Medically Reviewed by Dr. Rahul Sharma, BAMS, Kidney Specialist
Chronic kidney disease has five stages based on eGFR (estimated glomerular filtration rate): Stage 1 (eGFR 90+, mild damage with normal function), Stage 2 (eGFR 60–89, mild loss), Stage 3a (eGFR 45–59, mild-to-moderate loss), Stage 3b (eGFR 30–44, moderate-to-severe loss), Stage 4 (eGFR 15–29, severe loss), and Stage 5 (eGFR below 15, kidney failure). Early stages have no symptoms, making regular eGFR and uACR testing essential for timely detection.
Stages of Chronic Kidney Disease (CKD): From Early Signs to Kidney Failure
Kidney disease progresses gradually, often over years. You may feel perfectly healthy in Stage 1 or 2 while your kidneys are already losing function. By the time symptoms appear, the disease is usually at Stage 3 or beyond. Globally, CKD affects approximately 13.4% of the population (Lancet, 2024). In India, ICMR estimates a prevalence of 17.2%, with diabetes and hypertension as the two leading causes. Your doctor determines your CKD stage through two simple tests: a blood test measuring eGFR (how well your kidneys filter waste) and a urine test measuring uACR (how much protein leaks into your urine). Both tests together give the most accurate picture of your kidney health.
Concerned about your kidney function?
CKD Stages at a Glance — Quick Comparison Table
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| Stage | eGFR (mL/min) | Kidney Function | Common Symptoms | What to Do |
|---|---|---|---|---|
| Stage 1 | 90 or above | Normal or near-normal, but early damage detected | Usually none. May have protein in urine or high blood pressure. | Manage diabetes/BP. Annual eGFR + uACR testing. Lifestyle changes. |
| Stage 2 | 60–89 | Mildly reduced | Usually none. Mild fatigue possible. Protein in urine may increase. | Control underlying cause. Monitor eGFR every 6 months. Kidney-friendly diet. |
| Stage 3a | 45–59 | Mild-to-moderate loss | Fatigue, swelling in hands/feet, changes in urination, mild back pain. | See a nephrologist. Start ACE inhibitor/ARB if not already. Restrict sodium. |
| Stage 3b | 30–44 | Moderate-to-severe loss | Increased fatigue, nausea, loss of appetite, persistent swelling, bone pain. | Active nephrology care. Phosphorus and potassium restriction. Prepare for potential dialysis planning. |
| Stage 4 | 15–29 | Severely reduced | Nausea, vomiting, metallic taste, difficulty concentrating, anaemia, severe fatigue. | Dialysis planning begins. Discuss transplant evaluation. Erythropoietin for anaemia. |
| Stage 5 | Below 15 | Kidney failure (ESRD) | Extreme fatigue, shortness of breath, uncontrolled fluid retention, itching, muscle cramps. | Dialysis or kidney transplant required. Palliative care option. Close monitoring. |
What are the Stages of Chronic Kidney Disease?
Here are the 5 stages of CKD. These stages range from mild damage in stage 1 to complete kidney failure in stage 5.
The stages are categorized based on how much extra fluid and waste your kidneys can filter out of your blood.
Your kidneys can still filter out waste from your blood in the early stages of kidney disease.
But they need to work harder to get rid of waste and they even may stop working completely as they reach more advanced stages.
Before we begin with the stages of chronic kidney disease, let’s first understand what eGFR is.
eGFR (Estimated Glomerular Filtration Rate) is a test that measures your kidney function and helps determine your stage of kidney disease. The value of eGFR is calculated from your blood creatinine test results, age, body size, and gender.
eGFR tells how much kidney function you have. Kidney disease gets worse if GFR goes down.
What Is eGFR and How Does It Determine Your CKD Stage?
eGFR (estimated glomerular filtration rate) measures how many millilitres of blood your kidneys can filter per minute. Your doctor calculates eGFR from a blood test measuring creatinine (a waste product from muscle metabolism), combined with your age, sex, and body size. A normal eGFR is 90 or above. As kidney function declines, eGFR drops and the CKD stage increases.
