What Are the Five Stages of Kidney Failure?

There are five stages of chronic kidney disease (CKD), which range from very mild damage in stage 1 to complete kidney failure in stage 5, and are based on how well the kidneys can filter waste and extra fluid out of the blood.

Healthy kidneys filter the blood, removing waste and excess salt and water. They also help the body to produce red blood cells, control blood pressure, and maintain strong bones. Kidney failure means kidneys are damaged and unable to perform their usual functions. Kidney failure means:

• Kidney function has dropped below 15 percent of normal 
• Kidneys are not functioning well enough on their own for a person to survive 

There is no cure for kidney failure, but treatment can help people live longer. 

Early kidney failure may have no symptoms as the disease can progress slowly at first.

As kidney failure progresses, symptoms include: 

• Swelling in the legs, feet, or ankles
• Headaches
• Itching
• Tiredness during the day 
• Sleep problems 
• Upset stomach
• Nausea
• Loss of sense of taste
• Loss of appetite
• Weight loss
• Little or no urine production
• Muscle cramps, weakness, or numbness
• Pain, stiffness, or fluid in your joints
• Confusion, trouble focusing, or memory problems

Kidney failure results from damage to the kidneys. Causes of kidney damage include: 

• Physical injury 
• Certain diseases 
  • Diabetes
  • High blood pressure

Since early kidney disease often has no symptoms, patients with certain conditions should be checked regularly for kidney problems, including those who have: 

• Diabetes
• High blood pressure
• Heart disease
• A family history of kidney failure

Kidney disease and kidney failure is diagnosed with: 

• A blood test called glomerular filtration rate (GFR) that checks how well the kidneys are filtering the blood
• A urine test to check for albumin, a protein that can pass into the urine when the kidneys are damaged

There is no cure for kidney failure, but treatments may slow the progression of the disease and can help patients feel better. 

There are three main options to treat kidney failure: 

• Dialysis
  • Hemodialysis: a machine to moves the blood through a filter outside the body to remove waste
  • Peritoneal dialysis: the lining of the abdomen is used to filter the blood inside the body to remove waste
• Kidney transplant
• Conservative management to treat kidney failure without dialysis or a transplant
  • Also called comprehensive conservative care, supportive care, nondialytic care, comfort care, or palliative care
  • The goal is to provide quality of life while patients avoid hospital stays and other medical procedures 

Kidney disease can also lead to complications such as other health problems, including: 

• High blood pressure (hypertension)
• Heart disease
• Anemia
• Mineral and bone disorder
• Malnutrition

There are five stages of chronic kidney disease (CKD), which range from very mild damage in stage 1 to complete kidney failure in stage 5, and are based on how well the kidneys can filter waste and extra fluid out of the blood. 

How well the kidneys filter waste from the body is measured with the estimated glomerular filtration rate (eGFR), which is a number based on a blood test for creatinine, a waste product in the blood.

Stage 1 chronic kidney disease (CKD)

• eGFR of 90 or greater
• Mild kidney damage 
• Usually means kidneys are healthy and working well, but there are other signs of kidney damage such as protein in the urine or physical damage the kidneys

Stage 2 chronic kidney disease (CKD)

• eGFR between 60 and 89
• Mild kidney damage
• Similar to stage 1, stage 2 usually means kidneys are healthy and working well but there are other signs of kidney damage such as protein in the urine or physical damage the kidneys

Stage 3 chronic kidney disease (CKD)

• eGFR between 30 and 59: stage 3 is separated into two stages
  • Stage 3a refers to an eGFR between 45 and 59
  • Stage 3b refers to an eGFR between 30 and 44
• There is some kidney damage
• Kidneys are not working as well as they should 
• Symptoms may not yet be present at this stage, but when they occur, they may include swelling in the hands and feet, back pain, and urinating more or less than normal
• Health complications may occur including high blood pressure, anemia, and bone disease

Stage 4 chronic kidney disease (CKD)

• eGFR between 15 and 29
• Kidneys are moderately or severely damaged
• This stage is serious: it is the last stage before kidney failure
• Symptoms and health complications in stage 4 are the same as in stage 3
• In stage 4 kidney disease, patients should consult their nephrologist (kidney specialist) to prepare for kidney failure, in which dialysis or a kidney transplant is needed

Stage 5 chronic kidney disease (CKD)

• eGFR Less than 15
• Kidneys are very close to failure or have completely failed
• If kidneys fail, waste builds up in the blood, which makes patients very sick
• Some symptoms of kidney failure include itching, muscle cramps, nausea and vomiting, loss of appetite, swelling in hands and feet, back pain, urinating more or less than normal, trouble breathing, and trouble sleeping
• Patients with kidney failure must start dialysis or get a kidney transplant to survive