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Stages of Chronic Kidney Disease

Couple at computer.Learn about the different stages of CKD, symptoms, treatment information and tips

Most people with kidney problems have chronic kidney disease (CKD). That means the kidneys slowly stop working—usually over many years. There is no cure for chronic kidney disease, but there is good news. If you and your doctor discover a kidney problem at an early stage, you may be able to keep your kidneys working over a longer period of time.

It’s important to do what you can to help slow chronic kidney disease. The first step is learning more about it.

Not sure what the kidneys do or how they work? Get a short overview on the essential role of your kidneys.

Learn about Kidneys

5 stages of Chronic Kidney Disease

Glomerular filtration rate (GFR) is a measure of how well your kidneys are working, and helps your doctor determine how well your kidneys are cleaning your blood. The GFR test is done using a blood sample you provide. The National Kidney Foundation has divided chronic kidney disease into 5 stages based on your GFR.

The National Kidney Foundation has divided chronic kidney disease into 5 stages. Each stage is determined based on the percentage of kidney function remaining.

Adapted from the Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines, from the National Kidney Foundation

Early Stage Kidney Disease

Typically, many people who are in the early stages of chronic kidney disease do not experience signs or symptoms of kidney damage. This can make early stage kidney disease harder to diagnose and manage. That’s why it’s important to:

  • Understand causes and risk factors for chronic kidney disease
  • See your doctor on a regular basis

Know your GFR flow

Ask your doctor for your GFR and monitor it regularly according to his/her recommendation.

Stage and description GFR (mL/ min/1.73m) Clinical signs or symptoms may include
Stage 1: Kidney damage with normal or increased (GFR) Greater than 90 High blood pressure, urinary tract infections, abnormal urinalysis (test of the urine)
Stage 2: Kidney damage with mild decline in (GFR) From 60–89 High blood pressure, urinary tract infections, abnormal urinalysis (test of the urine)
Stage 3: Moderate decrease in (GFR) From 30–59 Low blood count, malnutrition, bone pain, abnormal nerve sensations such as tingling and numbness, reduced mental functioning and sense of well-being

Goals for Stages 1 and 2

  • Get diagnosis and treatment for underlying disease (high blood pressurediabetes, etc.) and/or infection.
  • Get treatment for other medical conditions.
  • Slow the progression of chronic kidney disease.
  • Reduce risks of complications.

What can I do to help myself?

See your doctor on a regular basis to have your blood tested for health problems. Ask these questions:

What is my blood pressure?

What is my A1C? (diabetics only)

  • What can I do about it?

What is my cholesterol?

  • Am I at risk for high cholesterol?
  • What can I do about it?

Make healthy lifestyle changes

  • Quit smoking
  • Exercise regularly
  • Eat healthy (see a dietitian for specific recommendations)
  • Reduce stress
  • Get enough sleep

Get medical attention for health problems such as:

  • Headaches
  • Fatigue
  • Increased thirst
  • Frequent urination or burning during urination
  • Unexplained weight gain or loss

Goals for Stage 3

Evaluate your condition with your doctors and treat complications. Slow the progression of the disease by treating the underlying condition (high blood pressure, diabetes, etc.) You may need to modify therapy for those conditions as required by your health care team.

What can I do to help myself?

See your doctor and discuss changes in your lab values and symptoms you may be experiencing.

Ask your doctor the following questions:

Do I have high blood pressure?

  • What can I do about it?

Is my blood sugar high?

  • What can I do to lower it?
  • What is my A1C? (diabetics only)

Am I at risk for anemia?

  • What can I do about it?

What is my albumin? (an albumin test shows how much protein you have in your diet).

Is my diet giving me what I need?

  • Is there something I should add to my diet?
  • Am I at risk for malnutrition?
  • What can I do about it?

What is my cholesterol?

  • How can I lower it?

Other recommendations:

  • Begin with a visit to a nephrologist (a physician who specializes in kidney disease). Work with your healthcare team (which might include a primary care physician, a nephrologist, nurse practitioner, registered dietitian and social worker) to correct anemia, malnutrition and bone disease.

A nephrologist can answer medical questions that you and your support team may have about chronic kidney disease. To find a nephrologist in your area, visit Find a Physician.

  • Get further information regarding kidney disease and learn how you can slow its progression.
  • Control blood pressure, blood sugar and high cholesterol.
  • Take all medications as prescribed.
  • Continue with healthy lifestyle changes.
  • Get support from a social worker, if you are working with one. Your social worker can help you find support groups, financial assistance, employment, counseling and answer insurance questions.