However, eGFR alone is not sufficient for complete CKD staging. The KDIGO 2024 guidelines recommend combining eGFR with uACR (urine albumin-creatinine ratio), which measures how much protein leaks from your kidneys into your urine. You can have Stage 1 CKD with a normal eGFR (above 90) if your uACR shows significant protein leakage. This is why both tests are essential — one shows how well your kidneys filter, the other shows whether they are damaged.
Stage 1 CKD means your kidneys have early signs of damage but are still filtering blood at a normal rate (eGFR 90 or above). The damage is usually detected through protein in your urine (albuminuria), blood in your urine, or imaging studies showing structural changes.
Most people feel completely normal at Stage 1 and would not know they have kidney disease without testing. This is precisely why Stage 1 is both the easiest to manage and the most commonly missed. If you have diabetes, hypertension, or a family history of kidney disease, regular screening with eGFR and uACR can catch CKD at this stage, when lifestyle changes and medication adjustments can prevent further damage.
What to do at Stage 1: Control blood pressure (target below 130/80 mmHg). Manage blood sugar if diabetic (HbA1c below 7%). Reduce sodium intake. Stay physically active. Get annual eGFR and uACR testing.
Stage 2 CKD indicates a mild reduction in kidney function with an eGFR between 60 and 89. Like Stage 1, most people at this stage have no noticeable symptoms. You might experience occasional fatigue or slightly more frequent urination, but these signs are easily overlooked.
The primary difference between Stage 1 and Stage 2 is that your kidneys are now measurably working less efficiently. The underlying cause — whether diabetes, hypertension, polycystic kidney disease, or glomerulonephritis — needs active management to prevent progression. Research published in the Kidney International journal shows that patients who control blood pressure and blood sugar at Stage 2 significantly slow or halt progression to later stages.
What to do at Stage 2: All Stage 1 actions apply. Monitor eGFR every 6 months. Begin a kidney-friendly diet with reduced sodium and controlled protein. Avoid nephrotoxic medications (NSAIDs like ibuprofen) without doctor guidance. Review all current medications with your doctor for kidney safety.
Stage 3a CKD — Mild-to-Moderate Loss (eGFR 45–59)
Stage 3a CKD means your kidneys have lost 40–55% of their filtering capacity. This is often the stage where symptoms first appear: persistent fatigue that rest does not relieve, mild swelling in your hands, feet, or ankles, changes in how often you urinate (especially at night), and occasional back pain near your kidneys.
Stage 3a is a critical decision point. At this stage, your condition can still be stabilized with active management, but without intervention, progression to Stage 3b and beyond becomes increasingly likely. Most guidelines recommend referral to a nephrologist (kidney specialist) by Stage 3a.
Stage 3b CKD — Moderate-to-Severe Loss (eGFR 30–44)
Stage 3b CKD means your kidneys have lost more than half their filtering capacity. Symptoms become more consistent and harder to dismiss: increased fatigue throughout the day, loss of appetite, nausea, persistent swelling, bone and joint pain, and difficulty concentrating.
At Stage 3b, complications begin to develop. Your body may struggle to regulate phosphorus and calcium levels, leading to bone disease (renal osteodystrophy). Anaemia becomes more common as your kidneys produce less erythropoietin, the hormone that stimulates red blood cell production. Your nephrologist will likely introduce dietary restrictions on phosphorus, potassium, and sodium, along with medications to manage these complications.
What to do at Stage 3 (both 3a and 3b): See a nephrologist regularly. Follow a renal diet with restricted sodium, phosphorus, and potassium. Take prescribed ACE inhibitors or ARBs to protect kidney function. Monitor eGFR every 3 months. Treat anaemia if present. Begin discussions about future treatment options, including dialysis access planning at Stage 3b.
At Stage 3? A MedicoExperts nephrologist can create your personalised kidney care plan or learn more about chronic kidney disease treatment options.
Stage 4 CKD is an advanced stage where your kidneys retain only 15–29% of their normal filtering capacity. Symptoms at this stage are significant and affect daily life: severe fatigue, persistent nausea and vomiting, a metallic taste in your mouth, loss of appetite leading to unintentional weight loss, difficulty concentrating or mental fog, shortness of breath, and increased fluid retention causing visible swelling.
