eye disease

  • Abnormal blood tests


CKD and high blood pressure


Uncontrolled high blood pressure is the second leading cause of kidney failure, right behind—you guessed it!—diabetes. CKD, diabetes, and high blood pressure are all closely related. Here’s what I mean: If you have diabetes, you naturally are at risk for developing CKD. But if you have high blood pressure in addition to diabetes, that makes your chances of developing CKD even higher.


What are the 5 stages of CKD? 


The National Kidney Foundation (NKF) groups CKD into 5 stages. Let’s talk about each of them, from Stage 1 to Stage 5.


Before we dive in though, there's a term you should know: glomerular filtration rate (GFR). Your GFR measures how well your kidneys work—how many milliliters (mL) of blood your kidneys can filter in one minute. It also tells healthcare providers what stage of CKD you’re in. 


A normal GFR is 90 mL/min or greater. If you’re older than 60 years old though, it might be more normal for your GFR to be between 60 and 89. One side effect of getting older is that your GFR tends to get lower, whether you have CKD or not. A lower GFR means that your kidneys can filter less blood in a minute, which could be a sign that your kidneys are getting worse.


Stage 1 CKD - normal GFR or GFR > 90 mL/min


In Stage 1 CKD, you have kidney damage, but your GFR is normal and you probably don’t have any symptoms. Most people don’t realize they’re in stage 1 because they’re kidneys aren’t damaged enough to be noticeable. At most, your healthcare provider may notice blood or protein in your urine or signs of kidney damage on a scan like an MRI.


Treating Stage 1 CKD:


The only medications you need for Stage 1 CKD are any that you’re taking to keep your blood pressure and blood sugar under control. Aside from that, eat a healthy diet with lots of vegetables, fresh fruits, and whole grains, and exercise regularly. And if you smoke, try your best to stop.


Stage 2 Mild CKD


Stage 2 CKD is where you’ll really start to see your GFR start to drop. It could be between 60 and 89 mL/min and although there’s kidney damage, there still aren’t any symptoms in most cases.


Treating Stage 2 CKD:


The treatment plan for Stage 2 CKD is much the same as the plan for Stage 1 CKD.


Stage 3 Moderate CKD


Stage 3 CKD is broken up into two sub-stages:

  • Stage 3A - GFR 45-59 mL/min

  • Stage 3B - GFR 30-44 mL/min


Once you’re in Stage 3, symptoms become more evident. Wastes begin to build up in the blood, and you might develop complications like high blood pressure, anemia, and bone disease. 


Other symptoms you might notice are:

  • Fatigue

  • Swelling and fluid retention

  • Changes in urine color, texture, or frequency

  • Back pain (which may really be kidney pain)

  • Restless legs


Treating Stage 3 CKD:


Around Stage 3, you might start seeing a physician who’s an expert in kidney disease—a nephrologist—and maybe even a dietitian to help you manage your diet.


If you haven't taken any blood pressure medications yet, you’ll probably start taking them now. ACE inhibitors and ARBs are two classes of high blood pressure drugs that help slow the progression of kidney disease.


Stage 4 Severe CKD


In Stage 4 CKD, you probably have advanced kidney damage and are on the verge of needing dialysis or a kidney transplant. You may develop any of the complications mentioned in Stage 3, in addition to heart or cardiovascular disease.


The symptoms are the same as Stage 3 CKD, plus:

  • Bad breath and taste changes

  • Loss of appetite

  • Trouble concentrating

  • Nerve pain, numbness, or tingling

Treating Stage 4 CKD:


You’ll definitely be seeing a nephrologist if you’re in Stage 4, and you’ll probably be seeing them pretty often—every 3 months, at least.


While you’ll still be taking your protective medications, your healthcare providers might also start talking with you about future treatment options—like dialysis or transplants.


Stage 5 End-Stage CKD (ESKD) - also known as end-stage renal disease (ESRD)


Once your GFR is 15 mL/min or less, you’re considered to be in end-stage renal disease (ESRD). At this point, your kidneys have little function, if any at all.


Treating Stage 5 CKD:


You’ll need one of two options in this stage: dialysis or a kidney transplant. Dialysis is available as hemodialysis or peritoneal dialysis (PD). PD is a more flexible option that doesn’t involve needles or a person to help you during treatment. You can also receive PD at home or at work, rather than having to be confined to your home or a center for hemodialysis.


Can CKD be reversed or cured?


It’s normal to wonder if CKD can improve if you stick to your medication regimen the way you’re supposed to. Even though there’s no cure, you can slow it down by:

  • Keeping your blood pressure under control

  • Keeping your blood sugar under control

  • Reducing your protein intake

  • Avoiding medications that can damage your kidneys

  • Exercising regularly and losing weight

What CKD Is + What It Means for Your Loved One


Have you ever made a pot of coffee? You put the coffee grounds into the filter, then let the water pass through. On the other side, you end up with a delicious coffee drink, without the coffee grounds, hopefully.


Well that’s sort of how your kidneys are supposed to work. Your kidneys are the filters and your blood passes through them. On the other side, instead of coffee, you end up with urine. But when your kidneys stop working like they should, you end up with other things in your urine that shouldn’t be there. Sort of like coffee grounds that shouldn't be in your mug. Except when your kidneys stop working, it’s a lot more serious than when your coffee filter fails.


I know that CKD can be a little tough to really understand, so I’m going to walk you step by step for each stage of CKD and what that means for you or your loved one. 


Stage 1 CKD


Let’s start with Stage 1. 


In Stage 1 CKD, you have some kidney damage, but they aren’t damaged enough to be noticeable. Your GFR—a number that tells you how much blood your kidneys are filtering every minute—is normal and you probably don’t have any symptoms. 


The only medications you need for Stage 1 CKD are any that you’re taking to keep your blood pressure and blood sugar under control. Eat a healthy diet with lots of vegetables, fresh fruits, and whole grains, and exercise regularly. And if you smoke, now’s a great time to stop.


Stage 2 CKD


In Stage 2, you’ll start to see your GFR start to drop. And even though there is some kidney damage, you still won’t notice symptoms in most cases.


The treatment plan for Stage 2 CKD is essentially the same as the plan for Stage 1.


Stage 3 CKD


Stage 3 CKD includes Stage 3A and 3B. 3B is more severe than 3A since your GFR will be lower.


Once you’re in Stage 3 and wastes start really building up in your blood, symptoms will start to appear. You might develop complications like high blood pressure, anemia, and bone disease. 


You could also notice:

  • Fatigue

  • Swelling 

  • Urine changes—like the color of your urine or how often you urinate

  • Back pain (which may really be kidney pain)

  • Restless legs


Around Stage 3, you might start seeing a physician who’s an expert in kidney disease—a nephrologist—and maybe even a dietitian to help you manage your diet.


If you haven't taken any blood pressure medications yet, you’ll probably start taking them now. They’ll probably be ACE inhibitors and ARBs, two classes of high blood pressure drugs that help slow down kidney disease.


Stage 4 CKD