Late Stage Kidney Disease

In later stages of chronic kidney disease you will likely be experiencing more noticeable or severe symptoms. At this time, you should be receiving kidney care from a specialist, called a nephrologist (a doctor who has special training in kidney diseases). To find a nephrologist near you, visit Find a Physician.

In late stages of kidney disease, it is important to evaluate your condition with your doctors. You should follow the prescribed treatment plan. This may include:

  • Treating complications of chronic kidney disease.
  • Treating the underlying condition (diabetes, high blood pressure, etc.)
  • Having your nephrologist adjust certain medications you may be taking because of your reduced kidney function.
  • Adjusting your diet

While it is likely very upsetting to learn that you have CKD, you should know that living with kidney disease is manageable, particularly with the right attitude and the right support. 

Take an important step to a better life with kidney disease

Learn how to recognize and understand your emotions.

Learn about Coping

Know your GFR flow

Ask your doctor for your GFR and monitor it regularly according to his/her recommendation.

Stage and description GFR (mL/ min/1.73m) Clinical signs or symptoms may include
Stage 4: Severe decline in (GFR)
From 15 to 29
Severe complications such as anemia, high blood pressure and bone disease.

Goals for Stage 4

Control blood pressure, blood sugar and cholesterol. Prepare for Stage 5, End Stage Renal Failure by discussing kidney (renal) replacement therapy, learning about different ways to treat kidney failure, and have access created for dialysis.

  • Stay in touch with your healthcare team regularly (which might include a primary care physician, a nephrologist, nurse practitioner, registered dietitian and social worker).
  • Educate yourself and your family as thoroughly as possible regarding kidney (renal) replacement therapies and talk about your options with your nephrologist to decide the best choice for you.
  • Plan for placement of your access. Planning for the placement of an access site for dialysis prior to kidney failure will give you more options to choose from. For hemodialysis either a fistula or a graft are considered best options. For peritoneal dialysis a PD catheter is placed in your lower abdomen area.
  • Visit a local dialysis center and ask for a tour—this is a great opportunity to ask questions.

End Stage Renal Disease (ESRD)

Stage 5 kidney failure, also known as End Stage Renal Disease (ESRD), is the final stage of chronic kidney disease. It is when both kidneys have stopped or almost stopped doing their jobs (less than 15% kidney function remaining).

If you are at this stage, you may have already decided on a kidney replacement treatment option. If not, it is not too late to understand your treatment options. This is a good time to discuss options for placement of an access site for dialysis with your doctors. Planning access for dialysis prior to kidney failure will give you more flexibility in choosing the treatment that is best for you.

Learn more about access for hemodialysis and peritoneal dialysis.


While it is likely very upsetting to learn that you have CKD, you should know that living with kidney disease is manageable, particularly with the right attitude and the right support.


Know your GFR Flow

Ask your doctor for your GFR and monitor it regularly according to his/her recommendation.

Stage and description GFR (mL/ min/1.73m) Clinical signs or symptoms may include
Stage 5 Kidney Failure Less than 15 Uremia (buildup of waste products in your blood), anemia, malnutrition, hyperparathyroidism, high blood pressure, swelling in hands/legs/eyes/lower back (also called the sacrum), shortness of breath.

Goals for Stage 5

  • Dialysis or kidney transplant.
  • Treat other medical diseases and complications.

What can I do to help myself?

  • Follow the prescribed kidney (renal) replacement therapy as planned.
  • Learn about services provided at Fresenius Medical Care dialysis clinics.
  • Be an active participant in your kidney (renal) care.
  • Keep taking medications and/or attending dialysis sessions as prescribed by your doctor. This is extremely important to your health and well-being.
  • Seek needed support (social, financial, etc.) by asking your social worker for assistance and/or resources.
  • See your doctor for changes in your health; cold or flu symptoms, new or unusual symptoms/problems, and changes to or worsening of existing symptoms/problems.
  • Learn about lifestyle changes to expect and ask questions.
Take charge of your kidney health

Make the right treatment decisions for your kidney health with Fresenius Medical Care Treatment Options Program (TOPs)

Learn more

There is a lot to learn, share and discuss when it comes to kidney replacement treatment options. Here are a few resources that can get you started:

Content developed with the help of Kidney School, a program of the Medical Education Institution, Inc., and the National Institute of Diabetes and Digestive and Kidney Diseases.


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