At Stage 4, your nephrologist will begin active preparation for kidney replacement therapy. This means evaluating whether dialysis (haemodialysis or peritoneal dialysis) or a kidney transplant is the better option for your situation. If transplant is a possibility, the evaluation process should begin now — waitlists can be long, and a pre-emptive transplant (before dialysis becomes necessary) generally produces better outcomes.
What to do at Stage 4: Work closely with your nephrologist. Prepare dialysis access (arteriovenous fistula creation 6 months before anticipated need). Begin transplant evaluation if eligible. Strict dietary management with a renal dietitian. Erythropoietin injections for anaemia. Manage cardiovascular risk (CKD Stage 4 patients have significantly elevated heart disease risk).
Stage 5 CKD, also called end-stage renal disease (ESRD) or kidney failure, means your kidneys function at less than 15% of normal capacity and can no longer sustain life without medical intervention. Symptoms at this stage include extreme fatigue, uncontrolled fluid retention, severe shortness of breath, persistent itching, muscle cramps, very low urine output, and difficulty sleeping.
At Stage 5, you will need one of three treatment paths: haemodialysis (typically three sessions per week at a dialysis centre, 3–4 hours each), peritoneal dialysis (done at home, often overnight), or a kidney transplant (from a living or deceased donor). Each option has different implications for your daily life, and your nephrologist and care team will help you choose based on your overall health, support system, and preferences.
Living well at Stage 5 is possible. Advances in dialysis technology and transplant medicine mean that many patients maintain productive lives. The key is consistent treatment adherence, dietary discipline, and regular monitoring. If you are a candidate for transplant, a successful transplant offers the closest return to normal kidney function.
What to do at Stage 5: Start dialysis as recommended. Maintain transplant evaluation if applicable. Work with a renal dietitian for strict fluid and dietary management. Monitor cardiovascular health closely. Seek emotional and psychological support — kidney failure is a significant life change.
How CKD Progresses — Can It Be Slowed or Reversed?
CKD progression is not inevitable at every stage. In Stages 1 and 2, effective management of blood pressure, blood sugar, and lifestyle factors can stabilize kidney function for years or even decades. At Stage 3, progression can be significantly slowed. The KDIGO guidelines estimate that only about one-third of Stage 3 patients progress to Stage 4 or 5 within 10 years if they receive active treatment.
The factors that most accelerate CKD progression are uncontrolled diabetes (the single largest driver), uncontrolled hypertension, high protein diets, smoking, frequent use of nephrotoxic medications (especially NSAIDs like ibuprofen and certain antibiotics), and recurrent urinary tract infections. Removing or controlling these factors is the foundation of CKD management at every stage.
At MedicoExperts, our nephrology team has observed that patients who begin structured management at Stage 2 or 3a — including dietary changes, medication optimization, and regular monitoring — consistently show better long-term outcomes than those who wait until symptoms force them to seek care. Early intervention remains the most effective strategy available.
When to See a Nephrologist — Stage-by-Stage Guidance
Stage 1–2: Your primary care doctor can manage CKD at these stages. See a nephrologist if your eGFR drops rapidly (more than 5 points in a year), if your uACR is rising, or if you have difficult-to-control blood pressure.
Stage 3a: Most guidelines recommend a nephrology referral at this point, particularly if you have diabetes, significant proteinuria, or rapid eGFR decline.
Stage 3b–4: Active nephrologist involvement is essential. You should be seeing a kidney specialist every 1–3 months.
Stage 5: Your nephrologist and dialysis/transplant team become your primary care team for kidney-related decisions.
Seek emergency medical care if you experience sudden severe swelling, difficulty breathing, chest pain, very low urine output, confusion, or seizures — these may indicate acute kidney injury superimposed on CKD and require immediate treatment.
Not sure what stage you are in?
Frequently Asked Questions (FAQs):
Q1: How many stages does chronic kidney disease have?
Chronic kidney disease has five stages, classified by eGFR (estimated glomerular filtration rate). Stage 1 is the mildest, with kidney damage but normal function (eGFR 90 or above). Stage 5 is the most severe, indicating kidney failure (eGFR below 15). Stage 3 is further divided into 3a and 3b based on the KDIGO guidelines, as the clinical management differs significantly between these sub-stages.
Q2: What is eGFR and what is a normal range?
eGFR (estimated glomerular filtration rate) measures how well your kidneys filter blood, expressed in millilitres per minute. A normal eGFR is 90 or above. An eGFR between 60 and 89 indicates mild kidney function loss, while below 60 signals moderate to severe damage. Your doctor calculates eGFR from a blood creatinine test, combined with your age, sex, and body size.
Q3: Can Stage 3 CKD be reversed?
Stage 3 CKD cannot typically be reversed, but its progression can be significantly slowed or stabilized with proper treatment. Controlling blood pressure, managing blood sugar, following a renal diet, and taking prescribed medications such as ACE inhibitors can prevent Stage 3 from advancing to Stage 4 or 5. Research shows that approximately two-thirds of Stage 3 patients do not progress within 10 years with active management.
Q4: What are the first symptoms of kidney disease?
Most people feel no symptoms in Stage 1 or 2 of kidney disease. The first noticeable symptoms usually appear at Stage 3 and include persistent fatigue, swelling in the hands or feet, changes in urination frequency (especially at night), mild back pain, and foamy or dark-coloured urine. Because early CKD is silent, regular blood and urine testing is the only reliable way to detect it early.
Q5. What diet should I follow at each CKD stage?
At Stages 1–2, reducing sodium intake and eating a balanced diet is usually sufficient. From Stage 3 onward, your doctor may recommend restricting phosphorus, potassium, and protein. At Stage 4–5, fluid intake may also be limited. A renal dietitian can create a personalised meal plan. Key foods to limit include processed foods, bananas, oranges, dairy products, and red meat.
Q6. How fast does CKD progress from Stage 3 to Stage 5?
CKD progression varies significantly between individuals. Some people remain at Stage 3 for many years with good management, while others may progress to Stage 5 within 2–5 years if underlying conditions like diabetes or hypertension are poorly controlled. Factors that accelerate progression include uncontrolled blood sugar, high blood pressure, smoking, obesity, and use of nephrotoxic medications.
Q7. What is the difference between CKD and kidney failure?
CKD (chronic kidney disease) is the overall condition of progressive kidney damage across five stages. Kidney failure specifically refers to Stage 5 CKD, where kidneys function at less than 15% of normal capacity and can no longer sustain life without dialysis or transplant. CKD Stages 1–4 are not kidney failure — they represent varying degrees of reduced function that can often be managed.
Q8. Is CKD staging the same in India as globally?
Yes. CKD staging uses the same international KDIGO classification worldwide, based on eGFR and uACR values. However, CKD prevalence in India is notably higher at 17.2% compared to the global average of 13.4%, largely due to high rates of diabetes and hypertension. Indian patients also face additional risk factors including heat-related dehydration, unregulated use of analgesics, and limited access to early screening in rural areas.
Next in Chronic Kidney Disease
- KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International Supplements. 2024;14(4S). https://kdigo.org/guidelines/ckd-evaluation-and-management/
- GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990–2021. Lancet. 2024;403(10443):2585-2616. DOI: 10.1016/S0140-6736(24)00484-7
- Singh AK, et al. Epidemiology and risk factors of chronic kidney disease in India — results from the SEEK study. BMC Nephrology. 2013;14:114. DOI: 10.1186/1471-2369-14-114
- National Kidney Foundation. CKD Staging and Classification. kidney.org/kidney-topics/stages-chronic-kidney-disease-ckd
- American Kidney Fund. Stages of Kidney Disease (CKD). kidneyfund.org/all-about-kidneys/stages-kidney-disease
- Levey AS, et al. A new equation to estimate glomerular filtration rate. Annals of Internal Medicine. 2009;150(9):604-612. DOI: 10.7326/0003-4819-150-9-200905050-00006
- ICMR. India — National Burden Estimates of Chronic Kidney Disease. Indian Council of Medical Research. 2023.
- Jha V, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260-272. DOI: 10.1016/S0140-6736(13)60687-X
This article is for informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions about a medical condition.
